Identification Number:
SI 00510 TN 9
Intended Audience:See Transmittal Sheet
Originating Office:OISP
Title:Requirement to File for Other Program Benefits
Type:POMS Transmittals
Program:Title II (RSI)
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 005 – Eligibility
Subchapter 10 – Requirement to File for Other Program Benefits
Transmittal No. 9, 10/18/2019

Audience

OCO-OEIO: CR, FCR, FDE, RECONE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

 

Summary of Changes

SI 00510.005 Types of Other Program Benefits

Subsection C - Removing reference to the Social Security Programs Throughout the World website.

 

SI 00510.010 Pensions and Certain Compensation Programs as Potential Sources of Other Benefits

Subsection E - Removing Social Security Programs Throughout the World link.

SI 00510.005 Types of Other Program Benefits

A. Policy — Other Program Benefits

1. Other Program Benefits Subject to Filing Requirements

Types of other benefits for which an individual must file include:

2. Requirement to File for Apportionment of Augmented VA Benefit

Payments from the Department of Veterans Affairs (VA) issued to the veteran or the veteran's surviving spouse may be augmented for dependents. Effective 11/17/94, the dependent's portion of the VA benefit is not income to an absent dependent unless he/she receives it directly.

Therefore, to get SSI, an individual is required to file for apportionment (direct payment) of an augmented VA benefit if he/she:

  • Is the spouse or child of a living veteran or the child of a deceased veteran with a surviving spouse and the veteran or surviving spouse receives VA compensation, pension, or educational benefits; and

  • Does not reside with the designated beneficiary, (i.e., the veteran or the veteran's surviving spouse); and

  • Has not been denied apportionment since living apart from the designated beneficiary.

NOTE: Dependents who are receiving a VA benefit by apportionment do not receive automatic cost-of-living adjustments. You are not required to refer these individuals to the VA to request an increase.

3. Other Program Benefits Exempt from the Filing Requirements

Types of other benefits exempt from the requirement to file for other program benefits are:

  • Temporary Assistance for Needy Families (TANF),

  • General Public Assistance,

  • Bureau of Indian Affairs General Assistance,

  • Victims' compensation payments,

  • Other Federal, State, local or private programs which make payments based on need, and

  • Earned Income Tax Credits.

4. Conditions Exempting VAIP from Filing Requirement

Based on Public Law (P.L.) 96-272, enacted in June 1980, certain individuals cannot be required to file for Department of Veterans Affairs Improved Pension Plan (VAIP) nor can their SSI and/or State supplementation eligibility be suspended for failure to file. These are individuals who:

  • Currently reside in Alabama, Alaska, Arizona, Colorado, Delaware, Idaho, Mississippi, Nevada, New Mexico, South Carolina, South Dakota, Texas, or Wyoming; and

  • Were entitled to a VA pension as of December 31, 1978.

(See SI 00510.010A. for situations where individuals must file for VAIP.)

5. Payments which are not Program Benefits

Payments such as child support, alimony, accelerated life insurance, etc., are not program benefits for which an individual must file.

B. Policy — Social Security Benefits

1. Title II Benefits

Title II benefits are the greatest source of other program benefits. Title XVI adjudicators must explore potential entitlement to Title II benefits during the initial application and posteligibility reviews. Claimants/recipients must pursue potential entitlement to retirement and/or disability benefits based not only on the his/her own earnings record, but also on a different SSN for Title II dependents, including divorced spouses, and/or survivor's benefits. However, they are not required to file for Medicare only as a condition for SSI eligibility.

NOTE: Medicaid eligibility may continue for individuals in certain categories, i.e., certain widow(er)s, surviving divorced spouses and disabled adult children, even if entitlement to or an increase in Title II benefits results in SSI ineligibility (see SI 01715.015B. for persons categorically eligible for continued Medicaid coverage).

2. Pursuing Title II Entitlement and Adjudicating Title II

a. Potential Title II Entitlement

In both SSI initial claims and posteligibility situations, if a claimant/recipient is potentially eligible for Title II benefits and either chooses not to file or not to elect full retroactivity, SSA must notify him/her in writing of the requirement to file for all other benefits (see SI 00510.020B. for referral procedure).

b. Adjudicating Title II Aspects of Title XVI Application

Because an application for SSI payments is also an application for Title II benefits, adjudicators must take steps to determine whether the claimant is entitled to Title II benefits. If an individual does not file a separate Title II application concurrently with the SSI application, action must be taken to adjudicate the Title II aspects of the SSI claim (see SI 00601.035 for policy and procedure for adjudicating Title II).

