GN 02608.200: Processing Initial Claims

changes
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~~Effective Dates: 05/02/2017 - Present~~
Effective Dates: 10/31/2017 - Present
TN 31 (05-17)
GN 02608.200 Processing Initial Claims
A. Field office (FO) initial claims development
The FO develops initial claims to apply the Government Pension Offset (GPO) according to the spouse’s response about receiving a pension based on non-covered government employment.
1. Spouse receives a periodic pension
When a spouse receives a Federal, State, or local periodic pension based on non-covered government employment, annotate the spouse's answers to the questions on the Additional Benefits (ADDB) screen and the applicable GPO screens in the Modernized Claims System (MCS) application path. If MCS is not available, complete the SSA-3885 (Government Pension Questionnaire).
If an exception to the GPO applies, develop according to instructions in GN 02608.200B.2. in this section.
A periodic pension can cause either partial or total GPO; for information about the types of GPO, see GN 02608.100B.
* If partial GPO applies:
* The claimant must provide evidence from the employer or pension-paying agency (e.g., an award letter) that shows the gross periodic pension amount, including pension amount changes as necessary, and the effective date of the pension. For additional types of evidence, see GN 02608.200B in this section.
* If the claimant receives a lump sum, obtain evidence and develop according to GN 02608.400.
* For pensions based on a combination of government and private employment, also request verification from the employer or pension-paying agency of the amount of the pension based on only the government employment (for more information, see GN 02608.400); or
* If the claimant receives a Federal pension, the Civil Service Data (DCSD) screen of the MCS Earnings Computation (EC) screens or the Civil Service (CS) Data line of the Informational/Certified Earnings Records (ICERS) is acceptable evidence about the periodic benefit. For information about the DCSD screen or the CS Data line in ICERS, see MS MCSEC 001.011 and SM 00349.090, respectively.
* If the claimant expects an increase in the current pension amount, enter the future month and year of the expected increase in the NEXT EXPECTED PENSION INCREASE DATE field on the Government Pension Periodic Payments (GPP1) screen. For information on the GPP1 screen, see MS COMMON 003.009.
* Do not enter a Stop Date for the current pension amount if the claimant expects an increase to the pension in the future.
* It is not necessary to establish a diary.
* The Regular Transcript Attainment and Selection Pass (RETAP) generates an alert for the processing center (PC) to follow up with the claimant for the expected pension increase.
* Inform the claimant to report any pension increase or decrease.
The system calculates the Social Security benefit amount based on the non-covered periodic pension information on the GPO screens.
* If total GPO applies:
* Accept the allegation without further development if the claimant alleges he or she began receiving the periodic pension on or before the date of entitlement (DOE) to spouse’s benefits.
* Verify and obtain evidence for the beginning month of the periodic pension if the claimant alleges he or she begins receiving the periodic pension after the DOE.
For information on how to handle payment of Medicare premiums when total offset applies, see HI 01001.190.
Electronically store evidence through the Non-Disability Repository for Evidentiary Documents (NDRed) system. For information about storing documents through NDRed, see GN 00301.322.
* If the claim has MCS processing limitations (for a list of processing limitations, see MS MCSEC 001.036):
* Process the claim via an A101/EF-101;
* Be sure the GPO data that propagates to the A101 is accurate. When the PC processes the award, the GPO data propagates to Manual Adjustment Credit and Award Data Entry (MACADE) screens.
* Include notice paragraphs, as appropriate. For notice instructions, see NL 00720.060.
For information about the A101 and EF-101, see MS MCS 014.001 and MS T2PE 009.001 respectively.
If other beneficiaries are due benefits on the same record, and you have not verified the periodic pension amount, apply total GPO to the spouse’s benefit. Include a paragraph in the notice to the spouse to explain why total GPO applies. Establish a diary code 025 on the Decision Input (DECI) screen to verify the pension amount.
NOTE: If the spouse is entitled to retirement (RIB) or disability (DIB) benefits on his or her own Social Security number, review the RIB or DIB record to determine if the Windfall Elimination Provision (WEP) should apply to the computation of the primary insurance amount (PIA) on that record. For more information about WEP, see RS 00605.360.
2. Spouse expects to receive a periodic pension, but has not yet applied for it
* When a spouse qualifies for a Federal, State, or local pension but has not yet applied for the pension, complete the following steps:
* Answer ‘Yes’ to the question about qualifying for a pension on the Additional Benefits (ADDB) screen and complete the additional questions on the ADDB screen about future entitlement to the pension.
* If the expected future date of entitlement is within one year, enter the date in the FUTURE PENSION ENTITLEMENT DATE field on the Government Pension (GPI1) ; or
* If the pension entitlement date is more than one year in the future or is unknown, enter a date in the FUTURE PENSION ENTITLEMENT DATE field of one year into the future. For information about the GPI1 screen, see MS COMMON 003.003.
