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GN 02406.147: Handling a Request for a Certified Payment Extract (CPE)

changes
← * →
  • Effective Dates: 12/07/2017 - Present
  • Effective Dates: 12/18/2017 - Present
  • TN 25 (07-11)
  • TN 44 (12-17)
  • GN 02406.147 Handling a Request for Certified Payment Extracts
  • GN 02406.147 Handling a Request for a Certified Payment Extract (CPE)
  • A. Introduction to certified payment extracts
  • A. Introduction to CPEs
  • The certified extract is a record of payments used as a legal document in a court of law. Certified payment extract (CPE) requests may derive from local courts, private sector attorneys, or other entities seeking verification of benefit information for child support enforcement cases or food stamp fraud. Most requests come from the Office of the Inspector General (OIG). Certified payment extract requests are priority and should be handled within twenty business days of receipt.
  • A CPE is a certified record of payments that may be used for legal purposes, including as evidence in a court of law. CPE requests may derive from local courts, private sector attorneys, or other entities seeking verification of benefit information (for example, for child support enforcement cases or fraud in the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps). CPE requests are priority cases and should be processed within 20 business days of receipt.
  • B. Request for payment extracts from local courts, private sector attorneys, or other entities
  • B. Requests for payment extracts from local courts, private sector attorneys, or other entities
  • To prepare correspondence for a payment extract follow these instructions for the format and required information. Exact style may vary in the different processing centers and components.
  • To prepare correspondence for a CPE, prepare the following:
  • * Cover memorandum (Follow the instructions in Exhibit 1 in GN 02406.147F.);
  • * Authorization for certification of the extract (Swear Statement) (Follow the instructions in Exhibit 5 of GN 02406.147F in this section.); and,
  • * CPE (follow the format shown in Exhibits 6 and 7 GN 02406.147F in this section.)
  • Prepare the following:
  • * Cover memorandum. Follow the instructions in Exhibit 2 GN 02406.147F ;
  • * Authorization for certification of extract (Swear Statement); follow the instructions in Exhibit 3 of GN 02406.147F;
  • * Certified payments extract use the format shown in Exhibits 4 and 5 GN 02406.147F.
  • NOTE: Exact style may vary in the different processing centers and components.
  • Include the following items in the correspondence:
  • * A short introductory paragraph that includes the beneficiary's name and timeframe covered by the extract;
  • * A short introductory paragraph that includes the beneficiary's name and the timeframe covered by the extract;
  • * The payment history including:
  • * Issue date of the check
  • * Exact amount of payment
  • * Explanation of the check represented payment for the stated period
  • * Extract of data relating to negotiated checks only
  • * Do not include non-negotiated checks in the extract (i.e. a returned check)
  • * Include hospital insurance and supplemental medical insurance (HI/SMI) explanation when there is a change in HI/SMI
  • * Annotate the check range in the “represented Payment for” column for all prior month accruals (PMA) and critical payments (CPS);
  • * Explain any check that represented an overpayment;
  • * If the beneficiary identification code (BIC) involved has a payee change include the dates of the change in the opening paragraph;
  • * If a financial institution is involved show the name and address of that institution;
  • * Mail or fax completed request to the regional office address listed under GN 02406.147D.
  • * Issue date of the check;
  • * Exact amount of payment;
  • * Explanation of the payment and payment period;
  • * Extract of data relating to negotiated checks only; and
  • * An explanation of any change in Hospital Insurance and Supplemental Medical Insurance (HI/SMI)
  • C. Processing Title II requests for certified payment extracts
  • IMPORTANT: Do not include non-negotiated checks (such as a returned check) in the extract.
  • * Annotate the check range in the “Represented Payment for” column for all prior month accruals (PMAs) and Critical Payment System (CPS) payments;
  • * An explanation of any check that represented an overpayment;
  • * If the beneficiary identification code (BIC) involved has a payee change, annotate the dates of the change in the opening paragraph; and
  • * If a financial institution is involved, show the name and address of that institution.
