TN 13 (07-17)

A. Field Office (FO) responsibilities before submitting a WD request to the Processing Center (PC)

The PC has jurisdiction of a WD request submitted after the adjudication of the application. However, the FO must take actions before forwarding the WD request to the PC.

1. Reviewing and processing the WD request

The FO technician must follow the steps below to process the WD request:

• review the WD request to ensure it meets the requirements listed in GN 00206.005.

• print a fax cover sheet using the Paperless Barcode application under TOEL “CLAIM WITHDR” with remarks “WITHDRAW- Claim Withdrawal [Post-adjudicative]”;

• annotate the cover sheet with the following message if the WD does not meet the time requirement for a (RIB) request : “WITHDR REC MM/DD/CCYY over 12 months or exceeds lifetime limit, previous withdrawal on file”;

• fax the WD request and any associated documentation to the servicing PC via the Paperless Barcode application and the Non-Disability Repository for Evidentiary Documents (NDRed). Once the documentation is stored and viewed in the Claims File User Interface (CFUI) (i.e. making sure all forms and documents are clear and legible), you can destroy the paper document(s). To determine which PC has jurisdiction, see GN 01070.245;

• suspend the claimant’s monthly benefit using the WDSP screen in Post-entitlement Online System (POS) as of the month the WD request was received;

• add the following special message to the Master Beneficiary Record (MBR) via the Miscellaneous Online Edited Transaction System (MONET): “WITHDR REC MM/DD/CCYY forwarded to PC# on MM/DD/CCYY”; include additional remarks if the WD does not meet the time requirement (e.g. over 12 months or exceeds lifetime limit);

• inform the claimant we will forward the request for WD to another component and the claimant will receive a subsequent request for repayment to remit funds in the envelope provided.

• advise the claimant to wait for the formal WD determination (i.e. notice of WD approval) before filing a new claim for the same benefit. If the claimant insists on filing a new claim prior to the WD approval, the FO must process the claim as a duplicate application. Follow instructions for duplicate applications in GN 00204.028.

2. Repayment submitted with the WD application request

Advise the claimant that the PC will mail a notice requesting repayment. However, if the claimant insists on repayment, accept any repayment in the form of money order, credit card, cashier's check, certified check or personal check. Advise the claimant that we will notify them of the final repayment amount required for the WD approval. Discourage the use of cash repayment by mail and advise the claimant that he or she is responsible for any lost cash payments. For information about processing remittances received in the FO, see GN 02403.006. Add a Special Message to the MBR with the date and amount of remittance.

3. Suspending benefits

Suspend benefits on the current claim using the claim withdrawal suspension (WDSP) per SM 03020.270. See the Modernized Systems Operation Manual MSOM COMMON 005.032 for instructions on the Withdrawal of Claim – Suspension screen. Do not include independently entitled divorced spouse (IEDS) beneficiaries when suspending benefits. For more information about IEDS, see RS 00202.100.

IMPORTANT: Do not suspend auxiliary benefits where the WD requester is the NH unless the auxiliary (or representative payee) has consented to the WD request.

B. PC actions to take when WD request is received

The technician must verify that the WD request meets the requirements in GN 00206.005. If the request does not meet the requirements, deny the WD request per GN 00206.014C in this section. If the request meets the requirements, then follow these steps:

1. Obtain consent from auxiliaries for NH’s WDs

Obtain a signed statement from any other beneficiary or proper applicant on the beneficiary’s behalf whose entitlement is nullified by the NH’s WD. The statement must clearly document if the auxiliary gives or refuses to consent to the WD request. If any beneficiary refuses consent, deny the WD request per GN 00206.014C.

NOTE: If an auxiliary on the record is deceased, we must obtain consent from a representative of their estate, per GN 00215.050 Liability of Deceased’s Estate.

2. Contact the Center for Medicare and Medicaid Services (CMS)

If the claimant’s WD request includes withdrawing HI entitlement, follow instructions on GN 00206.020D.2 to determine whether CMS made HI payments on behalf of the claimant.

3. Calculate repayment of benefits

If the FO did not process a suspension, suspend benefits on the current claim using the WDSP screen via POS per the instructions in MSOM COMMON 005.032 and calculate repayment amount due. This includes suspension of benefits for all potentially affected auxiliaries and any benefits they received. Include money withheld during closed tax years for voluntary tax withholding (VTW) per GN 02410.015, and Medicare payments (Hospital Insurance (HI) and Supplemental Medical Insurance (SMI) premiums per GN 00206.020, if applicable.

