Effective Dates: 12/9/2021 - Present
Retention Date: July 09, 2023
|Intended Audience:||All RCs/ARCs/ADs/FOs/TSCs/PSCs|
|Originating Office:||DCO OPSOS|
|Title:||Instructions for Reopening and Reevaluating SSI Claims Denied due to COVID-19 Disaster Assistance|
|Type:||EM - Emergency Messages|
|Program:||Title XVI (SSI)|
|Link To Reference:||See References at the end of this EM.|
This emergency message (EM) provides guidance on reopening and reevaluating Supplemental Security Income (SSI) claims that have been denied due to receipt and/or retention of COVID-19-related disaster assistance.
The agency is reopening cases where we may have denied an individual’s SSI claim based on the receipt and/or retention of pandemic-related financial assistance, which we initially counted for SSI purposes but later deemed to be excludable disaster assistance in EM-20014 REV 5. We are sending outreach notices to affected individuals because they may now qualify for SSI, including retroactive payments.
NOTE: These SSI claims may have been denied before the claims were sent to DDS for a medical decision or denied after completion of the Pre-effectuation (PERC) development, and after there has been a favorable medical determination.
C. Procedure for Identifying Disaster Assistance
Refer to EM-20014 REV 5 for updated information on sources of pandemic-related disaster assistance and the policy treatment for identified assistance types. For any assistance classified as disaster assistance in the chart in section C.1 of EM-20014 REV 5, follow the special processing and documentation instructions in EM-21050 REV 3.
For reference, we are providing a summary of the various disaster assistance types and their corresponding income codes on the UMIH field of the SSR.
|Possible Disaster Assistance Types||UMIH Code on the SSR|
|Emergency Assistance to Children and Families through the Pandemic Emergency Assistance Fund||F|
|Emergency Rental Assistance (ERA)||H (paid directly to landlord or utility provider-as outside ISM,) or
RL (paid directly to tenant/claimant/deemor)
|Tribal Payments under CARES Act and ARPA||SA, or SN|
|COVID-19 Funeral Assistance||SD|
|Higher Education Emergency Relief Fund (HEERF)||SG
|Unemployment Assistance under CARES Act, CAA, ARPA and Presidential Memorandum||SU|
Other Possible UMIH Codes on the SSR
|Disaster Assistance input as “Other Income”||SO|
|Manual Deeming of Disaster Assistance||V|
D. Basis for reopening
SSI claims denied N01/N04 due to the receipt and/or retention of pandemic-related disaster assistance may be reopened and revised, if appropriate, based on the guidance in this EM, within:
All cases in this workload qualify for good cause under “error on the face of the evidence” SI 04070.010F.4-5. However, reopening is not appropriate for a case where disaster assistance was received or retained but not material to the SSI claim being denied N01/N04.
The agency will not impose a deadline for individuals to respond to the outreach notices. These cases may remain reopened indefinitely, until resolved.
1. Outreach mailer for denied SSI claims
An outreach mailer will be sent to individuals whose SSI claim may have been denied due to the receipt and/or retention of COVID-19 disaster assistance. Certain denied claims will not receive the outreach mailer but will be addressed by Field Office technicians as an Ad Hoc workload in the near future. These cases are:
· 1 year for any reason, or
· 2 years upon finding of good cause.
· Denied claims with pending appeals.
The outreach notices will serve as the Affirmative Action in Writing to reopen these case (SI 04070.015B) and will be stored in the Online Retrieval Systems (ORS).
The outreach mailer will let individuals know:
· Denied claims with pending subsequent applications
· Denied claims with approved subsequent applications
· We may have denied their SSI claim because they received pandemic-related financial assistance; and
The outreach mailer will be released from the System’s centralized Print Management Facility (PMF) to approximately 144,000 claimants. The mailers will:
· They may now be eligible for SSI and/or retroactive payments; and
· They should contact us so we can reevaluate whether they are eligible for SSI and/or retroactive payments.
Undeliverable mail will be processed by OCO and WBDOC by:
· We started releasing the mailers on November 29, 2021.
· They will be released weekly for four weeks.
· They will be selected randomly by way of terminal digits, and
· They will be available in English and Spanish with Special Notice Options (SNO)
When individuals respond to the outreach mailer, technicians should set up an appointment so a technician can review the record and reevaluate all factors of eligibility and determine whether a correction needs to be made.