  • OIG requests certified extracts for use in prosecuting Title II fraud. These extracts are acceptable as evidence at fraud hearings in lieu of certified photocopies of checks and of testifying by the SSA official identified as the keeper of record.
  • Mail or fax the completed request to the regional office address listed under GN 02406.147D.
  • OIG submits requests for all Title II extracts from the corresponding Payment Service Center’s Regional Center for Security and Integrity (CSI) in writing. You can identify these extract requests by the CSI flag, see Exhibit 1 GN 02406.147F. For OIG requests, the CSI will distribute copies of the extract; provide address of the OIG contact requesting the extract and a reference number, if applicable.
  • C. Processing Office of the Inspector General (OIG) requests for CPEs
  • D. Title II payment extract request addresses
  • OIG requests CPEs for use in prosecuting fraud cases. These extracts are acceptable as evidence at fraud hearings in lieu of certified photocopies of checks and of testimony by the SSA official identified as the keeper of record.
  • OIG submits requests for all CPEs from the corresponding Payment Service Center’s Regional Center for Automation, Security and Integrity (CASI). You can identify these extract requests by the CASI flag. See Exhibit 2 in GN 02406.147F. For OIG requests, CASI will:
  • * distribute copies of the CPE;
  • * provide the address of the OIG contact requesting the CPE; and
  • * provide a reference number, if applicable.
  • D. RO mailing addresses for Title II CPE requests
  • Mail or fax completed CPE requests to the regional office address listed in the following chart:
  • Address
  • Region
  • Mail or fax completed request to the regional office address listed below.
  • Region 2: New York (NEPSC)
  • Social Security Administration
  • Center for Security and Integrity
  • CASI Security and Integrity Team Center for Automation, Security and Integrity
  • 26 Federal Plaza
  • Room 40–160A
  • Room 4030–160A
  • New York, NY 10278
  • Telephone: (212) 264-2604
  • Fax: (212) 264-0916
  • Fax: (212) 264-29590916
  • 2 New York
  •     
  • Region 3: Philadelphia (MATPSC)
  • Social Security Administration
  • Office of the Regional Commissioner
  • Center for Security and Integrity
  • Center for Automation, Security and Integrity
  • Attn: Carmen Butler
  • Attn: Carmen Butler
  • PO Box 8788
  • Philadelphia, PA 19101
  • Telephone: (215) 597-1014
  • Fax: 215-597-5203
  • Region 4: Atlanta (SEPSC)
  • 3 Philadelphia (MATPSC)
  • Social Security Administration
  • Center for Security and Integrity
  • Center for Automation, Security and Integrity
  • Birmingham Social Security Center
  • 1200 Rev. Abraham Woods Jr. Blvd.
  • Birmingham, Alabama  35285
  • Fax: (205) 801-1332
  •      
  • Region 5: Chicago (GLPSC)
  • 4 Atlanta (SEPSC)
  • Social Security Administration
  • Center for Security and Integrity
  • Center for Automation, Security and Integrity
  • P.O. Box 87479
  • Chicago, IL 60680
  • Telephone: (312) 575-4120
  • Fax: (312) 575-4121
  •    
  • Region 7: Kansas City (MAMPSC)
  • 5 Chicago (GLPSC)
  • Social Security Administration
  • Center for Security and Integrity
  • Center for Automation, Security and Integrity
  • MAMPSC
  • PO Box 15625
  • Kansas City, MO 64106
  • Telephone: 816-936-5555
  • Telephone: 816-936-5555 Fax: 816-936-5573
  • Fax: 816-936-5573
  •      
  • 7 Kansas City (MAMPSC)
  • Region 9: San Francisco (WNPSC)
  • Social Security Administration, SFRO
  • Center for Security and Integrity, 2nd FL
  • Center for Automation, Security and Integrity, 6th FL
  • PO Box 4206
  • San Francisco, CA 94804
  • Fax: 510-970-2644
  •      
  • Mail or fax completed requests for PC7 and PC8 to the address listed below.
