TN 14 (03-98)

A. Policy - SSI status for month(s) of actual receipt of retroactive title ii benefits

1. Determining Whether Changes Are Material

The adjusted title II income may or may not materially change the amount of title II income and countable income for a month the SSI claimant actually receives the remaining retroactive title II benefits (PMA month).

1. The amount of those benefits is not material if the SSI claimant is ineligible for the month of receipt (e.g., because of other income, such as the title II that was paid when regularly due). In such cases, the FO can stop the evaluation of the effect of the adjusted title II income at that point.

2. The amount of those benefits is material if the SSI claimant would be eligible except for the additional title II income from the retroactive benefits. Or, the claimant is eligible, but additional title II income reduces SSI for a later month when the month of receipt is the budget month for the payment computation. In all cases when the evaluation is material, use the rules below to compute the amount of the retroactive title II benefits that is income for SSI purposes for the month of receipt of the retroactive title II benefits.

2. All Months with Adjusted Title II Income Overlap Months of SSI Eligibility

When this applies, none of the title II retroactive benefits that were paid can be counted as income for SSI purposes in the month(s) that the SSI claimant /recipient actually receives retroactive benefits or in any later month.

3. No Overlap with Months of SSI Eligibility

When SI 02006.200 C.2.a. above applies, some retroactive title II benefits may be income in the month actually received. See below to determine the amount(s) of income for SSI purposes.

B. Procedure - amount of income for month(s) benefits received

The amount of any additional type A income for the months must be determined as follows whenever it is material and A. 3. above applies.

1. All Retroactive Title II Received in One Payment

Determine the retroactive benefits, if any, that are income for that month for SSI purposes, as follows:

• Add the amounts of title II income remaining after adjustment per SI 02006.200.C. above for the months prior to the first month of possible SSI eligibility (the total for column E of the SSA-2894 (see SI 02006.210 C. and D.)).

• Determine the actual amount of the title II retroactive benefit payment for the month of receipt.

• Use the lesser amount of these two amounts, as the additional amount of type A income for the month of receipt. Add that amount to the title II benefits regularly due and paid that month.

2. Retroactive Title II Benefits Were Paid and Received in More Than One Month

When a claimant receives retroactive title II benefits in 2 or more months, count the adjusted title II income in the latest month or months (at the END of the payments of retroactive benefits). This approach follows the rule that the earliest retroactive income should be adjusted for expenses.

• After adjusting the title II income amounts as explained in B.1. above by using the SSA-2894, look at the total amount of retroactive benefits remaining only for those months before the SSI DOE. This is the total in column E. of SSA-2894 (Offset Case Authorized Fee Worksheet) (see SI 02006.210 C. and D.). Do not count more than this amount as the additional type A income added to regularly due and paid title II (type A) income for any month the retroactive benefit is received.

• Use a PHUS query or a PSC or ODIO-provided explanation to identify all months and amounts of payment of title II retroactive benefits. (See SI 02006.205 D. for development procedures.)

• Use an SSI query to identify those type A monthly entries in the UM field that include retroactive benefits. These are entries in amounts greater than the monthly title II benefits which are regularly due. Review these entries to see which correlate with months in which retroactive benefits were paid per the PHUS query or the PSC explanation.

• Start with the amount of the latest (last) payment of retroactive benefits (per the PHUS query or PSC explanation) and compare it to the total amount of retroactive benefits remaining (from Column E.).

• If these 2 amounts are equal or the latest (last) payment is larger, use the total amount of retroactive benefits remaining as the additional amount of type A income to be added to the regularly due title II for that month. This total is the type A income amount for that month. No type A entry for any prior month should include any retroactive benefits. (See SI 02006.215 for procedures to correct prior type A entries, pay any underpayments due, and send notices.)

• If the amount of the latest (last) payment is less than the total amount of retroactive benefits remaining, use only the amount of the latest (last) payment as the additional type A income to be added to the regularly due title II for that month. Subtract the amount of the latest payment from the total amount of retroactive benefits remaining. This is the difference yet to be counted (see the next paragraph).

• Identify the month and amount of the prior (next-to-last) payment of retroactive benefits (per the PHUS query or the schedule). Compare this amount to the difference yet to be counted.

• If these 2 amounts are equal or the prior payment is larger, use the difference as the additional amount of type A income to be added to the regularly due title II benefit for that month. This is the total type A income amount for that month. No type A entry for any prior month should include any retroactive benefits.

• If the amount of the prior (next-to-last) payment is less than the difference, use only the amount of the payment as the additional type A income to be added to the regularly due title II for that month. Subtract the amount of the prior payment from the difference to find the remaining difference. This amount is yet to be counted.

Use the methods just described month-by-month to compute the additional type A amount from the next prior retroactive payment to be counted. Repeat this process as necessary until all of the remaining difference is counted. Once all of the difference is counted, no type A entry for any prior month should include any retroactive benefits.

