We are required to perform Title II windfall offset calculations on concurrent awards that have an overlapping past period of eligibility. Authorized fees and out-of-pocket expenses can affect windfall offset calculations by reducing the total amount of Title II past-due benefits that we count as income in the windfall period.

Cases with representative fees that are unknown or unresolved at the time of effectuation add additional complexity. When the fee determination is delayed, you may need to first calculate the windfall offset before the fee is authorized or approved and hold back past-due benefits for direct fee payment. This section describes how to process cases with unknown fees at the time of effectuation. When performing the offset, do not temporarily show a fee of $.01 (i.e. the obsolete penny process).

Once you know the total amount of the representative fees authorized by the agency per section 206(a) of the Act, or the court per section 206(b) of the Act, you must:

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  update the Title XVI record with the authorized fee information; and

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  adjust the SSR to account for the total Title II and Title XVI authorized fees.

Complete these actions within 120 days of the final fee authorization.

IMPORTANT: The total T2 fees include any additional fees paid on an auxiliary beneficiary’s claims when the auxiliary beneficiary has not appointed a representative. See GN 03940.050A.4 NOTE 2 & GN 03920.035B.2 When auxiliary claims are involved, the PC computes the total fees by adding the NH’s fee and any auxiliaries’ fees. Once the PC computes the total Title II fees, the PC communicates this information to the FO through a high priority (HP) modernized development worksheet (MDW). The FO then has 120 days to complete any necessary fee adjustments to the windfall offset data.

Continue to process an “initial” offset while waiting on the resolution of all fees in fee petition and some fee agreement cases (i.e. auxiliary benefits).

What is an “initial offset”? In some cases, it is possible the payment center (PC) can take the second day action to post an offset computed without fees and release some of the Title II past-due benefits while waiting on the fee authorization. In other cases, they may not complete processing of the “initial offset” because after applying windfall, there may not be enough Title II past-due benefits left to allow for 25% withholding, see GN03920.036.

Determine if the system was able to compute the initial windfall offset automatically. Check the Windfall Indicator (WIN) codes on the SSR to determine if the offset was completed, see SM 01320.021.

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  Clues the PC could not complete the "initial" offset include a pending 6W diary windfall coding in the MBR history segment, a pending e4345, and no offset entry on PHUS.

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  If a limitation or exclusion prevented automation of the initial windfall offset, an offset diary (e.g., 5W, 7W, etc.) will post to the SSR. If an offset diary posts, to take any necessary action, follow the instructions SM 01320.010.

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  If a 2L diary posts, to resolve any discrepancies between the fee statuses posted to the MBR and the SSR, follow instructions SM 02001.217 . If after ruling out all other possibilities for the 2L diary and the only discrepancy is that the SSR correctly reflects a fee status of unknown or unresolved, delete the 2L diary, and send to the SSR.

Once you have resolved any diaries preventing windfall automation, review SI 02006.210 & SM 01320.001 to locate any further instructions you may need to complete the initial windfall offset.

After you receive notification from the PC, OHO, or OAO of the total authorized fee, update the fee data for the offset as soon as possible but no later than 120 days after the final fee authorization.

Reminder: If you are still waiting for a fee decision for an auxiliary claim the you have not received the total authorized fee, set a Tickle date for the “FEE UPDATE” issue 60 days in the future. You will need to continue to follow up with this case every 60 days until all fees for all associated claims have been finalized.

Example 1 – This example illustrates a scenario where the fee is unknown or unresolved when the Title XVI decision is effectuated.

Tom was awarded concurrent benefits with an overlapping period of past eligibility. Tom had an appointed representative who was eligible to charge a fee. Tom’s representative did not submit a fee agreement before Tom’s case was awarded.

A claims specialist (CS) in Tom’s local FO processed Tom's case, following policy in SI 02006.204. The CS coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” and established the “FEEAUTHPEND” issue on the CCE development worksheet when the CS processed Tom’s award.

32 days later, the CS received notification via HP MDW from PC that Tom’s representative was authorized to charge and collect a fee. The CS followed the instructions in SI 02006.204F to update Tom’s record. The CS noted the initial windfall offset had automated with no exceptions. The CS updated the UFEE screens and sent the update to the SSR. The simulated SSR showed:

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  UMIH with Type U income; and

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  PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.

