A. REQUEST EXCLUDED UNDER SECTION 205(q) OR THE APPLICABILITY REQUIREMENTS NOT MET

These cases should only occur when a claimant insists upon filing a request for preliminary payment even though the situation is not covered by section 205(q) (e.g., disability payments, lump sums, or applicability requirements are not met). The DO/BO will advise the claimant in writing the reason for the exclusion and need not request an on-line benefit estimate from OCRO. The normal CAPS claims process will be utilized. The Forms SSA-1877 and SSA-795 with a copy of the notice to the claimant will be attached to and remain with the claim. No notification of the request will be sent to the processing center.

B. APPLICABILITY REQUIREMENTS MET BUT MINIMUM EVIDENCE REQUIREMENTS NOT MET-15 DAY TIME FRAME EXPIRED

When the DO/BO determines that the minimum evidence requirements are not met and the 15-day time frame (see RS 02807.025) has expired, the claimant must be advised in writing by the DO/BO why preliminary payments cannot be made. The DO/BO will input the claim under the normal CAPS process (where applicable). The DO/BO will then make every effort to complete the required development as soon as possible. The Forms SSA-1877 and SSA-795 with a copy of the notice to the claimant will be attached to and remain with the claim. Make sure the SSA-1877 is placed under the SSA-3293 (CAPS Routing) and SSA-3687-U2 (Determination of Benefit Rights-Coding Sheets) since these forms are not controlling. No notification of the request will be sent to the processing center.

NOTE: Need was indicated in these types of cases. Therefore, if sufficient evidence is later received which indicates the claimant is entitled to benefits although additional evidence might be required for a final determination, pay the claim via CPS regardless of the length of time which has elapsed from the initial preliminary payment request. Show in the NPF section of Form SSA-3263 (Critical Payment Direct Input) “CPS processed in accordance with RS 02807.045B., prior denied 205(q)(3) Case, requirements now met.” When all evidence for a final determination is received, forward the claims material to the special PC address for critical cases under cover of Form SSA-1671 (Request for Critical Case Payment). Annotate on the SSA-1671 “CPS payments made on prior denied preliminary payment request. Claimant entitled.” If claimant is found not entitled, follow instructions found in RS 02807.040D.