TN 5 (01-16)

A. Identifying a Section 301 determination

You can identify Section 301 cases in several ways:

• Remarks on the Master Beneficiary Record (MBR);

• A “Y” in the 301 indicator of the disability determination section query (DDSQ);

• A disability control file (DCF) event indicating “301 case” on the query CDR screen (QCDR) or the CDR entitlement (ECDR) screen (Title II cases); and

• A copy of the Section 301 decision in the claims folder records management system (CFRMS).

B. Procedure when ODO approves Section 301 payments

1. Title II cases

The Section 301 provision continues payments to the beneficiary (including Medicare and Medicaid) and any auxiliaries on the record until he or she stops participating in the vocational program, or ODO determines that continued participation will not increase the likelihood of permanent removal from the disability rolls. ODO will annotate the decision in the special message field of the MBR. The FO will check CFRMS for the Section 301 decision, and update the 301DEC tickle when the 301DEC tickle on the DCF CDRW matures.

2. Title XVI cases

The FO will receive Title XVI and concurrent Section 301 payment continuation cases from ODO via fax and modernized development worksheet (MDW) advising the FO to:

• Input a Vocational Rehabilitation Plan (VP) diary (or update existing VP diary) via the diaries (UDIA) function in Direct SSR Update (MS BUSSR 002.019 Update Diaries (UDIA)). The VP diary prevents the case from updating to an N07/N08 payment status;

• Update the 301DEC issue on the DCF; and

• Annotate the SSR remarks with “Section 301 payment continuation.”

ODO will review the SSR for the updated VP diary. ODO will follow up by calling the FO’s administrative phone number if the FO has not updated the VP diary within 15 days.

NOTE: If N07/N08 termination occurred, reinstate benefits effective with the N07/N08 month. Input a VP diary via the diaries (UDIA) function in Direct SSR Update. Remove the N07/N08 from the FO action if N07/N08 termination does not occur.

C. Procedure when ODO approves Section 301 payments for a closed period

1. Title II cases

ODO will process the termination action and send the closed period notice. ODO will annotate the decision in the special message field of the MBR. The FO will check CFRMS for the Section 301 decision, and receipt in the 301DEC tickle when the 301DEC tickle on the DCF CDRW matures.

2. Title XVI cases

ODO will send the closed period notice. The FO will receive Title XVI and concurrent Section 301 closed period cases from ODO via fax and MDW advising the FO to:

• Delete the VP diary;

• Receipt in the 301 issue on the DCF;

• Input N07/N08, effective with the month after the month shown in item 9C of the SSA-832 (Cessation Or Continuance of Disability or Blindness Determination and Transmittal - Title XVI); and

• Annotate the SSR remarks with “Section 301 closed period mm/yy-mm/yy.”

ODO will review the SSR for the N07/N08 input. ODO will follow up by calling the FO’s administrative phone number if the FO has not updated the diary within 15 days.

D. Procedure when ODO denies Section 301 payments

1. Title II cases

ODO will process the termination action and send the denial notice. ODO will annotate the decision in the special message field of the MBR. The FO will check CFRMS for the Section 301 decision and receipt in the 301DEC tickle when the 301DEC tickle on the DCF CDRW matures.

2. Title XVI cases

ODO will send the denial notice. The FO will receive Title XVI and concurrent Section 301 denial cases from ODO via fax and MDW advising the FO to:

• Delete the VP diary;

• Receipt in the 301 issue on the DCF;

• Input N07/N08, effective with the month after the month shown in item 9C of the SSA-832; and

• Annotate the SSR remarks with “Section 301 denial.”

ODO will review the SSR for the N07/N08 input. ODO will follow up by calling the FO’s administrative phone number if the FO has not updated the diary within 15 days.

E. Procedure for work reported while receiving Section 301 payments

When you receive a work report for a beneficiary receiving Section 301 payments, issue a receipt per DI 13010.020.

