Effective Dates: 11/25/2024 - Present

Identification Number:
GN 02270 TN 18
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Personal Conference Procedures When Waiver Cannot be Approved
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part GN – General

Chapter 022 – Overpayments

Subchapter 70 – Personal Conference Procedures When Waiver Cannot be Approved

Transmittal No. 18, 11/22/2024

Audience

PSC: BA, CCRE, CS, DCR, DS, LDCR, LDS, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: CS, FCR, RECOVR;
OCO-ODO: BTE, CST, CTE, CTE TE, PAS, PETL, RC, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

11/25/2024

Background

As a result of a Commissioner’s Security Stat initiative requiring us to review and streamline the overpayment waiver POMS, we reviewed six Title II waiver personal conference sections (GN 02270.003, GN 02270.005, GN 02270.007, GN 02270.009, GN 02270.013 and GN 02270.015), and one Title XVI waiver personal conference section (SI 02260.006). We revised and merged all instructions into four new sections (GN 02270.003, GN 02270.007, GN 02270.013 and GN 02270.015), to provide Title II and Title XVI instructions for processing waiver personal conferences. we are archiving GN 02270.005 and GN 02270.009.

Summary of Changes

GN 02270.003 Claims Folder Information for Personal Conferences

We:

1. Renamed the section "Overview of the Personal Conference - Title II and Title XVI."

2. Added citations to the applicable Title II and Title XVI law and regulations.

3. Added an introduction to the instructions.

4. Revised and restructured the instructions, clarifying the policy and procedures.

5. Ensured compliance with QUICC Handbook writing requirements.

 

GN 02270.007 File Review and Personal Conference Scheduling Miscellaneous Issues

We:

1. Renamed the section "Scheduling the File Review and Personal Conference - Title II and Title XVI."

2. Added citations to the applicable Title II and Title XVI law and regulations.

3. Added an introduction to the instructions.

4. Revised and restructured the instructions, clarifying the policy and procedures.

5. Ensured compliance with QUICC Handbook writing requirements.

 

GN 02270.013 Conducting the Conference

We:

1. Renamed the section "Conducting the File Review and Personal Conference - Title II and Title XVI."

2. Added citations to the applicable Title II and Title XVI law and regulations.

3. Added an introduction to the instructions.

4. Revised and restructured the instructions, clarifying the policy and procedures.

5. Ensured compliance with QUICC Handbook writing requirements.

 

GN 02270.015 The Personal Conference Decision

We:

1. Renamed the section "Initial Waiver Determination After the Personal Conference - Title II and Title XVI."

2. Added citations to the applicable Title II and Title XVI law and regulations.

3. Added an introduction to the instructions.

4. Revised and restructured the instructions, clarifying the policy and procedures.

5. Ensured compliance with QUICC Handbook writing requirements.

GN 02270.003 Overview of the Personal Conference - Title II and Title XVI

CITATIONS:

Social Security Act §§204(b), 1631(b)(1)(B)
20 C.F.R. §§404.502(a), 404.506, 416.557

A. Introduction

If we cannot approve the individual's waiver request after our initial review, we must offer the individual an opportunity to review their fie and present their case at a personal conference with an independent decisionmaker. This section provides guidance on:

  • •

    When in the waiver process, we must provide an individual an opportunity for a file review and a personal conference;

  • •

    Who may be a personal conference decisionmaker; and

  • •

    Procedures to follow prior to scheduling a personal conference.

    For information on scheduling a file review and personal conference, refer to GN 02270.007.

B. Policy

When an individual requests a waiver, we review the information that the individual, their representative payee, or their attorney or other representative gives to us to support the individual's waiver request. If we cannot approve the waiver after our initial review, we must offer the individual an opportunity to review their case file and appear at a personal conference with an independent decisionmaker.

The independent decisionmaker must be a neutral party who independently reviews the case. A technician who participated in the initial waiver review and made the preliminary recommendation not to approve the waiver cannot be the personal conference decisionmaker.

For more information on who may be a personal conference decisionmaker, refer to GN 02270.003C.

We must notify the individual in writing of our proposal to deny the waiver request and schedule a file review and personal conference. We cannot take any recovery actions until the individual has had an opportunity for a personal conference.

For more information on scheduling the file review and personal conference, refer to GN 02270.007

NOTE: We do not need to schedule a file review or personal conference if the independent decisionmaker can approve the waiver based on the evidence in file.

