GN 02604: Penalties
TN 23 (01-17)
A. Social Security notices
The notice language for administrative sanctions is on the Document Processing System (DPS).
1. Beneficiary not in pay and an administrative sanction applies
When we deny a beneficiary Social Security and subsequently find him or her subject to an administrative sanction:
Include the applicable language with the appropriate fill-in choices on form notice titled Important Information (see GN 02604.460B).
Use the caption, “Why We Will Not Pay You/Name of Claimant”
Include the appeals language in GN 02604.460C.
2. Beneficiary in pay and a sanction applies
When a beneficiary is in current payment status and we find him or her subject to an administrative sanction:
Include the applicable language with the appropriate fill-in choices on form notice titled Important Information (see GN 02604.460B).
Use the caption, “Why Your/Name of recipient (possessive form) Payments Are Stopping”
Include the appeals language shown in GN 02604.460C.
B. Language to explain administrative sanctions to the beneficiary
Use the language in this subsection to explain administrative sanctions.
______(1)________
Under Social Security rules, we will not pay a person Social Security payments for a certain period of time if that person:
made a statement or presented a material fact that the person knew or should have known was false or misleading, and the information was for use in deciding entitlement or benefit amounts; or
omitted material facts that the person knew or should have known we needed when we decided entitlement or benefit amounts; or
failed to report a material fact that could have affected entitlement or benefit amounts if the person knew or should have known that failing to disclose the information would be misleading.
When we do not pay the person, we call this a penalty. The first time we apply a penalty we will not make payments for 6 months, the second time we will not make payments for 12 months, and for any time after that we will not make payments for 24 months.
____(2)______
____(3)______
____(4)______
We have decided __(5)__ ___(6)____ as described above. ______(7)_________
___(8)____
Fill-ins:
|
1. |
Choice 1: |
We are writing to tell you that, if (you become/name of claimant becomes) entitled to Social Security benefits in the future, (you/she/he) will not receive all payments due. The rest of this letter will give you more information. |
|
Choice 2: |
We are writing to tell you that, even though (you are/name of beneficiary is) entitled to Social Security benefits, we will not pay (you/her/him) for MM/YY through MM/YY. The rest of this letter will give you more information. |
|
|
2. |
Choice 1: |
This penalty applies to Social Security and Supplemental Security Income payments. We will send a separate notice about (your/her/his) Supplemental Security Income payments (you/she/he) filed for or are already due. |
|
Choice 2: |
Null |
|
|
3. |
Choice 1: |
(Your/Her/His) entitlement to Medicare is not affected by this penalty. |
|
Choice 2: |
Null |
|
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4. |
Choice 1: |
Benefits to anyone else who may be entitled on this record are not affected by this penalty. |
|
Choice 2: |
Null |
|
|
5. |
Choice 1: |
you |
|
Choice 2: |
she |
|
|
Choice 3: |
he |
|
|
6. |
Choice 1: |
made a statement or presented material facts |
|
Choice 2: |
omitted material facts |
|
|
Choice 3: |
failed to report material facts |
|
|
7. |
Description of why we decided on the penalty |
|
|
8. |
Choice 1: |
Therefore, we will not pay (you/her/him) as described above if (you become/she becomes/he becomes) eligible for Social Security benefits and/or Supplemental Security Income in the future. |
|
Choice 2: |
Therefore, we will not pay (you/her/him) from MM/YY through MM/YY. If (you meet/she meets/he meets) all Social Security entitlement requirements beginning MM/YY, we will start payments again. |
C. Appeals language for administrative sanction cases
Use the appeals language in this subsection for administrative sanction cases.
If You Disagree With The Decision
If you disagree with the decision, you have the right to appeal. We will review your case and consider any new facts you have.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.
You must have a good reason for waiting more than 60 days to ask for an appeal.
To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out the form.
How To Appeal
There are three ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide your case.
Case Review. You have a right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case.
Informal Conference. You'll meet with the person who decides your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.
Formal Conference. This is a meeting like an informal conference. The difference is we can make people come to help prove you're right. We can make them bring important papers about your case, even if they don't want to help you. You can question these people at your meeting.
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.
D. Sample Title II notices
Below are sample Title II administrative sanction notices.
1. Claimant not in pay and an administrative sanction applies
Social Security Administration
Retirement, Survivors, and Disability Insurance
Important Information
Office Address:
Social Security Number:
Date:
CLAIMANT'S NAME
STREET ADDRESS
CITY/STATE ZIP CODE
Type of Payment
Individual--Disabled
We are writing to tell you that, if you become entitled to Social Security benefits in the future, you will not receive all payments due. The rest of this letter will give you more information.
