PROGRAM OPERATIONS MANUAL SYSTEMPart SI – Supplemental Security IncomeChapter 021 – Title XVI (SSI) UnderpaymentsSubchapter 01 – Title XVI (SSI) UnderpaymentsTransmittal No. 36, 12/03/2024
Audience
Originating Component
OISP
Effective Date
Upon Receipt
Background
When the Supplemental Security Income (SSI) System calculates a large underpayment due an individual, we must conduct a prepayment review for any SSI initial claim or post eligibility case involving an underpayment of $15,000 or more. An adjudicator must review the underpayment to ensure that we develop all factors of eligibility. There is a high risk of error in these cases because of the large payment amount. A reviewer may issue large underpayments or installment payments after conducting the prepayment review. This transmittal provides instructions for the underpayment prepayment review.
Summary of Changes
SI 02101.025 Basic Requirements of Supplemental Security Income Underpayment Review
We changed the title of the section from "Basic Requirements of Supplemental Security Income (SSI) Underpayment (UP) Review" to "Basic Requirements of Supplemental Security Income Underpayment Review."
Subsection E.1 we added a link to the SSI Underpayment Case Control Log application.
Subsection E.3 we updated adjudicator responsibilities in the step action chart.
Subsection E.4 we updated reviewer responsibilities in the step action chart.
Subsection E.5 we provided instructions for technicians to add remarks to the Report of Contact.
We removed the abbreviation for underpayment (UP)
Adjudicators must review large Supplemental Security Income (SSI) underpayments to ensure that we develop all factors of eligibility. There is a high risk of error in these cases because of the large payments.
A prepayment review is a review of the non-disability eligibility factors before authorizing payment.
Low-risk cases (LRC) are those SSI initial claims (ICs) with characteristics that are not error-prone.
Underpayment at risk is the SSI underpayment amount, minus the potential Title II offset for the underpayment period, per SI 02006.100C.1.
NOTE: Exclude a case from underpayment review if the amount "at risk" is less than the review threshold of $15,000. Refer to SI 02101.025C.1 in this section.
An adjudicator is a Claims Specialist (CS) or above, who performs the prepayment review. The adjudicator can be the individual who made the original determination.
A reviewer is a CS or above, and is someone other than the adjudicator. The reviewer examines the file after the adjudicator completes the prepayment review, but before the release of the underpayment. The reviewer completes the Underpayment Process (UOUP) screen and releases the underpayment.
Conduct a prepayment review for any SSI case (IC or post eligibility (PE)) when an individual is due an underpayment of $15,000 or more through the month prior to the current computation month (CCM). For a definition of the CCM, refer to SM 02101.001.
Do not conduct a prepayment review if the case:
Involves Title II offset and the SSI underpayment “at risk” is less than $15,000 per SI 02006.100; or
Is a low-risk criteria (LRC) case as described in SI 02101.025C.2.
A case meeting LRC criteria has all of the listed characteristics for all months of the underpayment period:
An initial claim;
An individual record (TMR = DI, BI, etc.) with a payment status code of C01 or E01;
An automated computation;
The only chargeable income includes these types on the UMIH field of the Supplemental Security Record (SSR):
Type A, G, or W (Title II benefits);
b. Type I (deeming allocations);
c. Type J (systems posted VTR);
d. Type RL (rental or lease);
e. Type RH (royalties or honoraria);
f. Type RI (interest or dividends) totaling $5 or less per month; and
Living arrangement is either:
B continuously,
b. A, continuously, with the same UMIH income types as living arrangement B, and General Assistance Grant Reimbursement (GA/GR) involvement and no State supplement category, or
c. Congregate care, as defined in SI 01401.001C.3.
An adjudicator and a reviewer perform the prepayment review.
The rules of administrative finality apply to underpayment cases; however, failure to release an underpayment is not an initial determination and is not subject to administrative finality. For administrative finality rules, refer to SI 04070.010 and SI 04070.070.
When the system computes an underpayment of $15,000 - $49,999.99, it holds the underpayment and sets a U2 diary until the reviewer releases the underpayment.
