TN 15 (09-01)

A. Policy

1. Request for different rate of adjustment/recovery

1. A recipient may request a different rate of adjustment at any time

2. Honor a request to reduce the rate of adjustment:

   • At the 10 percent rate unless:

     • The DOJ or OI has determined that the overpayment was the result of fraud, willful misrepresentation, or concealment of material information (see SI 02220.017A.3);

     • The Office of Counsel to the Inspector General has imposed a civil monetary penalty (see GN 02230.050, Civil Monetary Penalty (CMP)-Overview);

     • A Claims Representative (CR) or higher has determined that the overpayment resulted from similar fault, misrepresentation or concealment of material information by the SSI recipient or his or her deemor; or

   • Below the 10 percent rate when the overpayment can be completely recovered at the lower rate within 36 months or when the individual could not meet ordinary and necessary living expenses at a higher rate.

3. Do not honor requests to recover overpayments by monthly check adjustment from recipients subject to the payment limit for FLA-D. However, accept any refund(s) offered.

4. Do not change the rate at which a penalty is assessed.

5. Do not change the rate of recovery imposed as a penalty when SSI recipients spend excluded burial funds on other expenses not related to their burial.

6. Renegotiate the rate of recovery of conditional payment when the individual's income or ordinary and necessary living expenses change.

2. Changing proposed rate of adjustment

1. Negotiate the effective month of the new, negotiated rate (SM 01311.125).

2. When the recipient requests a rate of adjustment of less than the 10 percent rate:

   • Determine that the recipient is not actually requesting a waiver.

   • Negotiate a recovery rate that will complete recovery within 12 months. If this is not possible, try to arrange for repayment within 36 months.

   • Set the rate of adjustment appropriate for the financial situation of the individual. Determine a rate that allows the individual to meet his/her current necessary and ordinary living expenses.

   • If necessary, complete Section II of SSA-632 to evaluate the SSI recipient’s ordinary and necessary living expenses.

     NOTE: The rate of adjustment can never be less than $10.00.

3. When the recipient requests a rate of adjustment higher than 10 percent:

   • Explain that the maximum required rate is 10 percent.

   • Obtain a signed SSA-795 stating the recipient:

     Understands that the usual rate of adjustment is 10 percent; and

     Is voluntarily requesting a higher rate of adjustment.

4. Post a change to the 10 percent recovery rate when:

   • You approve a recipient's request for a higher or lower recovery rate (SM 01311.125); or

   • A 10 percent recovery case goes into Goldberg Kelly status and no money was withheld for the prior month (SM 01311.128).

     NOTE: Other changes, such as Cost of Living Adjustment (COLA), interstate move, etc., are automatically computed.

3. Denying a change of rate of adjustment

Manually prepare and issue a notice (SSA-L8166-U2) explaining the reason for the denial.

4. Request for reconsideration or waiver

1. A reconsideration of the facts of the overpayment should be filed within 60 days of the date an individual receives an overpayment notice (GN 03102.100). Field office (FO) and program service center (PSC) technicians must make a determination on the reconsideration issue when they receive an SSA-561-U2 (Request for Reconsideration) for a Title II or Title XVI overpayment (OP).

2. If the FO receives an SSA-561-U2 for a Title XVI OP, stop recovery and process the request per SI 02260.030C.2. If concurrent, see the NOTE: in GN 03102.225B.6.

3. Examples of the facts of the overpayment include the amount, period, and reason.

4. A request for waiver can be made at any time. It can be made after the overpayment has been completely recovered.

5. When a request for reconsideration or waiver is filed within 30 days (plus 5 days for mailing) of the date of the notice:

   • Recovery actions stop; and

   • Any payments withheld in the month the request is filed will be refunded by AOTP. (See SM 01901.001);

   • Adjustment is resumed only when the reconsideration determination affirms the fact of the overpayment or the request for waiver is denied.

   • Adjustment is resumed only after 30 days (plus 5 days for mailing) have passed from the date of the notice of the waiver denial, if the individual does not timely appeal the denial.

   • If the individual requests reconsideration of the waiver denial within 30 days (plus 5 days for mailing) of the date of the notice of waiver denial, adjustment is resumed only when the reconsideration determination affirms the waiver denial (see SI 02220.017A.6.a. and SI 02220.017A.6.b. below).

   • Recovery is not stopped when the overpaid individual pursues further levels of appeal (hearing, appeals council, etc.).

6. When a request for reconsideration or waiver is filed after the 30 (plus 5) day period:

   • Recovery actions are stopped; and

   • Effective only with the month the request is filed, any payments that were withheld to recover the overpayment are refunded by AOTP.

   NOTE: Recovery is not stopped for subsequent levels of appeal (hearing, etc.).

5. Different notices - Same recovery action

1. A revised initial determination can result in an overpayment. The automated system issues both the overpayment notice and the notice informing the individual of the revised initial determination at the same time.

2. When a manual notice is required, the recipient is notified of the revised determination on an SSA-L8155-U2 (Notice of Planned Action) if the change will result in a reduction in payment.

3. An SSA-L8100-U2 (Notice of Change in Payment) is used when the determination affects only past (prior) periods.

   NOTE: While these two forms have different levels of appeal, the overpayment recovery action is the same. The SSA-L8100-U2 provides the right to a hearing rather than to a reconsideration as with the SSA-L8155 (NL 00803.005).

4. When a request for reconsideration and/or waiver is filed within 30 days (plus 5 days for mailing) of the date of the notice, and until the initial appeal decision affirms the overpayment:

   • Recovery is discontinued; and

   • Any payments withheld in the month the request is filed are refunded.

   NOTE: Recovery is not stopped for subsequent levels of appeal (hearing, etc.).

6. Request for reconsideration of a waiver denial

1. When a request for reconsideration of waiver denial is filed within 30 days (plus 5 days for mailing) of the denial notice, do not resume recovery action until:

   • The determination affirms the waiver denial; and

   • Thirty days (plus 5 days for mailing) have passed from the date of the Notice of Waiver Denial.

2. If the request is filed after 30 days (plus 5 days for mailing) and good cause for late filing exists:

   • Recovery is stopped; and

   • The full monthly payment is reinstated.

3. If the request is filed after 30 days (plus 5 for mailing) and good cause does not exist, recovery continues.

B. References:

• Processing Appeal of Duplicate Checks Negotiation, GN 02406.310.

• Processing Reconsideration Requests, SI 04020.030 and MSOM BUSSR 004.010.

• Processing Waiver Requests, SI 02260.001 and MSOM BUSSR 004.009.

• See SI 04020.030 for Processing Reconsideration Requests.

• Add/Change/Delete Overpayment Decisions, MSOM BUSSR 004.007.

• Check Recovery Rate Adjustment, SM 01311.125 and MSOM BUSSR 004.013.

• Processing Reconsideration Requests for Concurrent Overpayments, GN 03102.225.