TN 69 (06-07)

A. Policy - General

As noted in GN 00204.020 and SI 00601.035B, a Title XVI application is an application for Title II benefits (not a lead or a protective filing, but an application). Therefore, the Title II entitlement must be adjudicated by:

• including the blanket adjudication paragraph on the Title XVI award or denial notice per GN 00204.025B.2.c., or

• completing and adjudicating a Title II application on the Modernized Claims System (MCS) or a paper application form such as an SSA-16 (Application for Disability Insurance Benefits).

1. Supplemental Applications

Technically, the MCS-generated application and the paper form are “supplemental” applications since the claimant has already filed a Title II application by virtue of filing the Title XVI application. The information obtained on MCS or the paper form merely supplements the relevant Title II information contained on the Title XVI application. MCS must be used to complete the supplemental Title II and/or to adjudicate the open Title II application unless one of the exclusions in MCS 004.002 applies (See SM 00380.500).

This policy applies to all Title XVI applications (including abbreviated applications), even if the claimant is already receiving another class of Title II benefits (for example, the claimant is receiving disability benefits and subsequently files for Title XVI benefits and is found to be eligible for Disabled Widow’s Benefits (DWB).

If an open application is discovered after the Title XVI award or denial notice was issued, the first option (i.e., issuing a blanket adjudicative paragraph) cannot be used. A Title II application must be completed and adjudicated per GN 00204.027D. An open application is applicable for all classes of Title II benefits, regardless of whether the individual was entitled to the benefits at the time the open application was filed. When an open application exists and a person subsequently becomes eligible for a class of benefits, the first month the person becomes eligible for the Title II benefit is the month of entitlement for Title II and the date of the open application is the filing date of the subsequent application.

2. Conversion Cases

No applications were filed with the Social Security Administration (SSA) in welfare cases converted to SSI in 1/74. Therefore, “welfare conversion “cases cannot result in an open Title II application. Welfare conversion cases can generally be recognized by the unique filing dates of 7/4/73 and 1/1/74, the presence of state grant amount (GA) and a dollar amount in the conversion segment identifier (CONV) line on the Supplemental Security Income Display (SSID). In these cases, the claimant can only become entitled to Title II benefits if he or she files a Title II application. However, the filing date may be protected by a redetermination. See GN 00204.015 for treating a redetermination as a Title II protective writing.

3. Applications Filed Prior to 1/1/74

There may be instances where it appears that a federal Supplemental Security Income (SSI) application may have been filed prior to 1/1/74. Unlike conversion cases, where an SSI application was never filed, these cases will not have any information in the CONV line on the SSID. Also, although these cases were filed prior to 01/01/74, these cases could not be adjudicated until 01/01/74, the date the SSI program was implemented. Interviewers should follow the instructions in GN 00204.027B.2. to determine if the Title II application is open or has been adjudicated.

B. Policy - Determining Whether The Title II was Adjudicated

1. General Assumption

Assume that the Title II claim was NOT adjudicated unless you have evidence to the contrary. Evidence to the contrary may include (but is not limited to):

• a Master Beneficiary Record (MBR) indicating that a Title II claim was adjudicated and/or a MCS record that shows a Title II claim was filed and denied (i.e., a disallowance notice was issued) but was not updated to the MBR,

• the notice data (NOTC) field of a SSID query where the notice history shows that either paragraph 1598 or 1599 was issued (see SM 01601.670 for information on the NOTC field),

• a copy of a notice on the Online Notice Retrieval System (MSOM ORS 003.001-1) that shows either paragraph 1598 or 1599 was issued (see NL 00804.245 for paragraph 1598 language; paragraph 1599 was replaced by paragraph 1598 in January 1991, but contained similar language),

• a copy of a manual Field Office (FO) or Disability Determination Service (DDS) notice that includes either paragraph 1598 or 1599, or

• a copy of a Title II denial notice resulting from a Title II application that was filed after the SSI application but the denial was never updated to the MBR.

