Effective Dates: 12/13/2023 - Present Previous | Next

TN 117 (12-23)

SI 00835.520 Redetermination Guidelines for LA and ISM

A. Introduction of redeveloping LA and ISM during redeterminations

This section provides instructions for redeveloping living arrangements (LA) and in-kind support and maintenance (ISM) during redeterminations.

This section supplements the development instructions in the following sections:

POMS Section

Reason

SI 00835.100 - SI 00835.200

LA Basis Instructions

SI 00835.340

Inside ISM instructions

SI 00835.350

Outside ISM instructions

SI 00835.400

ISM only to the Claimant instructions

SI 00835.482,

Loans of ISM instructions

SI 00835.510

Changes in ISM instructions

SI 02305.001

Redetermination instructions

B. Policy for redeveloping LA and ISM in redeterminations

1. General rule

Do not redevelop LA and ISM determinations on record for the period of review unless:

  • •

    an undeveloped change is indicated at the redetermination; or

  • •

    allegations pertinent to the period of review do not support the information on the Supplemental Security Record (SSR) or on the SSI Claims System living arrangement path.

2. Exceptions to the general rule

Redevelop the following issues as of the month the current redetermination is initiated. Redevelop these issues whether a redetermination is processed using a paper form or the SSI Claims System:

  • •

    Outside ISM and ISM only to the claimant;

  • •

    Inside ISM;

  • •

    Sharing or earmarked sharing; and

  • •

    Value of One-Third Reduction (VTR).

3. Chart summary on when to redevelop LA and ISM

The following chart summarizes when redevelopment of ISM is required for redeterminations processed on paper forms and in the SSI Claims System when seeding is not required. For the redevelopment procedures see sections SI 00835.520C. and SI 00835.520D.

NOTE: If a redetermination within the SSI Claims System requires seeding for redevelopment requirements, see SI 00835.520E.

LA/ISM SITUATION ON

SSR or SSI Claims System

IF RECIPIENT

REPORTS....

REDEVELOPMENT

PERIOD IS....

1. ISM based on a vendor

charge

information that conflicts with SSR/SSI Claims System

redevelop for any months where information conflicts

2. "

they do not know the value of the ISM

redevelop for entire period of review

3. "

information that agrees with SSR/SSI Claims System

do not redevelop the ISM

4. ISM based on estimate of Current Market Value (CMV)/Current Market Rental Value (CMRV)

no changes

redevelop starting with the initiation month of the redetermination

5. "

a breakpoint

redevelop starting with the breakpoint effective month

6. ISM due to rental subsidy

 

no changes

redevelop starting with the initiation month of the redetermination

7. "

a breakpoint

redevelop starting with the breakpoint effective month

8. Inside ISM, Sharing, Earmarked Sharing, and the VTR

no breakpoints

redevelop starting with the initiation month of the redetermination

9. "

a breakpoint

redevelop starting with the breakpoint effective month

10. Continuing Loan of

ISM

contributing towards household expenses; or

not contributing towards household expenses

develop living arrangement and ISM beginning the month after the loan period ended.

For information on developing loans of ISM see SI 00835.482C.

11. “

loan of ISM has not ended

develop whether a new bona fide loan exists beginning with the month after the previous loan ended (i.e., the month that SSI benefits started) If a bona fide loan does not exist, redevelop living arrangements beginning with first month of the redetermination review period.

For information on developing whether a loan is bona fide see SI 00835.482C.

C. Procedure for completing non-MSSICS redeterminations

1. Outside ISM and ISM only to the claimant

These types of ISM are generally discovered from direct allegation by the claimant. A claimant is usually able to report that outside ISM or ISM only to the claimant continued, began, or stopped over the period of review. Compare the claimant's allegations on the redetermination forms with the SSR.

a. ISM based on a vendor charge

If ISM is based on a vendor charge, compare the claimant's allegations on the redetermination forms with the SSR:

  • •

    Do not redevelop the ISM if the claimant's allegation of the vendor charge matches the SSR;

  • •

    Redevelop the ISM for any months the allegation of the vendor charge conflicts with the SSR (For information about computing outside ISM, see SI 00835.350. For information about ISM from vendor payments, see SI 00835.360);

  • •

    Redevelop the ISM for the period of review if the claimant does not know the value of the ISM received and an actual value of ISM is on the SSR; and

  • •

    Offer rebuttal if the claimant does not know the value of the ISM and the PMV is shown on the SSR. For information about rebuttal, see SI 00835.320.

b. ISM based on a CMV or CMRV estimate

When ISM is based on CMV or CMRV estimate:

  • •

    Redevelop the CMV or CMRV beginning with the month the redetermination is initiated and follow the instructions in SI 00835.350C.

