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RS 01404.110: Pre-lag Development and Documentation Requirements for Resolving Earnings Record Inaccuracies

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  • Effective Dates: 08/17/2016 - Present
  • Effective Dates: 06/26/2018 - Present
  • TN 14 (08-11)
  • TN 16 (06-18)
  • RS 01404.110 Pre-lag Development and Documentation Requirements
  • RS 01404.110 Pre-lag Development and Documentation Requirements for Resolving Earnings Record Inaccuracies
  • A. Policy on resolving earnings records inaccuracies
  • A. How to resolve earnings record (ER) inaccuracies
  • SSA employees are responsible for resolving earnings record inaccuracies. We are always required to resolve potential earnings record inaccuracies for any situation provided in RS 01404.110C.
  • SSA employees are responsible for resolving ER inaccuracies. When a claimant agrees with their Social Security Statement or the earnings posted to their ER, you must resolve earnings alert queries (EARQ) only in the following situations:
  • * Claimant is incapable and requires a representative payee; or
  • * Multiple FICA or possible duplicate earnings alert exists and using the alerted earnings could result in an incorrect increase.
  • In addition, unless required in RS 01404.110C, when a claimant agrees with their Social Security Statement or the earnings posted to their social security earnings record, we are required to resolve earnings alerts (EARQ) only in the following situations:
  • * it is clear the claimant is incapable and will require a representative payee; or
  • * a multiple FICA or possible duplicate earnings alert exists and using the alerted earnings could result in an incorrect increase.
  • B. When not to develop potential ER inaccuracies
  • B. When not to develop potential earnings record inaccuracies
  • Do not develop potential earnings record inaccuracies in the following situations:
  • * In Lump Sum Death Payment (LSDP)-only claims where no possible future entitlement exists.
  • * Subsequent claims when development was completed in a prior LSDP-only or other claim.
  • Do not develop potential ER inaccuracies in the following situations:
  • * Lump Sum Death Payment (LSDP)-only claims where no possible future entitlement exists.
  • * Subsequent claims after we completed development in a prior LSDP-only claim or other claims.
  • * Survivor claims if no combination of pre-lag or lag earnings establishes insured status.
  • * The additional alleged earnings (including lag earnings) do not affect entitlement, the primary insurance amount (PIA), or deductions.
  • * The additional alleged earnings are less than the amount needed for a quarter of coverage (QC) and no additional earnings are posted to the earnings record or alleged for the same quarter or year which would result in obtaining the amount needed for a QC unless it would affect the PIA as indicated above. For more information on increment amounts, see RS 00301.250.
  • * If the earnings record shows maximum earnings posted as duplicate items (i.e., the maximum is posted twice) unless a workers’ compensation/public disability benefit (WC/PDB) Average Current Earnings (ACE) determination is needed.
  • * The time limitation has expired and no exception exists. See exceptions to the statute of limitation in RS 02201.008.
  • * The Summary Earnings Query (SEQY) or Detailed Earnings Query (DEQY) show the MEF has been corrected.
  • * Unposted lag earnings in pre-claim situations, unless it is apparent from the number holder’s (NH's) explanation that the earnings will not be reported or posted for the preceding lag year. For more information on limits on earnings records development, see RM 03870.006.
  • * Additional alleged earnings (including lag earnings) do not affect entitlement, the primary insurance amount (PIA), or deductions.
  • * Additional alleged earnings are less than the amount needed for a quarter of coverage (QC) and no additional earnings are posted to the ER or alleged for the same quarter or year, which would result in obtaining the amount needed for a QC unless it would affect the PIA, as indicated above. For more information on increment amounts, see RS 00301.250.
  • * ER shows maximum earnings posted as duplicate items (i.e., the maximum is posted twice) unless a workers’ compensation/public disability benefit (WC/PDB) Average Current Earnings (ACE) determination is needed.
  • * Time limitation expired and no exception to the Statute of Limitations exists. See exceptions to the statute of limitation in RS 02201.008.
  • * When the Summary Earnings Query (SEQY) or Detailed Earnings Query (DEQY) shows that we corrected the Master Earnings File (MEF).
  • * Unposted lag earnings in pre-claim situations, unless it is apparent from the number holder’s (NH) explanation that we should not post earnings for the preceding lag year. For more information on limits on ER development, see RM 03870.006.
