SI 02007: SSI Interim Benefits Payments
TN 3 (11-05)
Citations:
Section 1631(a)(8)
of the Social Security Act;
20 CFR 416.1469(d)
A. Policy
When an administrative law judge (ALJ) makes a favorable disability or blindness decision on a case, the Appeals Council (AC) may decide on its own motion to review the decision or reopen the decision. It may do this because an office protests the ALJ's decision to the AC, or because quality assurance sampling of ALJ decisions causes the AC to question the ALJ's decision. When the AC decides to review or reopen a decision, the claimant receives a notice that tells him/her about the favorable ALJ decision, that the decision is being reviewed/reopened, and that benefits will be delayed while the case is under review/reopening. The notice also tells the claimant that there is a limit to how long benefits can be delayed.
The law (section 1631(a)(8) of the Social Security Act) requires SSA to pay monthly Federal benefits prospectively if a final decision is not made by the Commissioner within 110 calendar days after the date of the ALJ decision. These “interim benefits” start with the month in which the 110th day falls, and end with the month in which the final decision is made.
The law also provides that any interim benefits paid will not be considered overpayments, unless fraudulently obtained.
These requirements apply to both title II and SSI. Both title II and SSI can be paid as interim benefits. For SSI, only Federal SSI money is paid as interim benefits. Federally administered State supplementary payments are not paid as interim benefits.
If a field office (FO) has effectuated the favorable ALJ decision before the AC took action to review or reopen the case, then interim benefits are not an issue.
Interim benefits are also not payable when the ALJ has made a favorable decision, a long period of time has gone by while the FO is completing preeffectuation review development for SSI, but the AC own motion review is not involved. The FO must complete effectuation of the ALJ's decision and pay regular benefits as soon as possible.
Following are two examples of interim benefit cases:
EXAMPLE 1:
The ALJ issued a favorable disability decision on June 21, 2004.
The AC decided to review the case on its own motion.
The claimant began receiving SSI interim benefits starting with October 2004, because 110 days from June 21 is in October.
The AC reverses the favorable ALJ decision in February 2005, and the FO stops interim benefits in March 2005. The payments for October 2004 through March 2005 are SSI interim benefits.
EXAMPLE 2:
The ALJ issued a favorable disability decision on June 21, 2004.
The AC decided to review the case on its own motion.
The claimant began receiving SSI interim benefits starting with October 2004, because 110 days from June 21 is in October.
The AC remanded the case to the ALJ for further proceedings and a new decision.
The ALJ held a new hearing and issued a subsequent unfavorable decision.
The claimant filed a request for review of the unfavorable ALJ decision with the AC.
The AC denies the request for review.
The FO stops the interim benefits.
B. Policy - Related Policies
1. Interim Benefits in Cases of Delayed Final Decisions - Title II
See DI 42010.205. These sections state the policies and procedures for interim benefits under title II.
2. Nondisability Requirements
A person must meet all nondisability requirements for SSI eligibility to receive interim benefits (e.g., limitations on income and resources, and the requirement to file for other benefits.) See SI 00501.001.
3. Interim Assistance Reimbursement (IAR)
Interim benefits are not payable to the State for reimbursement. See SI 02003.001A.3.a.
4. Overpayments
Interim benefits are not overpayments unless fraudulently obtained. Unless interim benefits were fraudulently obtained, do not take any overpayment recovery action. See GN 04101.010 regarding “SSA Program Integrity Responsibilities”. Also see SI 02201.005 regarding SSI overpayments.
5. Reporting Responsibilities/Changes in Benefits Due/Appeal Rights
All SSI posteligibility rules apply to SSI interim benefit cases, except the rule about overpayments stated in SI 02007.001B.4. See SI 02007.015 for notice requirements.
For example:
Claimants receiving SSI interim benefits have the same reporting responsibilities as other SSI recipients;
Changes in nondisability factors can increase or decrease the monthly interim benefits due or cause interim benefits to stop;
Some changes in nondisability factors require the FO to conduct unscheduled redeterminations;
Due process requirements apply, including the requirement to provide an advance notice (Goldberg v. Kelly) before reducing or stopping interim benefits for nondisability reasons. (See SI 02301.001)
6. Windfall Offset
The rules for windfall offset apply to interim benefits. See GN 02610.005.
EXAMPLE:
Facts about the interim benefits:
The claimant applies for SSI and title II benefits in January 2004.
Based on the alleged date of disability onset, the first month in which title II benefits could be due is February 2004.
The ALJ issues favorable disability decisions on June 21, 2004.
The AC decides to review the case on its own motion.
The claimant begins receiving SSI and title II interim benefits starting in October 2004, because 110 days from June 21 is in October.
The AC affirms the favorable ALJ decision in February 2005.
The claimant continues to receive monthly SSI and title II benefits.
The claimant receives retroactive SSI benefits.
The windfall offset computation
The retroactive title II benefits would have been paid in February 2004 through September 2004.
The offset period begins February 2004, the first month title II benefits could affect SSI if paid when due.
The offset period ends November 2004, 2 months after the last month in which the retroactive title II would have been paid.
C. Procedure - Starting Interim Benefits
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Step |
Action |
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1 |
The ALJ makes a favorable disability/blindness decision |
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2 |
The Appeals Council decides on its own motion to review the ALJ's decision or decides to reopen the decision. |
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3 |
About 100 days after the ALJ decision, the Office of Appellate Operations (OAO) in the Office of Hearings Operations (OHO) will send the servicing FO and/or the processing center with jurisdiction an information sheet titled “Potential Interim Benefit Case”. This information sheet gives detailed information about the case. See SI 02007.010A. for an exhibit of the sheet.
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4 |
The FO conducts a Preeffectuation Review Contact (PERC), to determine eligibility and payment based on nondisability factors. See SI 00603.030. Interim benefits begin with the month in which the 110th day falls; therefore, you do not have to establish the payment amount for all months, only for the beginning month of interim benefits forward.
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5 |
The FO follows these steps:
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6 |
The FO sends a notice. If interim benefits are payable, see SI 02007.015B. for notice language. If interim benefits are not payable, see SI 02007.015C. for notice language. |
D. Procedure - Stopping Interim Benefits
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Step |
Action |
|---|---|
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1 |
When a final disability/blindness decision is made, OAO will notify the PC and/or the servicing FO indicating the final decision using the information sheet entitled “Potential Interim Benefit Case.”
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2 |
If the final decision is favorable, the FO pays the person all additional benefits he/she is due from the month of application forward.
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