Identification Number:
SI 01120 TN 59
Intended Audience:See Transmittal Sheet
Originating Office:OISP
Title:Incorporate EM-16012 into POMS
Type:POMS Transmittals
Program:Title XVI (SSI)
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 011 – Resources
Subchapter 20 – Identifying Resources
Transmittal No. 59, 09/25/2019

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 incorporates guidance from EM-16012 (Guidelines on issuing manual notices for individuals determined ineligible because of excess resources that include a countable trust) into SI 01120.204.

Generally, technicians must specify using free-form text in the notice each reason the trust does not meet the exception or other requirements in POMS. The notice must cite:

  1. 1. 

    The applicable section of the trust containing the problematic language or issue; and

  2. 2. 

    The POMS citation that contains the policy requirements on that subject.

Additionally, the notice must provide language indicating where the POMS can be found online.

Finally, this transmittal removes outdated instructions about which paragraphs to use for each notice and outdated exhibits of notice language. In their place are references to the DPS notice for each scenario and general information about what the DPS notice includes.

 

Summary of Changes

SI 01120.204 Notices for Trusts Established on or after 1/1/00

  • Subsection A - Provided clarifications to the Introduction section

  • Subsections B, C, D, F, and G - Added instructions about the requirement to include a free-form explanation of why the trust is countable; Replaced instructions about which paragraphs to use in the notice with a reference to the applicable DPS notice and general information about what the DPS notice includes.

  • Subsection D - Added a note about the effect of the 90-day amendment period on the notice of planned action.

  • Subsections E and H - Added instructions to not include a free-form explanation of why the trust is countable in these particular notices; Replaced instructions about which paragraphs to use in the notice with a reference to the applicable DPS notice and general information about what the DPS notice includes.

  • Subsection I (Removed) - Removed all exhibits of notice language because DPS now contains templates for each notice.

SI 01120.204 Notices for Trusts Established on or after 1/1/00

A. Introduction

A manual notice is required when an individual:

  • is ineligible for SSI due to excess resources, and those resources include a countable trust;

  • has excess resources that include a countable trust, but is eligible for SSI based on the undue hardship waiver in SI 01120.203G; or

  • has a change in eligibility or payment status due to trust/undue hardship involvement.

Use the listed Document Processing System (DPS) notices and free-form text requirements in this section to prepare the notices. If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

NOTE: If an individual has a trust that meets one of the Medicaid exceptions in SI 01120.203A., a manual notice is not required.

B. Procedure — Award Letter Based on Undue Hardship

1. Which DPS Notice to Use and When to Use it

Use the DPS notice entitled "TRUST - Award Based on Undue Hardship" (SSA-L8025) when the individual has excess resources that include a countable trust, but is eligible for SSI based on the undue hardship waiver. The automated award notice must be suppressed.

2. What the Notice Includes

The notice includes the following information:

  • TST012: provides language related to excess resources and definition of resources.

  • TST001: explains and defines undue hardship.

  • TST002: informs the individual whether he/she meets requirements for undue hardship.

  • TST003: tells the individual we will contact him/her to review undue hardship determination and gives date.

3. Required explanation of why the trust is countable

In the notice, specify using free-form text each reason the trust does not meet the exception or other requirements in POMS. You must cite:

  • the applicable section of the trust (or any joinder agreement, if applicable) containing the problematic language or issue; and

  • the POMS citation that contains the policy requirements on that subject.

For example, “Section ______ of the trust does not comply with Program Operations Manual System (POMS) SI ______.”

Additionally, provide the following language indicating where the POMS can be found online: “You can find the Program Operations Manual System (POMS) on the Social Security website at https://secure.ssa.gov/poms.nsf/Home?readform.

C. Procedure — Disapproved Claim Letter

1. Which DPS Notice to Use and When to Use it

Use the DPS notice entitled "TRUST - Disapproved Claim" when the individual has a period of ineligibility due to excess resources that include a countable trust and the individual is not eligible during the life of the application.

Tailor the notice based on the reason the individual does not qualify for undue hardship - either the individual's available funds exceed the limit or the trust does not have the required restrictive language on trust payments.

2. What the Notice Includes

The notice can be tailored to the reason the individual does not qualify for undue hardship.

a. No undue hardship – individual's funds exceed the limit

The notice includes the following information:

  • TST012: provides language related to excess resources and definition of resources.

