Effective Dates: 09/15/2020 - Present
Identification Number:
| EM-20043
|
| Intended Audience: | All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs/ODAR |
| Originating Office: | ORDP OISP |
| Title: | Internet Benefit Application (iClaim) Enhancements - Policy and Procedures |
| Type: | EM - Emergency Messages |
| Program: | Title II (RSI); Title XVI (SSI); Disability; Supplemental Nutrition Assistance Program |
| Link To Reference: | See References at the end of this EM |
|
Retention Date: 08/23/2024
A. Purpose
This emergency message (EM) replaces EM 17008 REV 2. This EM contains the current policy and procedures associated with the Internet benefit application (iClaim) and the changes to the criteria for filing a limited deferred Supplemental Security Income (SSI) application known as iSSI.
B. The iSSI application
As of April 1, 2017, applicants applying online for Disability Insurance Benefits (DIB) who answer “Yes” to the question, “Do you intend to file for SSI?” are able to submit an iSSI application if they meet the required criteria. These criteria included alleging disability but not blindness.
Effective September 12, 2020, applicants can access the iSSI path, even if they allege blindness, if they meet the following requirements:
· Age 18 through 64;
· U.S. citizen;
· Resides in 1 of the 50 states, the District of Columbia, or the Commonwealth of the Northern Mariana Islands;
· Alleges disability;
· Never married; and
· Claimant’s Social Security Number (SSN) does not exist in any SSI systems such as the Modernized SSI Claims System (MSSICS) or the Supplemental Security Record (SSR).
The iSSI application consists of questions that are common to both the Application for Disability Insurance Benefits (SSA-16) and the Application for Supplemental Security Income (SSI) (Deferred or Abbreviated) (SSA-8001-BK). The iSSI application also includes the SSI household question that reads, “Is everyone in your household receiving or applying for SSI?”
When an applicant submits a concurrent (iDIB/iSSI) iClaim application, a deferred SSIDI claim will populate into MSSICS. The iSSI data will transfer into the appropriate MSSICS screens. Any MSSICS fields associated with the deferred application questions that are not included in iSSI (for example, income and resource questions) will show as “unknown.” For third party initiated iClaims, a Report of Contact (DROC) contains the preparer’s information.
The Development Worksheet (DW01) screen in MSSICS will show “DEFER APP” as the issue with “INTERNET” in the Remarks field to indicate that the applicant filed the claim online. The DEFER APP issue will have a receipt date based on the date the first party applicant submits the iSSI claim. When a third party completes and submits the iSSI claim, the DEFER APP issue will have a tickle date for receipt of the signed Internet Application Summary set for 67 days, 60 days for the closeout period and 7 days for mailing. Technicians can receipt in the DEFER APP issue as soon as they contact the claimant and successfully attest the application over the telephone or upon receipt of the signed paper Internet Application Summary.
Submission of a first party iSSI claim that successfully propagates to MSSICS will build an SSR with an application characteristic code (AC) of DEF (nondisability development has been deferred) and a payment status code of H80 (hold for early input). For iSSI claims completed by third parties, the technician must manually build the SSR upon receipt of a signed Internet Application Summary. For more information about the signature of the application summary, refer to GN 00204.055D.4.b
C. Application development policy for iSSI
Most iSSI claims will not require any contact with the claimant for further development of the application before forwarding to the Disability Determination Service (DDS). You must contact an iSSI claimant if one of the following exceptions applies:
· DIB is a technical denial;
· Claimant is filing for a closed period of disability; or
· Date Last Insured (DLI) is in the past but the number holder (NH) is still eligible for a medical determination.
When one of these exceptions applies, contact the claimant to complete the remaining application questions and follow the deferred development process per SI 00603.003.
NOTE: Continue to follow the simultaneous development policy when required per SI 00603.002.C.
D. SSI protective filing policy for iClaims
The SSI Informal Denial notice (SSA-L991-U3) is no longer required for applicants who express an intent to file for SSI when completing an online application. iClaim provides closeout language to all applicants based on the date the applicant submits the online application.
First party applicants receive closeout language after clicking the “Accept and Continue to Step 2” button on the Summary page. Applicants who use third parties to complete and submit their online applications will receive closeout language in the Comprehensive Notice (SSA-L2). The closeout period provided in the SSA-L2 notice includes an additional seven days for mailing (67-day closeout period).
Technicians must review all SSA records (i.e. Modernized Claims Systems (MCS), 800# system, Internet Query Facility) to determine the earliest protective filing date for the SSI application. For information on protective filings for SSI, see SI 00601.020.
