The following are instructions for documenting the pension and annuity evidence. Follow
the documentation requirements in HI 03035.012 for pension and annuities and HI 03035.007 for an IRA, 401(k), or similar account. Once you have documented the evidence, refer
03035.006 and HI 03035.007 for instructions on completing the verification process. If the applicant alleges
that funds shown by the IRS data are withdrawals from an IRA, 401(k), or similar account,
complete the verification per HI 03035.020 and document the verification per HI 03035.006. Verify the amount in the underlying IRA, 401(k) or similar account.
NOTE: For determining eligibility for Extra Help, consider an IRA, 401(k), or similar account
a resource. Withdrawals from an IRA, 401(k), or similar account are a conversion of
a resource, and we do not count them as income.
1. Documentation needed when evidence is not required
If the applicant or payer agrees with the agency data, you must document how you obtained
the verification information by completing the comment section of the DWRC screen.
“I spoke with the applicant (in person, or by telephone) and he (or she) agrees with
agency data for the pension or annuity”; or
“The applicant submitted a letter from the payer of the pension or annuity and this
information agrees with the agency data (include payer name, address, contact’s name
and contact’s number).”
Before indicating “Verification Completed” and submitting the case for a subsidy determination,
document your discussion and findings on the other verification issues.
NOTE: Do not use abbreviations or shorthand that others may not understand.
2. Documentation needed when evidence is required
The interviewer must document the following information on the DWRC screen:
contact information, i.e., name of the person contacted, contact method, contact subject,
contact address, contact phone number;
type of evidence used to verify the pension or annuity (see HI 03035.012B.4. in this section for acceptable evidence);
tax year listed on the submitted evidence;
verified monthly amount of the unearned income that will be used in the determination;
allegation of the applicant or payer (including the type of contact, e.g., face-to-face,
telephone, or letter) which says the individual does not agree with the agency data
and the type of document he or she submitted as evidence.
For acceptable evidence, see HI 03035.012B.4., in this section
NOTE: If this information is not documented on the DWRC, the verification process is not complete. If you need to obtain evidence from the applicant, refer to HI 03035.006C.2 for additional instructions on sending an evidence request notice.
3. Documenting the report of contact screen (DWRC)
Use the following chart as a guide for the type of documentation required on the DWRC
If the following applies:
Then document or develop the file accordingly:
The applicant agrees with the IRS data
Document DWRC: Complete the preliminary fields on the DWRC screen such as the name of the person
contacted, contact method, contact subject, contact address, contact phone and record
the statement received from the applicant or payer.
For example, “I spoke with the applicant on 1/15/2010 and he agrees with the agency
data for the company pension.”
The applicant disagrees with the IRS data
Obtain evidence from the applicant
Inform the applicant that he or she must provide evidence before SSA can make a determination
on his or her Extra Help application. Refer to HI 03035.006C.2. when sending an evidence request notice.
Inform the applicant that he or she can mail or bring in the evidence to a field office.
Provide the applicant with the address and telephone number of the SSA office, and
contact person of the SSA representative to submit the evidence.
NOTE: If this is an Workload Support Unit (WSU) verification issue, provide the applicant
with the address and telephone number for the servicing or most convenient SSA office
as stated in HI 03035.006A.
Obtain evidence from the payer
If the applicant is unable to provide evidence, send the applicant an SSA-8510 (Authorization
for the Social Security Administration to Obtain Personal Information) for signature
along with a return postage paid envelope. When the applicant returns the signed SSA-8510,
send a request to the payer to obtain the necessary information.
After receiving the evidence, complete the required fields such as the name of the
person contacted, contact method, contact subject, contact address, contact phone
and record the statement received from the applicant or payer. Record the type of
document submitted as evidence. Include the tax year and the monthly amount used as
the verified amount. Refer to HI 03035.006 for instructions for completing the verification process.
The IRS data and the payer data conflicts (use the most current data)
Complete the required fields with the name of the person contacted, contact method,
contact subject, contact address, contact phone and record the statement received
from the applicant or payer.
Record the type of document submitted as evidence. Include the tax year and the monthly
amount listed. Include the following statement, “The IRS data and the payer data conflict.
The IRS (or payer) data is the most recent evidence for pension (or annuity) and will be used
as the verified amount to process the subsidy application.”