TN 24 (11-05)

A. Introduction

If the payee contacts the FO, TSC or PC and requests a replacement Representative Payee Report because they lost, damaged or misplaced the initial or second request SSA-623-OCR-SM, Representative Payee Report, SSA-6230-OCR-SM, Representative Payee Report, or SSA-6234-OCR-SM, Representative Payee Report self mailer, provide the payee with the appropriate version (and latest edition) of the SSA-623-F6, Representative Payee Report, SSA-6230-F6, Representative Payee Report, or SSA-6234-F6, Representative Payee Report. The SSA-623-F6 and SSA-6230-F6 forms are presently available electronically via FormFlow (E-forms).

B. Policy

The FO, TSC or PC must enter certain identifying and payment information on the form before giving it to the payee to complete and mail to WBDOC. The information is required to clear the title II system and title XVI (and concurrent) AR diary control that was established when the record was selected for accounting and to assist the payee in responding to the “Use of Benefits” questions.

CAUTION: WBDOC cannot process the SSA-623-F6, SSA-6230-F6, or SSA-6234-F6 with incomplete information. If WBDOC cannot process the form, it results in system generated follow-ups (i.e., second request accounting reports to payees or nonresponder alerts to the FOs).

C. Procedure – General

Take the following action to ensure that WBDOC can clear the control on the record.

• Use the eRPS, MBR or SSR to complete the top portion of the SSA-623-F6, SSA-6230-F6, or SSA-6234-F6 with enough information to permit control clearance. See GN 00605.035D, for required information.

• Provide the payee with the appropriate WBDOC address for control clearance. (These addresses are provided in GN 00605.030B.2.).

D. Procedure — Show Identifying and Payment Information

Complete as much of the top portion of the form as possible. In all events, show at least the minimum items described below.

CAUTION: If the MBR shows SSI involvement for the beneficiary, use the SSR to complete the form as a concurrent case.

1. All Forms

Always enter the following items on the forms:

1. Social Security Number on which the beneficiary receives benefits. In concurrent cases, enter the title XVI SSN.

2. The payee legend.

3. The beginning and ending dates of the 12-month report period (see GN 00605.035E. to determine the report period).

4. Item 3 on the SSA-623-F6 and SSA-6230-F6 or Item 2 on the SSA-6234-F6 - Total Accountable Amount (see GN 00605.035F. to determine the TAA).

2. Title II Forms

Always enter the following items on the forms:

1. The beneficiary's BIC.

2. All the BICs along with the child's first name when completing an SSA-6230-F6 form. (See GN 00605.010B.2. to determine which payee types and custody situations meet SSA-6230-OCR-SM criteria.)

3. Title XVI and Concurrent Forms

Always enter the following items on the forms:

1. The ID. For concurrent cases enter the ID and the BIC.

2. The beneficiary's full first name if not shown in the payee legend. (This situation should be rare but it is possible the beneficiary's name is formatted as a first initial and surname due to space constraints.)

3. The force pay indicator if applicable.

4. Enter the child's first name when completing an SSA-6230-F6 form. (See GN 00605.010B.2. to determine which payee types and custody situations meet SSA-6230-OCR-SM criteria.)

E. Procedure — How To Determine the Report Period

Use the RPS, MBR or SSR to determine the 12-month report period for which the payee must account.

1. Title II

1. Use the eRPA in the eRPS to query the system control file to determine the 12-month report period beginning and ending dates (always use the first day of the month with the beginning date and the last day of the month with the ending date), or

2. Review the MBR to determine the last month of the report period. Is there a NAM (Negotiated Accountability Month) date in the RPAYEE segment?

   • If yes, use the last day of the NAM month as the end month of the report period.

   • If no, use the last day of the DOS (date payee selected) month as the end month of the report period.

3. Assume the report period ended in the calendar year in which the NAM or DOS month most recently occurred.

4. Count back 12 full calendar months from the end of the report period. The first month is equivalent to the month after the NAM or DOS month.

EXAMPLE: On June 28, 2001, the payee contacts the TSC and asks for a replacement for a lost SSA-623-OCR-SM form. No NAM is present in the RPAYEE segment of the MBR for the beneficiary. The DOS date is 05/1998. The last month of the report period is May. The report period ended with the last day of May 2001. The first month of the report period is June; the 12-month report period is 06/01/2000 through 05/31/2001.

2. Title XVI and Concurrent

Use the SSR to determine the 12-month report period beginning and ending dates. Assume the report period ended in the calendar year in which the NAM or DOS month most recently occurred. The NAM is shown as M: and the DOS as S: in the REPY segment of the SSR.

It will be necessary to review the NM coding on the SSR:

1. If NM coding is present, begin the report period on the first day of the month following the NM and end the report period with the last day of the twelfth month.

   EXAMPLE 1: The SSR shows M:07/00. The four digits represent the month and year for which the payee last accounted; i.e., July 2000. The report period is 08/01/2000 through 07/31/2001.

   EXAMPLE 2: The SSR shows M:06/99. The calendar year is 2001. The report period is 07/01/2000 through 06/30/2001.

2. If there is no NM data, assume the payee has not previously accounted for payments received. The report period begins with the first day following the DOS month and ends with the last day of the twelfth month.

   EXAMPLE: The SSR does not display NM data. The DOS is 05/25/00. The report period is 06/01/2000 through 05/31/2001.

F. Procedure – How To Determine the Total Accountable Amount

The Total Accountable Amount (TAA) represents the total benefits paid during the 12-month report period plus conserved funds as reported on last year's accounting report.

1. Title II

Use the eRPA in the eRPS to query the system control file to obtain the TAA and complete Item 3 on the accounting report.

NOTE: Although the Payment History Update System (PHUS) record is used to determine benefits paid, it does not contain conserved funds data. When sending the payee a replacement accounting form, obtain the TAA from the eRPA screen.

2. Title XVI

Compute the total benefits paid during the 12-month report period by reviewing the Payment History (PMTH) segment of the SSR (along with the PHUS record for concurrent cases); obtain the prior conserved funds amount from the CF: field in the REPY segment; and complete Item 3 on the accounting report.

G. References:

• MS INTRANETERPA 001.001 through MS INTRANETERPA 005.015

• SM 00510.000 - Master Beneficiary Record

• SM 00630.000 - Payment History Update System