    EXAMPLE 1: The Claims Specialist (CS) contacts the provider of rent-free shelter to redevelop the CMRV of the recipient's residence. The landlord indicates that the CMRV has gradually increased in value from $150 to $250 during the period of review. The CS uses the new CMRV as of the initiation month.

  • •

    Redevelop the CMV or CMRV as of the breakpoint effective month if a breakpoint occurred during the period of review which changed the CMV or CMRV. For breakpoints see SI 00835.510; and

    EXAMPLE 2: The rent-free apartment occupied by a recipient is damaged by fire and the landlord has not repaired the damage. The abrupt change in the CMRV of this apartment is a breakpoint that is effective with the month of the fire (i.e., when the CMRV sharply declined). This change in the CMRV is a breakpoint belonging to the category “change in CMV of the household cost”. For information on outside ISM breakpoints see SI 00835.510B.2.).

    EXAMPLE 3: A provider stops supplying meals to the recipient in a particular month. The change from separate consumption (a breakpoint) is effective the month it occurs.

  • •

    Do not redevelop the CMV or CMRV as of the initiation month if a new CMV or CMRV is obtained in connection with developing a breakpoint.

c. ISM due to a rental subsidy

When ISM is due to a rental subsidy:

  • •

    Redevelop rental subsidy for the month the redetermination is initiated if someone in the household is related to the landlord or landlord's spouse as a parent or child;

  • •

    Obtain a new CMRV from the landlord effective with the month that the redetermination is initiated (For information on developing rental prepayments, see SI 00835.380D);

  • •

    Redevelop rental subsidy as of the breakpoint effective month if a breakpoint is alleged which may affect rental subsidy during the review period. For example, someone who is related to the landlord moved in, or a new landlord took over, or the household changed its payment to the landlord, or there is a residence change; and

  • •

    Do not redevelop the CMRV estimate as of the redetermination initiation month if a CMRV estimate is obtained in connection with developing a breakpoint.

2. Inside ISM, sharing, earmarked sharing, and the VTR

a. No breakpoints reported

When no breakpoints are reported:

  • •

    Assume that the living arrangements and inside ISM shown for the period of review are correct if the claimant reports no breakpoints; and

  • •

    Redevelop the LA and ISM as of the month the redetermination is initiated to uncover any changes in LA and ISM which may be due to gradual changes in average expenses or contributions since the last redetermination. For information on gradual changes in ISM see SI 00835.515.

NOTE: Follow the developmental requirements and curtailments in SI 00835.140 - SI 00835.170. When an SSA-8006 (Statement of Living Arrangements, In-Kind Support and Maintenance) is required see SI 00835.520C.3.

b. Breakpoint reported

When a breakpoint is reported:

  • •

    Develop a breakpoint reported at the redetermination if it was not developed previously (For information on breakpoints see SI 00835.510);

  • •

    Do not redevelop a breakpoint that occurred during the period of review if it was already developed. Assume that the determination made for a previously reported breakpoint was correct and redevelop LA and ISM as of the initiation month per SI 00835.520C.2.a.

    NOTE: For non-MSSICS LA and ISM changes, it is sometimes difficult to determine whether a breakpoint was previously reported and developed. This is especially true if a previously reported breakpoint resulted in no change to LA or ISM. The CS must rely on the SSR as well as any prior files or development maintained at the field office. If, after reviewing these records, there is any doubt about the event having been developed, develop the breakpoint.

  • •

    Do not redevelop the LA and ISM as of the month the redetermination is initiated when a breakpoint is developed at the redetermination.