E. Procedure for determining the SSI protective filing date based on a Title II iClaim
The date an applicant starts, reenters, or submits an iClaim application can serve as a protective filing date for SSI. When an applicant starts completing an online application, iClaim provides the SSI protective filing date and closeout language on the Re-entry Number screen. If the applicant reenters iClaim outside of the 60-day protective filing closeout period, iClaim generates a new protective filing date with closeout language. Regardless of when a third party submits an online application, iClaim generates a new protective filing date with closeout language. For additional information on when iClaim establishes a protective filing date, refer to INTERNETT2 001.004.
iSSI claims that successfully propagate to MSSICS will include the protective filing date from iClaim or the 800 Number system; whichever system includes the earliest protective filing date. However, for iSSI claims that fail to establish in MSSICS, review the Potential Internet Protective Filing Dates (IZ0A) screen to review the protective filing date(s) established by iClaim.
The IZ0A screen captures SSI potential protective filing dates. To access the IZ0A screen:
For an explanation of the information presented on the IZ0A screen, see INTERNETT2 001.004.
IMPORTANT: Information on the IZ0A screen purges 3 days after adjudication of the disability claim in MCS.
F. MCS alerts that identify an iSSI application
There are five MCS alerts that provide technicians information about the iSSI application when the applicant’s response is “Yes” to the intent to file for SSI question in iClaim.
Alert | Description |
| INTERNET CLAIM – DEV SSI CLAIM (FILED BEFORE ISSI UPDATE) | There is no iSSI claim - iClaim submitted before 04/01/2017 (release date) and imported into MCS after 04/01/2017. |
| INTERNET CLAIM – DEV SSI CLAIM (ISSI EXCLUSION) | There is no iSSI claim – claimant did not meet required criteria. |
| INTERNET CLAIM – ISSI CLAIM ESTABLISHED IN MSSICS | There is an iSSI claim - it successfully propagated to MSSICS. |
| INTERNET CLAIM – ISSI CLAIM FAILED TO ESTABLISH IN MSSICS | There is an iSSI claim - it failed to propagate to MSSICS. See section G for instructions for processing. |
| ISSI CLAIM ESTABLISHED (DEV AGED SSI) | There is an iSSI claim that successfully propagated to MSSICS - the claimant is within 2 months of age 65. |
When importing the DIB application, MCS generates one of the alerts to the following screen(s):
· General Message (GMES) screen, which only generates when the claim is imported into MCS,
· IZ01 screen (option 18 Internet on the MCS Main Menu), and
· Development Worksheet Remarks Screen (DW03).
G. What to do when an iSSI claim fails to establish in MSSICS
When an iSSI claim fails to propagate to MSSICS, you must manually establish a deferred SSI claim in MSSICS by using information from the iSSI application. You can obtain the iSSI application information by using the Online Retrieval System (ORS) or accessing the Customer Information Control System (CICS) screen by selecting option 18 Internet from the MCS Main Menu.
Since the iSSI application does not contain all of the questions of a deferred SSI application, the information you need to key into MSSICS is limited. Input “unknown” for any MSSICS questions that are not included in the iSSI application. You do not need to contact the claimant to establish the iSSI claim in MSSICS. Once you establish the iSSI claim in MSSICS, follow the procedures outlined in Section H of this EM for processing an iSSI claim.
IMPORTANT: First party iSSI claims that fail to establish in MSSICS are valid applications that require formal determinations.
H. Procedure for processing an iSSI claim
Once the iSSI claim is in MSSICS:
· Review and resolve identity alerts;
· Review all SSA records to determine the correct protective filing date and, if needed, update the protective filing date in MSSICS;
· Review the DIB claim to determine if one of the exceptions listed in Section C of this EM applies. If yes, you must follow the deferred development application process in SI 00603.003;
· Review the SSI and DIB claims to determine if you must use the simultaneous development process as per SI 00603.002C. If yes, follow the simultaneous development process in SI 00603.004; and
· Send the claim(s) to DDS for a medical determination.
NOTE: An allegation of blindness can meet presumptive criteria per SI 00603.002
I. Adjudicating an iSSI claim
Medical denials will automatically process to the SSR without completion of the remaining SSI deferred application questions.
For medical allowances, follow the Preeffectuation Review Contact (PERC) for deferred claims procedures in SI 00603.035.
J. Supplemental Nutrition Assistance Program (SNAP) application
An applicant will see a Supplemental Nutrition Assistance Program (SNAP) message in the iClaim path. The message provides a link to obtain information about SNAP benefits and additional information on filing for these benefits.
If a claimant contacts the field office (FO) and requests to file a SNAP application, follow normal procedures located in SI 01801.010.
Direct all program-related and technical questions to your Regional Office (RO) support staff or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns or problems to their Central Office contacts.
K. References:
EM-20043 - Internet Benefit Application (iClaim) Enhancements - Policy and Procedures - 09/15/2020