2. Appointment scheduling in eLAS
The outreach notice instructs denied claimants to contact the N8NN so TSC agents can schedule an appointment with the servicing FO. However, if an FO receives the call instead, technicians should:
· Receiving the undeliverable notices, and
· Remailing, if USPS returns the envelope with a yellow sticker, providing a new address.
· Review the SSR and determine if the prior SSI claim was denied N01 or N04 due to disaster assistance any time in or after March 2020.
· Consider this an oral inquiry (SI 00601.025A) and schedule an initial claim appointment in eLAS. Follow procedures in MS 00601.001 and annotate “Potential denied claim reopening-prior SSI claim denied due to pandemic-related disaster assistance” in the remarks section.
NOTE: The receipt and/or retention of the disaster assistance must be material to the denial of the SSI claim for reopening to apply.
3. Non-responders to the mailer
We fully anticipate some individuals to not respond to the mailer in a timely fashion. Therefore, we are adding a special message on the SSR to help technicians identify these cases. When determining the next action, technicians should thoroughly review the records and process any necessary corrections. These cases may remain reopened indefinitely, until resolved.
Special Message on the SSR:
If after the review, the CS determines that a reopening is not appropriate, document the reason in a DROC or SSA-5002 and remove the special message on the SSR.
E. Processing Instructions
1. Reevaluating the prior denial
If, after speaking to the claimant and reviewing the case, you determine that the income/resources that are the basis for the denial are not pandemic disaster assistance (this may include income or resources that were not documented on the SSR previously):
COVID-19 Disaster Assist – Received Denied Claim Reopening Outreach Notice. Review and determine necessary actions.
After documenting the case as indicated above, no further action is needed.
NOTE: If the technician begins a claim in MSSICS in error i.e., the original denial is correct and claimant does not want to file a new claim, the technician should delete the erroneous claim and document the record as outlined above.
2. Processing a reopened claim
a) Document the types of income/resources the claimant received in either a DROC in MSSICS or SSA-5002 and fax it into EF or CFUI.
b) Add the following special message to the SSR: “After further review, record denied correctly- was not denied due to Disaster Assistance.”
c) Ask the claimant if they want to purse filing a new claim
· If yes, take a new claim
· If no, send an L991 to close out the protective filing created by the appointment (SI 00601.037B.2.).
If after speaking to the claimant and reviewing the case, you determine that the claim was denied due to the receipt and/or retention of disaster assistance, process the reopened SSI claim following instructions in SI 00603.001 through SI 00603.004.
a) Creating a New Record in MSSICS/CCE
Reopening an initial claim denial requires the technician to create a new record using the prior claim’s information. Use the same Application Date, Protective Filing Date, and receipt date from the previously denied SSI claim.
3. SSI Offset
Windfall offset affects concurrently entitled individuals who are due retroactive payments from SSI and TII for the same months. If the claimant has filed for TII benefits and the TII retroactive benefit has already been released, follow instructions in SI 02006.205B and SM 01320.040 to post Type G income to the SSR and apply Title XVI offset.
4. Attorney and Non-Attorney Representation
In most situations, technicians should not resume prior representation from the denied claim without authorization from the claimant and updated representation forms. Exceptions to this policy can be found in GN 03910.060D. If appropriate and no exception applies, explain to the claimant that he or she must file new forms with the representative before we can add the representative to the case.
5. Cases involving an Interim Assistance Reimbursement (IAR)
Some of the denied claims may contain an expired IAR authorization. The IAR authorization is the State form that gives written permission for SSA to withhold the individual's initial claim or post-entitlement SSI retroactive funds and send it to the State to reimburse them for interim assistance (IA) provided to the individual. The authorization is valid up to the point that a determination is made or for 12 months.
Add the following remarks to the new record on the DROC screen: “Reopened based on error on the face of the evidence. Prior incorrect denial determination due to the counting of COVID-19 pandemic disaster assistance. Outreach notice date of MM/DD/YYYY is the affirmative action in writing.”
b) Processing Time
The Miscellaneous Clearance Data screen (CMSC) is used to document the reason the effective filing date is over 90 days old. Make sure to complete the CMSC to exclude the case from processing time. On page one of the CMSC, enter 3 for REASON EFFECTIVE FILING DATE IS OVER 90 DAYS OLD for the reopened prior claim.
To exclude non-MSSICS cases from processing, enter a code of C after the application date in the AP field on the SSA-450S.
During the interview, advise the claimant of the following:
· The IAR authorization must be submitted by the State within 30 days of the claimant signing the authorization.