  • 9 San Francisco (WNPSC)
  • Mail or fax completed CPE requests for PC7 and PC8 to the address listed below.
  • Office of Central Operations (PC7 or PC8)
  • Social Security Administration
  • Office of Central Operations
  • Center for Security and Integrity
  • Center for Automation, Security and Integrity
  • 1500 Woodlawn Drive
  • PO Box 32921
  • Room 7040 SWT
  • Baltimore MD 21241
  • Fax: 410-597-0140
  • Email: ||OCO Integrity Branch
  • E. Processing Title XVI request for certified payment extracts
  • E. Processing Title XVI requests for CPEs
  • To request Title XVI payment extracts, complete the request letter as appropriate. See GN 02406.147F for an example of the request letter. Email (preferred), mail or fax the information to the regional office of jurisdiction at the following address:
  • Address
  • Region
  • To request Title XVI payment extracts, complete the request letter as appropriate, see GN 02406.147D. Mail or fax information to the regional office of jurisdiction at the following address:
  • Region 1: Boston
  • Social Security Administration
  • JFK Federal Building
  • Room 1925
  • Boston, MA 02203
  • Fax: (617) 565-9359
  •  Region 2: New York
  • 1 Boston
  • Social Security Administration
  • Center for Programs Support
  • Center for Disability and Program Support
  • 26 Federal Plaza
  • Room 4060
  • New York, NY 10278
  • Telephone: (212) 264-4004
  • Telephone: (212) 264-1461
  • Fax: (212) 264-2071
  •   
  • Region 3: Philadelphia
  • 2 New York
  • Office of the Regional Commissioner/Seventh Floor
  • Center for Programs Support
  • P.O. Box 8788
  • Philadelphia, PA 19101
  • Fax: (215) 597-2989
  •   
  • Region 4: Atlanta
  • 3 Philadelphia
  • Social Security Administration
  • Center for Programs Support
  • Center for Disability and Program Support
  • Atlanta Regional Office
  • Suite 22T64
  • 61 Forsyth St, Suite 23T42
  • 61 Forsyth Street, S.W.
  • Atlanta, GA 30303-8907
  • Atlanta, GA 30303
  • Fax: (404) 562-1325
  •    
  •    Region 5: Chicago
  • 4 Atlanta
  • CRSI/SSI
  • PO Box 8280
  • Chicago, IL 60680-8280
  • Fax: (312) 575-4245
  •   
  •  Region 6: Dallas
  • 5 Chicago
  • SSA, MOS, CPS, SSI
  • 1301 Young St, Ste 670
  • Dallas, TX 75202-5433
  • Fax: (214) 767-1348
  • Phone: (214) 767-4224
  •    
  •    Region 7: Kansas City
  • 6 Dallas
  • Center for Programs Support
  • Center for Disability and Programs Support
  • ATTN: Certification Request
  • Room 1073, 601 E 12th St
  • Kansas City, MO 64106
  • Fax: (816) 936-5951
  •    
  • Region 8: Denver
  • 7 Kansas City
  • Social Security Administration - CPS 1001 17th Street Denver, CO 80202
  • Social Security Administration - CPS1961 Stout Street
  • Suite 06-145
  • Denver, CO 80294
  • Fax: (303) 844-4280
  •   
  •    Region 9: San Francisco
  • 8 Denver
  • Social Security Administration, SFRO
  • Center for Programs Support, 6th Fl
  • Center for Disability and Programs Support, 6th Fl
  • PO Box 4206
  • Richmond, CA 94804
  • Fax: (510) 970-8101
  • Attn: Regional Privacy Act Coordinator
  •    
  • Region 10: Seattle
  • 9 San Francisco
  • Social Security Administration, SPST
  • Suite 2900, MS 303A
  • 701 5th Avenue
  • Seattle, WA 98104-7075
  • Fax: (206) 615-2643    
  • Fax: (206) 615-2643
  • 10 Seattle
  • F. Example of formats to use when requesting payment extracts
  • F. Example formats for requesting payment extracts
  • Use these examples as a guide to format your request for CPEs. OIG uses one form to request CPEs for both Title II and Title XVI.