NOTE: If we are unable to locate information about the overpayment, the independent decisionmaker must find the overpaid individual not at fault and approve the waiver under the against equity and good conscience provision, refer to GN 02250.011

C. Who may be an independent decisionmaker for a personal conference

If you are unable to locate the pertinent overpayment documents in the Evidence Portal, or from the IRG, request the paper folder using instructions in GN 03340.010B.1.

1. The independent decisionmaker

The independent decisionmaker must be a technician who:

  • •

    Did not participate in the initial review and preliminary recommendation to deny the waiver;

  • •

    Did not participate in any prior waiver determination for the same overpayment; and

  • •

    Is the same grade level as, or a higher grade level than, the technician proposing to deny the waiver request.

In the rare situation when all employees at the appropriate grade levels have been involved with the initial waiver review, management may need to arrange for an authorized employee from another office to conduct the conference by telephone or video teleconference. In situations where the individual wants an in-office conference, the manager may arrange for an employee from another office to travel to the servicing field office (FO).

D. Procedures prior to scheduling the personal conference

Prior to scheduling the file review and personal conference, the decisionmaker must complete these actions. The FO must request any paper claim files. The decisionmaker must gather the paper and all electronic claim files for overpayment and waiver information and any information the prior technician considered during the initial review and preliminary recommendation to propose the waiver denial. Query the Evidence Portal (EP) and review the paper claim files for information such as:

  • •

    Form SSA-632, Request for Waiver of Overpayment;

  • •

    Information about the proposed waiver denial;

  • •

    Pay stubs or proof of income;

  • •

    Resource information;

  • •

    Other evidence about the overpayment, etc.; and

  • •

    Any other evidence the decisionmaker might use to inform the waiver decision.

This information must be presented to the individual at the file review and personal conference, refer to GN 02270.013.

For Title II cases, if you have questions about information in the file, contact the jurisdictional processing center (PC) via a Modernized Development Worksheet (MDW).

E. Examples of who may be an independent decisionmaker for a personal conference

Example 1:

Tammy is a Title II technician in Miami, Florida. Tammy processed a continuing disability review and determined that Jasmine was overpaid due to engaging in substantial gainful activity during the extended period of eligibility. We sent Jasmine an overpayment notice and they requested a waiver. Tammy did not participate in the initial review that led to the proposed waiver denial; therefore, they can be an independent decisionmaker for the personal conference.

Example 2:

Karen is a Title XVI technician in Los Angeles, California. As part of a scheduled redetermination, Karen verified Sonya's earned income. The income verification revealed that Sonya earned more than we estimated. When we input the verified wages, the system computed an overpayment. We sent Sonya an overpayment notice, and they requested a waiver. Karen did not participate in the initial review to deny the waiver; therefore, they can be an independent decisionmaker for the personal conference.

GN 02270.007 Scheduling the File Review and Personal Conference - Title II and Title XVI

CITATIONS:

Social Security Act §§204(b), 1631(b)(1)(B)
20 C.F.R. §§404.502a, 404.506, 416.557

A. Introduction

This section provides guidance on how to schedule a file review and personal conference when we cannot approve the individual's waiver request after our initial review. This section also provides guidance to follow when:

  • •

    The notice scheduling the file review and personal conference is returned as undeliverable;

  • •

    An individual wants a representative to take their place at a personal conference;

  • •

    An individual requests to conduct the personal conference on the same day as the file review; and

  • •

    An individual does not appear for or declines the file review or personal conference.

NOTE: We do not need to schedule a file review or personal conference if the independent decisionmaker can approve the waiver request based on the evidence in file.

B. Policy

When we cannot approve the individual's waiver request after our initial review, we must provide the individual the opportunity for a file review and personal conference. At the file review, the individual has the opportunity to review all overpayment-related evidence in the claims file and the evidence we used to determine that we could not approve the individual's waiver request. The purpose of the personal conference is to give the individual the opportunity to appeal personally, to testify, and to provide additional evidence and arguments to support their waiver request.

