Identification Number:
SI 02007 TN 5
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:SSI Interim Benefits Payments
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 020 – Benefits and Payments
Subchapter 07 – SSI Interim Benefits Payments
Transmittal No. 5, 08/26/2019

Audience

FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This transmittal provides instructions to technicians for issuing interim benefits in SSI disability and blindness cases with a favorable ALJ decision that have been under AC review for more than 110 days after the favorable ALJ decision. Included are instructions for when to start paying prospective monthly interim benefit payments, and when to stop these payments after SSA issues a final disability or blindness decision.

 

Summary of Changes

SI 02007.001 Interim Benefits in Cases of Delayed Final Decisions - SSI

1. Citations - We added citations to interim benefit regulations.

2. Subsection A

  • We divided the information into numbered sections for organization,

  • Updated the examples of interim benefits cases, and added an additional example,

  • Added an example of a case where interim benefits do not apply,

  • Added instructions regarding erroneous effectuation, and

  • Added language to clarify when the interim benefits should stop.

3. Subsection B - We updated the examples.

4. Subsection D - We added language to clarify procedures for stopping interim benefits for favorable and unfavorable final decisions.

5. Subsection E - We added POMS references.

SI 02007.001 Interim Benefits in Cases of Delayed Final Decisions - SSI

A. Policy for interim benefits

1. Appeals council (AC) review of favorable administrative law judge (ALJ) decisions

When an administrative law judge (ALJ) makes a favorable disability or blindness decision on a case, the Appeals council (AC) may decide on its own motion to review the decision or reopen the decision. It may do this because an office protests the ALJ's decision to the AC, or because quality assurance sampling of ALJ decisions causes the AC to question the ALJ's decision.

When the AC decides to review or reopen a decision, the claimant receives a notice that tells him or her about the favorable ALJ decision, that the decision is being reviewed or reopened, and that benefits will be delayed while the case is under AC review or reopening. The notice also tells the claimant that there is a limit to how long benefits can be delayed.

2. The law regarding interim benefits

Section 1631(a)(8) of the Social Security Act (the Act) requires the Social Security Administration (SSA) to pay prospective monthly Federal benefits to the claimant if the Commissioner of SSA (Commissioner) has not made a final decision within 110 calendar days after the date of the ALJ decision. These “interim benefits” start with the month in which the 110th day falls, and end with the month in which the final decision is made.

The law also provides that any interim benefits paid will not be considered overpayments, unless fraudulently obtained.

These requirements apply to both Title II and Supplemental Security Income (SSI). Both Title II and SSI can be paid as interim benefits. For SSI, only Federal SSI money is paid as interim benefits. Federally administered state supplementary payments are not paid as interim benefits.

3. Erroneous effectuation

a. If a field office (FO) effectuates a favorable ALJ decision before the AC takes action to review or reopen the case interim benefits are not an issue, and interim benefit policy is not applicable to the case.

  • Do not release any additional underpayment.

  • Leave the erroneously effectuated decision on the record until SSA issues a final agency decision.

b. If the final disability (or blindness) decision is unfavorable, the erroneously effectuated SSI payment is a collectible overpayment.

  • Document DROC and SSR Remarks - "Erroneous Effectuation of ALJ Approval -AC Review - Unfavorable Final Disability Decision." [Unit Code/Date].

  • Issue an SSA-L8171, Notice of Overpayment. See SI 02220.000, Recovery Procedures for Supplemental Security Income Overpayments.

4. Delay in payment following pre-effectuation review contact (PERC) - no AC review involved

Interim benefits are not payable when the ALJ has made a favorable decision and a claimant is waiting for the FO to complete the PERC development for SSI, but the AC's own motion review is not involved. The FO must complete effectuation of the ALJ's decision and pay regular SSI payments as soon as possible.

5. Examples of interim benefit cases

EXAMPLE 1:

  • The ALJ issued a favorable disability decision on June 21, 2018.

  • The AC decided to review the case on its own motion.

  • The claimant began receiving SSI interim benefits starting with October 2018, because 110 days from June 21 is in October.

  • The AC reverses the favorable ALJ decision in February 2019, and the FO stops interim benefits effective with May 2019. The payments for October 2018 through April 2019 are SSI interim benefits.

EXAMPLE 2:

  • The ALJ issued a favorable disability decision on June 21, 2018.

  • The AC decided to review the case on its own motion.

  • The claimant began receiving SSI interim benefits starting with October 2018, because 110 days from June 21 is in October.

  • The AC remanded the case to the ALJ for further proceedings and a new decision.

  • The ALJ held a new hearing and issued a subsequent unfavorable decision in February 2019.

  • The claimant filed a timely request for AC review of the unfavorable ALJ decision.

  • The AC denied the request for review in April 2019.

  • The FO stops the interim benefits effective in May 2019.

EXAMPLE 3:

  • The ALJ issued a favorable disability decision on June 21, 2018.

  • The AC decided to review the case on its own motion.