  • Use these examples as a guide to format your request for payment extracts. OIG uses one form to request payment extract for both Title II and Title XVI.
  • 1. Exhibit 1 Example of Extract Cover Note
  • Exhibit 1 — Form to Request Title II Payment Extract
  •    
  • Social Security Administration Regional Office- __________________ Date:
  •       
  •    
  • Special Agent's Name Special Agent's Title SSA/OIG 6401 Security Boulevard Baltimore, MD 21235
  •    
  •      
  • Dear (Agent's Name):
  • This is in reference to your letter dated ____________, about payments made to ___________(Recipient's Name), Social Security number _____________ for the period _____________ through _______________ . Please see enclosed extract.
  •      
  • If you have any further questions regarding this, please contact __________________, Region _____, at _________________ .
  •     
  • Sincerely, (Name)____________ (Title)____________ Regional Office ____________
  • Enclosure
  • 2. Exhibit 2 OIG Payment Extract Request Format for Title II and Title XVI
  •    
  • Office of the Inspector General Office of Investigations Social Security Administration
  •    
  •      
  • Date:         _______
  • To:         Social Security Administration (Regional Offices addresses) Fax:
  •    
  •      
  • From:        _______________________________________
  •                   _______________________________________
  •    
  •        
  • Subject:      Request for: ­­­­­­­­­­­­­­­­­­­­__________________________________________________
  • RE:            SSA OIG OI File Number (SSN) ________________________________
  •    
  • In conjunction with an official investigation being conducted by this office, this is a request for (if requesting payment extract, provide period of time covered): _________________________ _________________________ _________________________
  • Please forward the documents identified above to _______________________ at the following address no later than ___________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      (Requester phone number: _____________________) 
  • 3. Exhibit 3 Form to Request Title II Payment Extract
  • Request of Title II (SSA) Benefit Payments
  •    
  • Send to:
  • Social Security Administration
  • Center for Security and Integrity
  • (Insert the Processing Center of jurisdiction address )
  •    
  • Requests involving all Foreign Claims and Disability Claims under Age 55        
  • Please prepare:
  • (check one)
  •         (a) Certified extract (court date scheduled for)           (b) Extract (no court date scheduled)
  • of benefits for all payments issued to the following beneficiary (ies) under the following Social Security number(s) during the listed period:
  •     
  • Social Security Number (SSN):                          
  • Beneficiary (ies):
  • 1)         /      
  •  
  • 2)        /       
  •  
  • 3)        /      
  •  
  • Name                 Own SSN:
  • Time Period for record of payments (only months/years involved in investigation)
  • (After 12/83)
  • From                      Thru:                       
  •  
  •        (MM/YY)             (MM/YY)  
  •  
  • This request is made as part of an investigation of a possible fraud/violation of the _______________________________________________ program(s). Case Number: _______________ Name of Requester: _______________ Title of Requester:  _______________  Office of Requester: _______________         
  • This request is part of an investigation of a possible fraud/violation of the _______________________________________________ program(s). Case Number: _______________ Name of Requester: _______________ Title of Requester:  _______________  Office of Requester: _______________         
  • Requester Phone NO: _______________                   
  • Date:  _____________              Signature _____________    
  •    
  •  
  • Exhibit 2 – Cover Memorandum to the Office of Investigation:
  • 4. Exhibit 4 Cover Memorandum to the Office of Investigation
  • Letterhead Memorandum Paper
  • To
  • : Requesting Office
  • From
  • : Authoring Component
  • Subject
  • : 000-00-0000,                     
  •     
  •  (Claimant's name), Request for Certified Extract (Request dated ______) (Include reference number in the subject line)          
  •   
  • Attached are the authorization for certification of extract records, certified extract of benefits for payments issued to all beneficiaries on this account from _________through__________.