We must send a notice to the overpaid individual that includes:

  • •

    The fact that we cannot approve the waiver based on the information we have;

  • •

    The dates, times, and location of the file review and personal conference. The date of the personal conference must be at least five workdays after the date of the file review. Refer to GN 02270.007F for an exception;

  • •

    The procedure for reviewing the claims file prior to the personal conference;

  • •

    The option to conduct the personal conference in the field office (FO), by telephone, or by video teleconference. We inform the individual that if they elect to conduct the personal conference by video teleconference, they will designate the location for their end of the video teleconference;

  • •

    All other information necessary to fully inform the individual about the personal conference, including their right to be represented, present evidence, or bring witnesses to question.

Do not include this information in the notice:

  • •

    Appeal rights (because you have not made an initial determination on the waiver request);

  • •

    Overpayment recovery options (e.g., refund request or payment adjustment).

NOTE: If the overpaid individual's address is outside the United States, refer to GN 02215.010.

If the individual cannot come to the originally designated FO for a legitimate reason (e.g., the individual is incapacitated) and they are unable to appear meaningfully by telephone or video teleconference (e.g., the individual is hard of hearing ) the decisionmaker will make arrangements to travel as far as necessary to conduct the conference.

When an individual requests a face-to-face personal conference and the decisionmaker is from a FO other than the individual's servicing FO, the manager may arrange for an employee from another office to travel to the individual's servicing FO. For more information on who may be a personal conference decisionmaker, refer to GN 02270.003C.

After we schedule the file review and personal conference, the individual may choose to decline to attend the personal conference, or they may fail to appear at the personal conference. If the individual declines a personal conference, we will make a waiver determination based on the information in the file. If the individual does not appear for the scheduled personal conference, reschedule the personal conference. If the individual fails to appear for a second scheduled personal conference, we will make a waiver determination based on the information in the file, refer to GN 02270.007G.1.

NOTE: We will also make a waiver determination based on the information in the file if the individual is unable to come to the FO or participate in a telephone or video teleconference and the decisionmaker is unable to go to the individual's location (e.g., the individual is incarcerated and the facility does not allow any outside communication).

C. Procedures for scheduling the personal conference

If you cannot fully approve the waiver request after initial review, do not send a waiver determination notice. Instead, prepare the Personal Conference & Folder Review (Waiver/Recon) notice found in the Document Processing System (DPS), under the national and overpayment tabs.

NOTE: For Title XVI, do not input a determination on the Modernized SSI Claims System (MSSICS) Direct SSR Update screens.

D. When USPS returns the notice as undeliverable

If the United States Postal Service (USPS) returns the notice scheduling the file review and personal conference as undeliverable, develop for a new address, refer to GN 02605.055 and GN 02605.060.

If you obtain a new address, send a new notice to the individual. If you cannot obtain a new address, document your efforts on the DMS Remarks (DMS RMKS) screen for Title II cases and on the Report of Contact for Title XVI cases. Process the waiver as if the individual declined the personal conference and follow the steps in GN 02270.007G.1.

E. When the wants a representative to take their place at the personal conference

If the individual requests that their representative take their place at the personal conference, explain that a representative may be present and participate in the conference. However, the overpaid individual must be present at the personal conference.

F. When the individual requests to conduct the personal conference on the same day as the file review

We must schedule the personal conference at least 5 workdays after the date of the file review. However, we can hold the personal conference on the same day if the individual requests to conduct the personal conference on the same day as the file review. You must document their request on the DMS RMKS screen for Title II cases and on the Report of Contact for Title XVI cases.

G. Individual does not appear for or declines the personal conference or the file review

We will make a waiver determination based on the information in the file if the individual:

  • •

    Declines the personal conference;

  • •

    Fails to appear for the second scheduled personal conference; or

  • •

    Is otherwise unable to appear at the personal conference by telephone, video teleconference, or in person, and the personal conference decisionmaker is unable to go to the individual for the personal conference.

1. Individual does not appear for or declines the file review

If the individual does not appear for or declines the file review, no further action is necessary. The file review is voluntary, and the failure to appear does not affect the personal conference scheduling.

2. Individual does not appear for or declines the personal conference

a. If the individual does not appear for the personal conference, reschedule the personal conference. To reschedule the personal conference, send a notice of Personal Conference & Folder Review (Rescheduled). Explain that the failure to appear at the rescheduled conference will result in us making the waiver determination based on the evidence we have in their file.

b. If the individual does not appear for the rescheduled personal conference, make the waiver determination, according to GN 02270.015.

c. If the individual declines the personal conference, encourage the individual to come to the personal conference and tell them that you are an independent decisionmaker and still need to make a waiver determination. If the individual still does not want the personal conference, make the waiver determination, according to GN 02270.015.

