GN 01085: Retention Periods for Program-Related Documents and Forms

Effective Dates: 01/02/2015 - Present

BASIC (03-04)

A. Background

The Paperless Processing Center System (PPC) is a document imaging and management system that SSA employs in the payment centers (PCs) to manage the work.

This section provides guidance for the retention and subsequent disposition of program-related documents once an action has been successfully imaged; i.e., it is clearly readable.

The following retention policy applies only to paper forms (and other paper documents) that are scanned into the paperless imaging equipment in the PSCs.

B. Policy

SSA will destroy original documents and forms that are scanned into the paperless imaging system once the PSC determines that the images are of high enough quality to meet processing standards; i.e., the images are clearly readable.

Exclusions from destruction are:

Documents/forms contained in the initial claims files;
Documents that must be returned to the beneficiary; e.g., marriage certificates;
Disability medical documents;
Certain Title XVI documents.

C. Procedure

Set aside exclusions to the destruction process at the front-end of the process. Return forms and documents to the beneficiary as appropriate. Associate all other forms excluded from the destruction process with the paper claims file. Destroy the paper claims file in accordance with current retention schedules.
Destroy paper documents and forms that the PSC processed without imaging (e.g. direct input work).
Refer to the following chart for imaged documents. Retain documents contained in the initial claims file, and exclusions shown in GN 01085.030B.
Use the following guidelines for Title II forms and documents that are not listed in GN 01085.030D:
1. Computer Output – Destroy once the image is clearly readable.
2. Responses/Inquiries - Destroy once the image is clearly readable.
3. Statements - Destroy once the image is clearly readable, UNLESS it is part of the initial claims file. If the statement is part of the initial claims file, then follow the procedures in GN 01085.030C.1.
4. Reporting Events - Destroy once the image is clearly readable.

D. Exhibit - retention periods for program-related forms

The following exhibit is a guide for discarding forms in PSC modules using the paperless process. Although we display many forms, this is not an all-inclusive list. Follow GN 01085.030C.4. for unlisted forms.