  •     
  • Payments certified for the period______through______were for payment via direct deposit to (Bank’s name and address), for deposit to checking/savings account number ______and identified by the routing and transit number (RTN)                                                    .
  •   (Complete only if applicable)   
  •                  (Director's Signature)   
  •                  (Director’s Name)
  •  
  • Process Division__________ Attachments
  •    
  • Exhibit 3 – Authorization for Certification of Extract from records:
  • 5. Exhibit 5 Authorization for Certification of Extract from Records
  •      
  • Baltimore, Maryland 21241 Refer to:              
  •  (Requesting office Name and Address)
  •     
  • CERTIFICATION OF EXTRACT FROM RECORDS
  • In accordance with provisions of Title 42, United States Code (USC), Section 904, and the authority vested in me by 42 U.S.C. 902. I hereby certify that I have legal custody of certain records, documents, other information established and maintained by the Social Security Administration, pursuant to Title 42, United States Code, Section 405, and that the annexed is a true extract from such records in my custody as aforesaid.
  • In accordance with provisions of Title 42, United States Code (USC), Section 904, and the authority vested in me by 42 U.S.C. 902, I hereby certify that I have legal custody of certain records, documents, other information established and maintained by the Social Security Administration, pursuant to Title 42, United States Code, Section 405, and that the annexed is a true extract from such records in my custody as aforesaid.
  • I further certify that all signatures of the Social Security Administration officials on the annexed document(s) are genuine and made in accordance with the signers’ official capacity
  • IN WITNESS WHEREOF, I have set my hand and caused the seal of the Social Security Administration to be affixed this_______day of_______.
  • IN WITNESS WHEREOF, I have set my hand and caused the seal of the Social Security Administration to be affixed this ________day of_______.
  •      
  •      
  •            (Director's Signature)              (Director's Name)
  •         
  • Exhibit 4 – Extract Format
  • 6. Exhibit 6 Extract Request Format
  •      
  • Social Security Administration Refer to: ________
  •             
  • To Whom It May Concern:
  •            
  • The following Social Security benefits was certified for payment to John Doe and Jane I. Doe under Social Security claim number 000-00-0000 for the period July 3, 1997 through June 3, 1998 and have not been reported as non-receipt items.
  • The following Social Security benefits in the chart below were certified for payment to John Doe and Jane I. Doe under Social Security claim number 000-00-0000 for the period July 3, 1997 through June 3, 1998 and have not been reported as non-receipt items.
  •      
  • Approximate Date of Payment
  • Amount
  • Represented Payment for
  • July 3, 1998
  • $604.20
  • June 1998 minus supplemental medical insurance premiums of $9.60
  • August 1, 1997
  • $604.20
  • July 1997
  • September 3, 1997
  • $604.20
  • August 1997
  • October 3, 1997
  • $604.20
  • September 1997
  • November 3, 1997
  • $604.20
  • October 1997
  • December 3, 1997
  • $604.20
  • November 1997
  • January 2, 1998
  • $604.20
  • December 1997
  • February 3, 1998
  • $604.20
  • January 1998
  • March 3, 1998
  • $638.90
  • February 1998
  • April 3, 1998
  • $638.90
  • March 1998
  • May 3, 1998
  • $638.90
  • April 1998
  • June 3, 1998
  • $638.90
  • May 1998
  •  
  • $7,389.20
  • Total amount paid to John Doe and Jane I. Doe for July 3, 1997 through June 3, 1998
  •    
  • Exhibit 5 – OIG Payment Extract Request Format – Title II and Title XVI
  •    
  • Office of the Inspector General Office of Investigations Social Security Administration
  •    
  •      
  • Date:         _______
  • To:             Social Security Administration (Regional Offices addresses) Fax:
  •    
  •      
  • From:        _______________________________________
  •                   _______________________________________
  •    
  •        
  • Subject:      Request for: ­­­­­­­­­­­­­­­­­­­­__________________________________________________
  • RE:            SSA OIG OI File Number (SSN) ________________________________
  •    
  • In conjunction with an official investigation being conducted by this office, this is a request for (if requesting payment extract, provide period of time covered): _________________________ _________________________ _________________________
  • Please forward the documents identified above to _______________________ at the following address no later than ___________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      ­­­­­­­­­­­­_________________________________________________
  •                      (Requester phone number: _____________________) 
  •       
  • Exhibit 6 – Request for Title XVI Payment Extract
  • 7. Exhibit 7 Request for Title XVI Payment Extract
  •    
  • Social Security Administration Request for Title XVI Payment Extract
  •    
  • To: Social Security Administration (Regional Offices addresses) Fax:
  •    
  • From:
  •   
  • Subject: Request for: (check one)
  •    
  •  ____(a) Certified extract (court date scheduled for) ______ or  ______ (b) Extract (no court date scheduled) of benefits for all payments issued to (Recipient's Name)_____________ , (Payee's Name, if appropriate)____________ , (Recipient's SSN)     ______________ for the period of ________ thru (use MM/YY format).