If you determine that a prior Title II application is no longer open based on any item on this list other than the first bullet, be sure to document the Modernized Supplemental Security Income Claims System (MSSICS) or the SSID through the Report of Contact (DROC) screen in MSSICS or the Remarks field on the SSID. Be sure to indicate why an open application is not being pursued to avoid duplicate development in the future. This is particularly important when your decision is based upon any of the following:

• a previous Title II denial notice that is not posted to the MBR, or

• an indication of paragraph 1598 or 1599 in the NOTC field of the SSID since this field can only house the five most recent notices sent. As a result, the entry showing paragraph 1598 or 1599 may not be available at a later date, or

• a notice stored in the Online Retrieval System (ORS), since these notices are only retained for 7 years.

NOTE: It is not necessary to obtain prior files to search for any of the items listed. If the evidence listed (or any other evidence shows that the Title II aspects of the SSI application were properly adjudicated) is readily available, the evidence may be used to establish that the application was adjudicated. Otherwise, assume the application remains open.

2. Policy - 12/1/98 to 4/17/02

From 12/1/98 to 4/17/02, the Program Operations Manual System (POMS) permitted adjudicators to assume that the Title II aspects of a SSI claim were adjudicated in certain cases through the release of the blanket paragraph as noted in the chart below:

The use of these developmental assumptions (which included the input of closeout indicator (CLST) in the case characteristics code (CG) field for the period 10/1/86-5/94) was effective with the 12/98 POMS release and was discontinued in 4/02 after coding problems on the Social Security Record (SSR) were discovered. The coding problems have not been fully resolved and therefore, provide misleading information in some cases.

To determine the SSI adjudication date, adjudicators should use the date in the Initial Decision Date (IDD) field found in the Record Data (RCRD) segment of the SSID. If there is a start date record, prior records should be obtained. The date in the IDD field on each prior record is the adjudication date for the application to which that record applies. A start date record can be identified by the code **88888C in the IDD field.

NOTE: A date will be generated in the Decision Reversal Date (IDDR) field found in the RCRD segment of the SSID when an appeal is effectuated to reverse a prior denial decision. However, the entry in the IDDR field cannot be used as the adjudication date.

If the adjudication date cannot be obtained from the entry in the IDD field on the SSR (or from other evidence such as is shown in GN 00204.027B.1.), adjudicators must use the date of filing of the SSI application (which is readily available) to make an assumption as to whether Title II was adjudicated.

See GN 00204.027B.3. before reopening any Title II determinations made from 12/1/98 through 4/17/02 where a prior open application may have been an issue.

3. Reopening Title II Determinations That Did Not Consider an Open Application

Adjudicators may encounter situations where a Title II determination made after the date of the SSI application did not consider an open Title II application. Before reopening the Title II determination to establish an earlier month of entitlement date based on the open application, consider whether the determination was correct based on the POMS instructions in place at the time it was made using the following bullets as a guide:

• If a Title II determination was made at any time from 12/1/98 through 4/17/02 and the adjudicator assumed that no earlier open application existed, that determination was correct when made based on the POMS in place at the time (provided the earlier SSI claim was adjudicated after 9/30/86). The determination is not subject to reopening based on error on the face of the evidence. Reopening may be possible based on one of the other Title II administrative finality rules. See GN 04001.010, GN 04010.030 and GN 04020.080 for the policy on reopening within 1 year, 4 years and unrestrictive reopening respectively. For example, if you receive new evidence to indicate possible entitlement at the time of the prior Title II determination and no more than 4 years have elapsed since the date of that determination, reopening may be possible per GN 04010.030. In a case involving attainment of insured status, reopening may also be possible per GN 04020.070.