FORM NUMBER	TITLE	RETENTION DISPOSITION
SSA-1	Application for Retirement Insurance Benefits	UNTIL paper claims file is destroyed.
SSA-2	Application for Spouse Insurance Benefits	UNTIL paper claims file is destroyed.
SSA-3	Marriage Certification	UNTIL paper claims file is destroyed.
SSA-4	Application for Child Insurance Benefits	UNTIL paper claims file is destroyed.
SSA-5	Application for Mother or Father Insurance Benefits	UNTIL paper claims file is destroyed.
SSA-7	Application for Parent Insurance Benefits	UNTIL paper claims file is destroyed.
SSA-8	Application for Lump Sum Death Payment	PAPERLESS LSDP ONLY CLAIMS Destroy 60 DAYS after verification of systems acceptance of LSDP action. ALL OTHER LSDP/SURVIVOR CLAIMS UNTIL paper claims file is destroyed.
SSA-10	Application for Widow(er) Insurance Benefits	UNTIL paper claims file is destroyed.
SSA-11	Request to be Selected as Payee	Destroy once the image is determined to be clearly readable.
SSA-16	Application for Disability Insurance Benefits	UNTIL paper claims file is destroyed.
SSA-19	Application for Special Age 72-or-Over Monthly Payments	UNTIL paper claims file is destroyed.
SSA-21	Supplement of Claim of Person Outside the U.S.	Destroy once the image is determined to be clearly readable.
VA-21-4182	Abbreviated Application for VA Benefits	Destroy once the image is determined to be clearly readable unless used for protective filing; then retain UNTIL paper claims file is destroyed.
VA-21-8046	VA Payment Notice (Stop-Suspend-Resume)	Destroy once the image is determined to be clearly readable.
SSA-24	Application for Survivor Benefits	UNTIL paper claims file is destroyed.
SSA-25	Certificate of Election for Reduced Spouse benefits	UNTIL paper claims file is destroyed.
HCFA-40B	Application for Supplementary Medical Insurance	Destroy once the image is determined to be clearly readable.
BRI-46-289	Inquiry from OPM	Destroy once the image is determined to be clearly readable.
VA-70-7210	Request for Index and Locator Information	Destroy once the image is determined to be clearly readable.
SSA-101	Determination of Award - - Manual	Destroy once the image is determined to be clearly readable.
SSA-L106	School Certification of Birth Data	Destroy once the image is determined to be clearly readable.
SSA-122	Request for Additional Information	Destroy once the image is determined to be clearly readable.
SSA-149	Waiver of Benefit Payment	Destroy once the image is determined to be clearly readable.
SSA-150	Modified Benefit Formula Questionnaire for the Windfall Elimination Provision (WEP)	Destroy once the image is determined to be clearly readable.
SSA-174	Representative Payee Diary Card	Destroy once the image is determined to be clearly readable.
SF-180	Request Pertaining to Military Service Records	Destroy once the image is determined to be clearly readable.
SSA-208	Authorization for Garnishment	Destroy once the image is determined to be clearly readable.
SSA-209	Garnishment Information Update	Destroy once the image is determined to be clearly readable.
DD-214	Statement of Military Service	Destroy once the image is determined to be clearly readable.
SSA-L244	Letter Transmitting Reconsideration Determination	Destroy once the image is determined to be clearly readable.
SSA-250	Development Worksheet	Destroy once the image is determined to be clearly readable.
SSA-L250	Notice of Application for Withdrawal of Claim	Destroy once the image is determined to be clearly readable.
SSA-L293	RSDI Notice of Unscheduled CDR	Destroy once the image is determined to be clearly readable.
SSA-381-SP	Waiver of Option to Receive Spanish Language Notice	Destroy once the image is determined to be clearly readable.
SSA-385	OIO Case Folder Flag	Destroy once the image is determined to be clearly readable.
SSA-408	Route Slip	Destroy once the image is determined to be clearly readable.
SSA-409	Postadjudicative Routing	Destroy once the image is determined to be clearly readable.
SSA-450	Claims Input Data Form	Destroy once the image is determined to be clearly readable.
SSA-454	Report of Continuing Disability Interview	UNTIL paper claims file is destroyed.
SSA-455	Disability Update Report	UNTIL paper claims file is destroyed.
SSA-492	PC Case Folder Flag	Destroy once the image is determined to be clearly readable.
HA-520	Request for Review of Hearing Decision Order	Destroy once the image is determined to be clearly readable.
SSA-521	Request for Withdrawal of Application	Destroy once the image is determined to be clearly readable.
SSA-533	Translation Request	Destroy once the image is determined to be clearly readable.
HA-539	Notice Regarding Substitution of Party (Upon Death of Claimant)	Destroy once the image is determined to be clearly readable.