  • TST001: explains and defines undue hardship.

  • TST002: informs the individual that he/she does not meet the requirements for undue hardship.

  • TST004: notifies the individual to contact SSA if his/her income or resources change and he/she cannot afford food and shelter in a future month.

b. No undue hardship – trust does not have restrictive payment language

The notice includes the following information:

  • TST012: provides language related to excess resources and definition of resources.

  • TST001: explains and defines undue hardship.

  • TST011: informs the individual that he/she does not meet the requirements for undue hardship.

3. Required explanation of why the trust is countable

In the notice, specify using free-form text each reason the trust does not meet the exception or other requirements in POMS. You must cite:

  • the applicable section of the trust (or any joinder agreement, if applicable) containing the problematic language or issue; and

  • the POMS citation that contains the policy requirements on that subject.

For example, “Section ______ of the trust does not comply with Program Operations Manual System (POMS) SI ______.”

Additionally, provide the following language indicating where the POMS can be found online: “You can find the Program Operations Manual System (POMS) on the Social Security website at https://secure.ssa.gov/poms.nsf/Home?readform.

D. Procedure — Notice of Planned Action

1. Which DPS Notice to Use and When to Use it

Use the DPS notice entitled "TRUST - Planned Action" in posteligibility situations when the individual has excess resources that include a countable trust, undue hardship does not apply, and it is necessary to stop the individual's SSI check.

In addition, use this notice when an eligible individual who has excess resources that include a countable trust, but who has been receiving SSI based on undue hardship, no longer qualifies for undue hardship.

NOTE: If the trust qualifies for a 90-day amendment period, do not send the notice of planned action until the 90-day amendment period expires and the trust has not been amended to be policy-compliant. For more information on the 90-day amendment period, see SI 01120.201K2.

2. What the Notice Includes

The notice includes the following information:

  • TST012: provides language related to excess resources and definition of resources.

  • TST001: explains and defines undue hardship.

  • TST002: informs the individual that he/she does not meet requirements for undue hardship.

  • TST004: notifies the individual to contact SSA if his/her income or resources change and he/she cannot afford food and shelter in a future month.

3. Required explanation of why the trust is countable

In the notice, specify using free-form text each reason the trust does not meet the exception or other requirements in POMS. You must cite:

  • the applicable section of the trust (or any joinder agreement, if applicable) containing the problematic language or issue; and

  • the POMS citation that contains the policy requirements on that subject.

For example, “Section ______ of the trust does not comply with Program Operations Manual System (POMS) SI ______.”

Additionally, provide the following language indicating where the POMS can be found online: “You can find the Program Operations Manual System (POMS) on the Social Security website at https://secure.ssa.gov/poms.nsf/Home?readform.

E. Procedure — Notice of Change

1. Which DPS Notice to Use and When to Use it

Use the DPS notice entitled "TRUST - Change Qualify Due to Hardship Waiver" (SSA-L8151) in posteligibility situations when an individual who had been ineligible due to excess resources that include a countable trust is now eligible for SSI based on the undue hardship waiver.

2. What the Notice Includes

The notice includes the following information:

  • TST005: explains SSA's initial determination of ineligibility due to excess resources.

  • TST001: explains and defines undue hardship.

  • TST006: explains SSA's initial determination that the individual did not qualify based on undue hardship.

  • TST010: explains that the individual is now eligible based on undue hardship.

  • TST003: tells the individual we will contact him/her to review undue hardship determination and gives date.

3. No explanation required for why the trust is countable

You do not need to provide a free-form explanation of why the trust is countable in this notice because we already issued a previous notice explaining why the trust was countable.

F. Procedure — Revised Determination Notice

1. Which DPS Notice to Use and When to Use it

Prepare a manual notice of revised determination when changing a determination for past months due to excess resources that include a countable trust and a reconsideration has not been filed.

Use the DPS notice entitled "TRUST - Revised Determination (eligible)" for an individual who was determined ineligible in the past due to excess resources that include a countable trust and we are now determining that he/she was eligible for that period.

Use the DPS notice entitled "TRUST - Revised Determination (ineligible)" for an individual who was determined eligible in the past and we are now determining that he/she was ineligible for that period.