REMINDER: A redetermination (RZ) form may also be a protective filing for Title II benefits (see GN 00204.015) which must be closed out by taking a Title II application or issuing a protective filing closeout notice.

C. Procedure — FO Identification of Potential Entitlement to Other Program Benefits

Since the claimant/recipient may be entitled to more than one type of program benefit, e.g., Title II retirement or Title II survivor benefits, be sure to identify all potential sources of benefits.

Obtain clues to an individual's possible entitlement to other program benefits from:

  • Information obtained during the initial claim interview; including responses to lead questions on the application

  • Recipient's responses during the redetermination process

  • Inquiries received from another agency

  • FO precedent files on pension plans and foreign pension qualifying conditions.

  • Form SSA-93-U4 (Quality Review Feedback Report)

  • Third party reports

  • Critical birthday diaries (see SI 02309.001)

  • SSA queries: AACT, SEQY, SSID, etc.

SI 00510.010 Pensions and Certain Compensation Programs as Potential Sources of Other Benefits

A. Procedure — VA Benefits — General

Explore potential eligibility for a VA payment if the claimant/recipient is a:

  • Veteran; or

  • Surviving child (see SI 00830.314B.6.) or an unmarried widow or widower of a veteran or service person (individual who died while in service); or

  • Dependent parent (see SI 00830.314C.9.) of a disabled veteran or service person; or

  • Surviving parent (see SI 00830.314C.10.) of a veteran or service person who died from a service-connected cause; and

  • The criteria in SI 00510.010B. or SI 00510.010C. of this section are met.

REMINDER: When referring an individual to the VA, advise him/her to telephone first to obtain information on filing requirements and proofs he/she may need to bring.

B. Procedure — VA Pension

Refer an individual for VA pension payments (based on a nonservice-connected disability) if all of the following conditions are met:

  • The veteran or deceased service member served at least 90 days, at least one of which was during a wartime period; and

  • The veteran is permanently and totally disabled or is age 65 or older;

  • The individual being referred is a veteran, surviving spouse, or surviving child; and

  • The individual has not alleged, in a signed statement, having previously filed for VAIP (see SI 00510.005A.4).

EXCEPTION: Do not refer an individual who has been eligible for a VA pension since before 1979 and who is a resident of one of the States listed in SI 00510.005A.4.

NOTE: The wartime periods are:

WWI

4/6/1917 - 11/11/1918

WWII

12/7/1941 – 12/31/1946

Korea

6/27/1950 - 1/31/1955

Vietnam

8/5/1964 - 5/7/1975

(Persian) Gulf War

8/2/1990 – through a date to be set by law or Presidential Proclamation (per Dept. of Veteran’s Affairs).

Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom

2001- present.

Note: This war period is not yet listed on the Dept. of Veteran’s Affairs website. Refer claimant to VA Benefit Counselor at 1-800-827-1000.

C. Procedure — VA Compensation

Refer an individual for VA compensation payments if the veteran or deceased service person suffered a service-connected disability (even though minor) or died.

D. Procedure — Workers' Compensation Payments

If an individual alleges either injury on the job or has what appears to be a work-related impairment, refer him/her to the appropriate agency for assistance (see SI 00830.235).

E. Procedure — Foreign Work or Service Benefits

If an individual alleges working in or serving in the military of a foreign country, apply the guidelines in GN 01701.005 to obtain the necessary information to determine if the individual might qualify for benefits payable by the foreign country or by SSA as a result of a totalization agreement.

If there is no totalization agreement, refer to the Social Security in Other Countries website, and RS 02610.015 for additional guidelines.

F. Procedure — Other Pensions

1. Private Sector

Refer an individual for a private sector pension if the individual or former spouse:

  • Worked for a private employer with a pension plan;

  • Was age 25 or older during such employment; and

  • Is not or was not already receiving a pension from the employer (or union) based on that employment.

NOTE: If existence of a pension plan is uncertain, consult the FO pension plan precedent file discussed in SI 00510.010I. If the individual's eligibility for the private sector pension is still uncertain, refer him/her to the employer.