· If the IAR authorization has expired, the State is required to submit a new authorization.
· The IAR should not be added to the record until a State submits a new IAR authorization electronically or submits the authorization manually (this is for cases that will have a new record established since the record we are reopening is in terminated status).
· The system will automatically set the GR code, or the technicians will input the GR code to the System for manual States.
· Do not change or delete a GR code present on a record unless it was input erroneously SI 02003.020.
Example 1: Disabled child to Disabled Individual
On 05/18/2020, we denied an SSI claim because of the parents’ unemployment income. After receiving the outreach mailer, the applicant, who is now an adult, contacts the FO to discuss their denied claim.
The technician should thoroughly review the record to determine if reopening is appropriate, and develop the record using existing policy in SI 00603.001.
Since the applicant was a minor on the first moment of the protective filing month, the technician should alert DDS that an age 18 medical determination is also required. The technician should add remarks in EDCS, and indicate the following: “An adult medical determination is also needed as claimant is now 18”.
Example 2: Claimant only eligible for E02 month
· They previously signed an IAR authorization with the State allowing us to reimburse the State for interim assistance they may have received.
· We will need a new authorization from the State in order to reimburse the State.
· The State may reach out to them to sign a new authorization.
If the State is an “electronic” State, they can submit the IAR authorization electronically through SDX. Submission of the IAR will automatically set the GR code on the SSR. For non-electronic States, the State will submit a paper form to the local servicing field office.
On 09/28/2021, we denied an SSI claim due to unemployment benefits. In 12/2021, the claimant has received the outreach mailer and contacted the local FO to discuss their denied claim.
During the interview, the technician learns that the claimant continues to receive unemployment benefits. The unemployment from the state of California was excludable as disaster assistance in 09/2021 only and is countable from 10/2021 on. Technicians should develop the claim and forward it to DDS for a medical decision since the claimant is potentially eligible for benefits in 09/2021, see SI 00601.009C.3.
Example 3: Claimant no longer meets the non-medical requirements
DI 13010.110, Return to Work Within A Year of Onset (Title XVI)
On 06/10/2020, a claimant was denied due to unemployment benefits. In 12/2021, the individual has received the outreach mailer and contacted the local FO to discuss their denied claim.
During the interview, the CS learns that the individual is no longer eligible for SSI as of 09/2021 due to the receipt of an inheritance. Technicians should develop the initial claim and forward it to DDS for a medical decision since the claimant has potential eligibility from June 2020 through August 2021, see SI 00601.009C.3.
Example 4: Earnings over Substantial Gainful Activity (SGA)
In 08/2020, a claimant was denied due to disaster assistance. In 12/2021, the claimant contacts the local FO after receiving the outreach mailer to discuss their denied claim.
The technician develops the SSI claim and determines that the claimant was working and engaged in SGA in the following months: October 1, 2020 through June 15, 2021. Because the claimant worked and earned over SGA from October 2020 through June 2021, and the claimant worked and had substantial earnings for more than 6 months, we would not consider the person disabled until after the claimant stopped working on June 15, 2021. The technician would recommend a Potential Onset Date (POD) of 6/15/2021, the date that the SGA ceased, and then transfer the claim to DDS for a medical determination, see DI 13010.110, DI 25501.220.
Direct all program-related and technical questions to your Regional Office (RO) support staff. RO support staff may refer questions, concerns, or problems to their Central Office contacts.
DI 25501.220 Potential Onset Date (POD)
EM-20014 REV 5 Effect of COVID-19-Related Financial Assistance on SSI Income and Resources
` Special Processing Instructions for Applying Supplemental Security Income (SSI) Income and Resource Exclusions to Pandemic-related Disaster Assistance
MS 00601.001 Processing Leads/TSC Referrals - Overview
SI 00601.009C.3. Application Effective Date
SI 00603.001 Processing Disability/Blindness Initial Claims -Overview
SI 00603.004. Simultaneous Development Application Process
SI 02003.020 Field Office Processing of IAR Authorizations
SI 02006.205B. Identification and Notification of Affected Claimants and Their Representatives and Development of Title II Data
SI 04070.010F.4-5. Title XVI Administrative Finality - Reopening Policies
SI 04070.015. Reopening SSI Determinations
EM-21068 - Instructions for Reopening and Reevaluating SSI Claims Denied due to COVID-19 Disaster Assistance - 12/9/2021