SI 02305.034: Period of Review – RZs and LIs

changes
←	*	→

~~Effective Dates: 06/29/2017 - Present~~
Effective Dates: 08/16/2018 - Present
TN 44 (09-03)
SI 02305.034 Period of Review – RZs and LIs
A. Definitions
1. Period of Review
The period of review is the time period that the RZ or limited issue must cover. The date is the month and year of the latest of the dates in SI 02305.034B. and is no more than 26 months retroactive from the dates in SI 02305.034C.1. or SI 02305.034C.2.
2. Reference Date
The reference date is the date to which the recipient refers when answering questions on RZ forms.
3. Initiation Date for FO RZs
The RZ initiation date (RZI) is the date you obtain allegations on the RZ forms. It is the date:
* A completed, signed mailout SSA–8202–BK is received in the FO.
* An RZ form is completed and signed at a face-to-face interview.
* A MSSICS redetermination event is opened.
* An RZ form is completed by telephone interview.
The initiation date is important because it serves as protective filing for recipients who are entitled to receive Title II benefits on the date the RZ is initiated. (See GN 00204.015 for a discussion of RZs as protective filings).
See SI 02305.034E. for a discussion of the importance of transmitting the RZI as soon as possible after the RZ interview.
B. Policy — RZ Period Of Review
The RZ period of review covers eligibility factors both prospectively and retroactively. The beginning month of the period of review cannot exceed 2 years (plus 2 months for cases where the retrospective monthly accounting computation is used for income received in those months as budget months) retroactively from the initiation date of the current RZ.
The rules of administrative finality apply per instructions in SI 04070.001 ff. when recipient responses to questions on the form and/or evidence required to develop recipient responses result in affirmative action(s) in writing (see SI 04070.005A.9). The rules of administrative finality begin with the date the affirmation action in writing is received, not the date of RZ selection and not necessarily the initiation date of the RZ.
EXAMPLE: A redetermination was selected during the 10/04 merge with an 11/01/04 control date. There is a 5B diary (indicating a resource) which was set based on a 9/28/04 run. The claimant comes into the office and the RZ is initiated on 01/16/05. You discover at the RZ that the claimant has been receiving a pension for several years, and that his bank account has more than $1250. You request proof of the income and resources on 1/16/05. Since you diligently pursued the development, you can use the run date of the alert (9/28/04) as the date of affirmative action for the resource issue. Using the rules of administrative finality, you would go back to 10/02 (forward 1 month and back 24 months for resources). For the income, the date of RZ initiation (1/16/05) would be the date of affirmative action and you would go back to 02/03 which is the first month that payment can be changed.However since Retrospective Monthly Accounting (RMA) is involved you'd go back to 12/02 (forward 1 month and back 26 months to account for budget months, unless the income would make the person N01 in which case you would go forward 1 month and only go back the 24 months). Even though you go back 26 months, since income and RMA are involved, payment changes can only be made 24 months in the past due to the rules of administrative finality. See SI 04070.030F. - SI 04070.030G. & SI 04070.070B.2 for additional information and examples of RMA and administrative finality.
Unlimited reopening can occur if fraud and similar fault is an issue as described in SI 04070.020.
The period of review for development ends with the last day of the month before the current RZ initiation date and begins with the first day of the latest of the following (subject to the rules of administrative finality):
* Month the last RZ was initiated (the RZI field of the CRZD segment of a SSID, as described in SM 01601.460); or
* Month of application (use the date in the AP field of the PRSN segment of a SSID, as described in SM 01601.475); or
* Month of the supplemental SSA–8000–BK or PERC (the PC field of the CRZD segment of a SSID, as described in SM 01601.460); or
* Month of first eligibility (the DOE field of the PRSN segment of a SSID, as described in SM 01601.460).
NOTE: Prior LI case completion has no effect on the current RZ period of review.
When MSSICS RZs are completed, MSSICS determines the begin date of the period of review.
C. Policy — Reference Date
The rules of administrative finality do not apply to determining the reference date as they do when determining the begin date of the period of review. The reference date is determined before you receive allegations from the recipient. The rules of administrative finality apply only when an allegation is received from the recipient.
1. Determining Reference Date
The reference date is the month and year of the latest of the dates described in SI 02305.034B, and is no more than 26 months retroactively from the month/year you:
a. Send a Mail out SSA–8202–F6 to the Recipient for Completion and Return
The month/year is always presumed to be the first of the month when determining the reference date.
NOTE: The begin-date of the period of review is determined by the date FOs receive the signed RZ form in mailout situations. The reference date is determined by the date FOs mail the form to the recipient. Therefore, the reference date and the begin-date for the period of review may be different.
b. Conduct a Personal Contact Interview
The begin date of the period of review and the reference date are the same in personal contact interviews.
2. Examples of Reference Dates and Begin Dates for the Period of Review
Following are examples of reference dates and begin dates for the period of review that are different and the same.
a. Example — Reference Date and Begin Date for the Period of Review are Different
You are conducting an LEP RZ by mail. You mail the SSA–8202–BK to the recipient 10/02. The prior RZ was initiated 10/97. The reference date for the current RZ is 08/00. The recipient calls you after receiving the form and says he cannot complete and return the form until 12/10/02; you determine he has a valid reason. The completed, signed form is received in the DO 12/10/02; this is the current RZ initiation date. There is unverified income on the record so the begin-date for the period of review is 11/01/00. The reference date and the begin-date for the period of review differ by 3 months.