  • The claimant began receiving interim benefits starting with October 2018, because 110 days from June 21 is in October.

  • The AC remanded the case to the ALJ for further proceedings and a new decision.

  • The ALJ held a new hearing and issued a subsequent unfavorable decision in February 2019.

  • The claimant does not file an appeal to the AC.

  • Interim benefits terminate in April 2019.

6. Example of a non-interim benefit case

  • The ALJ issued a favorable disability decision on June 21, 2018.

  • A FO technician effectuated the favorable ALJ case to current pay.

  • The AC reviewed the case on its own motion.

  • The final disability decision on the case is unfavorable.

  • Payments made under the favorable ALJ decision are a collectible overpayment.

B. Related issues

1. Title II - interim benefits in cases of delayed final decisions

See DI 42010.205. These sections state the policies and procedures for interim benefits under title II.

2. Nondisability requirements for interim benefits

A person must meet all nondisability requirements for SSI eligibility to receive interim benefits (e.g., limitations on income and resources, and the requirement to file for other benefits.) See SI 00501.001.

3. Interim assistance reimbursement (IAR)

Interim benefits are not payable to the State for reimbursement. See SI 02003.001C.

4. Overpayments

Interim benefits are not overpayments unless fraudulently obtained. Unless interim benefits were fraudulently obtained, do not take any overpayment recovery action. See GN 04101.010 regarding “SSA Program Integrity Responsibilities”. Also see SI 02201.005 regarding SSI overpayments.

5. Reporting responsibilities, changes in benefits due, and appeal rights

All SSI posteligibility rules apply to SSI interim benefit cases, except the rule about overpayments stated in SI 02007.001B.4. See SI 02007.015 for notice requirements.

For example:

  • Claimants receiving SSI interim benefits have the same reporting responsibilities as other SSI recipients. See SI 02301.005 for recipient reporting;

  • Changes in nondisability factors can increase or decrease the monthly interim benefits due or cause interim benefits to stop;

  • Some changes in nondisability factors require the FO to conduct unscheduled redeterminations;

  • Due process requirements apply, including the requirement to provide an advance notice (Goldberg v. Kelly) before reducing or stopping interim benefits for nondisability reasons. (See SI 02301.001)

6. Windfall offset

The rules for windfall offset apply to interim benefits. See GN 02610.005.

EXAMPLE:

Facts about the interim benefits:

  • The claimant applies for SSI and Title II benefits in January 2018.

  • Based on the alleged date of disability onset, the first month in which title II benefits could be due is February 2018 (benefit entitled in January).

  • The ALJ issues favorable disability decision on June 21, 2018.

  • The AC decides to review the case on its own motion.

  • The claimant begins receiving SSI and Title II interim benefits starting in October 2018, because 110 days from June 21 is in October.

  • The AC affirms the favorable ALJ decision in February 2019.

  • The claimant continues to receive monthly SSI payments and Title II benefits.

  • The claimant receives retroactive SSI benefits.

The windfall offset computation

  • The retroactive Title II benefits would have been paid in February 2018 through September 2018 (benefits entitled from January through August 2018).

  • The offset period begins February 2019, the first month Title II benefits could affect SSI if paid when due.

  • The offset period ends November 2018, 2 months after the last month in which the retroactive Title II would have been paid.

C. Procedure for starting interim benefits

Step

Action

1

The ALJ makes a favorable disability/blindness decision

2

The Appeals Council decides on its own motion to review the ALJ's decision or decides to reopen the decision.

3

About 100 days after the ALJ decision, the Office of Appellate Operations (OAO) in the Office of Hearings Operations (OHO) will send the servicing FO and/or the processing center with jurisdiction an information sheet titled “Potential Interim Benefit Case”. This information sheet gives detailed information about the case. See SI 02007.010A. for an exhibit of the sheet.

  • If there are potential Title II interim benefits, OAO will fax the information sheet to the appropriate Processing Center (PC);

  • If there are potential SSI interim benefits, OAO will e-mail the information sheet to the servicing FO with the required information;

  • If there are potential Title II and SSI interim benefits (concurrent cases), OAO will e-mail the information sheet to the FO and fax the information sheet to the PC.

4

The FO conducts a PERC to determine eligibility and payment based on nondisability factors. See SI 00603.030. Interim benefits begin with the month in which the 110th day falls; therefore, you do not have to establish the payment amount for all months, only for the beginning month of interim benefits forward.

  • Attempt to complete processing within 10 working days of receiving the e-mail from OAO.

  • Compute payments using the “transitional computation cycle” (TCC). See SI02005.005. The month in which the 110th day falls is the first month of the TCC. There is no “E02” month. There is no “proration” of benefits based on the 110th day; the person is due unprorated benefits for the month in which the 110th day falls.

  • If the claimant is ineligible for SSI benefits for the first month for which interim benefits could be made (the month in which the 110th day falls), find the first month after the month the 110th day falls and which the person could be paid and proceed from there.