SSA-546	Workers' Compensation / Public Disability Benefits Information	UNTIL paper claims file is destroyed.
SSA-553	Special Determination	Destroy once the image is determined to be clearly readable.
SSA-559	Transmittal Sheet for Claims Folder / Material	Destroy once the image is determined to be clearly readable.
SSA-561	Request for Reconsideration	Destroy once the image is determined to be clearly readable.
SSA-562	Request for Assistance / Certification of Documents or Records	Destroy once the image is determined to be clearly readable.
SSA-L566	SSA Application Development	Destroy once the image is determined to be clearly readable.
SSA-573	Special Typing Instructions	Destroy once the image is determined to be clearly readable.
SSA-622	Representative Payee Questionnaire – Individual	Destroy once the image is determined to be clearly readable.
SSA-623	Representative Payee Report	Destroy once the image is determined to be clearly readable.
SSA-624	Representative Payee Evaluation Report	Destroy once the image is determined to be clearly readable.
SSA-625	Report by Former Representative Payee	Destroy once the image is determined to be clearly readable.
SSA-632	Request for Waiver of Overpayment Recovery or Change in Overpayment	Destroy once the image is determined to be clearly readable.
SSA-632	Recovery Interview Supplement	Destroy once the image is determined to be clearly readable.
SSA-635	Waiver Determination	Destroy once the image is determined to be clearly readable.
SSA-636	Transmittal Notice for a Hearing	Destroy once the image is determined to be clearly readable.
SSA-654	Request for Information From Uniformed Services	Destroy once the image is determined to be clearly readable.
SSA-655	Certification by Federal Agency	Destroy once the image is determined to be clearly readable.
SSA-656	Information as to Continuing Eligibility Under Title 38 USC, Section 412, Veterans' Benefits	Destroy once the image is determined to be clearly readable.
SSA-662	Reconsideration Determination	Destroy once the image is determined to be clearly readable.
SSA-702	Statement Regarding Date of Birth and Citizenship	UNTIL paper claims file is destroyed.
SSA-704	Certification of Contents of Document(s) or Record(s)	Destroy once the image is determined to be clearly readable unless contained in the initial claims file.
SSA-L706	Proof of Age Letter to Custodian	Destroy once the image is determined to be clearly readable.
SSA-721	Statement of Death by Funeral Director	Destroy once the image is determined to be clearly readable.
SSA-723	Statement Regarding Presumed Death Due to Unexplained Absence	UNTIL paper claims file is destroyed.
SSA-730	Request to Have SSI Overpayment Withheld from SSA benefits	UNTIL paper claims file is destroyed.
SSA-L732	Additional Information Needed From Claimant to Adjudicate Claim	Destroy once the image is determined to be clearly readable.
SSA-753	Statement Regarding Marriage	UNTIL paper claims file is destroyed.
SSA-754	Statement of Marital Relations	UNTIL paper claims file is destroyed.
SSA-760	Certificate of Support	UNTIL paper claims file is destroyed.
SSA-766	Statement of Self-Employment	Destroy once the image is determined to be clearly readable.
SSA-768	Certification of Evidence of Wages	Destroy once the image is determined to be clearly readable.
SSA-781	Certificate of Care and Responsibility for Welfare of Child Not in Applicant's Custody	UNTIL paper claims file is destroyed.
SSA-783	Statement Regarding Contributions	UNTIL paper claims file is destroyed.
SSA-787	Physician / Medical Officer Statement	Destroy once the image is determined to be clearly readable.
SSA-788	Statement of Care and Responsibility for Beneficiary	Destroy once the image is determined to be clearly readable.
SSA-790-RR	Request for Railroad Earnings	Destroy once the image is determined to be clearly readable.
SSA-795	Statement of Claimant or Other Person	Destroy once the image is determined to be clearly readable.
SSA-827	Authorization to Release Medical Information to SSA	Destroy once the image is determined to be clearly readable.
SSA-831	DIB Determination and Transmittal Sheet	Destroy once the image is determined to be clearly readable.
SSA-832	Cessation or Continuance of Disability / Blindness Determination and Transmittal - Title XVI	Destroy once the image is determined to be clearly readable.
SSA-833	Cessation or Continuance of Disability / Blindness Determination and Transmittal – Title II	Destroy once the image is determined to be clearly readable.
SSA-892	ESRD Medical Determination	Destroy once the image is determined to be clearly readable.
SSA-924	Folder Documentation	Destroy once the image is determined to be clearly readable.