  •  ____(a) Certified extract (court date scheduled for) ______ or  ______ (b) Extract (no court date scheduled) of benefits for all payments issued to (Recipient's Name)_____________ , (Payee's Name, if appropriate)____________ , (Recipient's SSN)     ______________ for the period of ________ through (use MM/YY format).
  •     
  • Please forward the materials requested to the following name and address by__________________.
  •                                                                     
  • _______________________________
  •  
  • Phone:   ___________________             
  •  Requester's Signature: _________________                  Date: _______________
  •     
  • Thank you for your assistance in this matter.
  •    
  • Exhibit 7 – Example of Extract Cover Note
  •     
  • Social Security Administration Regional Office- __________________ Date:
  •       
  •     
  • Special Agent's Name Special Agent's Title SSA/OIG 6401 Security Boulevard Baltimore, MD 21235
  •    
  •      
  • Dear (Agent's Name):
  • This is in reference to your letter dated ____________, about payments made to ___________(Recipient's Name), Social Security number _____________ for the period _____________ through _______________ . Please see enclosed extract.
  •      
  • If you have any further questions regarding this, please contact __________________, Region _____, at _________________ .
  •     
  • Sincerely, (Name)____________ (Title)____________ Regional Office ____________
  • Enclosure
  •    
  • Exhibit 8 – Example of Title XVI Payment Extract
  • 8. Exhibit 8 Example of Title XVI Payment Extract
  •    
  • Social Security Administration Regional Office ______________
  •    
  • I, _________________________, Social Security Administration, Region ___, hereby certify that the following business system records of the Social Security Administration pertain to the record of (Recipient's Name ) ________________ , Social Security number _________________ .
  • I further certify the records of the Social Security Administration show that entitlement to the Supplemental Security Income (SSI) payments as of (Date)____________ , under Section 1602 of the Social Security Act were paid to (Recipient's Name) __________________ .
  • I further certify that the records of the Social Security Administration show that eligibility for the Supplemental Security Income (SSI) payments as of (Date)____________ , under Section 1602 of the Social Security Act were paid to (Recipient's Name) __________________ .
  •    
  • Below is the record of the SSI payment for the period you requested. I further certify that the current representative payee is (Representative Payee's Name, when appropriate) ___________________.
  • Below is the record of the SSI payment(s) for the period you requested. I further certify that the current representative payee is (Representative Payee's Name, when appropriate) ___________________.
  •    
  • DATE
  • AMOUNT
  • 06/01/1990
  • $418.40
  • 06/02/1990
  • 5548.79
  • 07/01/1990-12/01/1990
  • 418.40 PER MONTH
  • 01/01/1991-12/01/1991
  • 439.40 PER MONTH
  • 01/01/1992-12/01/1992
  • 454.40 PER MONTH
  • 01/01/1993-12/01/1993
  • 466.40 PER MONTH
  •    
  • Sincerely,    (Name)      (Title)       Regional Office _____________________
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