SI NY02220.005 Documenting the SSI Overpayment (RTN 421 – 12/2009)
A. Documenting the SSI Overpayment – NDRed
The resolution of SSI overpayments must be documented. The SSA-632 (Request for Waiver of Overpayment Recovery or Change in Repayment Rate), and any other related paper documentation that cannot be recorded electronically, must be faxed into the Non Disability Repository for Evidentiary Documents (NDRed) for documentation purposes. Do not retain the paper material after it has been faxed into NDRed (GN 00301.316).
B. 2 Pin Process – SSI Overpayment $2,000.01 or Greater
Per POMS SI 02220.005 - If the amount of the overpayment is $2,000.01 or more, all overpayment waiver (approve or deny), discontinued collection, or suspension dispositions must be reviewed by office management in order to insure that the decision is both technically accurate and in conformance with POMS instructions.
The management review of overpayment dispositions is accomplished through a 2-PIN process. The employee will enter the decision that he/she wishes to record. When a decision is posted to the Overpayment Decision (UOPD) screen (BUSSR 004.008), or the Waiver (UOWV) screen (BUSSR 004.009), one of two alerts will be displayed as follows:
The management review of overpayment dispositions is accomplished through a 2-PIN process. The employee will enter the decision that he/she wishes to record. When a decision is posted to the Overpayment Decision (UOPD) screen (MSOM BUSSR 004.008), or the Waiver (UOWV) screen (MSOM BUSSR 004.009), one of two alerts will be displayed as follows:
AMOUNT IS GREATER THAN $2000 – NEED MANAGEMENT APPROVAL
If UOPD-SELECTION OF DISPOSITION DECISION equals 4, 5, 6, 7, 8, or 11 and the DECISION AMOUNT is greater than $2,000.00, the decision must be approved by management.
AMOUNT IS GREATER THAN $2000 – NEED MANAGEMENT APPROVAL
If the UOWV-DECISION AMOUNT is greater than $2000 and the REASON code = 3, 4,5,6,7 or 8, management approval is needed
At that time, management is required to review and, if appropriate, approve the decision. If approved, management will use the Decision Approval (UODA) screen (MSOM BUSSR 004.020) to complete the transaction. These transactions will only be processed if both inputs are made on the same day. Therefore, employees must alert a member of management the same day that the overpayment disposition decision requires management approval.
NOTE: The 2 PIN process is always required if the Overpayment Disposition Amount (OPA) is $2000.01 or greater - even if the individual overpayment sequences are less than $2000.01.
There are times when the entire overpayment is $2000.01 or greater, but the Overpayment Disposition Amount (OPA) for individual sequences on the SSR are less than $2000.01. This is not material to the POMS policy indicated above. The MSSICS system may not be able to indicate the actual total of a particular overpayment in one sequence, however, this has no impact on the mandated policy. For example, we may have three sequences for which the OPA for each sequence is less than $2000.01. However, collectively, the entire overpayment is greater than $2000.00.
MSSICS will not invoke the 2-PIN process in these situations and will not generate the “AMOUNT IS GREATER THAN $2000.00-NEED MANAGEMENT APPROVAL” alert. However, management review and approval of the waiver or uncollectible disposition is still required
C. 2 Pin Process – SSI Overpayment $20,000.01 or Greater
For overpayments $20,000.01 or greater, the Assistant Regional Commissioner for Management and Operations Support (ARC, MOS) is required to review all overpayment waiver (approve or deny), discontinued collection, or suspension dispositions and, if appropriate, approve the decision. The ARC, MOS is responsible for the second PIN transmission. In order to ensure FOs properly document their cases, a member of management should review the case prior to submission to the ARC, MOS.
The ARC, MOS review of overpayment dispositions is accomplished through a 2-PIN process. Once an overpayment decision of $20,000.01 or greater is ready for review (i.e., all paper documentation is faxed into NDRED, and there is a recommendation by the FO) an email should be sent to the ARC, MOS through the Center for Programs Support at ||NY CPS. A new Flag was created for FO staff to utilize to submit their SSI Overpayments to the ARC, MOS. All emails should include the new Flag as shown below.
