Effective Dates: 11/22/2024 - Present

Identification Number:
GN 02250 TN 64
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Waiver Provisions for Title II and Title XVIII Overpayments
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part GN – General

Chapter 022 – Overpayments

Subchapter 50 – Waiver Provisions for Title II and Title XVIII Overpayments

Transmittal No. 64, 11/22/2024

Audience

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

Originating Component

OISP

Effective Date

Upon Receipt

Background

Based on a Commissioner initiative, we are merging the Title XVI waiver POMS instructions with the Title II waiver POMS instructions. This transmittal updates and clarifies the policy and procedures for applying an administrative tolerance waiver determination of an overpayment when the original overpayment amount is $2,000 or less.

Summary of Changes

GN 02250.350 Administrative Waiver Tolerance of $2,000 or less

Re-titled the section to: "Administrative Tolerance for Overpayments $2,000 or Less- Title II and Title XVI"

Added citations "Social Security Act § 1631(b)(1)(B); 31 U.S.C. § 3711(a)(3) 20 C.F.R. §§ 404.515, 416.55"

Subsection A-We restructured this subsection as the "Introduction"

Subsection B

  • •

    Updated title to "Policy";

  • •

    Clarified the policy for when the administrative tolerance applies;

  • •

    Clarified presumption of fault;

  • •

    Added cross-references for fraud or similar fault, duplicate check negotiation; and

  • •

    Clarified waiver considerations for other members of the household.

Subsection C

  • •

    Created new subsection to clarify the procedures for adjudicating an administrative tolerance waiver;

  • •

    Included Administrative Tolerance Decision Tree;

  • •

    Included instruction for reconsideration requests;

  • •

    Included clarified instructions for when full waiver development is required;

  • •

    Included cross-references about waiver development, fault and personal conference; and

  • •

    Included instructions for approval and documentation procedures.

Subsection D-We created this new subsection to include examples for situations where we determine if we can approve the waiver under the administrative tolerance provision.

GN 02250.350 Administrative Tolerance for Overpayments $2,000 or Less- Title II and Title XVI

CITATIONS:

Social Security Act § 1631(b)(1)(B); 31 U.S.C. § 3711(a)(3) 20 C.F.R. §§ 404.515, 416.555

A. Introduction

This section provides guidance on when to apply an administrative tolerance waiver determination of a Title II or Title XVI overpayment when the original overpayment amount is $2,000 or less.

Under this provision, we can waive the overpayment because recovery would impede the efficient administration of the Social Security Act. This tolerance supports the efficiency of our overpayment recovery program. Using this tolerance promotes cost-effective recovery efforts, so we spend less on recovery activities than the amount we would expect to recover from individuals who are not at fault. We calculated the tolerance by considering the current average administrative cost of handling overpayment cases through our adjustment or recovery processes.

NOTE: If the Title XVI overpayment is due to countable resources exceeding the limit by $50 or less, we must deem the individual not at fault and waive the overpayment, unless we find clear evidence that the individual knowingly and willfully failed to report the excess resources correctly and timely. Refer to GN 02250.090.

B. Policy

When an individual requests waiver, we will waive recovery or adjustment of an overpayment if:

  • •

    the overpaid individual is not at fault; and

  • •

    the original overpayment amount (not the balance) is $2,000 or less.

We will not require the individual to complete Form SSA-632-BK for an overpayment that is $2,000 or less. We will need to fully develop the waiver request if we find that we cannot presume the individual is not at fault. For information on presuming the individual not at fault, refer to GN 02250.350B.1.

NOTE: Consideration of waiver under the tolerance is also dependent on overpayments to other members of the household, refer to GN 02250.350B.4.

 

1. Presumption of not at fault

For purposes of the administrative tolerance provision, presume the individual is not at fault and do not further develop fault unless the overpayment resulted from these situations:

If fraud or similar fault by the overpaid individual is involved in the overpayment, we cannot waive the overpayment. Refer to GN 02250.001.

If there is any indication that an individual may be at fault because of duplicate check negotiation, you must complete full waiver development to determine whether the individual is not at fault, refer to GN 02250.021B.6. If we find the individual is not at fault after full waiver development and the overpayment is $2,000 or less, we will waive the overpayment under the administrative tolerance provision.

2. Original overpayment amount is $2,000 or less

We use the original overpayment amount when considering the administrative tolerance provision. If an overpayment has been reduced to $2,000 or less by repayment or collection, the tolerance does not apply.