  • * Medicare-only claims and the 30th QC are not necessary for entitlement to premium HI.
  • C. When to develop potential earnings inaccuracies
  • C. When to develop potential ER inaccuracies
  • 1. Claims situations
  • 1. Develop for potential earnings record inaccuracies in the following claims situations:
  • Develop for potential ER inaccuracies in the following claims situations:
  • * Insured status is involved.
  • * Allegations of missing or inaccurate earnings.
  • * Claimant does not agree with the Social Security Statement
  • * The NH or surviving claimant is incapable and requires a representative payee. For more information on incapability and representative payees, see GN 00502.001 - GN 00502.075.
  • * It appears from the NH’s explanation that lag earnings will not be posted. (RM 03870.006)
  • * On an auxiliary or survivor's own earnings record when the applicant is eligible to apply on his or her own Social Security number (SSN).
  • * On life claim disallowances if possible future entitlement to benefits exists (per RS 02201.010 and GN 01010.440). Develop the earnings record issue after disallowing the claim.
  • * On lump sum death payment (LSDP)-only claims when a survivor is potentially entitled to future monthly benefits on the deceased NH's earnings record.
  • * A WC/PDB ACE determination is necessary. Develop even when maximum earnings are posted on the earnings record as duplicate items.
  • * On all scrambled earnings situations. (per RM 03870.045 - RM 03870.090).
  • * On DIB claims when the PIA computation includes one or two years of zero earnings that are not fully explained by the claimant's response to the childcare dropout year questions (RS 00605.235, GN 00204.055O, and MSOM MCS 005.027).
  • * On Medicare-only claims when entitlement to Medicare is an issue.
  • * Allegations of missing or inaccurate earnings. For Development of Earnings Records Inaccuracies, see RM 03870.015A.5.
  • * Claimant does not agree with their Social Security Statement
  • * Number holder or surviving claimant is incapable and requires a representative payee. For more information on incapability and representative payees, see GN 00502.001 - GN 00502.075.
  • * It appears from the NH’s explanation, not to post lag earnings, see RM 03870.006.
  • * Auxiliary or survivor's own ER when the applicant is eligible to apply on his or her own Social Security number (SSN).
  • * Life claim disallowances if possible future entitlement to benefits exists, per RS 02201.010 and GN 01010.440. However, develop the ER issue after disallowing the claim.
  • * Lump sum death payment (LSDP)-only claims when a survivor is potentially entitled to future monthly benefits on the deceased NH's ER.
  • * WC/PDB ACE determination is necessary. Develop even when we post maximum earnings on the ER as duplicate items.
  • * All scrambled earnings situations per RM 03870.045 - RM 03870.090.
  • * DIB claims when the PIA computation includes one or two years of zero earnings that the claimant did not fully explain in response to the childcare dropout year questions.
  • See Also:
  • * RS 00605.235 Childcare Dropout Years
  • * GN 00204.055 Internet Claim (iClaim) Application
  • * MSOM MCS 005.027 Disability Information (DISB)
  • * Medicare-only claims when entitlement to Medicare is an issue.
  • 2. Develop allegation of earnings record inaccuracy in the following pre-claim situations
  • 2. Pre-claim situations
  • Develop allegation of ER inaccuracy in the following pre-claim situations:
  • * Posted earnings are missing or inaccurate.
  • * Posted lag earnings are inaccurate.
  • * It appears from the NH’s explanation that lag earnings will not be posted (see RM 03870.006).
  • * It appears from the NH’s explanation that we should not post lag earnings per RM 03870.006.
  • NOTE: Check the Suspense File before posting a hand delivered W-2.
  • D. Earnings queries to use to develop potential earnings errors
  • D. Use Earnings queries to develop potential earnings errors
  • Use the following earnings queries when developing potential earnings record errors in all initial claims (in-office, Teleclaim, or Internet):
  • * The EARQ is used to identify potential inaccuracies on the earnings record for years after 1977 (SM 00355.001 – SM 00355.080, RS 01404.003A). The EARQ alerts replace the MCS EC earnings alerts messages on the Yearly Earnings Data (DEIE) and Remarks (DRMKS) screens for processing all claims (interview, Internet or Teleclaim). The EARQ displays alerts by year, alert type and EIN. There can be multiple alerts for the same SSN for different EINs. The EARQ displays each individual alert on a separate screen.