  EXAMPLE: A claimant began receiving SSI benefits at age 20 in 6/97. Her father died in 1/99; she contacted SSA in 12/00 to file for child's benefits. No redeterminations were conducted between 6/97 and 12/00. The FO assumed (per the POMS in place in 12/00) that the earlier Title II claim (based on the Title XVI application) had been adjudicated and awarded child's benefits back to 6/00. At the time of the Title II determination (12/00), the POMS said to assume the Title II aspects of the earlier SSI claim (adjudicated after 9/30/86) had been adjudicated. Therefore, the 12/00 determination was correct when made based on the POMS in place at the time and is not subject to reopening based on error on the face of the evidence.

• Prior to 12/1/98 and again after 4/17/02, POMS said to assume the Title II aspects of an earlier SSI claim had not been adjudicated (regardless of when the SSI claim was adjudicated). Therefore, all Title II determinations made during those periods should have considered an earlier open application. If they did not and an open application existed, they are subject to reopening at any time based on error on the face of the evidence (GN 04020.080).

  Reopen the Title II determination (if possible, under the rules of administrative finality) if the Title II application was adjudicated incorrectly (e.g., Title II entitlement existed but was overlooked when the Title XVI application was processed or lag earnings were not considered). See GN 04001.010, GN 04010.020 and GN 04020.080 for the policy on reopening within 1 year, 4 years and unrestrictive reopening respectively.

  EXAMPLE: A claimant began receiving SSI benefits at age 20 in 6/89. Her father died in 1/96; she contacted SSA in 12/97 to file for child's benefits. The FO awarded child's benefits retroactively to 6/97. At the time of the Title II determination (12/97), the POMS said to assume the Title II aspects of the earlier SSI claim had not been adjudicated (even though the process of generating an adjudicative paragraph by coding CLST in the CG field of the SSID was in place from 10/86-5/94). Therefore, unless there is evidence to show that the 6/89 Title II claim had been adjudicated previously, the 12/97 Title II month of entitlement (MOE) determination is subject to reopening and revision based on error on the face of the evidence (provided the requirements in GN 04020.080 are met).

  NOTE: When Title II was properly adjudicated based on the filing of the Title XVI application, consider whether a later Title XVI redetermination (RZ) can establish a protective filing date for Title II benefits. See GN 00204.015 for when a redetermination (RZ) serves as a protective filing for Title II benefits.

C. Procedure – Obtaining and Adjudicating Title II Applications -- Title XVI Claim Not Yet Adjudicated

If the Title XVI claim has not been adjudicated, determine the claimant's potential entitlement to any Title II benefit (including benefits on another SSN such as a widow, child (e.g. DAC) or parent) and process the Title II claim per SI 00601.035. For adjudicative responsibilities, see GN 01010.007 and GN 01010.008.

D. Procedure – Obtaining and Adjudicating Title II Applications -- Title XVI Claim Adjudicated

Be sure to follow instructions in SI 00510.020A.2.a. when sending out a SSA-L-8050 and setting up an appointment for a supplemental Title II application.

1. Determine Potential Entitlement to Title II Benefits

Determine the claimant's potential entitlement to any Title II benefit (including benefits on another Social Security Number (SSN) such as a widow, child (e.g. DAC) or parent).

2. Deceased Claimant Was Not Eligible for Any Title II Benefits

If the claimant is now deceased and was not eligible for any class of Title II benefits at any time between the date of the open application and the present (even after considering lag earnings and obtaining a certified earnings record per SI 00601.035), take no further action. Annotate MSSICS or the SSR (if possible) to explain that no action is being taken. No notice is required.