After the prepayment review, the reviewer accesses the Direct SSR Update to provide authorization for release of the underpayment through the UOUP screen. To view the UOUP screen, refer to MS 00304.018. The reviewer releases the underpayment to the individual or representative payee (payee) unless one of the listed criteria are met:
Interim Assistance Reimbursement (IAR) applies, per SM 01311.662;
Direct fee payment to an authorized representative, per SM 01311.664;
Installment only payments (the system will automatically release the payments), per SM 01311.668; or
Dedicated account case (the system will set all appropriate diaries, issue an alert and release an automated notice to the payee), refer to SI 01130.601 and SM 01300.667.
NOTE: For underpayments of $50,000 or more, refer to SI 02101.055.
The system releases an underpayment of $15,000 or more (except in dedicated account cases) after:
Completion of the UOUP screen. For UOUP screen information, refer to MS 00304.018 and SM 01311.661 (PE);
Force due(s). For instructions on when to use force due procedures, refer to SM 01701.001; or
One-Time Payment(s) (OTPs). For instructions on the OTP process, refer to SM 01901.001 and MS 00303.025.
For cases involving IA, refer to the instructions listed:
SI 02003.020 Field Office Processing of IAR Authorization
SI 02003.022 Processing eIAR Field Office Intervention Cases
SI 02003.023 Processing eIAR Exception Cases
SI 02003.025 IAR Payment Processing for Exception Cases and Proration Cases
SM 01005.623 Grant Reimbursement (GR) Field
SM 01005.627 Exception Processing (GR)
SM 01311.662 Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment
For cases involving dedicated accounts or installment payments, refer to the instructions listed here:
SI 02101.010 Past-Due Benefits Payable – Individual Alive Under Age 18 with Representative Payee – Dedicated Account Required
SI 02101.020 Large Past-Due Supplemental Security Income Payments by Installments – Individual Alive
SM 01301.450 Special Action Code (SZ)
SM 01311.661 How to Resolve a U2 Diary to Release Underpayments of $15,000.00 or More
The system generates the listed diaries and alerts associated with underpayment reviews:
Diary
Condition
U1
Underpayment is greater than $14,999.99 and less than $50,000; option ‘RELEASE UNDERPAYMENT/LOW RISK' selected from the Underpayment Processing (UOUP) screen; and the Low Risk Profile (LRP) criteria were not met.
U2
Underpayment is greater than $14,999.99 and less than $50,000.
U3
Underpayment exceeds $49,999.99 after we have issued the second installment payment.
U4
NOT AUTOMATED DEATH
Indicates the record contains a verification code of ‘U' in the UPV field of the MPMT segment (UPV:U).
AUTOMATED DEATH
Posted when a record's composition changes from eligible couple to eligible individual due to the death of one member of the couple.
After the reviewer selects the appropriate code from the UOUP screen, the system may set additional diaries and generate additional alerts for installment and or dedicated account cases as shown in the chart:
EA
Dedicated account - awaiting account establishment and payment.
IN
Dedicated account - Installment – automated one-time payment (A-OTP) required.
I9
IAR FO Intervention
Within 25 workdays from the FO transmission of the UOUP transmission and the IA agency eIAR transmission, eIAR requests FO intervention (assistance).
eIAR detects possible missing or erroneous SSR computations. eIAR is awaiting the FO review and corrections, if applicable, to the IAR Automated One-Time Payment (A-OTP) One-Time Payment Amount (UPOP) utility screen.
Alert
E1
Dedicated account - EA diary pending - awaiting account establishment and payment.
I6
Dedicated account - Installment - IN diary pending A-OTP required for installment payment.
For instructions on resolution of these diaries and alerts, refer to the instructions listed:
MS 00303.024 One Time Payment Amount (UPOP)
SM 01005.470 SZ Edits and Alerts
SM 01301.470 SZ Reject and Alert Conditions – Procedure
SM 01311.660 Overview of SSI Underpayment Processing
SM 01311.668 Processing Payments in Installments from an SSI Underpayment
SM 01311.669 How to Resolve a U1 Diary
SM 01311.670 How to Resolve a U3 Diary
SM 01311.675 How to Resolve a U4 Diary
Take these steps to process underpayment alerts.
Management is responsible for overseeing prepayment reviews added to the Underpayment Case Control Log until payment reflects on the SSR.
Make employees aware of their responsibilities in the process.