GN 02270.013 Conducting the File Review and Personal Conference - Title II and Title XVI

CITATIONS:

Social Security Act §§204(b), 1631(b)(1)(B)
20 C.F.R. §§404.502a, 404.506, 416.557

A. Introduction

We cannot deny a waiver request until we provide an opportunity for the individual to have a file review and personal conference. This section provides guidance on conducting the file review and personal conference after we have sent the individual a notice of the file review and personal conference. For information on scheduling a file review and personal conference and issuing the notice, refer to GN 02270.007.

This section also provides specific instructions on these aspects of conducting a personal conference:

  • •

    How the individual submits evidence for a telephone or video teleconference;

  • •

    The scope of the personal conference;

  • •

    Keeping a record of the personal conference;

  • •

    Actions to take during the personal conference;

  • •

    Obtaining information from the individual during the personal conference;

  • •

    Handling a difficult personal conference; and

  • •

    Closing the personal conference.

B. Policy for conducting the file review

Prior to scheduling the file review, we must gather overpayment and waiver information (e.g., SSA-632, pay stubs or proof of income, resource information, etc.). For more information about gathering evidence, refer to GN 02270.003D. At the file review, the personal conference decisionmaker must provide the individual and their representative with copies of any evidence in the claim file and pertinent sections of the law and regulations. Do not charge the individual for any of these documents.

At the file review, the individual must have the opportunity to review the claims file and applicable law and regulations with the personal conference decisionmaker, who is prepared to answer questions from the individual or their representative.

C. Policy for conducting the personal conference

1. Submitting evidence for a telephone or video teleconference

We must provide the individual the opportunity to submit evidence at the personal conference. If the overpaid individual requests to conduct the conference by telephone or video teleconference:

  • •

    The individual may provide the evidence prior to the conference; or

  • •

    If the individual did not submit evidence by mail, fax, or in person prior to the conference, continue with the personal conference and give them 15 days to submit any new evidence. Let the individual know that if they do not provide the evidence within 15 days, you will make your determination based on the evidence in the file.

    NOTE: We must offer the overpaid individual a face-to-face conference unless the Division of International Operation (DIO) in PC 8 has jurisdiction of the overpaid individual living outside of the U.S., refer to GN 002215.010.

    We will provide a suitable private space for the conference if it is in-person. As in-person conference usually takes place at the individual's servicing field office. However, there may be circumstances that the conference will take place at an alternative location, refer to GN 02270.007.

2. scope of the conference

By the time we conduct the conference, there may be other overpayments for the same individual. Restrict the conference to the waiver request for the overpayment for which you have scheduled the conference, even though recovering the other overpayments may involve similar issues.

3. Keep accurate records

During the personal conference, take notes about information pertinent to the waiver determination so that there is an accurate record of the conference to reference when making the determination.

4. Actions taken during the conference

Complete these steps at the personal conference:

  • •

    At the beginning of the personal conference, check the identity of everyone who is present and have them explain their role;

  • •

    Explain that you are the sole decisionmaker on the waiver, that you were not previously involved in deciding the waiver request, and that you will base your determination only on the evidence presented or reviewed at the personal conference, including the claims file and any new evidence presented at the personal conference. Explain that the conference gives the individual the opportunity to present their case, bring witnesses and furnish any new evidence to support their waiver request;

  • •

    Explain the provisions of the law and regulations that are applicable to the waiver determination;

  • •

    State whether the individual reviewed the claims file;

  • •

    Present the claims file and any other evidence that you have reviewed related to the overpayment and waiver request for the individual and representative to review;

  • •

    Briefly summarize the evidence that is already in the file that you will consider in making the waiver determination;

  • •

    Ask the individual if the information presented is correct and whether they fully understand it;

  • •

    Remind the individual that they did not provide additional evidence if they stated that they would provide more evidence.

5. Information obtained during the conference

Obtain the following information and evidence during the personal conference:

  • •

    The presentation of the individual's case and any arguments to support their waiver request from the individual and their representative, if any;

  • •

    Any additional evidence that the individual or representative presents;

  • •

    Updated financial information and verification from the individual if information in file is more than three months from the date we received the waiver request and if advantageous to the individual;

  • •

    Information from each witness and the witness' answers and statements in response to questions from you, the overpaid individual, and their representative.