3. Deceased Claimant Was Potentially Eligible for a Title II Benefit

If the claimant is deceased but was potentially eligible for a Title II benefit based on the open application, processing will depend on whether the information in file is sufficient to award Title II benefits and an eligible person can be located to receive an underpayment (U/P) (see GN 02301.030). Send a notice patterned after NL 00703.743 to the claimant’s last known address, estate or person(s) eligible to receive the (U/P).

a. Information Sufficient for Award - Person Eligible to Receive U/P Located

Obtain an application for the underpayment per GN 02301.050, prepare the Title II award, and process per GN 01061.020.

b. Information Sufficient for Award - Person Eligible to Receive U/P Not Located or Not Responding

Prepare the Title II award and forward to the processing center for the necessary action in posting the U/P to the MBR.

c. Information in File Not Sufficient for Award - Person Eligible to Receive U/P Located

If the requested information is obtained, take the necessary action to prepare an award. If the requested information is not obtained, document the steps taken to obtain the information and prepare a denial using code 064. Annotate the MBR with a special message (SP MSG) to explain the reason for the denial. For example, “10/25/06 – deceased number holder (DNH)/eligible person to receive potential U/P failed to provide necessary information.”

d. Information in File Not Sufficient for Award - Person Eligible to Receive U/P Not Located

Document the MCS Report of Contact (RPOC) screen about efforts used to locate an eligible person. Adjudicate the open application by preparing a denial using code 064. Annotate the MBR with a SP MSG to explain the reason for the denial. For example, “11/3/06 – (DNH)/no one eligible to receive potential U/P—if an eligible person is located, consider reopening.”

4. Living Claimant

Follow the procedure below to obtain and adjudicate a supplemental Title II application using alternative signature methods, when applicable. Appropriate notices will be generated by the system.

a. Application Received

Process and adjudicate the Title II supplemental application following normal procedures. The resulting MBR will be evidence that the Title II application is no longer open.

b. Application Received but Additional Evidence is Needed

If the claimant completes the Title II supplemental application but fails to cooperate (see GN 00204.027D.5.b.) by not submitting necessary documents/proofs, use MCS or MACADE to adjudicate the Title II claim as a disallowance (code 064).

NOTE: MCS must be used to complete the supplemental Title II and/or to adjudicate the open Title II application due to the Title XVI unless one of the exclusions in MCS 004.002 applies. (See SM 00380.500).

Document the MCS RPOC screen showing the efforts expended to obtain the materials along with the date of each attempt. If MACADE is the adjudicating vehicle, document the data field on the Evidence (EVID) screen. Annotate the MBR with a SP MSG to explain the reason for the denial such as: “064 denial/failure to provide necessary information.” The NOT3 screen in MCS should be coded to show the reason for the denial. If MACADE is used to process the 064 denial, the FO must input the denial and prepare the notice on the Document Processing System (DPS) giving the reason for the denial. The resulting MBR will be evidence that the Title II application is no longer open.

If the claimant is still receiving SSI benefits, follow the procedures in SI 00510.001 through SI 00510.030 (Filing for Other Benefits) to suspend the SSI benefits.

If the claimant subsequently submits the necessary evidence, treat it as an implied request for reconsideration. If the evidence or proofs are returned after the appeals period has expired, determine if there is good cause for late filing and process the reconsideration request accordingly. If good cause cannot be found in order to pursue the appeal, consider a possible reopening.

c. Application Not Completed

If the claimant cannot be contacted (see GN 00204.027D.5.a.) or fails to cooperate, complete the Title II supplemental application and adjudicate the Title II claim based on the claimant's signature on the Title XVI application (which, per GN 00204.020 and SI 00601.035B. is an application for Title II). The signature from the SSI application should be used to closeout the “Attest” issue and to denote a signed application was obtained. Adjudicate the open application by preparing a denial using code 064 either via EC processing in MCS or in MACADE. See note in GN 00204.027D.4.b. Also see MSOM MCS 009.003, SM 00380.040, and SM 00380.508 for EC and MACADE processing, respectively. Annotate the MBR with a SP MSG to explain the reason for the denial such as: “064 denial/failure to provide necessary information.”

When MCS is used, the NOT3 screen should be coded giving the reason for the denial. If MACADE is used the FO must input the denial and prepare the denial notice on DPS, specifying the reason for the denial (i.e., failure to provide necessary information). The resulting MBR will be evidence that the Title II application is no longer open.