C. Process - additional steps required

1. Background

In windfall offset computations, when a fee agreement has been approved, the representative's fee (both the portion determined based on the title II past-due benefit and the portion determined based on the title XVI past-due benefit) is used to reduce the title II income (GN 03940.050C.7).

A problem can occur when the fee amount used to reduce the title II income exceeds the fee amountwithheld by the title II system. The problem will occur when this is true and the representative fee adjustment recomputation is completed before the title II prior month accrual (PMA) check is paid. Most of these cases will involve fee agreementsalthough it is possible for this problem to occur in fee petition cases. When the authorized fee in a fee petition case is known before the PMA is paid AND that fee exceeds the title II withheld amount, this problem can occur.

Under the policy for windfall offset, some or all of the PMA check is noncountable income (NCI) for SSI eligibility/payment computation purposes since it has already been considered in the windfall offset computation. See GN 02610.005.C.12 for the definition of NCI.

In such circumstances, the field office will reduce the title II income, starting with the first month of the income, by the amount of the representative's fee, delete the offset computation and transmit the new (reduced) “W” postings to the Supplemental Security Record (SSR). See SI 02006.200 ff. for a description of the method.

The SSI system will use these new “W” postings to perform an offset computation and to determine the amount of NCI which will not be correct in the circumstances described. The NCI will be “short” by the amount of the nonwithheld representative's fee—generally, the portion determined based on the title XVI benefits and/or the amount withheld from the auxiliaries' PMAs.

NOTE: The situation described here is in addition to the situation described in SI 02006.201.A. when some or all of the fee adjustment occurs before entitlement to SSI.

2. Tolerances

The procedure described below is notnecessary:

• In fee agreement cases in which the fee withheld from the SSI recipient's Title II benefit is the specified dollar amount of the fee cap shown in GN 03940.003A.3, or

• In any case in which the ongoing title II payment amount precludes SSI eligibility and the PMA is paid after the first full (unadjusted)* monthly title II check is paid, or

• In fee petition cases where the authorized fee is no more than the title II withheld amount for the SSI recipient.

*Adjustment of current monthly benefits can be necessary when total RSDI withheld is less than the total fee (title II +title XVI fee). If there is a remaining fee amount to be paid, then adjustment of benefits may be necessary.

D. Procedure - field office

• When requested by the PSC (GN 02610.053A.2.) or as a result of beneficiary request or FO case identification, perform the offset recomputation, taking into account the total representative's fee. See GN 03940.050C for determination of the Title XVI portion of the fee in fee agreement cases. If the representative's fee withheld from the Title II benefit is less than the specified dollar amount of the fee cap shown in GN 03940.003A.3., diary the case for 30 days. If the withheld fee is the specified dollar amount of the fee cap shown in GN 03940.003A.3. for fee agreement cases, or the specified dollar amount of the fee cap shown in GN 03940.003A.3. or more for fee petition cases, no further action is necessary.

• Upon maturation of the diary, review the SSID to determine whether the PMA has been posted. If the PMA has not been posted, rediary for another 30 days. Repeat as necessary until the PMA has been posted.

  At this point, review to see if the ongoing title II is high enough to preclude ongoing SSI eligibility. If this is so, and the PMA was paid after the first full monthly payment, no further action is necessary. If, however, these conditions are not present, continue with step 3.

• Total the NCI calculated by the SSI system and the portion of the fee not withheld from the SSI recipient's title II benefit (i.e., the title XVI fee and any portion of the title II fee withheld from the auxiliaries). This is the total NCI that should be excluded from the PMA.

• Review the WNC and UMIH fields. The WNC field is posted in the PSC and represents the PSC determination of NCI, which does not include the title XVI fee and/or the part of the title II fee paid from the auxiliaries' withheld amounts.

  WNC is deducted automatically from the PMA by the system before the PMA is posted to the UMIH field. The type A income posted in the UMIH field is the result of the computation (PMA - WNC) +CMA (ongoing) type A. Further investigation is needed to determine the PMA actually paid.

• Obtain a PHUS query to determine the PMA actually paid to the beneficiary. Subtract the amount determined in 3. above from this “PHUS” PMA. This is the PMA amount that should be used to determine what to post in UMIH on the SSR.

• Find the amount of continuing type A unearned income posted for the month after the PMA. (NOTE: An exception to this occurs when the PMA is posted in December. The type A amount for November should be used instead of the January amount because of the COLA.) Add this amount to the amount determined in step 5.

• Delete the PMA posted by the system and post the amount determined in step 6 as type A income for the month.

• The system will pay out any underpayment due as long as it is still a “RIC:G” record. Otherwise, pay any underpayment through A-OTP.

• Enter the following in the CG field: PMA CALC MMYY.

E. Procedure - other allowable expenses apply in obtaining title II

If a claimant incurs other allowable expenses besides attorney fees in obtaining the title II income, add the amount of these expenses to the amount of authorized fees. (See SI 02006.200A.1. above.) Use that sum of expenses to adjust the title II income as explained in SI 02006.200.C.1. above.