6. Handling a difficult personal conference

You may encounter difficulties during the conference that prevent you from completing the conference. For example, the overpaid individual or their representative may be disruptive, unruly, or uncooperative. Inform them that you will end the conference if this behavior continues. If the conference remains unmanageable, end the conference. Document the efforts that you made to continue with the conference. Make the personal conference decision based on the information in the file and any other evidence and information you were able to obtain during the conference, following instructions in GN 02270.015.

7. Closing the personal conference

  • •

    Determine if there is any additional evidence that you need from the individual and ask them to submit the evidence within 15 days;

  • •

    Allow the individual and their representative, if any, to present any final summary or closing statement;

  • •

    Explain that you will make a decision and notify them in writing; and

  • •

    Explain repayment options and appeal rights in the event the decision is adverse to the individual.

    NOTE: Do not provide the decision at the conference.

GN 02270.015 Initial Waiver Determination After the Personal Conference - Title II & Title XVI

CITATIONS:

Social Security Act §§ 204(b), 1631(b)(1)(B)
20 C.F.R. §§404.502a, 404.506, 404.904, 416.551, 416.557, 416.558, 416.1404

A. Introduction

Following the personal conference, the decisionmaker documents the waiver determination and issues a written decision to the individual. This is the initial determination on the waiver request, and it is subject to the appeals process.

B. Policy

After the personal conference, we must provide a written decision to approve or deny the waiver request and inform the individual of their right to appeal the waiver determination. As the decisionmaker, you are responsible for independently and thoroughly examining all evidence related to the overpayment and the waiver request that was presented or reviewed at the personal conference. When making and documenting a waiver determination, you must support your findings by ensuring you identify and discuss the proper documentation and relevant facts.

NOTE: These instructions apply even if the individual declined the personal conference, the individual did not appear for a rescheduled personal conference, or we were not able to complete the personal conference. For more information about an individual declining a personal conference, or not appearing for a rescheduled conference, refer to GN 02270.007G. For more information about handling a difficult conference, refer to GN 02270.013C6.

1. Review the evidence before preparing the waiver determination

As the decisionmaker, prior to making your waiver determination, you must review all the evidence presented or reviewed at the personal conference, including any new information obtained during the personal conference.

Your decision must be based only on the evidence or information presented or reviewed at the conference. You may not discuss the waiver issues or your decision with the employee who conducted the initial waiver review. If you need to obtain or review additional evidence, you must allow the individual the opportunity to review the additional evidence and respond before making your determination.

2. The contents of a written waiver determination

Your written waiver determination must include:

  • •

    The individual's allegations;

  • •

    Information discussed and obtained at the personal conference that is relevant to the individual's waiver request, or, if appropriate, the fact that we offered the individual an opportunity for a personal conference and the reason we did not hold the conference (e.g., individual declined the conference or did not appear for a rescheduled conference);

  • •

    If you are making an at fault determination, your rationale for that decision;

  • •

    If you are making a not at fault determination, your rationale for that decision and your rationale for your findings on the remaining waiver provisions;

    NOTE: You must still issue this waiver determination even if you did not hold the personal conference because the individual declined the conference or did not appear for the rescheduled conference, or if you were unable to complete the personal conference because individual did not cooperate during the personal conference. Refer to GN 02270.007G and GN 02270.013C.6

3. The waiver determination

You must first make the fault determination, refer to GN 02250.005 through GN 02250.025.

NOTE: For information regarding Title XVI overpayments caused by resources exceeding the limit by $50 or less, refer to SI 02260.035

a. Waiver approval

If you determine the overpaid individual was not at fault, approve the waiver if any of these provisions apply:

  • •

    Administrative tolerance, refer to GN 02250.350;

  • •

    Deemed to defeat the purpose, refer to GN 02250.110;

  • •

    Against equity and good conscience, refer to GN 02250.150; or

  • •

    Defeats the purpose of the Act, refer to GN 02250.100.

