Effective Dates: 11/25/2024 - Present

Identification Number:
GN 02250 TN 65
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. 65, 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

11/25/2024

Background

Based on Commissioner initiative, we are merging the Title XVI POMS with the Title II POMS. We increased the resource limit to $6,000 for an individual, $10,000 for a couple, and $1,200 for each additional household member. We increased the margin for adjusted household expenses to $250. In addition, we update the criteria to exclude two vehicles per household as a resource.

Summary of Changes

GN 02250.100 Defeats the Purpose (Ability to Repay) of Title II and Title XVI - Waiver Determination

We changed the title of this POMS transmittal, added more Title II citations, and Title XVI citations.

Subsection A: We added countable resources that exceed the limit as a new defeats the purpose provision.

Subsection B: We re-titled this subsection, updated the resource limits, added a note to explain these resource limits are only for a waiver request and not for Title XVI eligibility, and added a formula for pro-rating monthly household expenses for a child.

Subsection C: We increased the margin for adjusted household expenses from $55 to $250. From the list of what we consider income, we removed room and board and contributions from family/friends. We clarified to only request documents that support total household income when the individual's alleged income does not exceed alleged expenses plus $250. We created new sub-sections for types of income and supporting documentation for clarity.

Subsection D: We clarified that the overpaid individual's expenses are based on their standard of living and removed the subjectivity. In the list of ordinary and necessary expenses, we changed "medical payments paid by the family" to "out of pocket medical expenses and we moved/updated "hairdresser" to "personal care products and services (like a haircut)." We updated acceptable monthly household expenses to remove the subjectivity and removed entertainment and travel/vacationing as an unacceptable monthly expense. We updated the title of sub-sections D3 and D4. We increased the margin for adjusted household expenses from $55 to $250.

Subsection E: We increased the resource limit from $3,000 to $6,000 for an individual, from $5,000 to $10,000 for a couple, and from $600 to $1,200 for each additional household member. We updated the list of items that we exclude as resources to include two vehicles per household, items of sentimental value, insurance policies, ABLE accounts, and certificate of deposit that has not reached its maturity date. We also moved trust fund and joint ownership in real estate from subsection E2 to the exclusion list. We added a new AFI cross reference. We added instructions for obtaining supporting documentation.

Subsection G: We provided instructions when the technician is unable to approve the Title II or Title XVI waiver based on the defeats the purpose provision.

Subsection H: We numbered sub-sections for the examples. We updated the dollar amounts in the examples to match the changes in thresholds. We added new examples for Title XVI income and resource exclusions and for AFI authorization refusal.

GN 02250.100 Defeat the Purpose (Ability to Repay) of Title II and Title XVI - Waiver Determination

CITATIONS:

Social Security Act §§204(b), 1631(b)(1)(B)

20 C.F.R. §§404.506, 404.508, 404.512, 416.550, and 416.553

A. Introduction

We will waive overpayment recovery when an individual requests a waiver if we find the overpaid individual is not at fault, and recovery would defeat the purpose of Title II or Title XVI of the Social Security Act. Before you determine if a waiver request meets the defeats the purpose provision (ability to repay), you should have already considered whether you can approve the waiver under one of these provisions:

 

B. Policy

Before making a defeat the purpose waiver determination, we must first determine the overpaid individual is not at fault in causing the overpayment, per GN 02250.005-GN 02250.025. Recovery of an overpayment defeats the purpose if recovering the overpayment would deprive the overpaid individual of the income and resources required for ordinary and necessary living expenses. To determine recovery of an overpayment defeats the purpose (meaning the individual doesn't have the ability to repay), we must find that:

 

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    The overpaid individual needs substantially all of their current income to meet their current ordinary and necessary living expenses (i.e., the monthly household income does not exceed monthly current ordinary and necessary living expenses by more than $250), per GN 02250.100C and GN 02250.100D; and

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    The overpaid individual has no more than $6,000 in resources or $10,000 if the individual has one other household family member. If the individual has more than one other household family member, add $1,200 for each additional household family member to their resource limit, per GN 02250.100E.