Contact the beneficiary to determine if he or she is still participating in a program of VR, employment, training, educational, or other support services. Document the above information, including the name and address of the service provider (if any), on an SSA-795( Statement of Claimant or Other Person) and fax it to ODO at:

1. Title II cases

Do not create a work review in eWork. Do not process a work CDR or a substantial gainful activity (SGA) determination for beneficiaries receiving Section 301 payments. Such beneficiaries are not entitled to a trial work period (TWP), or extended period of eligibility (EPE).

2. Title XVI cases

Non-disability provisions, such as income counting and resource limits, continue to apply to beneficiaries receiving Section 301 payments. Apply the earned and unearned income exclusions to the work and earnings of these beneficiaries as appropriate. This includes impairment-related work expenses (IRWE), blind work expenses (BWE), student earned income exclusions (SEIE), and the plan to achieve self-support (PASS). We can modify a PASS while a beneficiary is receiving Section 301 payments; however, we cannot approve a new PASS after we determine that the beneficiary is no longer disabled.

F. Procedure when ODO requests assistance from the FO

ODO may request assistance from the FO via MDW to:

• Obtain information about the service provider, or

• Determine the status of a beneficiary’s participation in a VR or similar program, or

• Determine whether such program ended,

If ODO requests FO assistance, obtain an updated SSA-4290-F5 (Development of Participation in Vocational Rehabilitation or Similar Program) and complete parts I and II. Return the SSA-4290-F5 to ODO via fax using the fax number provided on the MDW.

G. Procedure when ODO requests termination of Section 301 payments

When a beneficiary completes or stops participating in his or her program, benefits terminate effective the month after the month of completion, or the month after the month participation stopped.

EXAMPLE: If the beneficiary completes the VR or similar program during October 2015, payments terminate effective November 2015.

1. Title II cases

ODO sends the required notices, updates the remarks on the MBR and terminates benefits.

2. Title XVI cases

ODO releases the termination notice, annotates the DCF, and sends a fax and MDW to the FO requesting immediate action to terminate benefits with the effective date. The FO processes the termination with a two-day action:

Day 1 - use MSSICS Direct SSR Update:

• Delete the VP diary;

• Transmit the MG code of T with the disability cessation date (if not already on the record) via the Continuing Disability Review (UDCR) screen;

• Input a Remark indicating the period of Section 301 eligibility and termination date; and

• Suppress all notices per SM 01301.675.

Day 2 - use SSI Data Inputs – SPE1 (PE Single Input):

• Input C01 for the months Section 301 payments were due after the cessation;

• Input N07/N08 for the month benefits terminate per ODO's instructions; and

• Suppress all notices.

NOTE: Check all inputs for the proper C01 and N07 months to ensure the overpayment or underpayment is correct.

H. Procedure when FO receives report that participation in VR or similar program ceased or the program ended

The FO may receive new or revised information about the beneficiary’s participation in a VR or similar program from the beneficiary or the service provider during a redetermination (RZ) or other post-entitlement (PE) actions.

1. Title II cases

During any PE discussions, ask the beneficiary or representative payee if he or she is still participating in VR or a similar program if the MBR has a 301 indicator or 301 payment remarks. If the beneficiary stopped participating or the program ended, accept the allegation and:

• Obtain a statement from the beneficiary on an SSA-795 showing the date the program ended or the date participation ceased and fax it into eView or NDRED;

• Send a manual due process notice. Follow the instructions in DI 14510.007G.3;

• Wait 15 days for response to the due process notice;

If no response or the information you receive does not change the decision to suspend benefits, input S9 suspension the month after participation ended and:

• Input a 60-day diary using the CDRW on the DCF for case control;

• Fax the Potential Section 301 Case Flag to the Paperless Processing Center (PPC) system using the paperless fax number 1-877-385-0643;

• Check the block “Case S9.” Provide the effective S9 date and the date participation stopped or the program ended;

• Update the remarks on the MBR, “Section 301 participation ended. Sent to ODO mm/dd/yy;” and