    If the amount you are waiving is over $2,000, you must:

  • •

    Obtain the required second PIN (2-PIN) review before effectuating the waiver approval;

  • •

    Complete any final systems inputs; and

  • •

    Release the (Title II) approval notice. Refer to GN 02270.015C.1.b. if the (Title XVI) notice is excluded from automation. The notice should include the information in GN 02270.015B.2. and the information in GN 2250.370B. For more information about the waiver approval notice, refer to GN 02250.370.

    NOTE: To determine the level of review for a waiver approval, refer to GN 02250.301. After receiving the 2-PIN approval, release the waiver approval notice to the individual.

    b. Partial waiver approval

    If you determine that you can only waive a portion of the overpayment, you must sill obtain the required 2-PIN review if the amount that you are waiving is over $2,000. You do not need a 2-PIN review for the portion of the overpayment that you are denying.

    The Partial Waiver Approval (Initial Waiver Determination) notice is located in the Document Processing System (DPS) under the national and overpayment notices tabs. This notice must include the information in GN 02270.015B.2. and this information:

  • •

    The overpayment amount;

  • •

    The portion we waived and the reason we are unable to approve the entire overpayment amount;

  • •

    A statement that the individual who requested waiver does not have to repay the amount that we waived;

  • •

    A statement that the individual is responsible for repaying the part of the overpayment that we did not waive;

  • •

    Repayment options; and

  • •

    The appropriate appeal language. To determine the correct level of appeal, refer to GN 02250.380.

    c. Waiver denial

    When we deny a waiver, the overpaid individual must repay the overpayment because evidence in the file indicates they are at fault, or they do not meet the defeats the purpose provision or the against equity and good conscience provision.

    The waiver denial notice must include the information in GN 02270.015B.2. and this information:

  • •

    The overpayment amount;

  • •

    The reason for denial, including a fault determination and, if the individual is not at fault, why recovery would not be against equity and good conscience, and would not defeat the purpose of the Social Security Act; and

  • •

    The appropriate appeal language. To determine the correct level of appeal, refer to GN 02250.380.

    If you determine that recovery does not defeat the purpose after retrieving information from Accuity through Access to Financial Institutions (AFI), use the Waiver Denial for Defeats the Purpose notice. This notice is located under the national and overpayment tabs in DPS.

    If you are denying the waiver request because the individual did not authorize us to access their financial institution information, prepare the Waiver Denial notice, located in DPS under the national and overpayment tabs.

    d. Processing the waiver determination

    As the decisionmaker, you must process the waiver determination and complete the required systems inputs. Despite any systems inputs, we have not made an initial determination on a waiver request until we notify the overpaid individual of our determination and their appeal rights in writing.

    NOTE: Hold any paper files for 65 days after sending the personal conference notice, unless your office's procedures allow more time for retaining paper files, in case the overpaid individual requests a hearing.

C. Procedure for documenting and processing the initial waiver determination

1. Documenting and processing the waiver determination

Complete all required fields on Form SSA-635, Waiver Determination. For instructions on how to prepare the SSA-635, refer to GN 02250.315.

a. Title II

On the Debt Management System (DMS) Remarks (RMKS) screen, document the initial waiver determination. On the DMS Remarks Index (RMKI) screen, select 5=OTHER and title the remark "Initial Waiver Determination." For additional information about DMS, complete the Process Personal Conference (DRPC) screen in the DMS after you have conducted the personal conference and prepared your decision, refer to MS 01106.009.

If you are denying a Title II waiver that we completely recovered, request the payment center (PC) repost the overpayment to the Recovery of Overpayments Accounting and Reporting (ROAR) system. Document DMS Remarks. Explain that once you deny the waiver request, we will ask the PC to take another action to correct the balance of the new overpayment to $0 after posting the waiver denial. Once reposted, enter the waiver request and denial.

Annotate the RMKS screen with a summary of the initial waiver determination. Prepare and send the waiver determination notice using the DPS. You must complete all Title II waiver determination notices manually.

NOTE: The decisionmaker must complete the Waiver Disposition (DRWD) screen for the corresponding overpayment event to complete the DRPC screen. The decisionmaker cannot complete the DRPC screen if they also completed the DRWD screen. For instruction on completing these screens, refer to MS 01106.000, MS 01106.004, and MS 01106.009.