* It is not necessary to establish a diary.
* The month before the month of the FUT PENSION ENT field on the Master Beneficiary Record (MBR), the RETAP process generates an alert in the PC to develop the future entitlement to the pension.
* Inform the claimant to report when he or she starts receiving the retirement or disability pension based on non-covered government employment.
* For claims that require an A101/EF-101, show “Development of GPO required" on the BCF/Remarks/Notice (BCRN) screen and show either the expected future date of entitlement, or if the future date of entitlement is unknown, show a date no more than one year in the future before forwarding the claim to the PC.
When a spouse qualifies for a Federal, State, or local pension but has not yet applied for the pension, complete the following steps:
* Answer ‘Yes’ to the question about qualifying for a pension on the Additional Benefits (ADDB) screen and complete the additional questions on the ADDB screen about future entitlement to the pension.
* If the expected future date of entitlement is within one year, enter the date in the FUTURE PENSION ENTITLEMENT DATE field on the Government Pension (GPI1) ; or
* If the pension entitlement date is more than one year in the future or is unknown, enter a date in the FUTURE PENSION ENTITLEMENT DATE field of one year into the future. For information about the GPI1 screen, see MS COMMON 003.003.
* It is not necessary to establish a diary.
* The month before the month of the FUT PENSION ENT field on the Master Beneficiary Record (MBR), the RETAP process generates an alert in the PC to develop the future entitlement to the pension.
* Inform the claimant to report when he or she starts receiving the retirement or disability pension based on non-covered government employment.
B. Evidence Development
It is the claimant’s responsibility to secure and provide evidence about a pension. Acceptable evidence includes award letters, pension payment statements showing the gross pension amount, or other correspondence from the pension-paying agency or the employer.
1. Evidence from employer or pension-paying agency
If the evidence a spouse provides is not sufficient:
* Obtain an SSA-L4163 (Employer Questionnaire) from the pension-paying agency or employer. Complete all items that precede the section labeled “AGENCY/EMPLOYER RESPONSE,” and fill in the month of entitlement to the Social Security benefit in item #2 before mailing the form to the employer for completion; or
* Contact the pension-paying agency by telephone and complete an SSA-5002 (Report of Contact), or annotate the Report of Contact (RPOC) screen in MCS. If any information contradicts what the spouse provides, ask the spouse to explain, and document the explanation on SSA-5002 or the RPOC screen in MCS.
* If the employer or pension-paying agency does not provide the exact increases in past pension amounts, follow instructions in GN 02608.400C.
2. Develop when exemption applies
If an exemption applies, develop, obtain evidence, and enter information about the applicable exemption on the appropriate GPO data input screens, see instructions in GN 02608.101 through GN 02608.107.
Completion of the Government Pension Type field and other fields in the GPI1 screen cause specific exemption screens to come into the MCS claims path.
If an exemption applies based on a Federal Civil Service pension, complete the following:
* For claims processed via MCS, fax a request to the PC via the Paperless process to add code “N” on the Civil Service Government Pension Offset (CSGPO) field of the MBR; or
* For claims that require an A101/EF-101, add the remark “Post the CSGPO of “N” in the Remarks portion of the BCRN screen.
When the “N” is on the CSGPO field of the MBR, it precludes an alert from generating when we match with Office of Personnel Management (OPM) to detect an unreported or under-reported periodic pension amount.
3. Spouse refuses to cooperate to provide evidence
If the spouse refuses to cooperate and does not provide evidence for a partial GPO or a GPO exemption, enter a pension amount large enough to apply total GPO in the GPP1 screen beginning with the first month of entitlement to spouse’s benefits. Document the development and explain why total GPO applies on the RPOC screen in MCS.
Include a paragraph in the notice to the spouse to explain why total GPO applies.
C. Processing center (PC) initial claims processing
If the FO is unable to process the spouse’s claim via MCS, the FO uses an A101 or EF101 to manually award the claim and then transfers the case to the servicing PC.
1. Procedure when GPO applies
If GPO applies:
* The information from the Government Pension Offset Determination (GPOD) screen propagates into MACADE when the PC receives the A101. For additional information about how to access GPO screens, see SM 00883.400C.
* Process the claim through MACADE.
* Include additional notice paragraphs as appropriate. For notice instructions, see NL 00720.060.
* If the case involves future entitlement to a pension, the RETAP process generates an alert the month before the expected entitlement date to the pension. It is not necessary to establish a diary.
2. Procedure when GPO exemption applies
If a GPO exemption applies:
* Code the exemption on the GPOD screen.
* If the exemption involves an OPM Federal periodic benefit, post an “N” to the CSGPO field on the MBR. For information about the GPO application process, see SM 03030.020.
D. Reference
MS MCS 014.001 Automated SSA-101 Process – Overview

POMS Reference

GN 02608.200: Processing Initial Claims