3. Loan of ISM

If a continuing loan of ISM is indicated by the last living arrangement iteration in the SSI Claims System or by the remarks on the SSR, fully develop the living arrangement, household operating expenses, and the claimant's contributions starting the first month of the redetermination review period to determine the claimant's living arrangement and ISM.

4. When to use an SSA-8006 (Statement of Living Arrangements, In-kind Support and Maintenance)

a. SSA-8203 is completed

Complete an SSA-8006 when an SSA-8203 (Statement for Determining Continuing Eligibility for Supplemental Security Income Payments) is completed and the household is not a public assistance household, and one of the following exists:

  • •

    the claimant lives with someone other than a spouse, child (as defined in SI 00501.010), or a person whose income is deemable to the claimant;

  • •

    the claimant is an eligible child who lives with someone other than a parent (and children if present);

  • •

    the claimant is the householder and alleges that someone is contributing to household expenses; or

  • •

    the claimant lives only with children who have income, and there is an indication of unstated income. For information for computing inside ISM see SI 00835.340B.

b. SSA-8202 is completed

Complete an SSA-8006 when an SSA-8202 (Statement for Determining Continuing Eligibility for Supplemental Security Income Payments) is completed for a Data Operations Center (DOC) exclusion redetermination (RZ) because ISM less than the PMV is posted on the SSR.

NOTE: An SSA-8006 is not required when the redetermination is completed in the SSI Claims System because any LA and ISM information provided by the claimant can be documented directly within the SSI Claim. However, when needed, an SSA-8011 (Statement of Household Expenses and Contributions) or an SSA-L5061 (Letter to Landlord Requesting Rental Information) is still used in the SSI Claims System to process redeterminations in order to document issues such as sharing and rental subsidy.

D. Procedure for SSI Claim redeterminations when a pending file exists and seeding not required

For an SSI Claim, redeterminations and redevelopment of LA and ISM are required for the same issues as for redeterminations processed on paper forms. Regardless of the redetermination profile (e.g., HEP, MEP, LEP), all SSI Claim redeterminations are processed in one of two ways, full path redetermination or redetermination via the Living Arrangement Recap pages. The choice of whether to use the full path or the Living Arrangement Recap path is not based on the presence of any specific LA and ISM issue.

The following procedures apply to redeterminations for cases that already have an active SSI Claim pending file (i.e., seeding is not required). If seeding is required to process the redetermination, see SI 00835.520E (in this section).

1. Procedures for developing LA and ISM redeterminations

Follow these procedures when developing LA and ISM in redeterminations:

  • •

    Assume, absent information to the contrary, that all prior living arrangement periods are correct. Therefore, the current living arrangement on the SSI Claim is usually the beginning point of the review;

  • •

    Review thoroughly all of the current LA and ISM information on the full path pages or Living Arrangement Recap page with the recipient to determine whether the information is still correct and to detect breakpoints, if any;

  • •

    Develop a breakpoint by entering the date of the breakpoint on the Living Arrangement Change page to establish a new living arrangement period (LA iteration). Document the breakpoint and its effect on LA and ISM by completing the new living arrangement iteration provided by the SSI Claims System;

  • •

    Curtail development of LA and ISM if no breakpoint occurred and all the LA and ISM information on the full path or the Living Arrangement Recap pages are correct, unless one of the ISM issues requiring redevelopment is present; and

  • •

    Follow instructions in SI 00835.520D.2. and SI 00835.520D.3. (in this section) when an ISM issue requiring redevelopment is present.

2. Outside ISM and ISM only to the claimant

a. ISM based on a vendor charge

When ISM is based on a vendor charge:

  • •

    If the claimant's allegation of the vendor charge matches the information on the SSI Claim or the SSR for non-MSSICS cases do not redevelop the ISM;

  • •

    If the claimant's allegation conflicts with the SSI Claim or the SSR for non-MSSICS cases, redevelop the ISM. Use the Living Arrangement Change page in the SSI Claim to establish a new LA iteration starting with the month that the allegation and the information on the pages conflict; and

  • •

    If the claimant does not know the value of the ISM received, redevelop the ISM. Use the Living Arrangement Change page in the SSI Claim to establish a new LA iteration beginning from the first month where the value of the ISM is in question.

b. ISM based on a CMV or CMRV estimate

When the claimant gets ISM based on a CMV or CMRV estimate:

  • •

    Redevelop the ISM. Establish a new LA iteration as of the first day of the initiation month of the redetermination.

