TN 15 (03-05)

A. Glossary

1. Application

An application is a claim for benefits or for certain rights affecting benefits (e.g., freeze). Also, the application is the form by which a claim is made, including those produced by MSSICS/MCS and the Internet. See GN 00201.010 for signature requirements.

2. Claimant

A claimant is a person on whose behalf the application is made.

3. Applicant

The applicant is the person filing the application. When filing on his/her own behalf, this person is also the claimant.

4. Adult

An adult is a person age 18 or over.

5. Minor

A minor is a person under age 18.

6. Auxiliary

An auxiliary is any person other than the number holder (NH) entitled to benefits on the earnings record of a living NH.

7. Survivor

A survivor is any person entitled to benefits on the record of a deceased NH.

8. MOE and MOET

The MOE and the MOET are the month of entitlement.

9. MOEL

The MOEL is the month the claimant chooses benefits to begin (i.e., the month of election).

10. Decision

A decision is a written notice of a formal action at or above the administrative law judge (ALJ) level.

11. Determination

A determination is a judgment on a fact or a group of facts supporting a conclusion. Determinations are steps in the adjudication process and are made below the ALJ level.

B. Policy — when an application is/is not required

1. When an application is required for entitlement — Title II

1. A valid application is required to receive Title II benefits. See GN 00204.001 for requirements for a valid application.

2. If the individual dies before the prescribed form is filed, a person who would be eligible to receive benefits on the deceased's earnings record may file the prescribed application. (See GN 00204.005 for instructions when an individual dies before filing and GN 02301.001 - GN 02301.500 for processing underpayments.)

2. When an application is required for eligibility — Title XVI

1. A valid application is required unless one of the situations described in SI 00601.010B.2. applies.

2. See SI 00602.010 through SI 00602.015, SI 00604.001 through SI 00604.105 (SSA-8000-BK) and SI 00605.001 through SI 00605.050 (SSA-8001-BK) and MSOM MSSICS 001.001 through MSSICS 001.009 for Title XVI instructions on completing the applications.

3. When an application is not required for Title II and Title XVIII

1. An individual is not required to file an application for Medicare if he/she is receiving retirement or disability benefits upon attainment of age 65 or, if under age 65, has been entitled to disability benefits for 24 months. (See HI 00801.022 for age 65 and HI 00801.146B for disability.)

2. An individual becomes automatically entitled to retirement insurance benefits upon attainment of full retirement age (FRA) if he/she is receiving disability insurance benefits for the month before attainment of FRA.

3. A child entitled to child's insurance benefits for the month before attainment of age 18, is eligible for benefit continuation, with no break in entitlement, based on disability or school attendance. (See RS 00205.001 for eligibility criteria for a student and RS 00205.400E.2. for completion requirements for the SSA-1372 (Student's Statement Regarding School Attendance).

   Note: Refer to DI 10115.001 through DI 10115.050 for eligibility requirements for a childhood disability beneficiary and RS 00203.080 for application guidelines for childhood disability benefits (CDB)).

4. An individual in a Part A buy-in State can be enrolled in Premium-HI and supplementary medical insurance (SMI) if he/she is part of a buy-in coverage group. (See HI 00801.140A)

5. A disabled individual whose earnings fall below substantial gainful activity (SGA) during the extended period of eligibility (EPE) after he/she completes the trial work period (TWP) is automatically reinstated to DIB, CDB or disabled widow(er)'s benefits (DWB). (See DI 13010.210G.) These reinstatements are for cash benefits or freeze and apply only to disability benefits that did not cease prior to 12/01/80.

6. For situations in which unreduced benefits are automatically converted, without an application, refer to the appropriate benefits subchapter as shown below:

   • DIB to RIB conversions – RS 00201.001 through RS 00201.003 (see NOTE below);

   • Conversion from auxiliary child's benefits to surviving child's benefits – RS 00203.040;

   • Conversion to widow(er)'s benefits – RS 00207.004 through RS 00207.005;

   • Conversion to mother's/father's benefits – RS 00208.001, RS 00208.040, RS 00208.085, and RS 00208.090.

   NOTE: If the DIB NH is at FRA when a subsequent disability determination (i.e., medical or SGA) shows that DIB ceased prior to the conversion, the DIB to RIB conversion will remain valid, the conversion of entitled auxiliaries will also remain valid, and no new application is required.