To make the defeat the purpose waiver determination, we will review the monthly income, monthly expenses, and resources of the overpaid individual, the individual’s spouse, and all other household family members.

NOTE: The $6,000 and $10,000 resource limits only apply to the waiver determination. These resource limits do not apply to Title XVI eligibility. Some of the income and resource exclusions for Title XVI eligibility purposes do not apply when we make a defeat the purpose determination.

1. Definition of household family members

For purposes of determining whether recovery of an overpayment defeats the purpose, household family members are defined as the overpaid individual’s spouse and any dependents. A dependent is an individual who depends on the overpaid individual for financial support and whom the overpaid individual or their spouse can claim on their income tax returns. Even if a dependent family member resides outside the household (e.g., child away at school), still consider the individual as a dependent. For purposes of determining whether recovery of an overpayment defeats the purpose, we consider all household family members and the overpaid individual to be a single financial unit, with all income and resources available to each individual.

Where a child is overpaid, a household family member is defined as the child’s parents and their dependent family members. A dependent is an individual (e.g., the child’s sibling) who depends on the overpaid child’s parents for financial support and who the parents can claim as a dependent on their income tax returns.

2. Applying defeats the purpose for a child's overpayment

We consider income and resources as belonging to the child if the income and resources are:

 

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    In the child’s name or in an instrument (e.g., a trust) in which the child is a named beneficiary; and

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    Available for the child’s use. For information about how to determine whether resources are available to the child, refer to GN 02250.100E.

If any of the child’s income or resources help with household expenses, count the income, resources, and household expenses of the parents and any other household family members as belonging to the child in the defeat the purpose determination. If someone other than a household family member lives in the household, include any contributions that they make to the household as income to the child.

If any of the child’s income or resources do not help with monthly household expenses, make the defeat the purpose determination using only the child’s monthly income, share of monthly household expenses, and resources. To determine the share of monthly household expenses, apply a pro-rata share of the ordinary and necessary living expenses to the overpaid individual and each household family member. Use this formula to apply the pro-rata share: [Total monthly household expenses] / [Overpaid individual + Number of household family members]. 

For examples on how to apply the defeats the purpose provision for a child’s overpayment, refer to GN 02250.100H.1 and GN 02250.100H.3.

C. Monthly household income

To determine whether the overpaid individual needs substantially all their current income to meet ordinary and necessary living expenses, we compare the monthly household income to monthly household expenses. We subtract the monthly household expenses from the monthly household income. We will find the overpaid individual needs substantially all of their current income to meet current ordinary and necessary living expenses if monthly household income does not exceed monthly household expenses by more than $250, per GN 02250.100D4.  If the overpaid individual has more than $250 of remaining income after paying the monthly household expenses, the overpaid individual does not meet the defeats the purpose provision, per GN 02250.100D4.

Monthly household income includes the overpaid individual's monthly income and all of the household family members' monthly income. We consider any income that a household family member receives as income available to the overpaid individual. If someone other than a household family member lives in the household, include any contributions they make to the household as income to the overpaid individual. For the definition of household family member, refer to GN 02250.100B1.

1. Types of income

Income includes:

 

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    Government benefits (e.g., Social Security, railroad, workers' compensation, unemployment compensation);

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    Net wages;

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    Net income from self-employment;

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    Child support;

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    Alimony;

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    Pensions;

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    Investment income (e.g., interest, royalties, dividends, and rent); or

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    Income from an Individual Retirement Account (IRA), Keogh plan, or any other type of retirement plans.

2. Supporting documentation

The overpaid individual or representative payee (payee) is responsible for providing the documents that support the total household income. After reviewing the information on the SSA-632-BK, only request supporting documentation when the individual’s alleged income is less than $250 after paying monthly household expenses. The supporting documents must be no older than 3 months from the date we receive the waiver request.

