GN 00301: General Evidentiary Standards
TN 18 (05-04)
A. Example
Rita Moore, a Title II claimant, reports the receipt of a pension. The FO verifies the amount of the pension with the FBI in a telephone interview.
CLIENT: Rita Moore
CROSS-REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
- AGE - LAWFUL ALIEN STATUS - RELATIONSHIP -IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES -WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE X UNEARNED INCOME
DOCUMENT EVENT DATE: 08142003ISSUANCE/RECORDATION DATE (Y/N): N
IF YES, DATE RECORDED: ________ DATE ISSUED:________
DOCUMENT TYPE: RC LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: XXXXXXXXXX STATE:XX
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): N IF YES, RIN:
COMMENTS: Verified amount of pension with John Thomas, FBI, (555) 555-5555
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): N PAGE: S
B. Example
Rita Moore, a Title II claimant, reports the receipt of a pension and the FO obtains a signed statement from the FBI verifying the amount of the pension.
CLIENT: Rita Moore
CROSS-REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
- AGE - LAWFUL ALIEN STATUS - RELATIONSHIP -IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES -WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE X UNEARNED INCOME
DOCUMENT EVENT DATE: 08142003ISSUANCE/RECORDATION DATE (Y/N): N
IF YES, DATE RECORDED: ________ DATE ISSUED:________
DOCUMENT TYPE: 795 John Thomas (FBI) LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: XXXXXXXXXX STATE:XX
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): N IF YES, RIN:
COMMENTS: Mr. Thomas signed 795 verifying amount of pension
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): N PAGE: S
C. Example
For proof of age and citizenship, claimant/number holder (Rita Moore) submits a birth certificate showing child's name as Reita Koerrs. Claimant's maiden name on the application screen is Rita Korrs. The document is recorded for audit purposes since the name is different.
CLIENT: Rita Moore
CROSS-REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
X AGE - LAWFUL ALIEN STATUS - RELATIONSHIP -IDENTITY
X CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES -WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 04171932 ISSUANCE/RECORDATION DATE (Y/N): Y
IF YES, DATE RECORDED: 04171932 DATE ISSUED:09021973
DOCUMENT TYPE: BC Reita Koerrs LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: Hampton STATE:VA
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN:0933580-35
COMMENTS:
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): N PAGE: S
D. Example
Agnes Henderson is filing for RIB benefits. She brings in her 2003 W2 as proof of lag wages. Ms. Henderson works for AART's Office Supply Co. (EIN 32-1870732) in Seattle, WA.
CLIENT: Agnes Henderson
CROSS-REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
- AGE - LAWFUL ALIEN STATUS - RELATIONSHIP - IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES XWAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 12312003 ISSUANCE/RECORDATION DATE (Y/N): X
IF YES, DATE RECORDED: 99999999 DATE ISSUED: 99999999
DOCUMENT TYPE: W2 LANGUAGE:SSSSSSSS
PLACE DOCUMENT CREATED: CITY: Seattle STATE:WA
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN:32-18170732
COMMENTS: lag wages
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S
E. Example
Concurrent claims are filed on account #123-00-6789 by the disabled NH, Mary Ann Pharr (maiden name Neer) and child Wayne Pharr; Wayne's DOB is 4 /11/96. The child's birth certificate is presented as proof of age, citizenship and relationship for the child and as proof of age for the NH. Two Evidence Screens must be completed.
NHs Screen
CLIENT: Mary Ann Pharr
CROSS REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
X AGE - LAWFUL ALIEN STATUS - RELATIONSHIP -IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES - WAGES
- DEATH - MARRIAGE - SELF EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 04111996 ISSUANCE/RECORDATION DATE (Y/N): Y
IF YES, DATE RECORDED: 04111996DATE ISSUED: 04301996
DOCUMENT TYPE: CBC-Wayne Pharr LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: SEATTLE STATE:WA COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN:66432109-86
COMMENTS: N/Hs age at C's birth is 24 yrs.
