PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 022 – OverpaymentsSubchapter 50 – Waiver Provisions for Title II and Title XVIII OverpaymentsTransmittal No. 59, 09/27/2024
Audience
Originating Component
OISP
Effective Date
Upon Receipt
Background
Based on Commissioner initiative, we merged the Title II and Title XVI waiver POMS. We updated who can approve a waiver and when a review is required.
Summary of Changes
GN 02250.301 T2 Waiver Decision-maker
We made the following revisions to this section:
Subsection A - Changed the title of this section to "Overpayment waiver reviews"
Subsection B - Changed the title of this section to "Overpayment waiver approval policy"
Subsection C - Changed the title of this section to "Title II and Title XVI Overpayment waiver approval procedures" and added Title II and Title XVI waiver approval charts
CITATIONS:
Social Security Act §§ 204(b), 1631(b)(1)(B)
Certain waiver approvals require a second pin (2-PIN) review before effectuating the waiver determination. The amount of an overpayment waiver approval determines the level of the decision maker and reviewer that is required. For the applicable level of review, including required management and regional office (RO) review, refer to the charts in GN 02250.301C.
NOTE: If you can approve the waiver under the administrative waiver tolerance provision, you do not need a second pin review. For information about approving a waiver under the administrative waiver tolerance provision, refer to GN 02250.350.
The amount of a waiver approval determines the level of decision making and review.
Waiver approval amounts over $2,000 require a review and a second pin (2-PIN). After the decision maker determines they want to approve the waiver, the decision maker refers the case to the applicable reviewer for the second pin review. The reviewer ensures the determination adheres to documentation requirements, policy, and procedures. The reviewer must make sure that the decision maker recommends approving the waiver under the correct waiver provision. For more information about the required level of review and required inputs, refer to the Title II and Title XVI charts in GN 02250.301C.
If the reviewer does not have enough information to concur with the decision, they will notify the decision maker that the decision requires additional development or documentation. The reviewer must document the Debt Management System (DMS) Remarks (Title II) or a Consolidated Claims Experience (CCE) Report of Contact (Title XVI) with the reason for returning the case (e.g., no SSA-635, no proof of income, etc.). After the decision maker provides a thorough assessment of their waiver determination, they will return the case to the second pin reviewer for a subsequent review if the determination remains an approval after the corrections. If the reviewer concurs with the determination, the reviewer completes the required inputs. After receiving the 2-PIN approval, the decision maker releases the waiver approval notice to the individual.
If the reviewer disagrees with the waiver approval because it does not meet one of the waiver provisions, they will notify the decision maker. The reviewer must document DMS Remarks (Title II) or a CCE Report of Contact (Title XVI) with the rationale for non-concurrence. For instance, a not at fault determination is not supported by the policy in POMS GN 02250.005 or GN 02250.015, an against equity and good conscience determination is not supported by the policy in GN 02250.150, etc. The decision maker must refer the case to another decision maker for a folder review and personal conference (if a personal conference has not already occurred). If the personal conference was completed, the decision maker must revise the waiver decision to a denial and document the decision on the SSA-635 form.
NOTE: We do not require review and concurrence for waiver approvals made by a federal court, an administrative law judge (ALJ), or the Appeals Council. Since, the 2-PIN process is a systems requirement for waiver approvals over $2,000, the reviewer must still provide their 2-PIN approval in the system.
The Title II and Title XVI waiver approval charts provide these instructions:
The waiver approval amount;
Who can make a waiver approval determination (decision maker);
The inputs a decision maker must take for a waiver approval;
If a waiver approval review and second pin is required;
Who provides the waiver review (reviewer); and
The inputs a reviewer must make for a waiver approval.
For more information about waiver determination documentation, and completing and storing the SSA-635, refer to GN 02250.315.
For more information about the waiver approval notice, refer to GN 02250.370.
Waiver Approval Amount
Decision maker
Decision maker procedures
Review required?
Reviewer procedures
$2,000 or less
CSR or higher
For administrative waiver tolerance Title II procedures, refer to GN 02250.350C.1.
For PC instructions, refer to GN 02201.023.