If the overpaid individual does not provide supporting documents with the waiver request, send them a notice requesting this information and inform them that they have 30 days to provide it. For Title XVI, use the SSA-L8009 in the Document Processing System (DPS). For Title II, use the equivalent notice in DPS. If the individual notifies you that they are actively trying to obtain the supporting documents and needs additional time, allow them the additional time. If the individual has not provided the documents within 30 days or they have not notified you that they need additional time, you cannot approve the waiver under the defeats the purpose waiver provision. Refer the waiver request to an independent decision-maker to schedule a file review and personal conference.

D. Monthly household expenses

When making a defeats the purpose determination, we consider the household's ordinary and necessary living expenses. Whether expenses are considered ordinary and necessary will depend on the individual's lifestyle and personal circumstances. 

Round the total amount to the nearest dollar when you calculate the household expenses.  Include expenses of only the overpaid individual and any household family member, as defined in GN 02250.100B1. Do not include expenses of any individual who lives in the household and is not the overpaid individual or is not determined to be a household family member.

NOTE: We do not require proof of expenses.

1. Types of monthly expenses

Ordinary and necessary expenses include:

 

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    Fixed living expenses such as rent or mortgage payments;

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    Utilities, taxes, food, household supplies, personal care products and services (like a haircut), clothing, transportation, and insurance (life, homeowners, car, medical, etc.);

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    Out of pocket medical expenses;

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    Court ordered payments paid directly to the court;

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    Tuition and school expenses;

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    Expenses for the support of others for whom the overpaid individual is legally responsible; and

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    Miscellaneous ordinary and necessary living expenses which may be reasonably considered as part of the individual's standard of living, such as pet-related expenses and entertainment (e.g., cell phone, cable, internet, vacationing, or reading material).

2. Determining acceptable monthly household expenses

Expenses that are consistent with the overpaid individual's alleged standard of living are acceptable household expenses. An individual's standard of living is set by the individual. Do not question an individual's standard of living. For example, if the overpaid individual eats at a restaurant every night, accept that as their standard of living. Or, if the overpaid individual has cable television or multiple television streaming services, accept that as their standard of living.

3. One-time large expenses

If the overpaid individual has a large one-time expense (e.g., a large medical expense), prorate the expense by dividing the total amount of the expense over a 12-month period to determine the monthly amount.

4. Comparing income and expenses

We will find an overpaid individual needs substantially all income to meet current ordinary and necessary living expenses if monthly income does not exceed monthly expenses by more than $250. Every household has some unbudgeted or unaccountable expenses. This $250 margin allows for unbudgeted expenses or unaccountable expenses. We subtract the monthly household expenses from the monthly household income. If the balance is $250 or less and if the resources are at or below the amounts in GN 02250.100E, we will find that the individual needs substantially all income for ordinary and necessary living expenses and find that recovery defeats the purpose.

If the overpaid individual has more than $250 left over after paying the monthly household expenses, we will find that the individual does not meet the defeats the purpose provision because recovery of the overpayment would not deprive the individual of income needed for current ordinary and necessary living expenses. If we cannot approve the waiver, refer the waiver to an independent decision-maker to schedule a file review and personal conference.

NOTE: Even if the individual cannot repay the overpayment in one lump sum, we will find the individual can afford repayment because they can make repayment by benefit withholding or monthly installments if they have more than $250 in income remaining after paying expenses. Refer to GN 02210.030 and GN 02220.180 for Title II or SI 02220.025 and SI 02220.026 for Title XVI. Additionally, if the individual's financial circumstances change in the future and they are no longer able to afford monthly benefit withholding or repayment, they may make a subsequent waiver request. For more information, refer to GN 02250.303.

For examples on how to evaluate and compare income to expenses, refer to GN 02250.100.H.3, GN 02250.100.H.4, and GN 02250.100.H.5.

NOTE: An individual's monthly household expenses may be more than the monthly household income because the individual is not paying their bills, the individual is going into debt to pay bills, or someone else is paying their bills. The individual may have also made a mistake in reporting their expenses. We may ask the individual to explain the reason that expenses exceed income (e.g., they cannot afford to pay their bills so they are not paying all their bills).