SSA-1002	Statement of Agricultural Employer for Years Before 1988	Destroy once the image is determined to be clearly readable.
SSA-1003	Statement of Agricultural Employer for Years After 1987	Destroy once the image is determined to be clearly readable.
SSA-L1043	Letter Requesting Necessary Evidence	Destroy once the image is determined to be clearly readable.
SSA-L1044	(Follow-up) Letter Requesting Necessary Evidence	Destroy once the image is determined to be clearly readable.
SSA-L1045	(Closeout) Letter Requesting Necessary Evidence	Destroy once the image is determined to be clearly readable.
SSA-1099	SS Benefit Statement	Destroy once the image is determined to be clearly readable.
SSA-1129	Attorney Fee Case – Past Due Benefit Summary	Destroy once the image is determined to be clearly readable.
SSA-L1157	Notice of Disability	Destroy once the image is determined to be clearly readable.
SSA-1178	Evaluation of Fee Petition	Destroy once the image is determined to be clearly readable.
SSA-1203	Determination of Benefits Payable After Offset (WC/PDB)	Destroy once the image is determined to be clearly readable.
SSA-1208	Keep Flag on Top	Destroy once the image is determined to be clearly readable.
DD-1300	Report of Casualty	Destroy once the image is determined to be clearly readable.
SSA-1314	Annual Report Data	Destroy once the image is determined to be clearly readable.
SSA-1323	Report on Individual With Childhood Impairment	Destroy once the image is determined to be clearly readable.
SSA-1372	Student's Statement regarding School Attendance	Destroy once the image is determined to be clearly readable.
SSA-1383	Student Reporting Form – Changes	Destroy once the image is determined to be clearly readable.
SSA-1386	Student's Statement Regarding Resumption of School Attendance	Destroy once the image is determined to be clearly readable.
SSA-1388	Report of Student Beneficiary at End of School Year	Destroy once the image is determined to be clearly readable.
SSA-1390	Report of Student Beneficiary About to Attain Age 19	Destroy once the image is determined to be clearly readable.
SSA-1425	Reporting Changes that Affect SSA Payment	Destroy once the image is determined to be clearly readable.
SSA-1473	Request for Railroad Annuity Information	Destroy once the image is determined to be clearly readable.
SSA-1535	Application for Search of Census Records	Destroy once the image is determined to be clearly readable.
SSA-1588	Beneficiary Recontact Report	Destroy once the image is determined to be clearly readable.
SSA-1610	Public Assistance Agency Information Request	Destroy once the image is determined to be clearly readable.
SSA-1671	Transmittal of Critical Case	Destroy once the image is determined to be clearly readable.
SSA-1696	Appointment of Representative	Destroy once the image is determined to be clearly readable.
SSA-1709	Request for Workers' Compensation / Public Disability Benefits Information	Destroy once the image is determined to be clearly readable.
SSA-1719	RSI Postentitlement Direct Input	Destroy once the image is determined to be clearly readable.
SSA-1719-B	SSI Postentitlement Direct Input	Destroy once the image is determined to be clearly readable.
SSA-1719-C	SSI Postentitlement Direct Input	Destroy once the image is determined to be clearly readable.
SSA-1719-NC	SSI Non-Receipt Direct Input	Destroy once the image is determined to be clearly readable.
SSA-1720	Annual Report Direct Input	Destroy once the image is determined to be clearly readable.
SSA-1724	Claim for Amounts Due	Destroy once the image is determined to be clearly readable.
SSA-1826	Sample Itemized Statement of Earnings	Destroy once the image is determined to be clearly readable.
PHS-1867	Public Health Service DMW Credit Reporting Form	Destroy once the image is determined to be clearly readable.
SSA-2038	Date of Birth Determination	Destroy once the image is determined to be clearly readable.
SSA-2118	Request for Document Information	Destroy once the image is determined to be clearly readable.
SSA-2164	Work Notice Direct Input	Destroy once the image is determined to be clearly readable.
SSA-2417	Determination of Benefit Rights	Destroy once the image is determined to be clearly readable.
SSA-2454	Offset Worksheet (WC/PDB) – Triennial Redetermination Previously Applied	Destroy once the image is determined to be clearly readable.
SSA-2455	WC/PDB Offset Worksheet – Disability	Destroy once the image is determined to be clearly readable.
SSA-2506	Psychiatric Review Techniques	UNTIL paper claims file is destroyed.
SSA-2512	Pre-1957 Military Service – Federal Benefit Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-2514	Claimant's Intent to File	Destroy once the image is determined to be clearly readable.