2. What the Notice Includes

Depending on the nature of the revised determination, the notice includes different information.

a. Change from ineligible to eligible (DPS notice “TRUST – Revised Determination (eligible)”)

The notice includes the following information:

  • TST005: explains SSA's initial determination of ineligibility due to excess resources.

  • TST001: explains and defines undue hardship.

  • TST006: explains SSA's initial determination that the individual did not qualify based on undue hardship.

  • TST010: explains that the individual is now eligible based on undue hardship.

  • TST003: tells the individual we will contact him/her to review undue hardship determination and gives date.

NOTE: In TST006, in fill-in 7, use “could” and in fill-in 11, use “did not.”

b. Change from eligible to ineligible (DPS notice “TRUST – Revised Determination (ineligible)”)

The notice includes the following information:

  • TST012: provides language related to excess resources and definition of resources.

  • TST001: explains and defines undue hardship.

  • TST006: explains SSA's previous determination that the individual was eligible based on undue hardship.

  • TST002: informs the individual that he/she does not meet requirements for undue hardship.

  • TST004: notifies the individual to contact SSA if his/her income or resources change and he/she cannot afford food and shelter in a future month.

NOTE: In TST006, in fill-in 7, use “could not” and in fill-in 11, use “did.” In TST002, in fill-in 8, use “could” and in fill-in 11, use “cannot.”

3. Required explanation of why the trust is countable

In the notice, specify using free-form text each reason the trust does not meet the exception or other requirements in POMS. You must cite:

  • the applicable section of the trust (or any joinder agreement, if applicable) containing the problematic language or issue; and

  • the POMS citation that contains the policy requirements on that subject.

For example, “Section ______ of the trust does not comply with Program Operations Manual System (POMS) SI ______.”

Additionally, provide the following language indicating where the POMS can be found online: “You can find the Program Operations Manual System (POMS) on the Social Security website at https://secure.ssa.gov/poms.nsf/Home?readform.

G. Procedure — Reconsideration Affirmation

1. Which DPS Notice to Use and When to Use it

Use the DPS notice entitled "TRUST - Reconsideration Affirmation/Reversal" when the individual appeals a determination about excess resources that include a countable trust, undue hardship does not apply, and we affirm that SSA's initial determination was correct.

2. What the Notice Includes

The notice includes the following information:

  • TST005: explains SSA's initial determination of ineligibility due to excess resources.

  • TST001: explains and defines undue hardship.

  • TST006: explains SSA's initial determination that the individual did not qualify based on undue hardship.

  • TST007: notifies the individual that SSA still finds him/her ineligible due to excess resources.

  • TST008: notifies the individual that SSA still finds that he/she is ineligible because he/she does not qualify for undue hardship.

  • TST004: notifies the individual to contact SSA if his/her income or resources change and he/she cannot afford food and shelter in a future month.

3. Required explanation of why the trust is countable

In the notice, specify using free-form text each reason the trust does not meet the exception or other requirements in POMS. You must cite:

  • the applicable section of the trust (or any joinder agreement, if applicable) containing the problematic language or issue; and

  • the POMS citation that contains the policy requirements on that subject.

For example, “Section ______ of the trust does not comply with Program Operations Manual System (POMS) SI ______.”

Additionally, provide the following language indicating where the POMS can be found online: “You can find the Program Operations Manual System (POMS) on the Social Security website at https://secure.ssa.gov/poms.nsf/Home?readform.

H. Procedure — Reconsideration Reversal

1. Which DPS Notice to Use and When to Use it

Use the DPS notice entitled "TRUST - Reconsideration Affirmation/Reversal" when the individual appeals a determination about excess resources that include a countable trust, and we determine that SSA's initial determination should be changed because we now find that the individual is eligible for SSI based on the undue hardship waiver.

2. What the Notice Includes

The notice includes the following information:

  • TST005: explains SSA's initial determination of ineligibility due to excess resources.

  • TST001: explains and defines undue hardship.

  • TST006: explains SSA's initial determination that the individual did not qualify based on undue hardship.

  • TST009: informs the individual that SSA now finds that he/she is eligible for SSI based on undue hardship.

  • TST003: tells the individual we will contact him/her to review undue hardship determination and gives date.

3. No explanation required for why the trust is countable

You do not need to provide a free-form explanation of why the trust is countable in this notice because we already issued a previous notice explaining why the trust was countable.


SI 01120 TN 59 - Incorporate EM-16012 into POMS - 9/25/2019