Fax any new documents, including the SSA-635, into the Non-Disability Repository for Evidentiary Documents (NDReD) using the Evidence Portal (EP).

b. Title XVI cases

On the Report of Contact screen, document the initial waiver determination and choose "Other" on the drop down menu and title the subject "Initial Waiver Determination." For additional information about the Report of Contact, refer to MS 08122.010. Fax any new documents, including the SSA-635, into NDReD using the EP.

Complete the Direct SSR Update screens: Overpayment Decisions (UOPD), Add/Change/Delete Overpayment Decisions (UODC), and Waiver (UOWV).

Annotate the Report of Contact with a summary of the initial waiver determination.

For instructions on completing the direct SSR input for a waiver decision and the Direct SSR Update screens, refer to MS 00304.007 through MS 00304.009. Waiver approval notices are automated, unless an exclusion to systems-generated notices applies. We complete waiver denial notices manually in DPS. Refer to NL 0803.205 and NL 00803.210. For a list of exclusions to systems-generated notices, refer to NL 00801.010.

If the overpaid individual has a representative payee (payee), send the payee's copy with the SSA-4017 and a return envelope. If the overpaid individual has a legal guardian or appointed representative who is not the payee, send a photocopy of the notice to each individual. Refer to NL 00803.225 for notice distribution information.

2. Processing waiver approval, partial approval, and denial determinations

a. Waiver approval

Title II procedure

After completing the approval notice, post the waiver approval to the ROAR. If the case requires review, the reviewer will process the approval by completing the Review Personal Conference (DRPW) screen in DMS, refer to MS 01106.010.

If the waiver approval covers months in which we withheld or recovered benefits to recover the waived overpayment, the jurisdictional PC will refund the amount we withheld or recovered. Do not refund any amounts if there is another overpayment for a different overpayment period or an unresolved overpayment.

Title XVI procedure

Process the initial waiver determination using Modernized SSI Claims System (MSSICS) Direct SSR Update and the UOWV screen to post the approved waiver decision to the SSR. For waiver input instructions, refer to MS 00304.009. For instructions on sending the approval notice, refer to GN 02250.370.

If the waiver approval covers months in which we withheld or recovered benefits to recover the waived overpayment, refund the amount we withheld or recovered. Use the automated one-time payment (A-OTP) process to refund the recovered amount. For instructions on the A-OTP process, refer to SM 01901.005 and MS 00304.003 through MS 00304.009 and MS 00303.022. Do not refund any amounts if there is another overpayment for a different overpayment period or an unresolved overpayment.

b. Partial waiver approval

When we approve waiver of recovery for a portion of the overpayment, we relieve the overpaid individual from the obligation to repay that part of the overpayment. The individual is still responsible for repaying the remainder of the overpayment. For the portion of the overpayment that we are waiving, refer to GN 02250.370D. For the portion of the overpayment we are denying, send a manual waiver denial notice. For more information about which denial notice to send, refer to GN 02270.015C.3.c.

Title II procedure

Prepare the Partial Waiver Approval (Initial Waiver Determination) notice in DPS as described in GN 02270.015C.3. and complete the DRPC screen to process the decision to the ROAR.

Title XVI procedure

Process the partial approval using the UOWV screen to issue the notice for the waived amount and to post the partial waiver approval to the SSR. Refer to GN 02270.015C.3. for instructions on issuing the notice for the overpayment amount not waived.

c. Waiver denial

Complete the applicable systems waiver denial screens and issue a notice of waiver denial per GN 02270.015B.2.c Title II procedure

Complete the DRPC screen to post the waiver denial decision to the ROAR.

Title XVI procedure e

Complete the UOWV screen to post the waiver denial decision to the SSR.

3. Notice distribution and document storage

Store the initial waiver determination notice in the Online Retrieval System (ORS).

a. Case involves a paper folder

Title II procedure

Include a copy of the SSA-635 Waiver Determination in the folder returned to the jurisdictional PC and fax a copy of the SSA-635 to NDRed via EP. Annotate DMS with the date you return the paper folder to the PC.

Title XVI procedure

Include a copy of the SSA-635 Waiver Determination in the folder and fax a copy of the form to NDRed via EP.

b. Case involves an electronic folder

If the case has an electronic folder (EF), fax the SSA-635 into the EF via EP (non-disability) or eVIEW (disability). For eDIB claim folders, refer to DI 81010.090 Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes.


GN 02270 TN 18 - Personal Conference Procedures When Waiver Cannot be Approved - 11/25/2024