SSA-2519	Child Relationship Statement	UNTIL paper claims file is destroyed.
SSA-2521	Request for Priority Action	Destroy once the image is determined to be clearly readable.
SSA-2708	Request to Call or Visit the District Office	Destroy once the image is determined to be clearly readable.
SSA-2764	SALT Coding Sheet	Destroy once the image is determined to be clearly readable.
SSA-2795	Determination of Resumption of Award	Destroy once the image is determined to be clearly readable.
SSA-L3044	Social Security Notice to Employee	Destroy once the image is determined to be clearly readable.
SSA-3105	Important Information About Your Review Rights	Destroy once the image is determined to be clearly readable.
SSA-3368	Disability Report	UNTIL paper claims file is destroyed.
SSA-3369	Vocational Report	UNTIL paper claims file is destroyed.
SSA-L3400	Social Security Notice	Destroy once the image is determined to be clearly readable.
SSA-3428	Determination of Disallowance	Destroy once the image is determined to be clearly readable.
SSA-3440	Claims Collection Litigation Report	Destroy once the image is determined to be clearly readable.
SSA-3441	Reconsideration Disability Report	UNTIL paper claims file is destroyed.
SSA-3601	MCS or Non-CAPS Routing Form	Destroy once the image is determined to be clearly readable.
SSA-3621	MBR Account / Benefit Data Change Form	Destroy once the image is determined to be clearly readable.
SSA-3643	Offset Worksheet (WC/PDB) – Triennial Redetermination	Destroy once the image is determined to be clearly readable.
SSA-3820	Medical History and Disability Report	UNTIL paper claims file is destroyed.
SSA-3881	Questionnaire for Children Claiming SSI Benefits	UNTIL paper claims file is destroyed.
SSA-3885	Government Pension Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-3926	Determination of Benefit Adjustment	Destroy once the image is determined to be clearly readable.
HCFA-4040	Application for Supplementary Medical Insurance	UNTIL paper claims file is destroyed.
SSA-4078	Request for Earnings After Death	Destroy once the image is determined to be clearly readable.
SSA-L4107	Change of Address – Additional Information Needed	Destroy once the image is determined to be clearly readable.
SSA-4111	Certificate of Election for Reduced Widow(er) Benefit	Destroy once the image is determined to be clearly readable.
SSA-L4112	Request for Employment Information	Destroy once the image is determined to be clearly readable.
SSA-L4157	Request for Earnings Information	Destroy once the image is determined to be clearly readable.
SSA-4162	Child-Care Dropout Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-4164	Consent Form for a Representative Payee	Destroy once the image is determined to be clearly readable.
SSA-4184	Self-Employment / Corporate Officer	UNTIL paper claims file is destroyed.
SSA-4268	Explanation of Determination	Destroy once the image is determined to be clearly readable.
SSA-4345	SSI Offset Worksheet – Federal	Destroy once the image is determined to be clearly readable.
SSA-L4360	SS Benefit Information	Destroy once the image is determined to be clearly readable.
SSA-4385	Certification of Contents of Court Records	Destroy once the image is determined to be clearly readable.
SSA-4500	Federal determination of Error in State's Wage Reports	Destroy once the image is determined to be clearly readable.
SSA-4582	Wage Suspense / Reinstate Card	Destroy once the image is determined to be clearly readable.
SSA-4641	Authorization for SSA to Obtain Personal Information	Destroy once the image is determined to be clearly readable.
SSA-4734	Residual Physical Functional Capacity Assessment	Destroy once the image is determined to be clearly readable.
SSA-4734	Mental Residual Functional Capacity Assessment	Destroy once the image is determined to be clearly readable.
SSA-5002	Report of Contact	Destroy once the image is determined to be clearly readable.
SSA-L5004	Acknowledgment of Misdirected Tax	Destroy once the image is determined to be clearly readable.
SSA-5015	Diary and Listing Slip	Destroy once the image is determined to be clearly readable.
SSA-5016	Scouting Request – Pending Claim	Destroy once the image is determined to be clearly readable.
HA-5051	Transmittal of ALJ's Decision or Dismissal to ODAR	Destroy once the image is determined to be clearly readable.
SSA-5052	RSI Health Insurance Information Request	Destroy once the image is determined to be clearly readable.
SSA-L5114	Letter Notifying Self-Employed Claimant of Adjustment	Destroy once the image is determined to be clearly readable.