Why We Will Not Pay You
Under Social Security rules, we will not pay a person Social Security benefits for a certain period of time if that person:
made a statement or presented a material fact that the person knew or should have known was false or misleading, and the information was for use in deciding entitlement or benefit amounts; or
omitted material facts that the person knew or should have known we needed when we decided entitlement or benefit amounts; or
failed to report a material fact that could have affected entitlement or benefit amounts if the person knew or should have known that failing to disclose the information would be misleading.
999-99-9999
00/00/00 Page 2
When we do not pay the person, we call this a penalty. The first time we apply a penalty we will not make payments for 6 months, the second time we will not make payments for 12 months, and for any time after that we will not make payments for 24 months.
This penalty applies to Social Security and Supplemental Security Income payments. We will send a separate notice about your Supplemental Security Income payments you filed for or are already due.
Payments to anyone else who may be entitled on this record are not affected by this penalty.
We have decided you made a statement or presented material facts as described above. You gave us documents belonging to someone else to prove your age.
We will not pay you as described above if you become entitled to Social Security benefits and/or Supplemental Security Income payments in the future.
If You Disagree With The Decision
If you disagree with the decision, you have the right to appeal. We will review your case and consider any new facts you have.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.
You must have a good reason for waiting more than 60 days to ask for an appeal.
To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out the form.
How To Appeal
There are three ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide your case.
Case Review. You have a right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case.
Informal Conference. You'll meet with the person who decides your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.
Formal Conference. This is a meeting like an informal conference. The difference is we can make people come to help prove you're right. We can make them bring important papers about your case, even if they don't want to help you. You can question these people at your meeting.
999-99-9999
00/00/00 Page 3
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.
If You Have Any Questions
For general information about Social Security we invite you to visit our website at www.socialsecurity.gov on the Internet. For general questions and specific questions about your case, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 000-00-0000. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY/TDD number 000-00-0000. If you do call or visit an office, please have this letter with you. It will help us answer your questions.
Social Security Administration
2. Beneficiary in pay and a sanction applies
Social Security Administration
Retirement, Survivors, and Disability Insurance
Important Information
Office Address:
Social Security Number:
Date:
CLAIMANT'S NAME
STREET ADDRESS
CITY/STATE ZIP CODE
Type of Payment
Individual--Disabled
We are writing to tell you that, even though you are entitled to Social Security payments, we will not pay you for July 2001 through December 2002. The rest of this letter will give you more information.
Information About Your Payments
Under Social Security rules, we will not pay a person Social Security benefits for a certain period of time if that person:
made a statement or presented a material fact that the person knew or should have known was false or misleading, and the information was for use in deciding entitlement or benefit amounts; or
omitted material facts that the person knew or should have known we needed when we decided entitlement or benefit amounts; or
failed to report a material fact that could have affected entitlement or benefit amounts if the person knew or should have known that failing to disclose the information would be misleading.
999-99-9999
00/00/00 Page 2
When we do not pay the person, we call this a penalty. The first time we apply a penalty we will not make payments for 6 months, the second time we will not make payments for 12 months, and for any time after that we will not make payments for 24 months.
Your entitlement to Medicare is not affected by this penalty.
We have decided you made a statement or presented material facts as described above. You gave us documents belonging to someone else to prove your age.
Therefore, we will not pay you from July 2001 through December 2001. If you meet all Social Security entitlement requirements beginning MM/YY, we will start payments again.
If You Disagree With The Decision
If you disagree with the decision, you have the right to appeal. We will review your case and consider any new facts you have.
You have 60 days to ask for an appeal.
The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.
You must have a good reason for waiting more than 60 days to ask for an appeal.
To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out the form.
How To Appeal
There are three ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide your case.
Case Review. You have a right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case.
Informal Conference. You'll meet with the person who decides your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.
Formal Conference. This is a meeting like an informal conference. The difference is we can make people come to help prove you're right. We can make them bring important papers about your case, even if they don't want to help you. You can question these people at your meeting.
999-99-9999
00/00/00 Page 3
If You Want Help With Your Appeal
You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.
If You Have Any Questions
For general information about Social Security we invite you to visit our website at www.socialsecurity.gov on the Internet. For general questions and specific questions about your case, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 000-00-0000. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY/TDD number 000-00-0000. If you do call or visit an office, please have this letter with you. It will help us answer your questions.
Social Security Administration