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SI 02007.020: Follow ups and Controls on Continuing Title XVI Interim Benefits

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  • Effective Dates: 01/11/2018 - Present
  • Effective Dates: 01/12/2018 - Present
  • TN 4 (10-15)
  • SI 02007.020 Follow ups and Controls on Continuing Title XVI Interim Benefits
  • Section 1631(a)(8) of the Social Security Act requires us to pay monthly Federal benefits prospectively if the Commissioner of Social Security (COSS) does not make a final decision within 110 calendar days after the date of a favorable administrative law judge’s (ALJ) disability or blindness decision. These interim benefits start with the month in which the 110th day falls, and end with the month in which we make a final decision.
  • A. No interim benefits start order
  • The notice to a claimant about the favorable ALJ decision and the Appeals Council (AC) decision to review or reopen the decision tells the claimant that we may be able to pay interim benefits effective with the month in which the 110th day falls. The claimant may contact the field office (FO) to inquire about interim benefits as early as the first of the month in which the 110th day falls.
  • If the FO has not received the email information sheet “Potential Interim Benefit Case,” request the information you need to initiate interim benefits by sending a fax to: Office of Appellate Operations (OAO) (703) 605-7201
  • B. Final ALJ or AC decision not issued within nine months
  • Interim benefit payments require close management controls to prevent payment beyond the month of a final decision. Because of the sensitivity of this workload, follow the OAO development guidelines in the chart in this section.
  • The following procedures apply when a case is pending an AC decision or was remanded to the ALJ for a decision.
  • If
  • then
  • The claimant is still in interim benefit payment status for nine months
  • FO staff will query the Case Processing & Management System (CPMS) or Appeals Review Processing System (ARPS) to determine whether the case is pending with the AC or the Hearing Office (HO).
  •  
  • If the case is pending with the AC:
  • The FO will email the OAO at ^DCARO OAO 8001 and inquire about the status of the pending claim.
  • The OAO will provide status via telephone, fax, or email if the case is pending with the AC.
  • Contact OAO again in three months to follow up on the case.
  • If the case is pending in an HO:
  • The FO will email the Hearing Office Director (HOD) and inquire about the status of the pending claim.
  • Use the HO staff listing at: http://odar.ba.ssa.gov/hq-components/ocalj/field-staff-listings/
  • Obtain the name of the HOD. The HOD will provide status via telephone or email if the case is pending with the HO.
  • Contact The Office of Hearings Operations (OHO) again in three months to follow up on the case.
  • The claimant is still in interim benefit payment status for 12 months
  • The FO will query CPMS to verify if the case is pending with the AC or the HO.
  •  
  • If the case is pending with the AC:
  • The FO will write a memorandum to the Executive Director of the OAO requesting they expedite the case and inform the Executive Director that interim benefit payments have continued for 12 months without a final decision. Include any special characteristics of the case.
  • Send the memorandum via email to:
  • ^DCARO OHO and follow up on the case in three months.
  • ^DCARO OAO and follow up on the case in three months.
  • If the case is pending in an HO:
  • The FO manager will write a memorandum to the Director of the Division of Field Procedures (DFPP), Office of the Chief ALJ, requesting they expedite the case and inform the director that interim benefit payments have continued for 12 months without a final decision. Include any special characteristics of the case. The FO manager will forward the memorandum via email to |||OHO OCALJ DFP and follow up on the case in three months.
  • The claimant is still in interim benefit payment status for 15 months
  • The FO will query CPMS or ARPS to verify if the case is pending with the AC or the HO.
  • If the case is pending with the AC:
  • The FO will send an email with subject line “URGENT-SECOND NOTIFICATION” to ^DCARO OAO and inquire about the status of the claim pending decision. The OAO will provide status via telephone or email.
  • Follow up on the case in three months.
  • If the case is pending with the HO:
  • The FO will send an email with subject line “URGENT-SECOND NOTIFICATION” to |||OHO OCALJ DFP and inquire about the status of the pending claim. The DFP will provide status via telephone or email.
  • Follow up on the case in three months.
  • The claimant is still in interim benefit payment status after 15 months
  • The FO manager will forward the original memorandum written to the Director of the OAO or Director of the DFP to the Deputy Commissioner, Office of Hearings Operations (OHO) via email and request they expedite the case. Inform the deputy commissioner that interim benefit payments have continued for more than 15 months without a final decision. Include any previous correspondence with OHO (if available) or special characteristics of the case.
  • Await a reply from The Deputy Commissioner, OHO.
  • C. Related references
  • * SI 02007.001 Interim Benefits in Cases of Delayed Final Decisions-SSI
  • * SI 02007.015 Nondisability Notices for Interim Benefits - SSI
  • * DI 42010.225 Follow-ups and Controls on Continuing Title II Interim Benefits
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