MTH Name - Mary Ann Neer
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S
CHILD'S Screen
CLIENT: Wayne Pharr
CROSS REFERENCE SSN: 123006789 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
X AGE - LAWFUL ALIEN STATUS X RELATIONSHIP - IDENTITY
X CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES -WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 06151997ISSUANCE/RECORDATION DATE (Y/N): y
IF YES, DATE RECORDED: 04111996 DATE ISSUED:04301996
DOCUMENT TYPE: BC XXXXXXXXXXXXXXXXXXXXXXXXXXX LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: SEATTLE STATE:WA
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN: 66432109-86
COMMENTS: MTH: Mary Ann Pharr
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S
F. Example
Title II aged claimant, Franz Deuringer, submits a family bible with entries written in German as proof of age for a domestic RIB claim. The CR is a certified German translator. The document shows that the claimant was born on 4/3/33. The claimant's DOB allegation on the APPL screen in MCS is 4/2/33. (A personal letter was also presented. A second Evidence Screen can be used to code information concerning the letter.)
CLIENT: Franz Deuringer
CROSS REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
X AGE - LAWFUL ALIEN STATUS - RELATIONSHIP -IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES - WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 04031933 ISSUANCE/RECORDATION DATE (Y/N): X
IF YES, DATE RECORDED: 999999999 DATE ISSUED: 999999999
DOCUMENT TYPE: BIBLEXXXXXXXXXXXXXXXXXXXXXXXXX LANGUAGE: GERMAN
PLACE DOCUMENT CREATED: CITY: MUNICH STATE: XX
COUNTRY: GE OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): N IF YES, RIN: XXXXXXXXXXXXXXXXXXXXX
COMMENTS: 1 of 2 docs; m-discrep; age proven
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): Y PAGE: S
G. Example
Jonathan C. Grooms, a SSI recipient, reports that he moved on 2/05/2004 and now lives with roommates in an apartment. He verifies rental liability by providing a rent receipt from Reid Management dated 2/28/2004.
CLIENT: Jonathan C. Grooms
CROSS REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 2 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 3 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
- AGE - LAWFUL ALIEN STATUS - RELATIONSHIP - IDENTITY
- CITIZENSHIP X LIVING ARRANGEMENT - RESOURCES -WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 02282004ISSUANCE/RECORDATION DATE (Y/N): X
IF YES, DATE RECORDED: 99999999 DATE ISSUED: 99999999
DOCUMENT TYPE: Rent Recpt-Reid Mgmt LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: Birmingham STATE:AL
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN: 1005
COMMENTS: Rental liability; pd started 3/1/ 2004.
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S
H. Example
Cynthia Pollack files for SSI on 3/7/2004 and alleges owning a checking account with a balance of $500 and a savings account with a balance of $1000. She submits her bank statements from Crestar Bank dated 2/28/2004 as evidence of her resources. Her account number is 32-1675-88. Although her allegation appears to permit eligibility, the FO asks for proof of her resources. The amount is $5000, which makes her ineligible for SSI payments.
CLIENT: Cynthia Pollack
CROSS REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 2 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
- AGE - LAWFUL ALIEN STATUS - RELATIONSHIP - IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT X RESOURCES -WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 02282004 ISSUANCE/RECORDATION DATE (Y/N): X
IF YES, DATE RECORDED: 99999999 DATE ISSUED: 99999999
DOCUMENT TYPE: BANK STATEMENT-CRESTAR BANK LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: Beaumont STATE:TX
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN: 32-1675-88
COMMENTS: inelig provn; $5000 in savs/savings.
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S
I. Example
Marylin Wheeler, a SSI recipient, comes to the FO to submit her pay stubs (dated 3/3/2004 and 3/16/2004) for 3/2004 as proof of her monthly earnings. She reports her earnings on a monthly basis. Ms. Wheeler works for Shannon Moving Co. (EIN 37-8755123) in Boise, Idaho.
CLIENT: Marylin Wheeler
CROSS REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 2 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 3 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
- AGE - LAWFUL ALIEN STATUS - RELATIONSHIP - IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES X WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 03312004ISSUANCE/RECORDATION DATE (Y/N): X
IF YES, DATE RECORDED: 99999999 DATE ISSUED: 99999999
DOCUMENT TYPE: PAY STUBS - Shannon Moving Co. LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: Boise STATE:ID
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID (RIN)(Y/N): Y IF YES, RIN: 37-8755123
COMMENTS: Future Monthly Info Stored Locally
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S