Example 1: Applying deemed to defeat
Peter was overpaid $1,500. Peter submitted a waiver request and was found without
fault in causing the overpayment. First, the Claim Specialist (CS) determines Peter's
overpayment does not meet the administrative tolerance provision because the overpayment
is over $1000. Next, the CS determines if Peter meets the deemed to defeat the purpose
provision.
The CS determines Peter meets the deemed to defeat the purpose provision because Peter
currently receives SSI.
Example
2:
Defeats the purpose – income and resources exclusions do not apply
In December, John was overpaid $2,000 for failure to report wages. John is not married
and does not have any household family members. After receipt of the overpayment notice,
John submits a waiver request to a local field office.
After receipt of the SSA-632 (Request for Waiver of Overpayment Recovery), a Claims
Specialist (CS) makes an AFI request and discovers John has $6,000 in a bank account.
John alleges to have saved the SSI underpayment installment received in August. The
CS determines John is not at fault in causing the overpayment. The CS determines the
overpayment does not meet any other waiver provisions.
The CS determines the claimant does not meet the defeats the purpose provision because
John's resources are over $3,000. The underpayment in John's account must be considered
for the defeat the purpose provision even though the retroactive funds are excluded
for nine calendar months for SSI eligibility purposes.
Example
3:
Recovery defeats the purpose
Jacob, age 10, is overpaid $1,400. Jacob's parent and payee, Sarah, received an overpayment
notice on behalf of Jacob. Sarah completed the SSA-632, signed the financial authorization
and sent the form to the local field office.
We determined that Jacob is not at fault in causing the overpayment and does not meet
any other waiver provision. Jacob lives with Sarah and two siblings. Sarah does not
use any of Jacob's income or resources to help with the food or household expenses.
Therefore, we will consider only Jacob’s income, share of household expenses, and
resources.
Jacob receives $450 in Title II benefits.
We received Jacob's financial account information through an AFI request. Jacob has
$1,000 in a savings account. Therefore, Jacob is under the resource limit of $3,000.
The family's monthly household expenses total $2,000. Jacob's pro-rata share of expenses
is $500 ($2,000 divided by 4 individuals, including Jacob and 3 household family members).
Jacob's pro-rata share of expenses ($500) exceeds Jacob's income ($450). Jacob is
under the resource limit and Jacob’s expenses exceed Jacob’s income, recovery from
Jacob defeats the purpose.
Example
4:
Income exceeds adjusted household expense amount
Kayla, age 12, is overpaid $1,600. Kayla's parent and payee, Karen, received an overpayment
notice on behalf of Kayla. Karen completed the SSA-632, signed the financial authorization,
and sent the form to the local field office.
We determined that Kayla is not at fault in causing the overpayment and does not meet
any of the other waiver provisions. Karen told us that Kayla's income helps with food
and household expenses. Kayla lives with Karen, and three siblings. We need the monthly
income, monthly household expenses, and resources for all household family members
since Kayla's income helps with the household expenses.
Kayla receives Title II benefits in the amount of $500. Karen's net monthly income
from her employer is $3,000. Karen also receives $1,500 in child support every month
for Kayla's three siblings. The family's total monthly household income is $5,000
($500 for Kayla, $3,000 for Karen, $500 each for Kayla's three siblings = $1,500).
The total monthly household expenses are $3,000. When you subtract the monthly household
expenses ($3,000) from the monthly household income ($5,000), the balance is $2,000,
which is more than the $55 adjusted household expense amount.
We received Kayla's financial account information via an AFI request. Kayla has $2,000
in a savings account. Karen has $2,600 in a checking account. Karen owns a 2020 Ford
Edge, which is the only automobile in the household; therefore, we are excluding the
automobile as a resource. Each sibling has $200 in a savings account. The family does
not have any more resources.
After adding Kayla’s savings account ($2,000), Karen’s checking account ($2,600),
and the three siblings savings account (3 times $200 = $600), the total resources
are $5,200. The family meets the resource limit, which is $6,800 (5,000 for Kayla
and Kayla’s parent plus $600 each for the three other household family members).