E. Resources

To meet the defeats the purpose criteria, the overpaid individual must have income that meets the criteria in GN 02250.100D.4., and their resources must meet the criteria in GN 02250.100B. We must include an overpaid individual's and any household family member's resources in the defeats the purpose determination. For the definition of household family member, refer to GN 02250.100B1.

For the purpose of a defeats the purpose determination, resources include cash or other liquid assets or any real or personal property that could be converted to cash to repay an overpayment. If the resources are not available to the overpaid individual or a household family member, we will not consider those resources when we make a defeats the purpose determination.

For examples of resources that we consider when making a defeats the purpose determination, refer to GN 02250.255. For examples on how to evaluate and apply resources in a defeats the purpose determination, refer to GN 02250.100H.3, GN 02250.100H.4, and GN 02250.100H.5.

1. Items that we exclude as resources for the purpose of a defeats the purpose determination

 

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    Household furnishings,

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    Clothes,

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    Items of sentimental value,

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    One home (the overpaid individual's principal place of residence),

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    Any other real estate the overpaid individual co-owns and cannot sell (i.e. if the other individuals with shares will not agree to liquidate),

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    Two vehicles,

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    Any additional automobile(s) used for the support of the overpaid individual or a household family member who uses a wheelchair or mobility device,

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    Burial plot or prepaid burial contract,

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    Insurance policies,

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    Achieving a Better Life Experience (ABLE) accounts,

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    Certificate of Deposit if it has not reached its maturity date,

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    Trust fund that the individual cannot liquidate,

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    Any resource or fund that generates income the overpaid individual needs to meet ordinary and necessary living expenses,

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    Individual Retirement Account (IRA), Keogh plan, or other type of retirement plan (exclude as a resource, regardless of whether individual is receiving income from the retirement plan), and

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    Any other resource that cannot be converted to cash without incurring a penalty.

NOTE: Whether the trust fund is a resource depends on whether the assets in the trust are available to the overpaid individual (e.g., if the overpaid individual cannot use the principal until they attain age 25 or the trust fund is comprised solely of the proceeds of Veterans Affairs (VA) funds). Request guidance from the Office of General Counsel (OGC) on whether the trust fund is a liquid resource. Provide OGC with a full explanation of the facts as well as documentation of the trust.

2. Authorization to obtain financial account information

An overpaid individual must provide their authorization for us to obtain financial account information whenever we need the information to make a defeats the purpose determination or a deemed to defeat the purpose determination for the 150 percent of the Federal Poverty Level (FPL) criteria. The authorization is located at the bottom of the SSA-632-BK, "Request for Waiver of Overpayment Recovery" form. If an overpaid individual is legally competent, the overpaid individual must sign the authorization, even if they have a payee. If the overpaid individual is a legally incompetent adult or a minor child, the legal guardian or parent must sign the authorization.

If you need financial information from a spouse, parent, or other household family member, the overpaid individual or payee must provide the financial information. If you need additional financial information for the overpaid individual that you cannot receive through the Access to Financial Institutions (AFI) process, the overpaid individual or payee must provide the information. For a list of acceptable proofs, refer to GN 02250.255B3. AFI instructions are located on the Access to Financial Institutions - Home website.

NOTE: The documents to support the financial information about resources should be no older than 3 months from the date we receive the waiver request. If you already have financial records that you received for a Title XVI recipient, you may use those financial records, if the records are no older than 3 months from the date we receive the waiver request. If the information is more than 3 months from the date we receive the waiver request, contact the individual or payee to request updated information, refer to GN 02250.230B3.

If the overpaid individual does not provide supporting documents with the waiver request, send them a notice requesting this information and inform them that they have 30 days to provide it. For Title XVI, use the SSA-L8009 in the Document Processing System (DPS). For Title II, use the equivalent notice in DPS. If the individual notifies you that they are actively trying to obtain the supporting documents and needs additional time, allow them the additional time. If the individual has not provided the documents within 30 days or they have not notified you that they need additional time, you cannot approve the waiver under the defeats the purpose waiver provision. Refer the waiver request to an independent decision-maker to schedule a file review and personal conference.