  • * Use the DEQY for years after 1977 and SEQY for years 1937 to present ( see SM 00344.001 – SM 00344.035). The SEQY displays annual earnings from the MEF for the years 1937 on (SM 00345.900 – SM 00345.915). Determine whether resolution of the EARQ is required per RS 01404.110B and RS 01404.110C.
  • When developing potential ER errors in initial claims (in-office, Teleclaim, or Internet) use the following earnings queries:
  • If resolution of the earnings issue or EARQ alert is required, request a DEQY for the EARQ alert year(s) and the years before and after the alerted year(s) to discuss and review the questionable earnings record posting.
  • 1. EARQ
  • * Identify potential inaccuracies on the ER for years after 1977
  • * See SM 00355.000 Earnings Alerts Query (EAQY)
  • * See RS 01404.003 Wage Development Policy
  • * Alerts replace the MCS EC earnings alerts messages on the Yearly Earnings Data (DEIE) and Remarks (DRMKS) screens for processing all claims (interview, Internet or Teleclaim).
  • * Displays alerts by year, alert type and EIN; multiple alerts for the same SSN for different EINs.
  • * Displays each individual alert on a separate screen.
  • E. Procedure for general documentation of earnings records in claims cases
  • 2. DEQY
  • * Use the DEQY for years after 1977 and SEQY for years 1937 to present, see SM 00344.000
  • * SEQY displays annual earnings from the MEF for the years 1937, see SM 00345.900
  • * Determine whether resolution of the EARQ is required per RS 01404.110B and C.
  • * If resolution of the earnings issue or EARQ alert is required, request a DEQY for the EARQ alert year(s) and the years before and after the alerted year(s) to discuss and review the questionable ER posting.
  • General documentation guidelines for claims cases are below. For examples of documentation of guidelines for each of the EARQ alert situations, see RS 01404.120 and RS 01404.140.
  • E. Guidelines for documenting ERs in claims cases
  • In this subsection, we provide general documentation guidelines for claims cases.
  • For examples of documentation guidelines for each of the EARQ alert situations, see
  • * RS 01404.120 Gap Development
  • * RS 01404.140 Development of Possible Erroneous or Duplicate Postings
  • 1. No correction required for EARQ alerts
  • If an EARQ alert requires resolution, and review of the earnings record with the claimant/representative results in no corrective action, then:
  • * Obtain a statement from the claimant/representative identifying the years in question and an explanation. See RS 01404.110E.5 for manner of documentation.
  • If an EARQ alert requires resolution and review of the ER with the claimant or representative results in no corrective action, then:
  • a. Obtain a statement from the claimant or representative explaining and identifying the years in question. For documentation, see RS 01404.110E.5.
  • EXAMPLE: My ER is correct for 2007. I did not work in 2007 due to the birth of my child in 12/06. I did not work for 18 months from 12/06 through 05/08.
  • EXAMPLE: My earnings record is correct for 2007. I did not work in 2007 due to the birth of my child in 12/06. I did not work for 18 months from 12/06 through 05/08.
  • * If the claimant cannot explain the work history, document the file per RS 01404.110E.5, indicating that the claimant was informed of the possible erroneous posting and could not give an explanation.
  • * If the claimant questions the earnings record but no development is necessary per RS 01404.110B:
  • * Explain to the claimant why no corrective action is necessary; and
  • * Document the file to indicate why no action was taken per RS 01404.110E.5.
  • b. Document the file when the claimant cannot explain the work history per RS 0104.110E.5
  • EXAMPLE: The EARQ alerted for 1986 wages, but development is not necessary per RS 01404.110B (the time limitation for correction has expired).
  • Enter a remark that we informed the claimant of the possible erroneous posting due to claimant lack of explanation.
  • c. If the claimant questions the ER but no development is necessary per RS 01404.110B:
  • Explain to the claimant why no corrective is necessary; and
  • Annotate the file “We reviewed the EARQ alert for YYYY wages and state why no action was taken
  • EXAMPLE: We reviewed the EARQ alert with the claimant for 1986 wages; Development not necessary (the time limitation for correction has expired).
  • 2. No correction for uninsured spouse
  • Do not document if, in an auxiliary claim, the spouse is uninsured and has no posted earnings from 1978 on.