3. An individual requests reconsideration of an overpayment determination and the original overpayment amount is $2,000 or less

a. Request for reconsideration of the overpayment determination – Title II

If the individual requests a reconsideration of an overpayment determination and the overpayment is $2,000 or less, we presume the reconsideration request is a request for waiver. The processing center (PC) will process the waiver request after making a formal reconsideration determination that is not fully favorable to the individual or dismisses the individual’s overpayment reconsideration request.

b. Request for reconsideration of the overpayment determination – Title XVI

If the individual requests a reconsideration of an overpayment determination and the overpayment is $2,000 or less, we presume the request for reconsideration is a request for waiver. The FO will process the waiver request after the processing the reconsideration.

4. Waiver considerations for other members of the household

Consideration of waiver under the tolerance also depends on overpayments to other members of the household.

  • •

    For Title II, to waive an overpayment under the administrative tolerance provision in a single-family situation, each person’s original overpayment amount must be $2,000 or less. If any household member has an overpayment over $2,000, no member of the household may receive waiver under the administrative tolerance provision.

  • •

    For Title XVI, to waive an overpayment under the administrative tolerance for an eligible couple, each member’s original overpayment amount must be $2,000 or less. If either spouse has an overpayment over $2,000, neither spouse may receive waiver under the administrative tolerance provision.

C. Procedure

Evaluate the waiver request or overpayment reconsideration request to determine if you are going to process an overpayment reconsideration or waiver or both. You may use the Administrative Tolerance Decision Tree to assist you in this determination. When you have a reconsideration request, initiate corrective actions when applicable to update the record.

When you determine you will process a waiver request and after you have confirmed all case information is current, continue with following procedures to apply the tolerance.

If the original overpayment is $2,000 or less and you can presume the individual is not at fault, follow the approval procedures. For a Title II approval procedures, refer to GN 02250.350C.2. For a Title XVI approval procedures, refer to GN 02250.350C.4.

1. Full waiver development

Full waiver development is required if you are unable to approve the waiver request under administrative tolerance because:

  • •

    You need to fully develop for fault where there is duplicate check negotiation; or

  • •

    The amount of the overpayment is over $2,000.

If the amount of the overpayment is over $2,000, complete full waiver development, refer to GN 02250.002.

If there is duplicate check negotiation, obtain a form SSA-632-BK, refer to GN 02250.001. After reviewing the information in the SSA-632-BK and the case file, determine whether the individual is not at fault, refer to GN 02250.021B.6. If the original overpayment amount is $2,000 or less, and you find the individual not at fault, you must waive the overpayment under the administrative tolerance provision. If you cannot approve waiver after this initial review, propose a waiver denial and schedule a file review and personal conference. Refer to GN 02270.003.

NOTE: The FO (customer service representatives (CSR) and higher), Processing Center (PC), or the Teleservice Centers (TSC) (TSRs and SPIKES) can process any waiver request involving the tolerance. For Title II, only the PC can process reconsideration requests involving the tolerance. For Title XVI, the FO (claims specialist (CS) and higher) can process reconsideration requests involving the tolerance.

2. Title II approval procedures

  • •

    Verify the amount of the original overpayment before making a determination on a waiver request based on the administrative tolerance. If the individual has requested waiver of more than one overpayment, evaluate a waiver or reconsideration request against each separate overpayment.

  • •

    Input the waiver request to the system per MS 01106.002 Debt Resolution Menu (DRMU).

  • •

    Use the Waiver Disposition screen (DRWD) when processing waiver requests for overpayments of $2,000 or less (refer to MS 01106.004). Use code 77 (Dollar Down Rounding for the Decision Reason (refer to MS 01106.007).

  • •

    Continue to use Waiver Approval Under $500 (Primary) (DRWP) screen and Waiver Approval Under $500 (Contingent) (DRWC) screen for waivers under $500 (refer to MS 01106.006 and MS 01106.007).

  • •

    Complete and send a manual waiver approval notice. For more information on the waiver approval notice, refer to GN 02250.370.

  • •

    Annotate on the Remarks (RMKS) screen in DMS that you sent a waiver approval notice. For more information on the RMKS screen in DMS, refer to MS 01109.003.

NOTE: Do not split an overpayment of more than $2,000 into two or more amounts for the purpose of administratively discontinuing waiver development of the total overpayment.