Conduct a prepayment review if the underpayment is $15,000 or more, unless:
Title II offset reduces the underpayment at risk to less than $15,000. (For instructions on documenting no money at risk, refer to SI 02006.100F.2.); or
The LRC criteria outlined in SI 02101.025C are met.
Follow these steps to prepare the underpayment for release.
STEP
ACTION
1
Determine if all benefits due on the record can be paid without delaying the recurring check.
If YES, go to step 2.
If NO, release the recurring payment. Go to step 2.
2
Determine whether the case meets the LRC criteria:
If YES, go to step 4.
If NO, go to step 3.
3
Conduct the prepayment review. Query the Office of Child Support Enforcement (OCSE) online databases to determine if there are any undisclosed wages, unemployment compensation, or "new hire" information according to MS 05203.015 through MS 05203.018.
The query should include the individual and deemors. Follow the procedures in SI 00810.550. Go to step 4.
NOTE: If the FO receives an S2 alert for wages or U5 alert for unemployment compensation because of a central office database match, NEGATIVE VERIFICATION IS NOT REQUIRED.
4
Determine whether there is an IAR.
If YES, go to step 5.
If NO, go to step 7.
5
Determine whether a GR code is in the GRC field of the MPMT segment of the SSR.
If YES, go to step 7.
If NO, go to step 6.
6
Enter appropriate GR code and go to step 7. For grant reimbursement information, refer to SM 01005.623.
7
Determine whether we must release the underpayment using the A-OTP process per SM 01311.667, and SI 02003.023 and SI 02003.025 for IAR cases.
If YES, and this:
IS NOT a dedicated account case, after the reviewer enters the appropriate code on the UOUP screen to release the underpayment, follow instructions in SM 01901.015 and MS 00303.022 through MS 00303.025;
IS a dedicated account case, after the reviewer enters the appropriate code on the UOUP screen to release the underpayment, follow instructions in SI 02101.010, SM 01311.660 and SM 01901.015 and MS 00303.022 through MS 00303.025; or
IS an installment case with an exception, after reviewer has entered the appropriate code on the UOUP screen to release the underpayment, follow SI 02101.020 and SM 01901.015 and MS 00303.022 through MS 00303.025.
If NO, go to step 8.
8
Determine whether the case involves an attorney.
If YES, complete the UATH screen and RASR. Go to step 9.
If NO, go to step 9.
9
Determine whether the system automatically generates a notice. If not, prepare a manual notice. Go to step 10.
10
Document the review using the mandatory Underpayment Case Control Log. The adjudicator will answer the questions in the Underpayment Case Control Log|Create Underpayment for Review screen. Copy language for Report of Contact button.
MSSICS cases:
Create a Report of Contact page, and paste the text.
Lock the Report of Contact page to protect the contents.
Non-MSSICS cases:
Create an SSA-5002, Report of Contact and paste the text.
Store the SSA-5002 in the Evidence Portal (EP) or Certified Electronic Folder (CEF).
11
Follow these steps for reviewer's responsibilities.
Review the determination of the underpayment amount. Go to step 2.
Review the manual notice. Go to step 3.
Correct any deficiencies. Go to step 4.
Document the review using the Underpayment Case Control Log. The reviewer will answer questions in the Underpayment Case Control Log|Case Review screen. Copy language for Report of Contact button. Submit Completed Review button.
Create a Report of Contact page, paste the text.
Lock the Report of Contact to protect the contents.
Store the SSA-5002 in the EP.
Go to step 5.
Complete the UOUP screen to release the underpayment by entering the appropriate code on the UOUP screen. For UOUP data, refer to MS 00304.018.
Go to Step 6 if IAR is involved and the MPMT UPV of “V” is set.
Go to Step 7 if no IAR is involved.
After 25 workdays from the date the UOUP screen was transmitted (underpayment is $15,000.00 or more) and eIAR has not released the IAR payment, then:
Determine if there is an I9 diary and process accordingly;
If UPV of “V” is set and no I9 diary, do not delete the GRC; contact the RO.
The system releases the underpayment.
For the SSI underpayment workload, follow these instructions:
Paste into the Report of Contact screen, or the SSA-5002:
To paste into the Report of Contact screen, navigate to the Report of Contact screen. Select CTRL+V. The text will appear on the screen.
To paste into the SSA-5002, open the SSA-5002 form. Select CTRL+V and the text will appear on the form.