7. In an advance-filed claim, if an intervening event occurs after adjudication but before effectuation that nullifies the claimant's entitlement to the previously filed for benefit type, the application is an application for all other classes of Title II benefits. A new application is not necessary.

   EXAMPLE: A wife, DOB 08/16/41, files in 05/03 for spouse's benefits. The claim is adjudicated in 06/03 and the spouse is put on the Master Beneficiary Record (MBR) in advance-filed status with the month of entitlement (MOET) of 09/03. In 08/03, a notice is received that the NH died in 07/03. The spouse's application is a valid application for widow's benefits.

   It is possible that a deceased NH could have qualified for DIB during the 12 months before his/her death; however, an application for DIB must be filed within 3 months following the month of death. For this reason, if the widow(er) is not applying for the lump-sum death payment, or it will not be paid to anyone, and the NH died no more than 12 months beyond FRA, you must contact the widow(er) to determine if the NH was disabled prior to death. Record the results of the contact in the Special Message Field on the MBR.

   NOTE: In a retirement/spouse dual entitlement advance-filing situation where the NH dies before the spouse's MOET, the deemed filing provision no longer applies. Therefore, contact the claimant to discuss his/her MOET options, including withdrawal of the retirement claim when withdrawal is advantageous to the claimant. See GN 00204.039 and GN 00204.040 for reduced benefits and MOET options, respectively, and GN 00206.001 through GN 00206.150 for withdrawal policies and procedures.

8. A disabled widow(er) who is age 60, but not yet FRA, may elect to receive an aged widow(er)'s benefit if he/she is in suspense during the EPE because of SGA and payment of an aged widow(er)'s benefit though subject to the annual earnings test may still be advantageous. The individual can submit a SSA-795, Statement of claimant or Other Person (or other signed statement) to elect an aged widow(er)'s benefit for any month in which the individual was an aged widow(er). See RS 00615.315 for policy and procedure for simultaneous entitlement to a widow(er) and disabled widow(er)'s benefit.

9. An application may not be required if expedited reinstatement of disability benefits is requested under the Ticket to Work and Work Incentives Improvement Act of 1999 (see GN 00204.001F for the policy on using a reinstatement request as an application and DI 13050.000 for procedures on expedited reinstatement).

10. In situations where no payment or eligibility will result (i.e. technical entitlement or the claimant restricts the scope of the application).

    EXAMPLE: A widow is entitled on three different spouse records. All entitlements are discussed with the widow and an application is filed on the higher benefit record. The claim is documented with the filing decision and reason for the choice. Applications may not be needed on the other two spouse records if the claimant restricts the scope of the application per GN 00204.020. The first application that was filed would document the other entitlements.

4. When an application is required for re-entitlement — Title II

1. If entitlement terminates before the month the claimant can be re-entitled, the individual must file an application to become entitled again.

2. A deemed spouse must file a new application to become re-entitled if the entitlement was previously terminated because of the entitlement of a legal spouse (see RS 00202.040).

5. When an application is required for re-entitlement — Title XVI

Refer to SI 02301.205 for when a new application is required.

6. New application when DNA test results might allow reopening of child disallowance

When a child submits DNA test results that may constitute new and material evidence for reopening a prior child relationship disallowance within 4 years, the adjudicator should immediately take a new application. Under some States' intestacy laws, the DNA test results establish the child's status with respect to the number holder prospectively from the date of the DNA test, rather than back to the child's date of birth. In those cases, SSA cannot make a new decision prior to the date of the DNA tests; thus, we may not be able to reopen the prior determination. Benefits would be only payable based on a new application. At the time the DNA test results are submitted, the adjudicator will not necessarily know whether the DNA tests operate prospectively or retroactively. (The adjudicator may need to research POMS and legal precedent opinions, and possibly submit the issue to the Regional Chief Counsel.) Taking a new application will protect the child's benefit rights if we later find that we cannot reopen the prior determination. (See GN 00306.050 through GN 00306.065)

7. When a Title II application is required — Title XVI application taken

When a claimant wishes to file a Title XVI application, the claims interviewer must take a Title XVI application and a separate Title II application unless the claimant meets one of the exceptions in SI 00601.035B.2.