    NOTE: To establish a new LA iteration date as of the first day of the initiation month, input the last day of the prior month as the date of change on the Living Arrangement Change page.

  • •

    Redevelop the ISM if a breakpoint occurred during the period of review which changed the CMV or CMRV estimate. Establish a new LA iteration as of the date of the breakpoint.

  • •

    Do not redevelop the CMV or CMRV as of the initiation month if a new CMV or CMRV is obtained in conjunction with developing a breakpoint.

c. ISM due to a rental subsidy

When ISM is due to a rental subsidy:

  • •

    Redevelop rental subsidy if someone in the household is related to the landlord or the landlord's spouse as parent or child;

  • •

    Obtain a new estimate of the CMRV as of the redetermination initiation month;

  • •

    Establish a new LA iteration as of the first day of the month the redetermination review period begins. This is required even if the new estimate of the CMRV has not changed;

  • •

    Develop the breakpoint if a previously unreported breakpoint is uncovered which affects rental subsidy. Establish a new LA iteration in the SSI Claim as of the date of the breakpoint; and

  • •

    Do not redevelop the CMRV as of the initiation month if a new CMRV estimate is obtained in conjunction with developing a breakpoint.

3. Inside ISM, sharing, earmarked sharing, and the VTR

Follow these procedures when developing inside ISM, sharing, earmarked sharing, and the VTR in redeterminations:

  • •

    If the claimant reports no breakpoints, assume that the living arrangements and ISM for the period of review are correct.

  • •

    If any reported breakpoint was not developed previously, develop it at the redetermination. Establish a new LA iteration as of the date of the breakpoint.

  • •

    If no breakpoints are uncovered, establish a new LA iteration as of the first day of the initiation month of the redetermination to redevelop these LA and ISM issues and to uncover any gradual changes in expenses and contributions that may affect the LA and ISM determination.

  • •

    Do not redevelop the LA and ISM as of the initiation date when a breakpoint is developed as part of the redetermination.

4. Loan of ISM

If a continuing loan of ISM is indicated by the last LA iteration on the SSI Claim or by the remarks on the SSR, fully develop the LA, household operating expenses, and the claimant's contributions starting the first month of the redetermination review period to determine the claimant's LA and ISM.

E. Procedure for SSI Claim Redeterminations when seeding is required

Use the following procedures to redevelop ISM for redeterminations in an SSI Claim that require seeding:

1. Seed living arrangements

When seeding is required:

  • •

    Retrieve living arrangement information from the Seed Living Arrangement page, see MS 08110.005. View the Representative Payee information within the SSI Claims System on the Mailing/Payment Address Comparison (CPAD) screen, see MS 04427.006.

  • •

    Assume, absent evidence to the contrary, that LA data on the SSR is correct.

  • •

    Select “full LA development” on the Seed Living Arrangement page starting with the LA in effect as of the redetermination initiation month. The SSI Claims System establishes LA iteration as of the first day of that month.

  • •

    Develop prior LA periods only if the adjudicator determines that full development of prior LA period(s) is needed (e.g., there is an indication of previously unreported breakpoints or a continuing loan of ISM).

NOTE: If a change earlier than the selected period is discovered during the interview, the CS must select an earlier LA period for full development using the Period List and Living Arrangement Summary page. The Period List page allows selection of an earlier period and full LA development is requested on the appropriate Living Arrangement Summary page. To view the Period List page in MSOM see MS 08110.006 and to view the Living Arrangement Summary page in MSOM see MS 08110.002.

2. Completing the SSI Claim living arrangement pages

When completing the living arrangement pages within the SSI Claim:

  • •

    Begin with the earliest living arrangement period selected for full development and completely develop that living arrangement period (and subsequent periods if any) up through the current month;

  • •

    Contact the recipient (or payee) to obtain information so that all of the data on the pages can be completed and updated through the current month; and

  • •

    Complete all the living arrangement pages within the SSI Claim under the living arrangement iteration(s).