3. Sending requests to financial institutions using the e4641 system

Technicians must use the e4641 system to request financial account information if it is needed for a defeats the purpose determination. The e4641 system gives us the ability to access financial account balances and allows the generation of up to twelve GeoRequest searches to financial institutions located in the geographic area where the overpaid individual resides.

If a financial institution does not participate in the electronic AFI process and you need the financial account information for a defeats the purpose determination, you must send the completed and signed SSA-4641, "Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records," form to the nonparticipating financial institution.

Foreign financial institutions do not participate in the electronic AFI process. If you need financial account information from a foreign financial institution to make a defeats the purpose determination, you must send the completed and signed SSA-4641 directly to the financial institution.

NOTE: Do not request the overpaid individual's financial account information if you can approve the waiver under another waiver provision.

4. No financial information received from the financial institution

If the financial institution does not respond to the AFI request within 15 days, review the SSA-632-BK to determine if the overpaid individual's resources were completed and use the information from the form. If the financial information was not completed on the SSA-632-BK, contact the overpaid individual or payee to ask them to provide the information. Document their response on an SSA-795, "Statement of Claimant or Other Person." If the overpaid individual or payee does not provide the financial account information, you cannot approve the waiver under the defeats the purpose provision. Refer the waiver request to an independent decision-maker to schedule a file review and personal conference, per GN 02270.007.

5. No financial authorization provided

If the overpaid individual, parent, or legal guardian failed to complete and sign the financial authorization, contact the overpaid individual, parent, or legal guardian to ask if they will provide authorization for us to obtain the overpaid individual's financial records. If they indicate that they want to provide their authorization, send an SSA-4641 to the overpaid individual, parent, or legal guardian and give them 15 days to return the signed form. If they do not provide their authorization, you cannot approve the waiver under the defeats the purpose provision. Refer the waiver request to an independent decision-maker to schedule a file review and personal conference.

6. Refuses to authorize SSA to obtain financial account information

If the overpaid individual, parent, or legal guardian refuses to provide, or revokes the authorization to obtain financial information, you cannot approve the waiver under the defeats the purpose provision. Refer the waiver request to an independent decision-maker to schedule a file review and personal conference. For an example on when an individual refuses to provide authorization to access financial account information, refer to GN 02250.100H.6.

F. Estate requests a waiver

Although waiver of recovery of an overpayment from an estate is possible under other provisions, recovery from an estate can never defeat the purpose because an estate does not have ordinary and necessary living expenses. If the estate has been closed and the distributee(s) request a waiver, the waiver may be approved under the defeats the purpose provision. For more information on closed estates, refer to GN 02215.070.

G. Processing a defeat the purpose determination

Before completing the following steps, you must first determine that the overpaid individual is not at fault in causing the overpayment:

 

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    Ensure there is an AFI authorization per GN 02250.100E.3.

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    Request the overpaid individual’s financial account information according to the requirements outlined in GN 02250.100E.

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    Review the SSA-632-BK to make sure the information in the form and supporting documentation is no more than 3 months old from the date that we receive the waiver request. If the information is more than 3 months old from the date we receive the waiver request, contact the individual to request updated information, refer to GN 02250.230B.3.

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    After reviewing the monthly household expenses, monthly household income, and resource information, determine if the overpaid individual meets the defeats the purpose requirements outlined in GN 02250.100B.

 

NOTE: Make sure you calculate the overpaid individual’s resources correctly. The overpaid individual may include their resources on SSA-632-BK. Compare the information on the SSA-632-BK and the financial account information that you receive via an AFI request to ensure you are not counting the overpaid individual's resources more than one time.

If you can approve the waiver under the defeats the purpose provision, follow the instructions in GN 02250.301 and GN 02250.370.