If the claimant is still receiving SSI benefits, follow the procedures in SI 00510.001 through SI 00510.030 (Filing for Other Benefits) to suspend the SSI benefits.

If the claimant subsequently contacts SSA to complete the supplemental application, treat the supplemental application as an implied request for reconsideration. If the date of the contact is after the appeals period has expired, determine if there is good cause for late filing and process the reconsideration request accordingly.

NOTE: A third party can submit an internet (iClaim) application that serves as a protective filing, however, it is not considered a valid application per GN 00204.055E.1. A protective filing established in iClaim by a third party is closed out by notices automatically mailed to the claimant, see GN 00204.055E. If the third party submits an iClaim and we are not able to obtain a signature or attestation from the proper applicant within 6 months, delete the iClaim per GN 00204.055H.2.b. A Title XVI wet signature cannot be applied to the third party iClaim.

5. Unable to Locate (Whereabouts Unknown) or Failure to Cooperate

a. Unable to Locate (Whereabouts Unknown)

In situations where the claimant’s whereabouts are unknown the FO must use reasonable efforts to locate the claimant. Review the claims folder and SSA records (SSR/MBR) for leads to the claimant's whereabouts. Document fully when (the date) and what steps were taken to locate the claimant on the RPOC screen in MCS. Complete the following steps in an effort to contact the claimant:

• Telephone - If a telephone number is located, try to contact the claimant by telephone. Telephone at different times, leave messages when possible and give the claimant a time to return calls. Check the local directory and/or call directory assistance for a new telephone number and address for the claimant. If telephone contact is unsuccessful, send the claimant a call-in/come-in letter.

• Come- in/Call-in Letter – Using the Document Processing System (DPS), send a come-in/call-in letter to the last known address of the claimant stating the reason that we need him/her to come to/call the office. The letter should include any protective filing information and the timeframe in which the claimant must respond (see GN 00301.150B.5.). It should also inform the claimant of actions that will take place if he/she does not respond.

• If there is no response to the “come-in/call-in” letter after 15 calendar days, send a second letter and form SSA-L2001 (Address Information Request) to the Post Office (PO) for a current address, unless the letter has been returned with a legend indicating that the letter is undeliverable and has no forwarding address. Review the folder for the names and telephone numbers of family members or friends, prior treating sources or people who previously represented the claimant. Follow step 1 (telephone) to pursue available leads that could potentially be of assistance in locating the claimant.

• If the come-in/call-in letter is returned undeliverable prior to the 15 calendar days, send Form SSA-L2001 to the PO, unless the letter has been returned with a legend indicating that the letter is undeliverable and has no forwarding address. Follow the previous step to attempt to locate claimant,

• After all efforts have been exhausted and whereabouts of the claimant remains unknown, follow GN 00204.027D.4.b. to deny the Title II open application and refer to Title XVI for suspension of the Title XVI payment.

b. Failure to Cooperate

FO personnel should offer whatever assistance is available to aid physically or mentally disabled claimants with filing and/or obtaining the information necessary to complete the Title II claim. However, if the claimant appears capable but is uncooperative and indicates either by actions or a written or verbal statement that he/she does not wish to pursue the claim, a denial should be processed and a notice must be sent to the claimant (see GN 00204.027D.4.c.). Document the RPOC screen with the date and a brief explanation of the actions that lead to the denial and place a special message on the MBR to explain the reason for the “064” denial.

E. References

SI 00601.035, Adjudicating Title II when a Title XVI application is filed

GN 01010.007 Adjudicative Responsibilities

GN 01010.008 Field Office (FO) Adjudicative Responsibilities

GN 04001.010, When and Why SSA Reopens – Policy Principle

GN 04010.030, Reopenings – New and Material Evidence

GN 04020.080, Unrestricted Reopening – Clerical Error or Error on the Face of the Evidence