No
N/A
$2,000.01 or more but less than $5,000
CSR or higher (proposes waiver approval)
Decision maker:
Enter the waiver disposition input in DMS and document DMS remarks you referred the case for review.
Complete the SSA-635, include your name, title, and the date.
Refer the proposed waiver approval to the Reviewer for review.
After the Reviewer approves the decision, store the SSA-635 following the instructions in GN 02250.315 and release the waiver approval notice.
Yes,
Reviewer: CS or higher (Reviewing, 2nd PIN)
Review the decision. If you concur, complete the waiver review input in DMS (MS 01106.005), and annotate your concurrence on the SSA-635 (name, title, and date).
Return the case to the Decision maker to release the waiver approval notice.
$5,000 or more but less than $75,000
CS or higher (proposes waiver approval)
Reviewer: Field office management review required. (Reviewing, 2nd PIN required)
Reviewer (management):
Review the decision. If you concur, complete the waiver review input in DMS. For more information about the Review Waiver Disposition (DRWR) screen, refer to MS 01106.005. Annotate your concurrence on the SSA-635 (name, title, and date).
$75,000 or more
Refer the proposed waiver approval to the management official for review before sending to CDPS/MOS for review.
After RO approves the decision, store the SSA-635 following the instructions in GN 02250.315 and release the waiver approval notice.
Yes
FO management AND RO review required for waiver approval
Reviewer: Management official (Reviewing Only). Field office management review required (do not complete 2nd PIN)
RO Reviewer (2nd PIN): CDPS/MOS review required (reviewing 2nd PIN required)
Review the decision. If you concur, annotate your concurrence on the SSA-635 (name, title, and date) (do not update DMS or complete 2nd PIN). Mandatory referral to RO for review from CDPS/MOS.
Send the proposed waiver approval to vHelp. Attach the SSA-632, SSA-635 and supporting documents to the vHelp question.
RO Reviewer (2nd PIN required):
Review the decision. If you concur, complete the waiver review input in DMS, and annotate your concurrence on the SSA-635 (name, title, and date).
Inform the FO of your concurrence and notify the FO to send the applicable waiver determination notice.
For administrative waiver tolerance Title XVI procedures, refer to GN 02250.350C.2.
IMPORTANT: The Decision maker and Reviewer inputs must be done on the same day.
Complete the SSA-635, include your name, title, and the date. Refer proposed waiver approval to the Reviewer for review.
Input the waiver approval via direct SSR update. Request the reviewer to second PIN.
After the Reviewer approves the decision, store the SSA-635 following the instructions in GN 02250.315.
Reviewer:
Review the decision. If you concur, annotate your concurrence on the SSA-635 (name, title, and date), and return the case to the Decision maker for the waiver input.
Complete the second PIN via direct SSR update input.
$5,000 or more but less than $35,000
Completes the SSA-635, include your name, title, and the date. Submit your proposed waiver approval to the management official for review.
Input the waiver approval via direct SSR update. Request the management official to second PIN.
After the management reviewer approves the decision, store the SSA-635 following the instructions in GN 02250.315.
Reviewer: Field office management review required (Reviewing, 2nd PIN required)
$35,000 or more
Complete the SSA-635, include your name, title, and the date. Submit your proposed waiver approval to the management official for review before sending to CDPS/MOS for review.
Input the waiver approval via direct SSR update after receiving the RO Reviewer’s request.
Contact RO Reviewer to complete the second PIN input.
After the RO reviewer approves the decision, store the SSA-635 following the instructions in GN 02250.315.
FO management Reviewer: Management official (Reviewing Only).
Review the decision. If you concur, annotate your concurrence on the SSA-635 (name, title, and date). Mandatory referral to RO for review from CDPS/MOS. Send the proposed waiver approval to vHelp. Attach the SSA-632, SSA-635 and supporting documents to the vHelp question.
Review the decision. If you concur with the FO’s proposed approval, annotate your concurrence on the SSA-635 (name, title, and date), and return the case to the Decision maker for the waiver input. The input must be done by a CS or TE.
RO Reviewer:
After the FO’s waiver approval input, second PIN the approval.