Effective Dates: 11/22/2024 - Present Previous | Next

TN 61 (11-24)

GN 02250.315 Documenting Waiver Determinations on Form SSA-635 - Title II and Title XVI

A. Introduction

This section provides the policy for documenting a waiver determination on Form SSA-635 (Waiver Determination) and the procedures for completing and storing the form.

B. Introduction

We must always document our waiver determination.  A waiver determination is an initial determination with appeal rights.  A waiver determination is the basis for all subsequent appeals, including actions brought in federal court.

We require an SSA-635 For Title II and Title XVI to document waiver determinations over $2,000.  For more information on documenting waiver determinations of $2,000 or less, refer to GN 02250.350.

For Title II waiver determinations, we must complete an SSA-635 for each overpaid individual included on the SSA-632, if the overpaid individuals were: 

  • •

    living in the same household during the overpayment period;

  • •

    living in the same household when the waiver was requested; and

  • •

    overpaid for the same reason.

You must document the SSA-635 by clearly stating the relevant facts of the overpayment and provide a rationale in support of your waiver determination. The facts supporting a waiver determination include:

  • •

    What caused the overpayment;

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    The dates of the overpayment;

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    The original amount of the overpayment;

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    If the overpaid individual is at fault or not at fault

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    If we determine the overpaid individual is not at fault, whether recovery is:

    • –

      deemed to defeat the purpose;

    • –

      against equity and good conscience; or

    • –

      defeats the purpose of the Act;

  • •

    If a Title XVI overpayment is caused by resources exceeding the limit by $50 or less per month an SSI overpayment; and

  • •

    The POMS section that supports the waiver determination.

We must review any records that contain information relevant to the overpayment amount and reason, including but not limited to:

  • •

    Information on the form SSA-632 (Request for Waiver of Overpayment Recovery);

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    Supporting documentation;

  • •

    Notes or additional evidence provided during a personal conference;

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    The overpayment notice;

  • •

    Online Retrieval Notices (ORS);

  • •

    Master Beneficiary Record (MBR);

  • •

    Recovery Accounting and Reporting System (ROAR);

  • •

    Payment History Update System (PHUS);

  • •

    Debt Management System (DMS);

  • •

    OPWiz application;

  • •

    Supplemental Security Income Record (SSR); and

  • •

    Any records in an electronic repository (i.e., Evidence Portal, Consolidated Claims Experience (CCE), eView, eWork, eComps, Paid vs. Payable charts etc.).

C. Procedure

Complete these steps for the SSA-635.  

1. Name of overpaid individual

Enter the overpaid individual's name.

2. Social Security Number and BIC

Enter the overpaid individual's Social Security Number and BIC.  Include the BIC for overpaid Title II individuals.

3. Name of representative payee (If applicable)

Enter the name of the representative payee, if applicable.

4. Overpayment period (MM/YYYY thru MM/YYYY)

Enter the period of overpayment in MM/YYYY thru MM/YYYY format.

5. Overpayment notice date

Enter the original overpayment notice date in MM/DD/YYYY format.

6. Total original overpayment amount

Enter the original amount of the overpayment. This amount will include recovered amounts.

7. Outstanding overpayment balance (when we receive the waiver request)

Enter the outstanding overpayment balance (when we received the waiver request), if applicable. Enter zero if the overpayment is fully recovered.

8. Supplemental Security Record (SSR) number (Title XVI only)

For Title XVI, enter the SSR number where we posted the overpayment.  For example, SSR 3X3.

9. Waiver requested on sequence number and sequence date (Title XVI only)

For Title XVI, enter the overpayment sequence number and sequence date (SQD field) from the Overpayment Sequence Data (OPSQ) segment on the SSR with a pending waiver. For example, Sequence 05 – SQD 120123. For more information on the OPSQ segment on the SSR, refer to SM 01311.035.

10. Waiver requested on the Recovery of Overpayments, Accounting and Reporting (ROAR) System Event Number (Title II only)

For Title II, enter the ROAR Event number.  For example, ROAR Event 02.

11. Who is requesting a waiver? (GN 02250.001)

Check the box(s) indicating which overpaid individual(s) requested the waiver.  For information about who may request a waiver, refer to GN 02250.001.

12. Does the overpayment involve fraud or similar fault on the part of the overpaid individual? 

Check Yes or No.  If Yes, stop development and refer to GN 02250.001H.

13. Is the individual requesting a waiver of the original overpayment amount or the remaining balance  – (GN 02250.310)

Check the box for original overpayment amount (including funds we already recovered) or the remaining balance. Refer to question 3 on the SSA-632.

14. What caused the overpayment?

Fill in the field labeled “Required Field -Detailed explanation of how the overpayment occurred”.

15. Title XVI Only – Excess resources of $50 or less per month – (GN 02250.090)

In some cases, an overpaid individual’s resources may exceed the Title XVI limit by such a small amount that we will deem the overpaid individual to be not at fault and waive recovery of the overpayment, unless we find clear evidence that the individual knowingly and willfully failed to report the excess resources correctly and timely.  If applicable, fill in the field explaining why waiver is approved on this basis.

16. Fault determination – (GN 02250.005 through GN 02250.025)

Check the box indicating if you determined the overpaid individual is “not at fault” or “at fault” for the overpayment. You are required to explain your rationale.  Your rationale should include why you made the fault determination. If you make an “at fault” determination, provide your rationale, STOP and go to question 20.

17. Deemed to defeat the purpose (GN 02250.110)

If you make a “not at fault” determination, consider whether you can approve the waiver under deemed to defeat the purpose.

18. Against equity and good conscience (GN 02250.150)

If you make a “not at fault” determination, consider whether you can approve the waiver under against equity and good conscience.

19. Defeats the purpose (GN 02250.100)

If you make a “not at fault” determination, consider whether you can approve the waiver under defeats the purpose.

20. Waiver denial

Check the box that supports your determination and complete the required field to support your rationale.

21. Signature and date required

Enter the NAME, TITLE, AND DATE into the required field.

To determine the level of the review thresholds for waiver approvals, refer to GN 02250.301. Each individual who is responsible for approving the waiver must include their name, title, and date of the review.

Important information about storing the SSA-635

After making a final waiver determination, fax or import the SSA-635 (with any additional supporting documentation) into the Evidence Portal (EP).  Do not fax or import the SSA-635 into EP if further review is required for waiver approvals. To determine the level of review required (e.g., peer review, management review or ARC MOS review) for a waiver determination, refer to GN 02250.301.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202250315
GN 02250.315 - Documenting Waiver Determinations on Form SSA-635 - Title II and Title XVI - 11/22/2024
Batch run: 11/22/2024
Rev:11/22/2024