NOTE: Advise claimants to contact the Internal Revenue Service (IRS) or their tax advisor to discuss any tax implications.

4. Notify the claimant

Use the exhibit notice E3700 in NL 00703.700 to notify the claimant of the:

• reason we are requesting repayment;

• amount to be repaid (less any remittance received in the FO as identified in a Special Message on the MBR);

• method of calculation; and

• method of repayment (i.e., certified check, cashier’s check, personal check, money order, credit card or cash).

Remember to include a refund envelope to send the repayment and diary the case for 45 days.

5. Repayment received or no repayment due

The following section provides instructions for when we receive repayment or no repayment is due. For situations where we do not receive payment, refer to section C of this section.

• If the claimant made repayment by remittance and there is no corresponding “EVENT 019 DIR REMT” on the Payment History Update System (PHUS) record for the remittance amount, prepare a Form SSA-559 (Transmittal Slip for Claims Folders) to the Benefit Authorizer (BA) to add “EVENT 019 DIR REMT” to the PHUS record of the remitter. For more information on “EVENT 019 DIR REMT,” see SM 00630.219.

• Use Manual Adjustment Credit and Award Data Entry (MACADE) to input the action taken on the WD request.

• Use a Form SSA-573 (Special Typing Instructions) to request exhibit notice SSA-L250 (Approval of WD) found in NL 00701.093 or use Aurora, when appropriate. Include paragraph 257 located in NL 00708.100 or use a dictated notice.

NOTE: Refer to GN 00206.025 for WD request and repayments involving RRB claims.

C. PC actions for denying a request for WD application

1. RIB claim with previous WD or past 12-month time limit

Determine if the claimant is within 12 months of his or her current date of entitlement and has not previously withdrawn a RIB claim after adjudication.

NOTE: Counting begins the first month after the current date of entitlement (DOEC) and ends with the last day of the 12th month. For example, if the DOEC were April 2013, then the 12 months would expire the last day of April 2014. Follow the steps below if the request is more than 12 months after the DOEC or the claimant previously withdrew a RIB claim:

• deny the WD request. For notice of WD and appeal rights, see GN 00206.145;

• add listing code *128 to the record;

• add the following special message to the MBR: “WITHDR REC MM/DD/CCYY denied-over 12 months or previous withdrawal”;

• prepare a manual notice using Aurora exhibit notice E4019 (WD Denial) found in NL 00703.703;

• resume monthly payments if benefits were suspended.

2. Repayment not received

If we do not receive repayment from the claimant within 45 days of the initial notification:

• send 30-day closeout notice E3702 as shown in NL 00703.702; and

• diary the case for 30 days;

• after the 30 days, resume payment under the prior award if the claimant has not made repayment, and

• deny the WD. For notice of WD and appeal rights, see GN 00206.145.

3. Partial payment was received or claimant alleges payments

• If the claimant alleges that, he or she submitted payments but there is no record in our system, review all SSA records and evaluate if we received the payment but have not processed it yet. If your review determines that we did not receive payment, deny the WD.

• If the claimant submitted a partial repayment, accept it but determine the reason he or she has not made full repayment. Prepare and send an acknowledgment notice stating the balance due, and re-diary for 15 days.

• If the claimant does not submit the remaining payment due after the 15 days, deny the WD request, and refund any previous partial payment received. For notice of WD and appeal rights, see GN 00206.145.

• If the claimant does submit the remaining payment due, follow instructions per GN 00206.014B.5 this POMS section.

D. References

• GN 00206.001 Withdrawal (WD) of a Title II Benefit Claims Application

• GN 00206.005 Requirements for Withdrawal (WD) of a Benefit Application

• GN 00206.020 Hospital Insurance (HI) and Withdrawals (WD)

• GN 01010.027 District Office Final Authorization (DOFA) Exclusions

• GN 02410.015 Voluntary Tax Withholding (VTW)

• NL 00703.700 Withdrawal Repayment NH

• OS 00501.005 Initial Handling of Remittances Received From the Mailroom or an Operations Component