TN 40 (04-22)

GN 02215.200 Preparation of the Bankruptcy Proof of Claim

A. List of Documents

The following documents are required for filing a Proof of Claim:

  • Notice of bankruptcy (from the bankruptcy court),

  • Proof of Claim (Official Form 410), and

  • Certificate of Indebtedness.

    Prepare the documents electronically, with electronic signatures where applicable. Email the documents to the appropriate Regional Chief Counsel based on the chart in GN 02215.200E below.

B. Official Form 410

Prepare the Official Form 410 electronically, using this link to obtain the form: http://www.uscourts.gov/sites/default/files/form_b_410_16.pdf. This form is authorized by the Court and used to file a Proof of Claim. In Part 1, the form has separate entries for where to send notices and where to send payment. In Part 3, check the second box that says, "I am the creditor's attorney or authorized agent."

C. Certificate of Indebtedness (SSAL-400)

Prepare the Certificate of Indebtedness document electronically, located in inForm, with the appropriate executive's signature or their designee. Include the following information on this document.

1. Case Number

Enter the bankruptcy case number in this field. For example, 59-27467-csi. You will find the case number in section of the bankruptcy petition titled, "Information to identify the case."

2. Claim number/Collection ID and BIC

Enter the last 4 digits of the individual's claim Social Security Number (SSN) and their beneficiary identification code (BIC). The Collection ID is for future use.

3. Debtor Name/Address

Enter the individual's full name and address.

4. Beneficiary Notice Control Number

Enter the individual's Beneficiary Notice Control Number (BNC) if applicable. The BNC is an encrypted 13 character alphanumeric code that we use to replace the SSN when applicable. Since this form is internal, including the BNC may not be necessary.

5. Total debt due

Enter the date, MM/DD/YYYY format, that you are completing this form where it says, "Total debt due to the United States as of." Enter the total debt amount owed in $999,999.99 format. If the individual has multiple outstanding debts, add each outstanding balance together and enter the total. For example, Jessie Lane has an outstanding debt balance of $5,250 for Debt 1, an outstanding debt balance of $700 for Debt 2, and an outstanding debt balance of $14,744 for Debt 3. Therefore, their total debt amount owed is $20,694 and this is the amount that you will enter in this field.

6. Overpayment/debt information

Enter the pertinent information regarding the overpayment/debt, in general terms, where it says, "The claim arose in connection with an overpayment of Social Security benefits." If the individual has multiple outstanding debts, enter the information regarding each debt, being brief, and stating the facts.

  • Include the appropriate section of the Act that applies for the overpayment, such as Section 204 of the Social Security Act;

  • Describe the payments made to a representative payee, if conserved benefits are involved, such as the amount(s) and the date(s) of the payments and the regulatory authority from which the claim arose, 20 CFR 404.2045;

  • Include information relating to a failure to report or any other material fact;

  • Include any administrative decisions, such as waiver denial or affirmation of the overpayment upon reconsideration and do not include SSA's attempts to collect the debt; and

  • Explain any adjustments or refunds which reduced the original overpayment amount(s).

7. Electronic Signature

Forward the completed form electronically to the appropriate executive or their designee for electronic signature. The PDF form allows for the signature based on the individual's PIV card.

D. Assembly and Disposition of Documents

Assemble the below documents, in electronic format, and send them (as an attachment) via email to the applicable OGC Regional Office for review. Each document should be in its own separate PDF file:

  • Notice of Bankruptcy,

  • Proof of Claim (i.e. Official Form 410), and

  • Certificate of Indebtedness.

CAUTION: Do not send a copy of the electronic claims folder, unless specifically requested by the Chief Counsel.

E. Regional Office of General Counsel Email Addresses

Below is the list of email addresses for the respective Region's Office of General Counsel. Use these email addresses to send the Proof of Claim request.

Regional OGC Email Addresses

Region

Email Address

Boston

OGC.R1.Bankruptcy@ssa.gov

New York

OGC.R2.Bankruptcy@ssa.gov

Philadelphia

OGC.R3.Bankruptcy@ssa.gov

Atlanta

OGC.R4.Bankruptcy@ssa.gov

Chicago

OGC.R5.Bankruptcy@ssa.gov

Dallas

OGC.R6.Bankruptcy@ssa.gov

Kansas City

OGC.R7.Bankruptcy@ssa.gov

Denver

OGC.R8.Bankruptcy@ssa.gov

San Francisco

OGC.R9.Bankruptcy@ssa.gov

Seattle

OGC.R10.Bankruptcy@ssa.gov

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202215200
GN 02215.200 - Preparation of the Bankruptcy Proof of Claim - 04/19/2022
Batch run: 06/02/2022
Rev:04/19/2022