SSA-5526	Request for Assistance – Disability	Destroy once the image is determined to be clearly readable.
SSA-5527	Request for Assistance – Representative Payee	Destroy once the image is determined to be clearly readable.
SSA-6220	Representative Payee Questionnaire – Institutions	Destroy once the image is determined to be clearly readable.
SSA-6230	Representative Payee Report for Children	Destroy once the image is determined to be clearly readable.
SSA-7004	Request for Earnings and Benefit Estimate Statement	Destroy once the image is determined to be clearly readable unless used for protective filing; then retain UNTIL paper claims file is destroyed.
SSA-7005	Personal Earnings and Benefit Estimate Statement	Destroy once the image is determined to be clearly readable unless used for protective filing; then retain UNTIL paper claims file is destroyed.
SSA-7008	Request for Correction of Earnings	Destroy once the image is determined to be clearly readable.
SSA-7011	Statement of Employer Regarding Earnings	Destroy once the image is determined to be clearly readable.
SSA-L7013	Request to Employer for Wage Information	Destroy once the image is determined to be clearly readable.
SSA-L7014	Request for Earnings Information	Destroy once the image is determined to be clearly readable.
SSA-L7015	Follow Up to SSA-L7014 Request	Destroy once the image is determined to be clearly readable.
SSA-7052	DO Record of Earnings Discrepancy Development	Destroy once the image is determined to be clearly readable.
SSA-7057	Request for Tax Return Information	UNTIL paper claims file is destroyed.
SSA-7104	Partnership Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-7160-F4	Employment Relationship Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-7157	Farm Arrangement Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-7160	Employment Relationship Questionnaire	UNTIL paper claims file is destroyed.
SSA-7161	Foreign Enforcement Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-7162	Foreign Enforcement Questionnaire	Destroy once the image is determined to be clearly readable.
SSA-7163	Questionnaire about Employment or Self-Employment Outside USA	Destroy once the image is determined to be clearly readable.
SSA-8000	Application for SSI – Long Form	UNTIL paper claims file is destroyed.
SSA-8001	Application for SSI – Short Form	UNTIL paper claims file is destroyed.
SSA-8006	Statement of Living Arrangements, In-Kind Support and Maintenance	UNTIL paper claim or postentitlement file is destroyed.
SSA-8008	Living Arrangement and In-Kind Support and Maintenance Guide	UNTIL paper claim or postentitlement file is destroyed.
SSA-8010	Statement of Income and Resources	UNTIL paper claim or postentitlement file is destroyed.
SSA-8011	Statement of Household Expenses and Contributions	UNTIL paper claim or postentitlement file is destroyed.
SSA-8202	Statement for Determining Continuing Eligibility for SSI	Destroy 7 YEARS after completion of the redetermination action.
SSA-8203	Statement for Determining Continuing Eligibility for SSI Payment	UNTIL paper claim or postentitlement file is destroyed.
SSA-8299	Request for Special Age 72 Reinstatement	Destroy once the image is determined to be clearly readable.
SSA-8510	Authorization to SSA to Obtain Personal Information	Destroy once the image is determined to be clearly readable.
SSA-8740	Referral and Treatment Status of SSI Drug Addicts and Alcoholics	UNTIL paper claim or postentitlement file is destroyed.
SSA-9432	Notice Regarding Military Service Wage Credits	Destroy once the image is determined to be clearly readable.
SSA-9584	State Mental Institution Policy	Destroy once the image is determined to be clearly readable.
SSA-9584	Certification by State Mental Institution	Destroy once the image is determined to be clearly readable.
SSA-L9778	Work Report	Destroy once the image is determined to be clearly readable.
SSA-L9779	Work Report	Destroy once the image is determined to be clearly readable.
SSA-L9780	Work Report	Destroy once the image is determined to be clearly readable.
SSA-L9781	Work Report	Destroy once the image is determined to be clearly readable.
HA-13041	Statement of Service	Destroy once the image is determined to be clearly readable.
NA-13047	Reply to Request for Information	Destroy once the image is determined to be clearly readable.
NA-13075	Questionnaire about Military Service	Destroy once the image is determined to be clearly readable.

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GN 010: Adjudication

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POMS Reference

GN 01085: Retention Periods for Program-Related Documents and Forms

A. Background

B. Policy

C. Procedure

D. Exhibit - retention periods for program-related forms