CAUTION: When a Title XVI application is filed, the claimant has also filed for Title II benefits. Both applications must be adjudicated per SI 00601.035.

C. Policy — filing an application

1. Filing decision

The interviewer/adjudicator is responsible for explaining the advantages and disadvantages of filing an application so that the individual can make an informed filing decision. The decision to file belongs solely to the claimant or his/her proper applicant. After an explanation of the advantages and disadvantages of filing and the filing considerations, if the individual decides to file, the claims interviewer should take an application. If a Title II claimant does not wish to file for Title XVI see GN 00201.005E for documenting the decision and GN 00201.005F for closing out any protective filing. If a Title XVI claimant does not wish to file, see SI 00601.037B. See GN 00203.015 for teleclaim procedures where the claimant does not know the Social Security number.

2. Advantages of filing

Filing an application will ensure that:

• Medicare/Medicaid entitlement is established when appropriate;

• A formal determination is issued with appeal rights; and

  NOTE: If the individual is inquiring about Title II benefits, explain that if he/she files a Title II application, SSA will issue a formal determination for all types of Title II benefits. If the individual is inquiring about Title XVI benefits, explain that filing a Title XVI application is also an application for all types of Title II benefits and that SSA will issue a formal determination for all types of Title II benefits.

• Any questions about an individual's apparent ineligibility will be resolved.

3. Disadvantages of filing

There are situations where filing may not be advantageous. Discuss the following when applicable:

• Delayed retirement credits can be earned for non-entitlement months from full retirement age (FRA) through the month before age 70. (see RS 00615.690)

• The reduced benefit taken before FRA may be offset completely after Government Pension Offset (GPO), while an unreduced benefit may permit some payment after GPO. (see GN 02608.100)

• Work deductions may be imposed based on the annual earnings test. (see RS 02501.001 through RS 02501.075)

• When reduced benefits are involved, advise the claimant about restriction on retroactivity and the possibility of higher benefits if filing is delayed. (see GN 00204.039)

• When a claimant is entitled to an aged widow(er)'s benefit and a disability benefit, the widow(er)'s month of entitlement (MOET) date should not be earlier than the MOET for disability benefits.

NOTE: Filing for other benefits is a requirement to receive SSI. The other benefits may represent countable income that could reduce SSI payments. See SI 00810.001– SI 00810.700 for the policy on countable income and SI 00510.001 through SI 00510.030 for the requirement for filing for other benefits.

4. Documenting an unfavorable filing decision

If there are any unusual circumstances that affect the filing date of an application or the amount of benefits (e.g., the claimant insists on filing even though it is not in his/her best interest) document the facts and the decision electronically (i.e., on the Remarks screen in the Modernized Claims System (MCS or Modernized Supplemental Security Income Claims System (MSSICS) as appropriate).

5. SSI involvement

When an applicant files a Title XVI application, he/she has also filed for Title II based on the scope of the Title XVI application (as explained in SI 00601.010D). However, since the Title XVI application does not contain the needed information to adjudicate the Title II application, claims interviewers must take a separate Title II application each time a Title XVI application is taken unless one of the exceptions in SI 00601.035B.1. applies.

While the individual retains the right to make the final decision about filing a separate Title II application, that decision should only be made after a full explanation of the impact of the decision on his or her Title XVI benefits. (See SI 00601.035C.4. for instructions on denying the Title XVI application if the individual does not file a separate Title II application.)

D. Procedure — filing considerations — Title II

1. Immediate Filing

The field office should not delay taking an application because of:

• Administrative conveniences, operational goals, case-processing concerns, need for extensive development;

• Doubt about entitlement/eligibility; or

• An individual's possible move to another service area.

NOTE: See GN 00201.005C.3. for situations when immediate filing may not be advantageous.

2. Individual is under Full Retirement Age (FRA)

a. Reduced benefits

• Advise the claimant about restrictions on retroactivity; and

• Advise the claimant that higher benefits may be payable if filing is delayed.

b. Other payments involved

Consider the impact of GPO when filing prior to FRA.

3. Individual within 4 months of FRA or older

Individuals at or near FRA should consider filing a claim after the interviewer:

• Advises the claimant that work deductions do not apply at FRA (i.e., work deductions apply in the year FRA is attained);

• Advises the claimant that delayed retirement credits will increase the monthly benefit amount (See GN 02409.100 through GN 02409.130 for instructions on voluntary suspension of benefits);

• Advises the claimant of the grace year;

• Tells the claimant how his/her self-employment income exclusion will be affected; and

• Informs the claimant about his/her Medicare eligibility.

