RS 00205.400: Processing Claims and Conversion Cases for Student Benefits

changes
←	*	→

~~Effective Dates: 07/09/2014 - Present~~
Effective Dates: 01/05/2018 - Present
TN 19 (06-09)
RS 00205.400 Processing Claims and Conversion Cases for Student Benefits
A. Background
To reduce the number of inappropriate interruptions of benefit payments and to improve payment accuracy to student beneficiaries, we changed from a back-end to a front-end enforcement process for students whose date of birth is 06/02/83 or later. We revised Form SSA-1372 (RS 00205.400C).
The student obtains the school official's certification of the student's school attendance before returning the form to the field office (FO). The student also leaves page 4 of the SSA-1372 with the school official for reporting changes in full-time attendance (FTA).
We eliminated Forms SSA-1386, SSA-1388, and SSA-1390.
B. Policy
The student must have an official of his or her school certify the student's attendance before we adjudicate the claim. The official must answer the questions on page 3 in addition to completing the signature area of the form. Obtain FTA verification of all periods of attendance, whether current or retroactive, in which the child has attained age 18 prior to adjudication in every case. This policy applies to all educational institutions.
C. Student's statement regarding school attendance (Form SSA-1372)
For an exhibit of Form SSA-1372, see OS 15010.580.
D. Procedure for an initial or re-entitlement claim
1. General
If you are taking a claim for a child who is at least age 17 years and 6 months, or will be that age or older as of the date the claim is processed, determine if the child will be a student in the month of attainment of age 18. In addition, question the child about childhood disability benefits (CDB).
If the child alleges disability, follow the instructions in RS 00203.080 – RS 00203.090 to develop a CDB claim.
For instructions about determining fugitive status, follow the instructions in GN 02613.050 (Initial Claims – Determining Fugitive Status) and EM-09025.
NOTE: A child who qualifies for student benefits as the child of a living NH in an initial claim must be in FTA “throughout the month” for the first MOET. A student is deemed to meet this requirement if he or she meets the definition of FTA in What is Full-Time Attendance in RS 00205.300.
2. Forms
The FO completes the child’s application in MCS (or on Form SSA-4-BK, Application for Child's Insurance Benefits, for MCS exclusions) and Form SSA-1372, Student's Statement Regarding School Attendance, and provides the student with the following forms:
* Form SSA-1383, Student Reporting Form; and
* Form SSA-453-F4, How Your Earnings Affect Your Benefits.
3. School certification
The student must take the SSA-1372 to the school for a school official to certify on page 3 the school attendance information the student provided on page 2. The student must leave page 4, Notice of Cessation of Full-Time Attendance, of the SSA-1372 with the school official so the school will be able to report the date and reason the student's full-time attendance ended.
The student, either in person or by mail, must return pages 2 and 3 of the SSA-1372 to the FO after the school official certifies the student's information.
4. Processing the claim
Process the claim as follows:
STEP
ACTION
1
Review Form SSA-1372
* to resolve any discrepancies; and
* to determine whether there are factors that preclude student entitlement (e.g., incarceration (RS 00205.130), being paid by an employer to attend school (RS 00205.125A.1.)).
Does it appear the child may qualify for student benefits?
If yes, go to step 2.
If no, go to step 5.
2
Determine if the school the child is attending is an educational institution (EI) as discussed in RS 00205.250.
Does the development indicate the school is an EI?
If yes, go to step 3.
If no, go to step 5.
3
Determine if the child is in full-time attendance (FTA) as discussed in the following sections:
* RS 00205.300, What is Full-Time Attendance?
* RS 00205.310, Scheduled School Attendance
* RS 00205.315, Duration of Course of Study
* RS 00205.320, Deemed Full-Time Attendance During a Period of Nonattendance
* RS 00205.325, When Student Benefits Terminate
Does the development indicate the child is in FTA?
If yes, go to step 4.
If no, go to step 5.
4
Take action to award benefits (MSOM COMMON 005.029).
Enter the school’s operating basis as certified by the school official in question 3 on page 3 (Certification by School Official) of the SSA-1372.
Absent evidence to the contrary, consider the student to be a legally competent adult and pay benefits directly to him or her. Appoint a representative payee only if the student is incapable of managing benefits. Continue entitlement while developing a representative payee.
