POMS instructions in effect prior to the issuance of EM-97207 (dated 12/18/97) stated that aliens who were not receiving SSI benefits on 8/22/96 were subject to 1996 welfare and immigration reform law for the entire period in the life of their SSI applications, even if that included periods prior to 8/22/96.

EM-97207 changed those instructions. Under current policy, SSA applies the alien eligibility law that was in effect prior to 8/22/96 to any pre-8/22/96 period in the life of the individual's application. This policy applies to all aliens who filed for SSI prior to 8/22/96 or whose protective filing dates are prior to 8/22/96.

Pursuant to EM-97207, field offices (FOs) were to readjudicate SSI claims that had been denied N13 as a result of the POMS instructions that were in effect prior to the issuance of EM-97207.

IMPORTANT: Because these were readjudications--as opposed to reopenings--the rules of administrative finality did not apply.

The readjudication initiative described in EM-97207 also applied to:

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  individuals who applied for SSI prior to 8/22/96, who were denied on or after
  
  8/22/96 based on alien status under 1996 welfare and immigration reform law, and who had (or have) pending reconsiderations, hearings, or requests for Appeals Council review; and

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  the processing of hearings that were remanded to FOs for revised determinations of eligibility in light of the changes in law contained in P.L. 105-33.

IMPORTANT: Under current law, the alien eligibility of a qualified or nonqualified alien who received SSI benefits on 8/22/96 (or, as may be the case in a readjudicated claim, received benefits for 8/22/96) is "grandfathered." (See SI 00502.100A.2. and SI 00502.100A.7. for the categories of qualified and nonqualified aliens, respectively. See SI 00502.150 for the grandfathering rules that apply to qualified aliens and SI 00502.153 for the grandfathering rules that apply to nonqualified aliens.)

Individuals who filed for SSI on or after 8/22/96 and were denied based on pre-8/5/97 welfare and immigration reform law may be eligible under the provisions of P.L. 105-33, which was enacted on 8/5/97. As instructed by EM-97207, FOs readjudicated these individuals" claims and awarded benefits, where possible, retroactively to the date of filing.

Because these were readjudications, not reopenings, the rules of administrative finality did not apply.

During 12/97, CO sent the ROs listings of individuals who had filed for SSI prior to 8/22/96 and who were denied based on alien status (N13) on or after 8/22/96. ROs referred the cases to servicing FOs. Upon receipt of the case listings, FOs sent each listed individual a manual come-in letter and subsequently readjudicated the individual's previously denied claim following the procedures below.

Cases containing pending appeal codes were included in the listings for RO and FO control purposes only. It was assumed that those cases were already under manual control in the FO. If the appeal code was accurate and up-to-date, the FO did not send a come-in letter to the individual.

FOs used listings provided by the ROs to identify individuals who had to be sent manual come-in letters. Before preparing a come-in letter, the FO obtained a current SSI query and verified that the record was still in N13 denial status. If the record was no longer in N13 status, EM-97207 instructed the FO to determine whether readjudication was still necessary.

FOs reviewed listed cases containing pending appeal codes to ensure that the codes were accurate and up-to-date. If a final reconsideration, hearing, or Appeals Council decision had already been issued in the case, EM-97207 instructed the FO to input the correct PL field code and determine whether readjudication was still necessary.

The FO sent a come-in letter to each listed individual explaining that the SSI rules for people who were not U.S. nationals or citizens had changed and, as a result, the individual might be able to receive benefits even if their alien status has not changed. The letter asked the individual to contact the FO within 30 days and listed the types of evidence SSA needed to see.

If the individual did not contact the FO within 15 calendar days from the date of the come-in letter, the FO sent a followup letter. The 30-day closeout date included in the first letter was also included in the followup letter (unless the FO had negotiated a new date with the addressee).

If the individual did not respond by the applicable 30-day closeout date, the FO followed the closeout procedures in SI 00601.110.

EM-97207 emphasized the importance of making all possible efforts to obtain the information and evidence needed to readjudicate these cases.

A claimant was not to be found ineligible for SSI based on failure to cooperate (denial status N18) if:

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  a third party or prospective representative payee (other than those listed in SI 00601.110A.1.) failed to provide requested information or evidence; or

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  the FO could not obtain the information/evidence from a third party, the claimant had acted in good faith, and the FO could determine eligibility and payment based on information in file; or

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  ineligibility could be based on another denial reason.