1. Title II documentation

If you cannot approve the waiver under the defeats the purpose provision, document why you cannot approve the waiver on the Remarks (RMKS) screen in the Debt Management System (DMS) and input the denial using the DRWD screen in DMS, per MS DMS 006.004. Refer the waiver request to an independent decision-maker to schedule a file review and personal conference.

2. Title XVI documentation

If you cannot approve the waiver under the defeats the purpose provision, document why you cannot approve the waiver on the Report of Contact screen in the SSI Claims System after an independent decision maker conducts a file review and personal conference. Refer the waiver request to an independent decision-maker to schedule a file review and personal conference.

H. Examples

1. Recovery defeats the purpose—Income needed for current ordinary and necessary living expenses and resources below the limit

Jacob, age 10, is overpaid $2,400. Jacob's parent and payee, Sarah, received an overpayment notice on behalf of Jacob. Sarah completed the SSA-632-BK, signed the financial authorization, and sent the form to the local field office.

We determined that Jacob is not at fault in causing the overpayment and does not meet any of the other waiver provisions. Jacob lives with Sarah and two siblings. Sarah does not use any of Jacob's income or resources to help with the food or household expenses. Therefore, we will consider only Jacob’s monthly income, share of household expenses, and resources.

Jacob receives $450 in Title II benefits.

We received Jacob's financial account information through an AFI request. Jacob has $1,000 in a savings account. Jacob is under the resource limit of $6,000.

The family's monthly household expenses total $3,000. Jacob's pro-rata share of expenses is $750 ($3,000 / 4 = $750 for Jacob and 3 household family members).

Jacob's pro-rata share of expenses ($750) exceeds Jacob's income ($450). In addition, Jacob is under the resource limit. Because Jacob's expenses exceed their income and income does not exceed expenses plus the $250 margin, recovery from Jacob defeats the purpose. We will approve their waiver request.

2. Title XVI: Recovery does not defeat the purpose – Title XVI income and resources exclusions do not apply

John was overpaid $4,000 because of excess wages and they are no longer eligible for Title XVI. John is not married and does not have any household family members. After receipt of the overpayment notice, John submits a waiver request to a local field office.

After receipt of the SSA-632-BK, the technician determines John is not at fault in causing the overpayment and that the overpayment does not meet any other waiver provisions. The technician makes an AFI request and discovers John has $7,000 in a bank account. John alleges to have saved the Title XVI underpayment installment received in August.

The technician determines John does not meet the defeats the purpose provision because John's resources are over $6,000. The underpayment in John's account must be considered for the defeat the purpose provision even though the retroactive funds are excluded for nine calendar months for Title XVI eligibility purposes. We are unable to approve John’s waiver request because John does not meet the defeats the purpose waiver provision. An independent decision-maker will schedule a file review and personal conference.

3. Income exceeds the $250 margin

Kayla, age 12, is overpaid $4,600. Kayla's parent and payee, Karen, received an overpayment notice on behalf of Kayla. Karen completed the SSA-632-BK, signed the financial authorization, and sent the form to the local field office.

We determined Kayla is not at fault in causing the overpayment and does not meet any of the other waiver provisions. Karen told us that Kayla's income helps with food and household expenses. Kayla lives with Karen and three siblings. We need the monthly income, monthly household expenses, and resources for all household family members since Kayla's income helps with the household expenses.

Kayla receives Title II benefits in the amount of $500. Karen's net monthly income from their employer is $3,000 and they also receive $1,500 in child support every month for Kayla's three siblings. The family's total monthly household income is $5,000 ($500 + $3,000 + $1,500 = $5,000).

The total monthly household expenses are $4,000. When you subtract the monthly household expenses from the monthly household income, the balance is $1,000 ($5,000 - $4,000 = $1,000), which is more than the $250 margin.

We received Kayla's financial account information via an AFI request. Kayla has $2,000 in a savings account. Karen has $2,600 in a checking account and owns a 2020 Ford Edge, which is the only automobile in the household. Therefore, we are excluding the automobile as a resource. Each sibling has $200 in a savings account. The family does not have any more resources.

