RS 01505.042: Procedures to Resolve General State and Local Coverage Issues
Effective Dates: 11/30/2016 - Present TN 24 (11-09) RS 01505.042 Procedures for Resolving General State and Local Coverage Issues A. General procedure for resolving state and local coverage issues The following provides an overview of the procedure for resolving state and local coverage issues. 1. Tolerance rule for questionable coverage Do not develop in a claims case if the primary insurance amount (PIA) is, not affected by $1 or more. 2. Questions for development and documentation The following coverage questions may need to be developed and documented: * Is the individual an employee?
- * What is the identity of the employing entity?
* Is the employing entity included in the agreements?
- * Which Agreement or modification covers the service of the position?
- * What is the legal status of the employing unit, e.g., a governmental or proprietary function?
- * Is there an optional or required exclusion that applies?
* Is the employee's position under a state or local retirement system? * What is the retirement system status of the individual (i.e., member, ineligible, or optional)? * What is the date, the position was first placed, under the retirement system (or systems)? * Did the individual vote for or against coverage in a coverage referendum? Or, was he or she given additional opportunity for such coverage and so elected? * Was there a break in the individual’s service and or a break in retirement system membership? * Was the individual in an employment relationship on the date controlling retroactive coverage? 3. Procedures for making a coverage determination and correcting earnings Make a determination; use Form SSA-553 (Special Determination); Correct reporting errors as needed; use Form SSA-7010-U5 (see, Wage Correction/IRS Coordination RS 01405.000). Document the file including: * modification number * questionnaires * statements of the facts * copies of records * all other pertinent information Send a copy of the determination or a memorandum to notify the Parallel Social Security Office (PSSO).
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