NOTE: Full development of the appropriate living arrangement period(s), done in conjunction with seeding, takes the place of the redevelopment of ISM that is normally required for the redetermination. For documentation requirements see SI 00835.520F (in this section).

F. Procedures for documenting ISM redevelopment

1. When documentation is required

Whether the redetermination is processed on paper or in the SSI Claims System, obtain the required documentation for the ISM issue that is being redeveloped.

Example 1: Non-MSSICS redetermination: rental subsidy

The CS is conducting a redetermination for a claimant who rents a house from their adult child. Rental subsidy must be redeveloped for the redetermination. Redevelopment requires contacting the landlord and documenting the new CMRV estimate on a Report of Contact page in the SSI Claim. For non-MSSICS cases use the SSA-L5061 (Letter to Landlord Requesting Rental Information). Fax the paper form in the appropriate electronic folder. Do not retain the paper form after the issue is documented electronically. For information on rental subsidy, see

SI 00835.380.

Example 2: SSI Claim redetermination: loan of ISM (Seeding not required)

The LA pages in the SSI Claim indicate that the claimant has a continuing loan of ISM that covers their pro rata share of household operating expenses. In this case, the SSI Claim has no information about household expenses and contributions. Development of the household expenses and contribution is needed beginning with the first month of the review period to verify the claimant is contributing and to determine the countable ISM amount, if any. See SI 00835.482I. for instructions on documenting loans of ISM. In certain sharing situations a statement from a knowledgeable household member verifying the household expenses and contributions is required on Report of Contact page. Refer to SSA-8011, Statement of Household Expenses and Contributions, to ensure that all information is documented accordingly. For non-MSSICS cases use the SSA-8011 and fax the paper form in the appropriate electronic folder. Do not retain the paper form after the issue is documented electronically. For information on developing sharing see SI 00835.160.

Example 3: SSI Claim redetermination: rental subsidy (Seeding required)

The CS is conducting a redetermination for a claimant who rents a house from a parent. By seeding an SSI Claim and contacting the claimant, the CS obtains the information needed to complete the LA period. However, since rental subsidy is an issue that must be redeveloped for the redetermination, the CS must contact the landlord to obtain a new estimate of the CMRV as of the redetermination initiation month. Document the rental subsidy amount on Report of Contact page within the SSI Claim. For non-MSSICS cases use the SSA-L5061 (Letter to Landlord Requesting Rental Information). Fax the paper form in the appropriate electronic folder. Do not retain the paper form after the issue is documented electronically.

2. When documentation is not required

Do not obtain documentation of LA and ISM issues when redevelopment is not required.

Example: Verification of rental liability not required

The CS is conducting a redetermination for a claimant who lives with two adult roommates and has rental liability. The CS seeds the case within the SSI Claim and contacts the claimant to complete the LA pages. Although verification of rental liability is required if this was an initial claim, it is not necessary to redevelop rental liability for a redetermination. Therefore, the CS does not ask for verification of rental liability. The CS assumes, absent evidence to the contrary, that this issue was correctly developed in the past. In the SSI Claims System on the Home Ownership and Rental Liability page the “Rental liability verified” question should be answered “Yes.”

G. References

  • •

    SI 00835.320 Rebuttal Procedures and Presumed Maximum Value Rule

  • •

    SI 00835.340 Computation of In-Kind Support and Maintenance from Within a Household

  • •

    SI 00835.350 Computation of In-Kind Support and Maintenance (ISM) from Outside a Household (Including Vendor Payments by a Third Party Outside the Household)

  • •

    SI 00835.380 Rental Subsidies

  • •

    SI 00835.510 Breakpoints

  • •

    SI 00835.515 Gradual Changes in ISM

  • •

    MS 08110.001 Living Arrangements - Overview

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500835520
SI 00835.520 - Redetermination Guidelines for LA and ISM - 12/13/2023
Batch run: 10/01/2024
Rev:12/13/2023