TN 49 (06-18)

A. General information about the FMS 1199 (Schedule of Courtesy Check Disbursements)

The FMS-1199 Form is a multi-purpose Regional Financial Center (RFC) document used to initiate the process of debiting the agency for incorrect credits and reversing credits for cancelled checks.

The following examples are scenarios of reasons the Processing Center’s (PC) may receive FMS-1199s:

• When the RFC fails to locate the Courtesy Check Disbursement items although a check cancels. The Department of the Treasury (Treasury) issues a replacement check based on the nonreceipt procedures.

• Treasury reverses erroneous cancelled check issuances and notifies the RFC responsible for the cancellation. The RFC prepares an FMS – 1199 form and submits it to the Debt Management Branch; the Accounting Technicians receives this information and completes the SF-224 Form (Statement of Transactions) for courtesy check disbursements.

There is a possibility that duplicate payments exist for items appearing on the FMS-1199 form. Treasury issues a replacement check when the original payment is cancelled. However, the PC may also issue another check for the original cancelled check.

B. Procedure for processing the FMS 1199 in Title II cases

PC personnel will send a photocopy of the Form FMS-1199 to the Check, Customer Service Representatives (CSR), Benefit Earnings Technician (BET), or Disability Service Examiner (DSE) for processing as follows:

1. Examine the beneficiary’s Master Beneficiary Record (MBR) and Payment History Update System (PHUS) records for indications of original check status such as “held,” “returned,” or “cancelled.” If any of these indications exist, annotate the MBR with the remark “VOID--FMS-1199 RECEIVED FOR CANCELLED CK--(MO/YR).”

   Any PC action resulting in a beneficiary’s held, returned, and cancelled check action is erroneous due to Treasury's reversal of the check cancellation (reflected by Form FMS-1199).

2. Submit cases with the erroneous actions to the Benefit Authorizer (BA), via Form SSA-559 (Transmittal Slip for Claims Folder), and indicate pertinent data. When incorrect actions are nonexistent, return folder to files.

C. Process for processing the FMS- 1199 in Title XVI cases

The Division of Benefit Accounting and Systems Requirements (DBASR) compiles documents to include into the SF-224 for Agency Location Code 28-04-0004 SSI. They send copies of this form to Treasury Operations Branch (TOB) for review or processing. The analysts in TOB reviews the Supplemental Security Record (SSR) and the Treasury Status Query Control Record for check status information and any subsequent actions related to that payment month. After reviewing and collecting the information, TOB updates the SSR or initiates field contact for case resolution.