b. Example — Reference Date and the Begin Date for the Period of Review are the Same
You are conducting a SSA–8202–BK RZ by telephone in 11/02. There is no unverified income on the record. The prior RZ was initiated 12/01/00. The reference date and the begin-date for the period of review will be the same; i.e., 12/01/00.
D. Policy — Period Of Review For Limited Issue And Manual Deemed Income Cases
1. DI (Dedicated Account Monitoring) Diary
The period of review is 12 months retroactive from the date you conduct the dedicated account-monitoring interview.
2. IRS, MEF, Unemployment Compensation, State Wage, and MSIS Interface (5B, 5H, K6, K7, U5, S2, SB, R8 and D8) Diaries
See SI 02310.005.C.5. for a discussion of administrative finality and development.
3. Wage/NESE/Deemed/Continuing Type F Unearned Income Cases
The period of review covers eligibility factors prospectively and retroactively to the first day of the month following the most recent month for which income was verified, following the rules of administrative finality.
4. Critical Birthday (KC/KE/K8/K9/KP) Diaries
The period of review covers eligibility factors prospectively and retroactively from the first day of the month following the month of the critical birthday.
5. Insured status (KZ) diary
See SI 02309.010 for a discussion of the period for which a KZ diary needs development.
6. Verifying Allegations for the Period of Review
Allegations are verified following the rules of administrative finality as described in SI 04070.000. Allegations may be verified outside the rules of administrative finality if fraud and similar fault appears to be an issue as described in SI 04070.020.
E. Procedure
1. Transmitting a RZ Initiation Date
The following is procedure for transmitting the initiation date to the recipient's record:
Complete a SSA–1719B transaction for paper RZs or “build transaction SSR” (BTS) for MSSICS RZs and transmit the initiation date to the SSR as soon as possible after the interview in personal contact cases or receipt of a signed mailout redetermination or receipt of a DOC transfer for which an initiation date was not previously input. This prevents:
* Development gaps caused when no initiation date is posted;
* Development by one FO when another FO has already initiated an RZ;
* Establishment of a D6 diary;
* Establishment of the RZ in the TSC when a TSR transmits a PE change in MSSICS before the RZ is cleared.
Transmitting an initiation date will not always exclude the RZ from being reselected as an RZ with a new profile. Usually, initiated unscheduled RZs are the only cases that are “reselected” and “reprofiled.” Use the interview method appropriate for the new profile code.
EXAMPLE: A profile C RZ was initiated on 12/04/02. The recipient is a disabled child of an individual in the military who gets transferred out of the U.S. in 02/03 while the RZ is still pending. The case will be reselected as a profile V. (See SI 02305.013 for profile definitions.)
~~2. Transmitting a RZ Completion Date~~
2. Transmitting an RZ Completion Date
Transmit a completion code via 1719b input for paper RZs or close an RZ event and BTS in MSSICS only after receipt of a signed RZ form or MSSICS RZ printout is received from the recipient or his/her rep payee and RZ development is complete.
Transmit a completion code via 1719b input for paper RZs or close an RZ event and BTS in MSSICS only after receipt of a signed RZ form or MSSICS RZ printout is received from the recipient or his/her rep payee and RZ development is complete. If a completed RZ remains open for an extended period, follow up with the recipient/couple to determine if there have been any changes to their non-medical eligibility factors (i.e., income, resources, and living arrangements), and update their records accordingly.
NOTE: Regardless of when you BTS, the RZI will be the date you opened the RZ event on the PMEN screen in MSSICS.
3. Initiation Date of the Prior RZ
The initiation date of the prior RZ is located in the RZI field of the CRZD segment of an SSID. Prior LI (profile X) initiation and completion has no effect on determining the initiation date of the prior RZ.
The following chart tells you how to establish the initiation date of the prior RZ if the RZI field is blank on the CRZD history segment of an SSID:
* If the payment quality review (RZT=F) was the last RZ, use the RZ control date (RZ–D) on the SSID to establish the prior initiation date;
* If a T30/T33/Start date action occurred since the last RZ, use the RZD date on the SSID to establish the prior initiation date;
* If the case has a selection indicator code of J or K (RZS = J or K), use one of the dates in SI 02305.034B. to establish the prior initiation date;
* All other cases without a prior RZI, use the RZ completion date (RZC) of the most recent RZ on the SSID.
4. Development in Overlap Period
The period of review may overlap a prior period for which factors of eligibility were developed.
EXAMPLE: If an initial claims update was completed on 04/15/03, the subsequent period of review would begin on 04/01/03. There is an overlap period of 15 days.
* If the record shows that a factor of eligibility was previously developed, do not develop that factor of eligibility for the overlap period (other than Medicaid-use test, or threshold test for 1619(b) cases). This includes factors of eligibility developed in limited issue cases and recipient reports.
* If a factor of eligibility is based on status as of the first of the month, assume it was developed for the prior action. Do not redevelop that factor of eligibility.
NOTE: See SI 02310.047 for instructions on developing previously developed IRS interface data.
5. Development Outside the Period Of Review
The following describes required development of changes that occur outside the period of review:
* If the change occurred prior to the last RZ, develop only the factor that changed following the rules of administrative finality per SI 04070.001.
* If the change occurred after current initiation date, develop as necessary. However, do not delay input of RZ completion indicator until the change is developed.
6. Curtailing Development
The following describes when development may be curtailed during an RZ:
* If the recipient is ineligible based on one or more factors of eligibility for the entire period of review curtail development of all other factors of eligibility;
* If the recipient is ineligible based on one or more factors of eligibility for only part of the period of review curtail development of all other factors only for periods of ineligibility.

POMS Reference

SI 02305.034: Period of Review – RZs and LIs