RS 01505.042:
Procedures to Resolve General State and Local Coverage Issues
Effective Dates: 11/30/2016 - Present- Effective Dates: 01/03/2018 - Present
TN 24 (11-09)- TN 27 (01-18)
RS 01505.042 Procedures for Resolving General State and Local Coverage Issues- RS 01505.042 Procedures to Resolve General State and Local Coverage Issues
A. General procedure for resolving state and local coverage issues- A. Tolerance rule for questionable coverage
The following provides an overview of the procedure for resolving state and local coverage issues.- Do not develop a claims case if the primary insurance amount (PIA) is not $1 or more.
1. Tolerance rule for questionable coverage- B. Questions for development and documentation
Do not develop in a claims case if the primary insurance amount (PIA) is, not affected by $1 or more.2. Questions for development and documentationThe following coverage questions may need to be developed and documented:* Is the individual an employee?- You need to document the following:
- * Is the claimant an employee?
- * What is the identity of the employing entity?
* Is the employing entity included in the agreements?- * Is the employing entity included in the Agreements?
- * Which Agreement or modification covers the service of the position?
- * What is the legal status of the employing unit, e.g., a governmental or proprietary function?
- * Is there an optional or required exclusion that applies?
* Is the employee's position under a state or local retirement system?* What is the retirement system status of the individual (i.e., member, ineligible, or optional)?* What is the date, the position was first placed, under the retirement system (or systems)?* Did the individual vote for or against coverage in a coverage referendum? Or, was he or she given additional opportunity for such coverage and so elected?* Was there a break in the individual’s service and or a break in retirement system membership?* Was the individual in an employment relationship on the date controlling retroactive coverage?3. Procedures for making a coverage determination and correcting earningsMake a determination; use Form SSA-553 (Special Determination);Correct reporting errors as needed; use Form SSA-7010-U5 (see, Wage Correction/IRS Coordination RS 01405.000).Document the file including:* modification number* questionnaires* statements of the facts* copies of records* all other pertinent information- * Is the employee's position under a State or local retirement system?
- * What is the retirement system status of the claimant (member, ineligible, or optional)?
- * What date was the position first placed under the retirement system (or systems)?
- * Did the claimant vote for or against coverage in a coverage referendum? Was he or she given additional opportunity for such coverage and so elected?
- * Was there a break in the claimant’s service and or a break in retirement system membership?
- * Was the claimant in an employment relationship on the date of controlling retroactive coverage?
- C. Make a coverage determination and correct earnings
- Correct reporting errors using the instructions in RS 01405.000.
- If there is not sufficient space on the Earnings Modernization Item Correction (ICOR) screens to document your determination or if you determine there is no need to adjust the earnings record, prepare a special determination using the Form SSA-553 (Special Determination).
- Include in your documentation:
- * modification number;
- * questionnaires;
- * statements of the facts;
- * copies of records; and
- * all other pertinent information.
Send a copy of the determination or a memorandum to notify the Parallel Social Security Office (PSSO).- Send a copy of the determination or a memorandum to the regional office.
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