After adding Kayla’s savings account, Karen’s checking account, and the three siblings’ savings account, the total family resource amount is $5,200 ($2,000 + $2,600 + $600 = $5,200). The family's resource limit is $13,600 which is $10,000 for Kayla and Karen (individual and one family member), and $1,200 for each of the three siblings ($10,000 + ($1,200 x 3) = $13,600).

After evaluating Kayla’s and the household family members’ resources, we determined that the resources are under the resource limit. However, the total monthly household income exceeds the $250 margin (after subtracting expenses from income). We are unable to approve Kayla's waiver because they do not meet the defeats the purpose waiver provision. An independent decision-maker will schedule a file review and personal conference.

4. Resources exceed the limit

Tom received an overpayment notice and was overpaid $3,500. Tom lives with their spouse, Alice. Tom completed the SSA-632-BK, signed the financial authorization, and sent the form to the local field office. We determined Tom is not at fault in causing the overpayment and does not meet any of the other waiver provisions.

Tom provided the couple’s monthly income, monthly household expenses, and household resource information. Tom receives $2,500 in Title II benefits and a monthly pension of $1,000. Alice receives $1,000 in net income. Together they receive $4,500 per month in income. Tom and Alice's monthly household expenses are $4,450. When subtracting the monthly household expenses from the monthly household income, the balance is $50 ($4,500 - $4,450 = $50), which is less than the $250 margin.

We received Tom's financial account information via an AFI request. Tom has $15,000 in a savings account and $1,000 in a checking account. Tom owns a 2018 Chevy Equinox, and Alice owns a 2020 Ford Edge, which are the only two automobiles in the household. Therefore, the automobiles are excluded as a resource. Alice has a $10,000 Certificate of Deposit. They do not have any more resources. After adding Tom’s savings account, checking account, and Alice’s CD, the total resource amount is $26,000 ($15,000 + $1,000 + $10,000 = $26,000). Tom's resources exceeds the resource limit which is $10,000 (individual and one family member).

Although Tom's and Alice's income do not exceed the $250 margin, they exceed the resource limit. We are unable to approve Tom's waiver because they do not meet the defeats the purpose waiver provision. An independent decision-maker will schedule a file review and personal conference.

5. Resources exceed the limit

Jerry received an overpayment notice and was overpaid $5,250. Jerry completed the SSA-632-BK, signed the financial authorization, and sent the form to the local field office. Jerry lives alone in a home that they own. We determined Jerry is not at fault in causing the overpayment and does not meet any of the other waiver provisions.

Jerry receives $2,000 in Title II benefits and $1,500 from a pension. Jerry’s total monthly income is $3,500 and their monthly household expenses are $3,450. After subtracting the monthly household expenses from the monthly household income, the balance is $50 ($3,500 - $3,450 = $50), which is less than the $250 margin.

We received Jerry's financial account information via an AFI request. Jerry has $16,000 in a savings account. Jerry owns a home (their principal residence), a car, and a camper. We excluded Jerry's home and two vehicles (car and camper) as resources. Jerry's resources total $16,000 (savings account). Jerry’s resources exceeds the limit which is $6,000 (individual).

Although Jerry’s income does not exceed the $250 margin, Jerry exceeds the resource limit. We are unable to approve Jerry's waiver because they do not meet the defeats the purpose waiver provision. An independent decision-maker will schedule a file review and personal conference.

6. Refused to provide authorization to access financial account information

Rachel received an overpayment notice and was overpaid $2,500. Rachel completed the SSA-632-BK and sent the form to the local field office. Rachel refused to provide authorization for us to obtain financial account information.

We determined that Rachel is not at fault in causing the overpayment and does not meet any of the other waiver provisions.

We cannot approve Rachel's waiver under the defeats the purpose waiver provision because they refused to give us permission to access financial account information. An independent decision-maker will schedule a file review and personal conference.


GN 02250 TN 65 - Waiver Provisions for Title II and Title XVIII Overpayments - 11/25/2024