After evaluating Kayla’s and the household family member’s resources, we determined
that the resources are under the resource limit. However, the total monthly household
income exceeds the allowable adjusted household expense amount. We are unable to approve
Kayla's waiver because Kayla does not meet the defeats the purpose waiver provision.
An independent decision-maker will schedule a folder review and personal conference.
Example
5:
Exceeds resource limit
Tom received an overpayment notice. Tom was overpaid $3,500. Tom completed the SSA-632,
signed the financial authorization, and sent the form to the local field office.
Tom lives with Tom's spouse, Alice. We determined that Tom is not at fault in causing
the overpayment and does not meet any of the other waiver provisions.
Tom provided the couple’s monthly income, monthly household expenses, and Alice’s
resource information. Tom receives $2,500 in Title II benefits and a monthly pension
of $1,000. Alice receives $1,000 in net income. Together they receive $4,500 per month
in income.
Tom and Alice's monthly household expenses are $4,450. When you subtract the monthly
household expenses ($4,450) from the monthly household income ($4,500), the balance
is $50, which is less than the $55 adjusted household expense amount.
We received Tom's financial account information via an AFI request. Tom has $15,000
in a savings account and $1,000 in a checking account. Tom owns a 2018 Chevy Equinox,
which is the family’s only automobile; therefore, we are excluding the automobile
as a resource. Alice has a $10,000 Certificate of Deposit. They do not have any more
resources. After adding Tom’s savings account ($15,000), checking account ($1,000),
and Alice’s CD ($10,000), the total resources are $26,000. Tom exceeds the resource
limit ($5,000 for Tom and Alice).
After evaluating Alice’s and Tom’s resources, we determined that their resources exceed
the resource limit. We are unable to approve Tom's waiver because Tom does not meet
the defeats the purpose waiver provision. An independent decision-maker will schedule
a folder review and personal conference.
Example
6:
Exceed the resource limit
Jerry received an overpayment notice. Jerry was overpaid $5,250. Jerry completed the
SSA-632, signed the financial authorization, and sent the form to the local field
office. Jerry lives alone in a home that Jerry owns. We determined that Jerry is not
at fault in causing the overpayment and does not meet any of the other waiver provisions.
Jerry receives $2,000 in Title II benefits and $1,500 in a pension. Jerry’s total
monthly income is $3,500. Jerry’s monthly household expenses are $3,450. When you
subtract the household expenses ($3,450) from the household income ($3,500), the balance
is $50, which is less than the $55 adjusted household expense amount.
We received Jerry's financial account information via an AFI request. Jerry has $5,000
in a savings account. Jerry owns a home, which is Jerry's principal place of residence,
an automobile, and a camper. We excluded Jerry's home and automobile as resources.
We must include the camper as a resource because the camper is not Jerry’s principal
place of residence or equipped for an individual who needs a mobility device. The
current fair market value of the camper is $11,000. After adding Jerry’s savings ($5,000)
and camper ($11,000), which can be converted to cash, Jerry's resources total $16,000.
Jerry exceeds the resources limit ($3,000 for Jerry).
Although Jerry meets the adjusted household expense amount, Jerry exceeds the resource
limit. We are unable to approve Jerry's waiver because Jerry does not meet the defeats
the purpose waiver provision. An independent decision-maker will schedule a folder
review and personal conference.
Example
7:
Refusal to provide authorization to access financial account information
Rachel received an overpayment notice. Rachel was overpaid $2,500. Rachel completed
the SSA-632 and sent it to the field office. Rachel refused to provide authorization
for us to obtain Rachel's financial account information.
We determined that Rachel is not at fault in causing the overpayment and does not
meet any other waiver provision.
We cannot approve Rachel's waiver under the defeats the purpose waiver provision because
Rachel refused to give us permission to access Rachel's financial account information.
An independent decision-maker will schedule a folder review and personal conference.