Per SI 00601.110, before denying a claim based on failure to cooperate, the FO had to:

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  follow the procedures in SI 00601.100C. and SI 00601.120 for requesting information/evidence and offering assistance;

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  try to obtain the information/evidence from other sources, if third parties had failed to cooperate with SSA;

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  attempt to contact the individual by phone to determine if additional time was needed and to offer assistance;

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  review the case file for names of relatives, friends, or medical treating sources who might be able to provide assistance;

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  pursue any known sources of assistance including linkages with community organizations established through outreach activities--particularly important where a language barrier might have interfered with the claimant's ability to cooperate; and

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  develop for a new payee if the prospective representative payee (who was other than the legal guardian or parent with custody of a minor child) could not be located or failed to cooperate.

If the claimant's, payee's, or (in a couple's claim) the claimant's spouse's whereabouts were unknown, the FO followed the instructions in SI 00601.110B.6.

If a denial based on failure to cooperate was appropriate, the FO input denial code N18 and allowed the system to issue an automated denial notice (unless a manual notice was needed for some other reason).

If after readjudicating the claim, the alien would receive SSI benefits ("receive" as defined in SI 00502.150B.1.) for the month of 8/96--for example, the alien would be in C01, E01, N01, N02, or N04--the alien would be able to receive SSI indefinitely, provided all other factors of eligibility continued to be met.

This is the case because the alien eligibility of an individual who received SSI benefits on (or for) 8/22/96 is "grandfathered." (See SI 00502.150 for information on the grandfathering provision that applies to qualified aliens who were receiving benefits on 8/22/96. See SI 00502.153 for information on the grandfathering provision that applies to nonqualified aliens who were receiving benefits on 8/22/96.)

IMPORTANT: If the individual was neither a PRUCOL nor LAPR alien during the period prior to 8/22/96, but subsequently adjusted to a qualified alien status, the individual could be SSI-eligible based on meeting the "blind/disabled and lawfully residing in the U.S. on 8/22/96" exception described in SI 00502.142. EM-97207 instructed FOs to be alert to situations where eligibility was possible for some, but not all, months within the life of the SSI application. In such situations, N13 payment status could be applicable for months prior to the first month in which the individual was eligible.

If the individual did not contact the FO by close of business 2/2/98, the FO sent a followup letter asking the individual to contact the FO by 2/16/98 (30 days after the date of the automated come-in letter), provided a later date had not been negotiated with the addressee.

If the individual did not respond by the applicable 30-day closeout date, the FO followed the closeout procedures in SI 00601.110.

EM-97207 emphasized the importance of making all possible efforts to obtain the information and evidence needed to readjudicate these cases. (See SI 00502.152C.5. for the mandatory closeout procedures that applied in these cases.)

If a denial based on failure to cooperate was appropriate, the FO input denial code N18 and allowed the system to issue an automated denial notice (unless a manual notice was needed for some other reason).

FOs followed the systems instructions in SI 00502.152C.11. to ensure that every individual received a new initial claim award or denial notice.

In the course of routine business--for example, in conjunction with responding to an inquiry or processing a redetermination--the FO may identify an individual whose prior N13 denial meets the criteria for readjudication described in SI 00502.152B.1. or SI 00502.152B.2., but whose denial was not previously readjudicated and/or was not referred by CO to the FO for readjudication. In such a case, readjudicate the prior denial following the procedures below.

In 2/97, the individual became a naturalized U.S. citizen and refiled for SSI. The 2/97 claim was allowed.

Since the individual was no longer in N13 denial status when (during late-1997) CO identified records meeting the readjudication criteria, the individual's prior N13 denial was not referred to the FO for readjudication. Upon identifying the prior N13 denial as meeting those criteria, the FO should readjudicate the denied claim.

Readjudicate according to applicable procedures in SI 00502.152C or

SI 00502.152D. any claim that:

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  was denied due to alien status (N13) using the welfare and immigration reform eligibility rules in effect prior to 8/5/97;

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  meets the criteria for readjudication described in SI 00502.152B.1. or
  
  SI 00502.152B.2.; and

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  shows no indication -- in the file or on the Supplemental Security Record
  
  (SSR) -- of having previously been readjudicated.

Apply the alien eligibility policies described in SI 00502.100 ff. and determine whether the individual was an "eligible alien" (and, if so, met all other factors of SSI eligibility) for the period beginning with the date the prior claim was filed and ending with the date the individual refiled for SSI.