  • Do not document if, in an auxiliary claim
  • * The spouse is uninsured, and
  • * No posted earnings from 1978 on.
  • 3. Partial awards
  • * Prepare partial awards if immediate payment is due and we cannot resolve the ER inconsistency per GN 01010.110.
  • * Develop the unresolved or questionable earnings issue post-adjudicative.
  • Prepare partial awards (GN 01010.110) if immediate payment is due and the earnings record inconsistency cannot be resolved. Develop the unresolved/questionable earnings issue post-adjudicatively.
  • 4. Claimant unsure or unwilling to agree to the accuracy of their ER
  • 4. Claimant unsure or unwilling to agree to the accuracy of their earnings record
  • When the claimant or representative is unsure of the NH’s work history or is unwilling to agree to the accuracy of the ER, document the file per RS 01404.110E.5
  • When the claimant/representative is either unsure of the NH’s , work history or is unwilling to agree to the accuracy of the earnings record, document the file per RS 01404.110E.5
  • EXAMPLE: Mr. Jones is unsure of his work history and is unwilling to agree to the accuracy of his Social Security earnings record concerning the alerted earnings for 1979 and 1992.
  • EXAMPLE: Mr. Jones is unsure of his work history and is unwilling to agree to the accuracy of his ER concerning the alerted earnings for 1979 and 1992.
  • 5. Manner of documentation
  • Document the file as follows:
  • a. Paper claims
  • Use the Remarks portion of the application.
  • b. Earnings computation (EC) claims
  • Use the Report of Contact – RPOC screen (MSOM MCS 008.007), or the Worksheet Remarks – (DW03) screen as appropriate (MSOM MCS 008.006).
  • Use the following screens to document:
  • * Report of Contact – RPOC screen per MSOM MCS 008.007
  • * Worksheet Remarks – (DW03) screen per MSOM MCS 008.006.
  • c. Teleclaims
  • Follow RS 01404.110E.5.a. or RS 01404.110E.5.b., as appropriate.
  • For teleclaims documentation follow:
  • * RS 01404.110E.5.a. Paper claims
  • * RS 01404.110E.5.b. Earnings computation (EC) claims
  • d. Internet and Modernized Claims System (MCS) claims
  • Use the MCS Report of Contact – (RPOC) screen (MSOM MCS 008.007), or the Worksheet Remarks – (DW03) screen as appropriate (MSOM MCS 008.006).
  • e. In the modified posted earnings (EMOD) item correction (ICOR) System
  • Enter any remarks necessary concerning the NH’s work history on the Worksheet Remarks (ERMK) screen (MSOM EM 017.005). Enter information pertinent to the basis of the decision on the Earnings Rationale (EART) screen (MSOM EM 026.003).
  • Use the following screens to document:
  • * MCS Report of Contact – (RPOC) screen MSOM MCS 008.007
  • * Worksheet Remarks – (DW03) screen MSOM MCS 008.006.
  • e. Modified posted earnings (EMOD) item correction (ICOR) System
  • * Enter any remarks necessary concerning the NH’s work history on the Worksheet Remarks (ERMK) screen, MSOM EM 017.005
  • * Enter information pertinent to the basis of the decision on the Earnings Rationale (EART) screen, MSOM EM 026.003.
  • f. Post-adjudicative statement
  • If no correction is being made or a statement is being requested by the PC as the result of a post-adjudicative review and it was determined that the NH did not previously explain or insufficiently explained an earnings record inconsistency, complete a “Statement of Claimant or Other Person,” SSA-795. The PC should advise the FO how to forward the information; whether to FAX the SSA—795 using the 3601 or fax to NDRED, etc.
  • If we do not make any corrections or the PC request a statement, as the result of a post-adjudicative review, and we determined that the NH did not previously explain or insufficiently explain an ER inconsistency,
  • * Complete a “Statement of Claimant or Other Person,” SSA-795.
  • * PC should advise the FO how to forward the information; FAX the SSA-795 using the 3601 or fax to NDRED, etc.
  • NOTE: It is not necessary to obtain the claimant’s signature, simply document the claimant’s statement as indicated.
  • NOTE: If the NH or claimant states he or she is not signing the SSA-795, prepare a SSA-5002 indicating that the claimant will not sign the SSA-795. Fax the completed form to Paperless or to NDRED, as appropriate.
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