NEW YORK REGION
SSI OVERPAYMENT OVER $20,000 APPROVAL REQUEST
TO: ||NY CPS Date Referred to RO _________
FROM: ____________________________ FO Code _____________
Recipient's Name: ____________________________________________
Recipient's SSN: _____________________________________________
FO Adjudicator Name ______________________________Phone #: ______________
Management Approver's Name: ______________________Phone #:______________
FO Recommended Disposition - Check one:
[ ] Waiver Approval
[ ] Waiver Denial
[ ] Suspend Collection
[ ] Uncollectible
[ ] Not a True OP
[ ] Compromise Settlement
[ ] Other:
NOTE: All Cases Must Be Faxed into NDRED and Include:
Has appeal of the medical cessation been exhausted and were all appeals pursued in good faith? Yes__ No_
Was the initial overpayment notice issued 60 day after last decision? Yes__ No__
Is the folder or all denial notices, including hearing decisions attached? Yes__ No__
Is the correct cessation month posted to the SSR? Yes__ No__
Is SSA-632 properly and fully completed and less than 1 year old? Yes__ No__
Was SSA 632 completed after exhaustion of all appeals? Yes___ No____
If you answered no to any of the preceding questions, the file is not ready for referral and you need to review the explanation page for the additional actions that are needed.
Explanation for Disability Cessation Cases
Per GN 02201.009B.7., the initial overpayment notice is not to be sent until appeal of the medical cessation has been exhausted. Per SI 02260.007.2c, in order to determine good faith, review the (cessation) file and any other available records and determine whether the appeal of the medical cessation was made in good faith. If a claimant fails to cooperate with the DDS in DHU processing of a reconsideration of a cessation, do not assume the appeal was made in good faith. Good faith cooperation with further levels of appeal will not change the determination based on a prior period of non-cooperation. If the individual cooperated with the processing of the appeal, assume that the appeal was made in good faith. In order to determine this, you need to review evidence in the medical cessation file (SSA-833 DI 13095.095), reconsideration determination, and hearing determination, etc,).
Per SI 02260.007.3 do not send the overpayment notice during the 60-day appeal period, or when an appeal has been timely filed. Do not send the overpayment notice even when the title XVI case is listed on the “B3” diary list. Once the appeal period has expired and no appeal has been filed, or all appeals have been exhausted, follow normal overpayment notice procedures. Send a revised overpayment notice--When an overpayment notice is issued in error or the content is incorrect, a revised notice should be issued with the appropriate paragraph advising this notice revises previously issued notice dated XX/XX/XXXX.
Refer to 1.
Per SM 05905.041 the correct month of cessation should be reflected on the SSR (DISB - MG: T-MM/YY). The payment status of N07/N08 should be posted for the correct month (3rd month after cessation month). In order to determine this, you need to review evidence in the medical cessation file (SSA-833, reconsideration determination, and hearing determination, etc).
Per SI 02260.005 the SSA-632-BK (Request for Waiver of Overpayment or Overpayment Recovery or Change in Repayment Rate) should be completed in full.
If the overpayment notice was sent prior to exhaustion of all appeals and a SSA-632 was received, the waiver must be dismissed as no overpayment exists. If the claimant wishes to pursue a waiver, we should take a new SSA- 632 after the new notice has been released.
After the case is reviewed by ARC, MOS, the email will be returned with a concurrence of the decision or comments for additional development. If the decision is a concurrence, the FO employee can enter the decision to the system, and email back to the ARC, MOS, through the Center for Programs Support at ||NY CPS, to complete the transaction.
Related SSI Overpayment Policy POMS References:
SI 02220.000 -- Recovery Procedures for SSI Overpayments
SI 02220.030 -- Compromise Settlement
SI 02220.040 -- Bankruptcy
SI 02220.045 -- Estate
SI 02220.050 -- Suspensions and Termination
SI 02220.051 -- Efforts to Locate
SI 02220.052 -- Fails to make Installment
SI 02220.053 -- Individual Deceased
SI 02260.000 -- Waiver Provisions for SSI Overpayments
SI 02260.001 -- Waiver Requirements
SI 02260.006 -- Personal Conferences
SI 02260.007 -- Waiver Procedures for Disability Cessation Cases
SI 02260.010 -- Development of Without Fault
SI 02260.015 -- Establishing without Fault
SI 02260.020 -- Defeat the Purpose of Title XVI
SI 02260.025 -- Against Equity and Good Conscience
SI 02260.045 -- SSA-632 Exhibit