• Fax a copy of the flag and the SSA-795 to:

2. Title XVI cases

During an RZ or any other PE event, if the case has a VP diary, ask the beneficiary or representative payee if he or she is still participating in VR or a similar program. If the beneficiary states that the program ended for any reason, accept the beneficiary’s allegation, and:

• Obtain a statement from the claimant on an SSA-795 or on the Person Statement Screen (DPST) in MSSICS, showing the date the program ended or the date participation ceased and fax it into eView or NDRED;

• Send a manual due process notice. Follow instructions in DI 14510.007G.3; and

• Wait 15 days for response to the due process notice.

If no response, or the information you receive does not change the decision to suspend benefits:

• Input payment status N05 with the next Current Operating Month (COM) to avoid multiple overpayments;

• Suppress the systems-generated notice;

• Add the Remark,” N05 due to pending 301 determination, participation ended MM/YY” to the SSR;

• Fax the Potential 301 Flag to ODO’s paperless fax number 1-877-385-0643;

• Check the block “Case N05.” Provide the effective N05 date and the date participation stopped or the program ended; and

• Fax a copy of the flag and the SSA-795 or DPST to:

3. Due process notice

For Title II cases, send the SSA-L951-U2 (Social Security Notice Letterhead). For Title XVI cases, send an SSA-8165-U2 (Important Information) notice to the beneficiary and the representative payee using the following language:

“We plan to suspend your benefits, effective MM/YYYY, because you told us that you are no longer participating in your approved program of vocational rehabilitation, employment training, educational, or other support services.

On <fill in date of previous notice>, we notified you that your disability had ended, but we would continue to pay you because you were participating in an appropriate program of vocational rehabilitation, employment training, or educational or other services.

You told us that you stopped participating in your program in MM/YYYY.

Another office will make the special decision about whether you are eligible for payments for the month your disability ended through the month your participation in the program ended. We will notify you of their decision in another letter.

If you have any questions, you may contact your local Social Security office. The address and telephone number are printed at the top of this notice. If you call or visit a Social Security office, please have this notice with you. It will help us answer your questions.”

I. Beneficiary responds to due process notice regarding the suspension

If the beneficiary disagrees with the suspension:

• Ask if the information we have is correct.

• If the beneficiary has information that proves he or she is still in VR or a similar program, document the response on an SSA-795.

• If the beneficiary does not have proof, but claims he or she is participating in VR or a similar program, use form SSA-4290-F5 and SSA-827 (Authorization to Disclose Information to the Social Security Administration) to obtain evidence from the service provider.

• If the beneficiary states our information is correct, explain the suspension of benefits and explain that it is a terminating event, since the DDS determined that the beneficiary is no longer disabled and no longer eligible for Section 301 benefits.

• If the claimant states he or she is still disabled and wants to file a new claim, take a new claim.

J. Past due VP diaries

ODO follows up on matured VP diaries and no FO action is required. However, if you discover a past due diary during an RZ or PE event, check eView or CFRMS for recent development requests and denial or allowance notices. If there is no recent case activity, send a fax alerting ODO of the past due VP diary to:

K. Policy for overpayments resulting from continuing payments

A beneficiary who is overpaid because he or she received continued payments while awaiting a Section 301 determination can be found without fault for the overpayment if the person acted in good faith in believing he or she was participating in a qualified program, and cooperated with our development of his or her participation. However, this does not mean that automatic waiver applies. You must complete full waiver development (defeat the purpose or against equity).

The following are examples of when a person may not have acted in good faith:

• The beneficiary knew he or she did not begin participating in a program before the medical cessation or that participation did not continue for at least two months after cessation.

• The beneficiary did not cooperate with Section 301 development requests from the Social Security Administration (SSA) or DDS.

IMPORTANT: If you must make a good faith determination, consider any physical, mental, educational, or linguistic limitations the beneficiary has that affect his or her ability to act in good faith. For instructions on making fault or without fault findings, see GN 02250.005C.