~~Fax the SSA-1372 into the Non-Disability Repository for Evidentiary Documents (NDRed) or eDIB for retention in the Claims File Records Management System (CFRMS).~~
Fax the SSA-1372 into the Non-Disability Repository for Evidentiary Documents (NDRed) or eDIB for retention in the Claims File User Interface (CFUI).
~~Destroy the paper copy after verifying receipt of the document in CFRMS.~~
Destroy the paper copy after verifying receipt of the document in CFUI.
~~If PC action is necessary, in addition to faxing the form into CFRMS, fax the form to the Paperless fax number of the appropriate PC.~~
If PC action is necessary, in addition to faxing the form into CFUI, fax the form to the Paperless fax number of the appropriate PC.
5
Deny the claim (disallowance code 38, student not attending an EI, or disallowance code 41, student not in FTA, SM 00380.100).
Fax the SSA-1372 following the instructions in step 4. If the child is also applying for disability benefits, annotate Form SSA-1372 “Not full-time student” and fax it with the disability material.
E. Process when a child beneficiary is currently on the rolls
1. SSA-1387 to payee
Central Office (CO) mails Form SSA-1387, Advance Notice of Termination of Child's Benefits, to the payee when a child beneficiary attains age 17 years and 9 months. This notice informs the payee that the child's benefits will terminate at age 18 unless the child is a full-time elementary or secondary-school student or qualifies for childhood disability benefits. The notice further explains what action the payee should take if the child is disabled and the child should take if he or she is a full-time student. If the child is disabled, the payee should call or visit any Social Security office or call SSA's toll-free number.
If the payee visits an FO, he or she should take:
* The SSA-1387;
* A history of the child's disabling condition;
* Names and addresses of the child's medical record sources;
* Names and addresses of the schools the child attended;
* The child's employment history;
* The child's Social Security number; and
* A copy of a check or bank statement, if the child's name is on the account, for direct deposit.
The notice tells the payee that, if the child will be a student after age 18, the child must complete the SSA-1372 and return it to a local Social Security office before age 18.
2. SSA-1372 to child
At the same time CO mails the SSA-1387 to the payee, it mails the SSA-1372 to the child. The cover sheet tells the child that, to receive student benefits after age 18, he or she must:
* Complete the SSA-1372, Student's Statement Regarding School Attendance;
* Take the form to an official of his or her school to certify the student's attendance;
* Leave the form, “Notice of Cessation of Full-Time Attendance,” with a school official; and
* Return the completed form to a Social Security office.
* For direct deposit, he or she should take a voided check or a copy of a bank statement with his or her name on the account.
The cover sheet tells the child that, to receive childhood disability benefits, he or she must contact a Social Security office and provide:
* A history of the disabling condition;
* Names and addresses of medical record sources;
* Names of schools attended;
* His or her work history; and
* His or her Social Security number.
F. Procedure for age 18 conversion cases
1. The student returns the SSA-1372 to the FO
If the child returns the completed and certified SSA-1372 (pages 2 and 3) to the FO, the FO reviews the student's statement and the school's certification to determine whether student benefits are payable. Be sure the child has answered the disability question.
If the child alleges disability, follow the instructions in RS 00203.080 – RS 00203.090 to develop a CDB claim.
For instructions about determining fugitive status, follow the instructions in GN 02613.050 (Initial Claims – Determining Fugitive Status) and “Fugitive Felon: Stop Suspension or Denial of Individuals with Felony Warrants Affected by the Martinez Settlement” EM-09025.
If the child does not qualify for student benefits, process the denial (RS 00205.400F.5.).
If the child qualifies for student benefits, process the SSA-1372 and give or mail the student the following forms:
* SSA-1383, Student Reporting Form; and
* SSA-453-F4, How Your Earnings Affect Your Benefits.
2. If a PC receives a misrouted SSA-1372
Review the student's statement and the school's certification (pages 2 and 3) to determine whether student benefits are payable. Be sure the child has answered the disability question.
If the child alleges disability, develop a CDB claim.
If the child does not qualify for student benefits, process the termination (RS 00205.400F.6.).