Once the CS confirmed the system accounted for the fees and computed the underpayment, the CS typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue.

Example 2 – This example illustrates the steps needed when a fee is unknown or unresolved when the Title XVI decision is effectuated and the total amount of the fee is delayed for an extended period because of additional fees due from an auxiliary claim.

Jeff was awarded concurrent benefits with an overlapping period of eligibility. Jeff had an appointed representative who will charge a fee. Jeff’s representative submitted a fee agreement, which the ALJ approved. A CS in Jeff’s local FO, processed Jeff's case. The CS noticed Jeff had two auxiliaries listed on the record, a spouse and a child. The CS realized that because the two auxiliary claims had not been processed yet, the CS did not know the total amount of the authorized fees.

The CS coded the UFEE screen to show “FEE SITUATION: 1=UNKNOWN OR UNRESOLVED FEE” and established the “FEEAUTHPEND” issue and a “FEE UPDATE” issue on the CCE development worksheet. The CS receipted in the “FEEAUTHPEND” since the fee agreement was approved by the ALJ. The CS set a TICKLE for 60 days for the “FEE UPDATE” issue. The CS completed a PERC with Jeff, closed the event, and updated the SSR. The system successfully computed the initial windfall offset.

61 days later, the CS was checking the TICKLE list in WAC and noticed the “FEE UPDATE” issue on Jeff’s case had matured. One of the auxiliary claims on Jeff’s record had been processed, but the other had not. The CS extended the TICKLE for the “FEE UPDATE” issue another 60 days.

20 days later, the CS received notification from the PC of the authorized fees for the Title II claims via a HP MDW. The PC had processed both auxiliary claims to completion and determined the fee amounts for both claims. The CS now knew the total authorized fee amounts. The CS updated the UFEE screen on Jeff’s record and sent the update to the SSR. The simulated SSR showed:

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  UMIH with Type U income; and

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  PMTH showing the system released an underpayment that takes into account RMA and corresponding months of Type U income.

Once the CS confirmed the system accounted for the fees and computed the underpayment, the CS typed the date of completion in the RECEIVED column for the “FEE UPDATE” issue. 

e4345 2.0

SSI eComputations

RASR

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  GN 03910.050 Contacting a Represented Claimant

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  GN 03920.031 Representative’s Fee – Title XVI Past-Due Benefits

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  GN 03920.035 Title II Past-Due Benefits Subject to Withholding

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  GN 03930.025 Receipt and Routing of Fee Petitions

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  GN 03930.030 Title XVI - Adjudicating Claims and Posteligibility Actions Involving Representatives Who May Petition

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  GN 03930.032 Direct Payment to the Appointed Representative Under the Fee Petition process for Title XVI and Certain Title II Concurrent Cases and Windfall Offset Calculation

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  GN 03930.090 No Fee Petition or Fee Authorization Received by PC or FO When Diary Matures and SSA is Withholding Past-Due Benefits – Non-Court Case

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  GN 03940.050 Title XVI – Field Office Processing of Fee Agreements on Favorably Decided Concurrent Title II and Title XVI Claims

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  MS 00302.014 Representative Fee Update Data (UFEE)

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  MS 00304.018 Underpayment Processing (UOUP)

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  MS 03509.004 Clearance Menu (CMEN)

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  SI 02006.200 Title II and Title XVI Offset Cases – Subtraction of Authorized Fees from Title II Retroactive Payments

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  SI 02006.210 – Field Office Representative Fee Adjustment Procedures Summary and Worksheets

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  SI 02101.010 – Past-Due Benefits Payable - Individual Alive Under Age 18 with Representative Payee - Dedicated Account Required

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  SI 02101.020 Large Past-Due Supplemental Security Income (SSI) Payments by Installments – Individual Alive

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  SI 02101.025 Basic Requirements of Supplemental Security Income (SSI) Underpayment (UP) Review

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  SM 01311.662 Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment

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  SM 01320.001 Finding Windfall Offset Related Instructions

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  SM 01320.010 Windfall Offset Diaries and Alerts - W1, 3W, 4W, 5W, 6W, 7W, 8W, 9W

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  SM 01320.021 Windfall Indicator (WIN) Codes Used in the Automated Offset Process

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  SM 01320.400 Recomputation of Title II Offset

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  SM 01901.005 When to Use One Time Payments (OTPs)