TN 40 (04-20)

SI 02301.205 Suspension and Reestablishing Eligibility

CITATIONS:

Section 1631(j)(1)(B) of the Social Security Act;
20 CFR 416.1320;
Public Law 109-163, Section 689

A. Introduction

This section explains when to reinstate Supplemental Security Income (SSI) benefits or take a new application to reestablish eligibility again after a suspension. It reflects the SSI suspension and reinstatement policy in SI 02301.201B.

Generally, SSI recipients have 12 consecutive months after the effective date of a suspension to have benefits reinstated without filing an application.

Section 689 of Public Law 109-163, effective January 6, 2006, provides that blind and disabled children of military personnel stationed overseas have 24 months (instead of the 12 month suspension period) to have payments reinstated after a suspension. It also provides that "military-related" recipients who become SSI ineligible as a result of their spouse or parent(s) being called to active military duty (including the Reserve or National Guard) have 24 consecutive months after the suspension (instead of the 12 month suspension period) to have benefits reinstated without having to file a new application. "Military-related" recipients are aged, blind or disabled spouses residing in the United States or blind or disabled children residing in the United States or overseas. Recipients affected by PL 109-163 may have more than 24 months to reinstate their SSI benefits if they meet one of the conditions shown below in SI 02301.205B.2.

 

A suspension is always effective the first day of a month for that entire month. EXCEPTION: Proration of payments may apply for a month following a month in payment status codes (PSC) N02, N03, N06, N07, N08, N13, N22 or N23. After the 12-month suspension period (or the 24-month suspension period) ends, a new application may be required to reestablish eligibility.

See Also

SI 00501.415 Blind or Disabled Children of Military Personnel Stationed Overseas - Overview

SI 01310.170 Deeming Concept - Absence From a Deeming Household Due to Military Service

SI 02005.008 Proration After Period of Ineligibility

SI 00601.010 Filing Applications

 

B. Procedure for reinstating benefits when a suspension is on the record

1. Before the 12 (or 24) Month Suspension Period Ends

Reinstate benefits before the suspension period ends when a recipient reestablishes eligibility for a nonpay month(s). See the example at SI 02301.205E.1.

IMPORTANT: The system automatically terminates a record (PSC T31) after 12 consecutive suspension months are posted unless an exception exists (see SM 01801.305). However, a record will be in T31 status before the 12th suspension month ends due to computation periods and run dates. In those cases, reinstatement may be proper. See the example at SI 02301.205F.1.

2. After the 12 (or 24) Month Suspension Period Ends

Reinstate benefits after the suspension period ends when:

  • A recipient appeals the suspension and reestablishes eligibility during the administrative appeal period or civil suit (see example at SI 02301.205F.4); or

  • There is a favorable appeal decision on the suspension determination (including a favorable Federal Court decision); or

  • SSA reopens and revises a suspension determination under the rules of administrative finality in SI 04070.001.

C. Procedure for taking a new application - terminating a record

1. New Application

Take a new application when you cannot reinstate benefits using the procedure in SI 02301.205B. See the example at SI 02301.205F.2.

2. Terminate an Active Record

Terminate an active record and take a new application when the record has been in a suspense status code as shown in SI 02301.215B over 12 (or 24) consecutive months and:

  • The record is not in GK or statutory benefit continuation status (see SM 01601.790C.17 for the code G in the CMPH field); and

  • An appeal is not pending (see SM 01601.685C., field L, for the different appeal codes A, C, H, R, and O); and

  • The 60-day period to appeal the suspension has expired. See SI 04005.012 on how to count the 60-day period and SI 04005.015 about good cause for extending the time limit.

NOTE: If there is an underpayment on a record, pay the underpayment, if due, before terminating the record (see SI 02101.002).

D. Procedure for handling retroactive suspensions that do not involve fraud or similar fault (FSF)

When a recipient is currently eligible and receiving benefits and you discover a past period of ineligibility, correct the data on the record, subject to the rules of administrative finality. Do not terminate a record due to a past period of ineligibility of 12 (or 24) months or longer if the recipient is currently eligible. These instructions apply in most cases related to reopenings under the 1-year rule or for good cause under the 2-year rule. For more information about administrative finality, see SI 04070.000. For more information about reopening, see SI 04070.010F.

NOTE: If a recipient is currently ineligible and benefits are suspended retroactively for 12 (or 24) consecutive months or longer, the system will automatically terminate the record 95 days after the last payment unless an exception applies per SM 01801.305.

E. Procedure for handling retroactive suspensions that involve fraud or similar (FSF)

Different rules apply when we reopen cases based on a fraud or similar fault (FSF) determination. When a revised determination or decision is a past period of ineligibility of at least 12 consecutive months, and you are applying unrestricted reopening to the initial determination or decision due to FSF, you must terminate benefits effective with the start of the first 13th consecutive month of suspension.

REMINDER: SSI cases involving FSF are entitled to due process protections, including appropriate notices and Goldberg-Kelly processing. For more information, see SI 04070.050 and SI 02301.300.

For more information on FSF, see SI 04070.020 and SSR 85-23.

F. Examples

1. Reinstate Benefits – Record is T31 – New Application not Required

In December 2005, the recipient receives a Notice of Planned Action to suspend his benefits effective January 1, 2006 for excess resources. January 2006 is the first suspension month posted to the record. The recipient contacts the field office in December 2006, the 12th suspension month, and shows he spent down his resources in November 2006. He is eligible again effective December 1, 2006. The record is T31. (The CMPH field shows T31 effective January 1, 2007.) The field office establishes a new start date record to reinstate benefits because he regained eligibility in the 12-month suspension period. For more information about processing a one-time payment, see SM 01901.015.

2. Take A New Application – Record is T31

The recipient in example 1 contacts the field office in December 2006 and shows that his resources fell below the limit on December 15, 2006. He would not be eligible again based on resources until January 1, 2007. Because January 2007 is beyond the 12-month suspension period, he must file a new SSI application.

3. Retroactive suspension resulting in a termination due to FSF

A recipient in current pay leaves the United States (U.S.) for an unreported period from July 15, 2010 through November 30, 2011. He has an SSI redetermination December 1, 2011 and does not report any period of absence. He remains in the U.S. through June 1, 2014 when the Office of Inspector General informs us of an investigation that concludes the recipient knowingly failed to report his absence from the U.S. He knowingly concealed information that is material to the deemed initial determinations during the period of absence. A Claims Specialist (CS) reopens and revises the determinations because the determinations were obtained by similar fault. The recipient's record results in at least 12 consecutive months of retroactive suspension due to absence from the U.S. A CS terminates benefits retroactively and calculates an overpayment beginning August 2010, despite the recipient’s current eligibility status.

4. Reinstate Benefits during the 60-Day Appeal Period – Appeal Filed

In December 2016, the field office sends a Notice of Planned Action to suspend benefits retroactively effective January 1, 2016 for excess resources. The recipient appeals the suspension during the 60-day appeal period and reports he exhausted his resources. He is eligible again based on resources effective January 1, 2017. Because he filed an appeal and regained eligibility in the 60-day appeal period, the CS reinstates benefits effective January 1, 2017.

NOTE: If the recipient in this example did not file a timely appeal (good cause did not exist), he must file a new application. The date he requested to file an appeal will be the protected filing date for the application. For more information about protective filing, see SI 00601.015.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502301205
SI 02301.205 - Suspension and Reestablishing Eligibility - 04/06/2020
Batch run: 04/06/2020
Rev:04/06/2020