4. Effect of filing when other program payments are involved

a. Retirement, Survivors, Disability Insurance (RSDI) benefits

Consider the following issues to help the claimant decide whether to file for Title II benefits:

• Inform the claimant that the amount of railroad (RR) annuity, Veterans Affairs (VA) payments, private pensions, etc., may be reduced because of entitlement to RSDI benefits. For RR unemployment cases, see RS 01601.170. For RR annuity cases, see RS 01601.130 - RS 01601.140. Because of possible reductions, the total monthly income including Social Security benefits may be less than what the individual is already receiving. If the claimant, spouse or former spouse is eligible to receive benefits from the Railroad Retirement Board (RRB), whether or not he/she is actually receiving them, and the claimant has not already contacted the local RRB office about the effect of filing for SSA benefits, he/she should do so prior to filing for SSA benefits.

  NOTE: A SSA application does not protect the filing date of a RRB life claim. For this reason, it is important to tell the NH to file an application with RRB to claim benefits under the Railroad Retirement Act (RRA) (RS 01602.500). See RS 01601.100 for the policy on when an application filed with the RRB is considered an application for Title II benefits.

• Do not advise the individual of the exact effect Social Security benefits will have unless there are specific instructions from the other program regarding a particular benefit or annuity.

• Advise the claimants who have questions about other benefits or annuities to contact the agencies involved.

• Take an application to avoid a loss of benefits and advise the claimant of his/her withdrawal rights.

• Advise the claimant to contact the field office after he/she learns the effect Social Security benefits has on the other benefit.

b. Black Lung (BL) benefits

Explain to the potential applicant that Title II disability benefits based on a miner's earnings may be subject to offset if Part C-BL benefits are received.

c. Veteran pension (VA)

• Ensure that the individual knows of the effect Title II benefits has on a VA pension (RS 01702.410) since the VA regards withdrawal after adjudication as a waiver of payment “not pursuant to a statute.” (See GN 00206.025 for instructions on processing a withdrawal request).

• Determine whether a widow(er) with children eligible for a VA pension wants to file for the children only. This applies where the widow(er) has other income and the family maximum is involved. The widow (er) should contact the VA for an explanation of its income limitations so that he/she can make a favorable decision.

• Consider an application filed with SSA for survivor benefits to be an application for survivor benefits with the VA. See GN 00204.001E.

5. Disability applications

1. Advise the claimant, that it is to his/her advantage to file immediately. Tell the claimant that this is especially true in cases where special assistance is required, (e.g., for minors, legally incompetent persons, institutionalized persons, and terminally ill individuals). See GN 00502.001 through GN 00502.300 for representative payee procedures and DI 11005.601 through DI 11005.605 for instructions on handling terminally ill individuals.

2. Tell the claimant that if his/her condition worsens and he/she already has a claim pending or the claim is being appealed, a new application is not required. Instead, only additional medical evidence that substantiates the worsening condition may need to be submitted. (See DI 12010.025)

3. Follow DI 23015.001 when a claimant fails to pursue the claim.

4. When non-entitlement is obvious (e.g., lack of insured status), explain the eligibility requirements.

5. Let the individual make the decision regarding filing. If he/she decides to file, take an application. See GN 00204.009 regarding ABAP procedures.

6. Applications involving Railroad (RR) employment

1. Ensure that the question about the number holder's (NH's) work in the RR industry on or after 1/1/37 is answered so that Social Security Administration (SSA) can determine whether RR compensation may be included in computing benefits. It will also be helpful to determine certification of benefits.

   NOTE: A SSA application does not protect the filing date of a Railroad Board (RRB) life claim. For this reason, it is important to tell the NH to file an application with RRB to claim benefits under the RRA (RS 01602.500). See RS 01601.230 for the policy on when an application filed with the RRB is considered an application for title II benefits.

2. Use the information to help determine whether the RRB or SSA has jurisdiction of the claim in death cases. SSA's action depends on whether the NH's total RR service is at least 120 months.

