Audience:

DO/BO/TSC:

CR, CR TII, FR, OA, OS, RR, SR

OCO-ODO-IND:

CATA, IS, ISTA

OCO-ODO-SHARE:

CA, RECONR

OCO-OIO:

BIES, CA, CATA, FCR

PSC:

CA, CRTA, CS, ICDS, IES, ISRA, RECONR

Section 205(q)(3) of the Social Security Act provides that when an individual alleges a monthly benefit is due but has not been paid, and there is some evidence that the allegation is true, although there is not enough evidence for a final determination, preliminary payments may be made before the expiration of the 90 or 30-day time limits contained in section 205(q)(2). Section 205(q)(1) authorizes the procedures under which the expedited payment of monthly insurance benefits may be made. Provisions for making expedited payments after entitlement has been established are in RS 02805.015. This subchapter provides the criteria for making preliminary payments.

The purpose of the provision for preliminary payments is to provide speedy payment to those individuals who are in dire need of benefit payments to meet everyday living expenses at the time an initial claim is being filed, if there is some evidence of entitlement but more evidence is needed for a final determination. An additional hardship would be incurred if benefits were delayed while the additional evidence for a final determination is being sought.

A. Assessing Need

The adjudicator in the DO/BO is responsible for identifying claims situations in which the preliminary payment procedures should be applied. To meet this responsibility, the DO/BO adjudicator must be alert to any indication the claimant may be in dire need that may become apparent during the initial or some later claims interview.

Many persons who file for social security benefits do so in advance of entitlement; e.g., persons approaching planned retirement age or the first month of possible entitlement to benefits. Other individuals who file have other sources of funds in the short term to tide them over until the social security benefits can begin through the normal processes; e.g., persons separated from employment involuntarily and eligible for unemployment compensation. Many persons in need may be helped through the critical case procedures (see RS 02801.001 ff.) when all needed evidence is readily available at the time of filing.

However, the plight of nonworking claimants who may not have at hand the evidence needed for a final determination, especially aged widows or young widows with small children, is of particular concern since the time of the worker's death is not anticipated and short term sources of funds to meet basic needs are, at times, not available. The plight of nonworking retirement benefit claimants must also be considered. For instance, if a NH's unemployment compensation has ceased and the NH is ineligible for Supplement Security Income (SSI) benefits, there may be dire need. Preliminary payment is also available in cases when pending claims must be reconstructed because of unforeseen destruction or damage since inordinate delays may result in dire need. Preliminary payment may also be used in conjunction with the use of emergency evidentiary procedures (see GN 00301.060).

The preliminary payment procedure was intended by Congress to meet the immediate needs of claimants in these kinds of situations. The following instructions represent an effort to meet those needs while at the same time maintaining the effectiveness of normal processing procedures. Persons who meet the requirements of RS 02807.005 will be deemed to be eliglble for preliminary payments.

B. Payments

The preliminary payment procedure contains the risk that the payments may be erroneous because they are being made with less than enough evidence for a final determination. The presumption that the evidence is available is implicit in the procedure.

When preliminary payments have been made, the additional evidence needed for a final determination should be submitted as soon as possible. If it is not received by the time the 4th check is due (3 checks already issued), the presumption that the evidence is available is substantially weakened and the risk of erroneous payment has materially increased. Therefore, if the evidence for a final determination is not received by the time the 4th check is due to be issued, the preliminary payments will be stopped automatically by the Critical Payment System (CPS) (see RS 02807.035). Three checks is the maximum number which can be issued with less than enough evidence for a final determination.

NOTE: If at some point a payment or payment to some but not all claimants is possible because evidence for a final determination is on hand for these claimants, partial adjudication should be made. In this situation, preliminary payment will not be made when payment can be made under the partial adjudication procedures to claimants who are in the same household (see RS 02807.005F.).

C. Request

The minimum evidence requirements (see RS 02807.010) must be met before preliminary payments may be made. However, it is not necessary to meet these requirements before the filing of a request for preliminary payment. The request will be secured during the initial interview, if possible, even though the district office/branch office (DO/BO) does not have some required evidence; e.g., the certified earnings record (E/R) from the Office of Central Records Operations (OCRO) of insured status. The request for preliminary payment may be taken at any point in the adjudicative process since claimants may not be fully aware of their needs at the time of the initial interview.