  • Do not pay federally administered state supplementary payments.

  • Include in countable income any Title II interim benefits. See DI 42010.210 for a description of procedures the PC follows to coordinate the generation of title II interim benefits with SSI interim benefits.

  • The person may be eligible for income and resource exclusions related to disability or blindness, such as the exclusion for blind work expenses, and the exclusion of income or resources for a plan for self-support.

5

The FO follows these steps:

  • Stop the interim benefit payment from going to the state as interim assistance reimbursement (IAR). Check the supplemental security record (SSR) for a pending IAR indicator (a grant reimbursement code (GRC) of R or F). For active MSSICS cases, delete the indicator via the CMSC screen. For non-MSSICS cases, delete the indicator via PR9 per SM 01005.623.

  • Pay SSI interim benefits through the force due (M02) process per MSOM BUSSR 002.006.

    • Enter a FORCE DUE BEGIN DATE on the Force Due Control (UFDC) screen equal to the first month in the computation history to ensure that an erroneous underpayment is not released. See MSOM BUSSR 002.004.

    • On the Collect Force Due Amounts (UFDU) screen, enter zero Federal and State due amounts for months prior to the first month of interim benefits. Enter the Federal SSI due amount and a zero State due amount for the first month of interim benefits. The system will continue to pay monthly benefits until the record is terminated or the due amount is reduced to zero. See MSOM BUSSR 002.005.

  • On the REMARKS section of the SSR, add the following language: M02 REQ’D INTERIM BENEFIT PAYMENTS EFFECTIVE XX/XX/XXXX (date payments will start) UNTIL FINAL ALJ DECISION MADE//UNIT CODE-FO CODE-XX/XX/XXXX (date the remark is added).

6

The FO sends a notice. If interim benefits are payable, see SI 02007.015B. for notice language. If interim benefits are not payable, see SI 02007.015C. for notice language.

D. Procedure for stopping interim benefits

Step

Action

1

When a final disability/blindness decision is made, OAO will notify the PC and/or the servicing FO indicating the final decision using the information sheet entitled “Potential Interim Benefit Case.”

  • If there were potential Title II interim benefits, OAO will fax the information sheet to the PC.

  • If there were potential SSI interim benefits, OAO sends an e-mail with the information sheet to the servicing FO;

  • If there were potential Title II and SSI interim benefits (concurrent cases), OAO will fax the information sheet to the PC and e-mail the information sheet to the FO.

2

If the final decision is favorable, the FO pays the person all additional benefits he or she is due from the month of application forward.

  • If IAR applies, send the first check for the past-due benefits to the state or local subdivision by adding the GR field information to the SSR before changing the force due amounts. For MSSICS cases, add the GR field information via the CMSC screen. For non-MSSICS cases, add the GR field and SOST field information via PR9; see SM 01005.623.

  • Issue underpayments to the person:

    • Use “M02” to issue underpayments by changing any due amount for months in the retroactive period. Follow the rules for issuance of underpayments by installment; see SI 02101.020. Once all underpayments are issued on the “M02” record, terminate this record and establish a new start date record. See MSOM MSSICS 007.001.; OR

    • Terminate the “M02” record, and establish a new start date record. See MSOM MSSICS 007.001. Then issue the underpayments by one-time payments (OTPs). Post the OTPs to the terminated record, not the new record. The instructions for posting an OTP to a terminated record are in SM 01901.130.

    NOTE: This method may be preferable if the underpayment must be paid in installments, and you do not want to keep the “M02” record active for a long period.

    • Send an SSA-L8025-U2, SSI Notice of Award; see NL 00802.010 and NL 00802.015. Explain the recovery of interim benefits from the retroactive benefits that are due; see NL 00804.115 (choose paragraph 1480 or 1484.)

    If the final decision on the interim benefit case is unfavorable the FO:

    • Stops the interim benefit payments after the 60-day appeals period ends; and

    • Sends no notice, because the OHO (AC or ALJ) notice explains why the claimant is not eligible for SSI and provides any applicable appeal rights.

E. References

DI 42010.205 - Interim Benefits in Cases of Delayed Final Decisions - Title II

DI 42010.210 - ODAR Requests Payment of Interim Benefits in Own-Motion Review Cases Involving a Disability Issue - Title II

GN 02610.005 - Introduction to Title II/Title XVI Windfall Offset

GN 04101.010 - SSA Anti-Fraud Responsibilities (Sensitive)

SI 00501.001 - Eligibility Under the Supplemental Security Income Provisions

SI 00603.030 - Preeffectuation Review Contact (PERC) - Introduction

SI 02003.001 - Interim Assistance Reimbursement (IAR)

SI 02005.005 - Transitional Computational Cycle (TCC)

SI 02007.010 - Exhibits

SI 02007.015 - Nondisability Notices for Interim Benefits - SSI


SI 02007 TN 5 - SSI Interim Benefits Payments - 8/26/2019