3. Determine if a deceased NH was insured (partially or fully) under the RR act and had a current connection with the RR industry at death. RRB will use both the RR and Social Security (SS) Title II earnings to compute the annuity. (See RS 01601.100B.6. for current connection definition.)

   NOTE: Social Security Administration (SSA) jurisdiction does not preclude RR certification responsibility. SSA will adjudicate the claim but certify payment to RRB for further actions. In certain circumstances, RRB remains the agency that has the authority and jurisdiction for adjudicating the claim. (See RS 01601.310 and RS 01601.310D. for examples.)

4. Explain to the NH who has filed for RR disability annuity (but only appears eligible for SS Title II freeze) that his/her RR application is also an application for a Title II freeze. (See DI 10105.025 - DI 10105.040.)

5. Do not advise the claimant to file a Title II freeze application, but accept a freeze application if the claimant insists on filing. Inform the claimant that he/she will be notified of a Title II freeze allowance or denial based on a joint RRB-SSA disability determination.

6. For additional references see:

   • Processing applications involving RR credits,RS 01601.210.

   • Use of the SSA-671 (Railroad Employment Questionnaire, RS 01602.608.

   • Jurisdiction Determinations of Survivor Benefits, RS 01601.300.

   • Certification of Social Security Benefits to the RRB, RS 01601.310.

7. Effect of dollar down rounding-dual entitlement or family maximum involved

The claims interviewer and/or the adjudicator should explain the effect of dollar down rounding when dual entitlement or the family maximum is involved.

E. Policy — exploring Title XVI eligibility with Title II claimants

1. When to explore Title XVI eligibility

The claims interviewer must explore Title XVI eligibility with every Title II claimant who is:

• within 2 months of age 65 or older (e.g., if the claimant's date of birth is March 4, within 2 months of age 65 attainment would be January and February), or

• alleging disability or blindness.

EXCEPTIONS:

The claims interviewer is not responsible for exploring Title XVI eligibility with the Title II claimant when:

• The 800 Number System shows that, at the time of the Title II application referral, a Title XVI oral inquiry occurred and was closed out with a SSA-L991 because the individual did not want to file for Title XVI. The MCS DW01 screen must contain the annotation that the SSA-L991 was issued and the date it was issued, or

• The SSA approved internet application (i.e., iClaim) indicates that the individual did not want to file for Title XVI. Online closeout language closes out the oral inquiry created by the Title II application. See SI 00601.027B.2. Title II Application as a Supplemental Security Income (SSI) Oral Inquiry; or

• The claimant meets the exception in SI 00601.025A.

See SI 00601.027 for the policy on when the Title II application filing date serves as an oral inquiry for SSI.

2. Documenting the filing decision

When SSI eligibility is explored, the claims interviewer must ensure that the claimant's intent to file is documented. The documentation requirement is satisfied when:

• a Title XVI application is taken;

• an appointment is scheduled to complete a Title XVI application and the appointment is documented on the Title II application per GN 00201.005F.2.a.;

• the SSA-L991 closeout notice is issued for the reason does not want to file as one of the denial reasons and documented on the MCS DW01 screen or on the paper Title II application per GN 00201.005F.2.b. See GN 00204.010 for the criteria of a protective writing;

• the filing for SSI question in iClaim is answered “no”; or

• the SSI question is not answered “yes” on the MCS Identification (IDEN) or Child (CHD) screen.

CAUTION: If the claimant's intent to file is not properly documented, the filing date of the claimant's title II application may serve as an oral inquiry for SSI. See SI 00601.027 for the policy requirements.

F. Procedure — exploring Title XVI eligibility with Title II claimants

1. Claims interviewer/adjudicator responsibilities

• Explain Title XVI eligibility requirements with the claimant;

• Explore the claimant's potential eligibility;

• Explain the advantages and disadvantages of filing;

• Ask the claimant if he/she wishes to file;

• Document the claimant's filing decision per GN 00201.005E.2.;

• Close out the SSI oral inquiry per GN 00201.005F.2.; and

• Close out any Title II protective writing per GN 00204.012.

2. Protective filing closeout

a. Claimant wishes to file

If the applicant wishes to file for SSI, complete an application.