2. Public Sector

Refer an individual for a public sector pension when the individual or former/deceased spouse (or a deceased parent when the claimant/recipient is a child) is not or has not received a pension based on this employment and meets the guidelines below.

a. Federal Civilian Employment

An individual may be eligible for a Federal pension if the worker did not withdraw employee contributions to the pension plan, and was employed under the:

  • Civil Service Retirement System (CSRS) , for a minimum of 5 years;

  • Federal Employees Retirement System (FERS) , for a minimum of 18 months.

NOTE: Often Federal employees covered under CSRS who are ill will take an extended leave of absence without pay, and may file for SSI. Do not require such individuals to file a claim with OPM unless it is clear that they have terminated their job status.

b. Employment in the Federal Uniformed Services (Military)

An individual may be eligible for a military service pension if the service person served a minimum of 20 years.

c. Employment by a State or Local Government

An individual may be eligible for a State or local government pension if the worker:

  • Was employed for a minimum of 5 years, or employed, regardless of the length of time, either by a State or as a teacher in a public college or university; and

  • Did not withdraw employee contributions or withdrew employee contributions but was either a teacher in a public college or university or was employed by a State or local police/fire department.

NOTE: If the individual is uncertain about whether contributions were withdrawn, refer him/her to the former employer or contact the employer to resolve any questions.

G. Procedure — Eligibility Uncertain

If the adjudicator questions an individual's potential eligibility for another benefit:

  • Check the precedent file,

  • Consider contacting the organization involved, or

  • Use evidence in the claimant's/recipient's possession to resolve the issue.

If the individual is not potentially eligible, document the file with the reason why.

If eligibility for the other benefit remains uncertain, refer the individual to the appropriate source.

H. Procedure — When Not To Refer

1. No Apparent Eligibility

If an individual does not meet the basic eligibility requirements for a benefit per A. - G. above:

  • Do not refer, and

  • Document the file with the reason.

2. Prior Denial

If the individual alleges having filed previously and been denied for reasons other than failure to pursue, accept his/her signed statement regarding the denial, unless there is evidence to the contrary.

3. Contributions Withdrawn

If an individual alleges that he/she or the employee (if a deceased spouse) withdrew his/her contributions from a public sector pension, accept the individual's signed statement regarding the withdrawal unless:

  • The employee was a teacher in a public college or university or was employed by a State or local police/fire department (and no precedent exists which states that, once funds are withdrawn, no benefits are payable); or

  • There is evidence to the contrary (e.g., the FO precedent file indicates funds may not be withdrawn).

4. Application Pending

If an individual alleges an application for the other benefit is pending:

  • Send the SSA-L8050-U3 to the benefit source, and

  • Set up a diary to control for receipt of the SSA-L8050-U3 per SI 00510.025C.2.

I. Procedure — Use of Precedent File

1. General

Use the precedent file to reduce the number of repeat contacts and to maintain information regarding Federal, State, local, company or union pension plans. Note that information in the precedent files is used to determine whether referrals to the benefit source should be made.

IMPORTANT : Do not use these precedents to determine whether the person is entitled to the other benefit.

2. File Organization

Keep pension plan information as a separate precedent or incorporated with other precedent data, e.g., the sick pay plan precedent file for the same company or agency.

a. File Content

Include the following data for each employer:

b. General Identification

  • Employer's name and address

  • Name and phone number of the person who can supply pension information

c. Pension Plan

  • Existence of a pension plan

  • Statement as to whether or not employees contribute and, if they do, what happens to those contributions upon termination of employment for reasons other than retirement or disability

  • Vesting requirements

  • The pension plan provisions for survivors and/or dependents (including divorced spouses)

d. Union

  • Whether or not there is a union

  • If so, does the union provide a pension?

  • The name, address, and local phone number of the union

  • The conditions to qualify for the pension

  • The union contact for additional information on the pension (including the phone number)

e. Any Other Pertinent Information

Date pension information was obtained and recorded

3. File Maintenance

Each time you use the precedent file, check the date the precedent was established. If the precedent file has not been updated within the last 12 months, update it based on contact with the employer.


SI 00510 TN 9 - Requirement to File for Other Program Benefits - 10/18/2019