3. How to document the waiver determination – Title II

Document the waiver request and determination in a remark on the DMS Remarks (RMKS) screen containing the:

  • •

    Requester’s full name;

  • •

    Requester’s relationship to the overpaid individual;

  • •

    Overpayment amount;

  • •

    Overpayment period;

  • •

    Overpayment sequence number;

  • •

    Documents and records we used to make the waiver determination; and

  • •

    Method by which we received individual or representative payee’s request for waiver (mail request, in-office request, or phone request on MM/DD/YYYY, etc.).

Annotate the waiver approval on the DMS RMKS screen as follows “Waiver approval; overpayment is $2,000 or less.”

4. Title XVI approval procedures

Verify the original amount of the overpayment before deciding a waiver request based on administrative tolerance. If the individual has requested waiver of more than one overpayment, evaluate a waiver or overpayment reconsideration request against each separate overpayment. A separate Overpayment Sequence (OPSQ) number in the OPSQ segment of the Supplemental Security Income Record (SSR) does not, by itself, indicate a new overpayment period. For a discussion of the OPSQ segment of the SSR, refer to SM 01310.220.

  • •

    Input the request using the Waiver (UOWV) screen using Direct SSR Update in MSSICS, which provides reason codes to document the reason for the waiver decision. For information on the UOWV screen, refer to MS 00304.009.

    NOTE: Do not split an overpayment of more than $2,000 into two or more amounts for the purpose of administratively discontinuing waiver development of the total overpayment.

  • •

    Complete and send a manual notice of an approved waiver (DPS notice, Waiver Approved Letter) to the overpaid individual and a copy to the representative payee (if applicable) if the system does not generate an automated notice. For more information on the waiver approval notice, refer to GN 02250.370.

  • •

    Annotate on the Report of Contact page in the Consolidated Claims Experience (CCE) that you sent a waiver approval notice. For more information on the Report of Contact page in CCE refer to MS 08122.010. For non-MSSICS/CCE cases, record the statement on Form SSA-5002 Report of Contact and fax into the Non-Disability Repository for Evidentiary Documents (NDRed) using the Evidence Portal (EP). For more information on EP refer to MS 09701.001.

5. How to document the waiver determination – Title XVI

Document the waiver request and determination on Report of Contact page in Consolidated Claims Experience (CCE) or on form SSA-5002, Report of Contact containing the:

  • •

    Requester’s full name;

  • •

    Requester’s relationship to the overpaid individual;

  • •

    Overpayment amount;

  • •

    Overpayment period;

  • •

    Overpayment sequence number;

  • •

    Documents and records we used to make the waiver determination; and

  • •

    Method by which we received individual or representative payee’s request for waiver (mail, in-office, or phone request on MM/DD/YYYY, etc.).

D. Examples

Here are examples of situations where we determine if we can approve the waiver under the administrative tolerance provision.

EXAMPLE 1:

Double check negotiation requires further development

Lucy did not receive the February 2024 SSI payment on the first of the month. They requested a replacement check. We sent a replacement check to Lucy. We advised them to return the original check if they received the check or found it. On February 9, 2024, they received the replacement check. Lucy cashed both checks.

Lucy received an overpayment notice informing them that the regular February 2024 monthly payment of $943 and the $943 replacement check were both cashed. Lucy went to the local office to request a waiver. There is an indication that Lucy may be at fault because of double-check negotiation. Therefore, we cannot presume Lucy is not at fault and must evaluate the waiver request using full waiver development, according to GN 02250.001. If after Lucy submits a form SSA-632-BK, we determine that Lucy is not at fault, we will waive the overpayment under the administrative tolerance provision. If we find Lucy is at fault and cannot approve waiver after the initial review, we must propose a denial and schedule a folder review and personal conference.

EXAMPLE 2:

Administrative tolerance does not apply

Linus was overpaid $4,500 due to a late report of their marriage. They repaid $2,600 of the overpayment, then subsequently requested a waiver because they could no longer afford to repay the remaining balance. Even though Linus now owes only $1,900, the administrative tolerance does not apply to waive the overpayment because the original overpayment was $4,500. We must evaluate the waiver request using full waiver development.

EXAMPLE 3:

Administrative tolerance applies

We conducted a redetermination in November 2023. We verified Marcy’s wages for the period December 2021 through October 2023. The verified wages caused an overpayment of $800 between March 2022 and September 2023. We sent a notice of overpayment to Marcy and they requested a waiver. The technician presumed Marcy was not at fault because there was no indication of fraud, similar fault, or duplicate check negotiation. Since the total amount of the overpayment was $2,000 or less, we approved the waiver under the administrative tolerance provision.

 


GN 02250 TN 64 - Waiver Provisions for Title II and Title XVIII Overpayments - 11/22/2024