NOTE: If the claimant is clearly ineligible for SSI and wishes to file, take an abbreviated application (ABAP). See SI 00602.001 through SI 00602.025 for ABAP policies and procedures. If the applicant wishes to file but is unable to complete the SSI application at the time of the Title II interview, follow the procedures in SI 00601.037 for scheduling an appointment. Annotate the MCS RPOC screen or the remarks section of the paper Title II application “SSI appointment scheduled.”

b. Claimant does not wish to file

If the Title II claimant does not wish to file for SSI:

• issue a SSA-L991 notice to closeout the oral inquiry. See SI 00601.040 for SSA-L991 policy and completion instructions; and

• annotate the MCS DW01 screen with the Title XVI closeout issue (i.e., T16CO) and enter the date the SSA-L991 notice was issued in the REC field or annotate the remarks section of the paper title II application “SSA-L991” and the date the notice was issued.

3. Effectuation of concurrent Title II and Title XVI applications

If the Title XVI and Title II applications are filed concurrently, be sure to enter the windfall offset code on the BECF screen (MCS). The entry of this code will prevent the release of the title II retroactive payment until the Title XVI is paid. See GN 02610.005 for the windfall offset procedures and SI 02006.005B for curtailing development in Title II offset situations.

G. Policy — providing applications to third party representatives

1. Providing limited number (10 or Less) of applications

A limited number (10 or less) of application forms can be provided upon request to the following:

• attorneys;

• accountants;

• religious order; and

• any business entity representing private individuals

Do not furnish application forms to advocacy or political groups that can not represent individuals for Social Security purposes.

2. Do not honor requests for more than 10 applications

Do not honor requests for more than 10 applications. Explain to the requester that:

• the field office (FO) does not keep supplies of applications for outside use;

• forms may become obsolete due to frequent revisions;

• obsolete forms may delay processing;

• an interview with a claim representative is preferred (or completion of a SSA Internet application) to help reduce development and assure the claimant's understanding of responsibilities; and

• up-to-date forms and instructions are available in the FO for specific cases.

3. When third parties request a large supply of applications

When third parties (e.g., large law firms or major for-profit organizations) ask for large supply of applications or any SSA forms or pamphlets, instruct them to order the materials directly from SSA as follows:

a. Requisition by faxing

Requisition a supply by faxing to 410-965-2037.

b. Requisition by mail

Requisition by mail, on the company letterhead to:

NOTE: The letter must include the form numbers, Inventory Control Number, quantities, name and telephone number of a contact person. Tell the requestors that benefit applications are available on the Internet - Social Security Online at http://www.ba.ssa.gov/online/ . Applications can be obtained- by calling 1-800-772-1213.

H. Policy — accepting applications from third parties

SSA may accept an application signed by a third party on behalf of a claimant if there is good cause for the claimant not signing and a loss of benefits would result. See GN 00204.003 for proper applicant policy, GN 00201.015 for attestation policy, GN 00204.010 for Title II protective filing policy and SI 00601.015 through SI 00601.025 for SSI protective filing policy. Whether or not the third party is the claimant's representative, a proper applicant (GN 00204.003 and SI 00601.012) must sign the application.

Examples of third parties include, but are not limited to, members of a church, a labor union representative, veterans' group, senior citizens' association, etc.

SSA may not disclose information about the claimant to a third party without the claimant's written consent unless the third party is the claimant's appointed representative (see GN 03340.040 and GN 03910.001 through GN 03910.090).

In adjudicating a claim, when the accuracy of the information provided is questionable, the FO should contact the claimant directly for clarification unless there is an appointed representative (see GN 03910.050). An adjudicator may determine that it is appropriate to redevelop information previously provided.

Following are examples of situations that may require re-contact with the claimant:

EXAMPLE 1: A third party assists with multiple claims for children in foster care. Foster care payments are alleged. The FO should verify the amount and source (Title IV-B, Title XX or Title IV-E) of alleged foster care payments in order to determine the amount of countable income.

EXAMPLE 2: An adjudicator notices that a third party who assists numerous claimants often submits a pre-printed SSA-795 (Statement of Claimant or Other Person) to declare the value of In-Kind Support and Maintenance as a loan. Re-contact with the claimants is required to verify the intent to repay the loan appropriate (SI 00835.480).

I. References

• GN 03910.025 Authority Of A Representative

• GN 03910.050 Contacting A Represented Claimant

• GN 03340.040 Disclosure To Third Parties And Authorized Representatives