If the child does qualify for student benefits, the PC will:
* Send the student the following forms:
* SSA-1383, Student Reporting Form; and
* SSA-453-F4, How Your Earnings Affect Your Benefits.
* Process the SSA-1372 (RS 00205.400F.6.).
3. Form SSA-1372 is received after benefits terminated and the child was in FTA in the age 18 attainment month
If the child was in FTA in the age 18 attainment month and his or her entitlement was erroneously terminated, treat the SSA-1372 as new and material evidence. Do not require a new application unless the period of nonattendance exceeded four consecutive months (RS 00205.320D).
Input the information per RS 00205.400F.6.
4. Student changes schools or does not graduate on schedule
If the student changes schools or does not graduate on schedule, he or she must complete another SSA-1372, have his or her attendance certified by a school official, and return pages 2 and 3 to the FO for processing.
The FO inputs new entitlement data to the STUD screen (MSOM COMMON 005.029) based on the new SSA-1372. See RS 00205.400F.6., step 4, in this section.
5. Form SSA-1372 is received after benefits terminated and the child was not in FTA in the age 18 attainment month
If we receive a Form SSA-1372 after terminating benefits and the child was not in actual or deemed FTA in the age 18 attainment month (RS 00205.320D), send the child a notice informing him or her of our decision. Include paragraph number 209 (with appropriate fill-ins) from NL 00708.100.
6. Processing Form SSA-1372
Process the Form SSA-1372 as follows:
STEP
ACTION
1
Review Form SSA-1372
* To resolve any discrepancies; and
* To determine if there are factors that preclude student entitlement (e.g., incarceration (RS 00205.130), being paid by an employer to attend school (RS 00205.125A.1.)).
Does it appear the child may qualify for student benefits?
If yes, go to step 2.
If no, go to step 5.
2
Determine if the school the child is attending is an EI as discussed in RS 00205.250.
Does the development indicate the school is an EI?
If yes, go to step 3.
If no, go to step 5.
3
Determine if the child is in FTA as discussed in the following sections:
* RS 00205.300, What is Full-Time Attendance?
* RS 00205.310, Scheduled School Attendance
* RS 00205.315, Duration of Course of Study
* RS 00205.320, Deemed Full-Time Attendance During a Period of Nonattendance
* RS 00205.325, When Student Benefits Terminate
Does school certification establish the child is in FTA?
If yes, go to step 4.
If no, go to step 5.
4
Follow the instructions in MSOM COMMON 005.029 to process the conversion to student benefits.
Absent evidence to the contrary, consider the student to be a legally competent adult and pay benefits directly to him or her. Appoint a representative payee only if the student is incapable of managing benefits. Continue entitlement while developing a representative payee.
Code the STUD screen (MSOM COMMON 005.029) based on the student's expected graduation date from a secondary school and considering age 19 attainment (RS 00205.325). Enter the school’s operating basis as certified by the school official in question 3 on page 3 (Certification by School Official) of the SSA-1372.
Fax the SSA-1372 into the Non-Disability Repository for Evidentiary Documents (NDRed) or eDIB for retention in the Claims File Records Management System (CFRMS).
Destroy the paper copy after verifying receipt of the document in CFRMS.
If PC action is necessary, in addition to faxing the form into CFRMS, fax the form to the Paperless fax number of the appropriate PC.
5
The system automatically terminates benefits at age 18 if student data or disability data is not posted to the Master Beneficiary Record (MBR).
Fax the SSA-1372 following the instructions in step 4. If the child is also applying for disability benefits, annotate Form SSA-1372 “Not full-time student” and fax it with the disability material.
G. Procedure for VA non-insured cases
In Veterans’ Administration (VA) non-insured cases (RS 01702.540), forward completed student development and supporting evidence to the PC for processing.
If the child qualifies as a student, the PC prepares the award and lists the case under code 166, Development of Non-Insured VA Payment, (RS 01702.558 and RS 01702.562).
If the child does not qualify as a student, the PC prepares an amended award to terminate the child's benefits and adjusts rates to the remaining beneficiaries (RS 01702.572).

POMS Reference

RS 00205.400: Processing Claims and Conversion Cases for Student Benefits