Citations:

Social Security Act as Amended—Sections 1133 and 1611(e) (2);

P.L. 96-272 Regulations—20 CFR 416.210

TN 8 (12-07)

A. Introduction

Supplemental Security Income (SSI) is intended to be a program of last resort. Therefore, it is important to assess the other benefit programs for which an individual is eligible based on his/her own activities or based on indirect qualification through family circumstances.

B. Policy — General

1. Filing for other benefits as a condition of eligibility

A claimant/recipient is not eligible for SSI if:

• SSA advises him/her, on a written, dated notice, of potential eligibility for other benefits; and

• He/she does not take all appropriate steps to file for and, if eligible, obtain any such payments within 30 days of receipt of such notice.

2. Receipt of written notice

A claimant's/recipient’s receipt of a written, mailed notice is assumed to be 5 days after the date shown on the notice.

3. Characteristics of other benefits

Other benefits for which a claimant/recipient must file, upon written notification, include annuities, pensions, Title II benefits (e.g., retirement, disability, widow's, parent's benefits), and payments similar to those discussed in SI 00510.005. These benefits have the following characteristics in common. They

• Require an application or similar action;

• Have conditions for eligibility;

• Make payments on an ongoing or one-time basis; and

• Are sources of income that reduce SSI payments.

4. Steps to pursue other benefits

A claimant/recipient must take all appropriate steps to pursue eligibility for other benefits. This includes:

• Applying for the benefit; and

• Providing the other benefit source with the necessary information to determine eligibility for the benefit.

5. Exception to requirement to file

A claimant/recipient is eligible for SSI, despite failure to apply for other benefits within the 30-day period or take other necessary steps to obtain them, if there is good reason for not doing so. For example, there is good reason if:

• The claimant/recipient is unable to file for other benefits because of illness; or

• It would be useless to apply because the claimant/recipient had previously applied and the other program has already turned him/her down for reasons that have not changed.

NOTE: If there is an insured status (KZ) diary, follow the instructions in SI 02309.010B.

6. Impact on SSI payments for failure to file

Failure to file for designated other program benefits has a direct impact on SSI eligibility and benefit payment.

• If a claimant/recipient does not file for the other program benefit(s) identified in the written SSA-L8050-U3 (SSI Claim Information Notice) or the SSA-L8051-U3 (Referral Notice for Social Security Benefits), or files, but does not pursue (as explained in SI 00510.001B.4. ), he/she is not eligible for SSI effective with the application date (initial claim).

• If a claimant/recipient does not file for a designated benefit(s), or files but does not pursue that benefit(s) (as explained in 4. above), SSI eligibility stops with the month he/she received the written notice to file for the other program benefit, (post-eligibility).

7. Computing the overpayment for post entitlement claims

If we deny or suspend eligibility for payments, we compute the overpayment starting with the month the claimant/recipient received the SSA-L8050-U3 or SSA-L8051-U3. (See SI 02220.001 for instructions on overpayments.)

C. General exception to filing requirements

Do not require a claimant or recipient to file for other benefits when applying for them would result in no additional benefit which could affect the individual's eligibility or payment amount. In situations where technical entitlement for TII benefits is possible (e.g. child benefits with a family max) the child listed on the NH’s record should be made aware that eligibility for benefits may result at a later time, and it must be developed as a protective filing, as per GN 00204.010C3. Therefore, a closeout notice must be mailed or an application must be taken. 

NOTE: If there is an insured status (KZ) diary, follow the instructions in SI 02309.010B.

1. Deeming situations

Do not require a deemor to file for other program benefits. If a deemor files for and receives other program benefits on his/her own initiative, the amount of benefits he/she receives and/or retains is subject to the deeming policies in SI 01320.001 (income) and SI 01330.001 (resources).

2. Pursuit of benefits

Do not require a claimant/recipient to pursue a claim for other program benefits through the appeals process. For example, in a concurrent claim, if the SSI denial is appealed, the individual does not need to pursue a Title II appeal for SSI eligibility.

EXAMPLE- Potential to Adopt Title XVI Disability Determination for Title II: Mr. Osborne filed a claim for both Title II and Title XVI benefits/payments on 7/10/07 alleging disability beginning 9/10/05. The claims were denied at both the initial and reconsideration levels. He filed for a hearing. The ALJ determined that Mr. Osborne was disabled beginning 7/07, and was entitled to SSI payments. The claimant no longer wished to pursue the Title II hearing and requested a dismissal. Although the ALJ did not make a decision on the Title II claim, the claimant must be referred to file for Title II since the SSI disability decision may be adopted for Title II if insured status is met as of onset.

EXAMPLE-Title II Benefit Pursued and Denied, FOB Requirement met: Ms. Arch filed for SSI and disabled widow's benefits (DWB). The SSI claim was denied due to excess income. The DWB claim was sent to the DDS for a medical determination. Ms. Arch appealed the SSI decision which was reversed on appeal. The DWB claim was later denied due to lack of severity of the disability within the prescribed period. No further action is necessary by the claimant to pursue the DWB benefit for purposes of meeting the SSI filing for other benefits requirement.

3. Title II benefits during appeals process

Do not require a SSI claimant/recipient to elect or agree to continued receipt of Title II benefits during the appeals process, e.g., if he/she decides to appeal a prior medical cessation.

D. Policy — payment options for other program benefits

1. General

Most of the types of program benefits for which a claimant/recipient must file offer choices about the method of payment. He/she must file for all other program benefits payable at the earliest month and in the highest amount available based on the earliest month.

EXCEPTIONS

• For exceptions relating to a surviving spouse’s annuity, see SI 00510.001D.3.

• For exceptions relating to lump sum payments only, see SI 00510.001D4.

a. Title II benefits

In the case of Title II benefits, a claimant/recipient must file for the benefit with the most retroactivity. If an individual is eligible for another Title II benefit which is higher, but has less retroactivity, this benefit must also be elected effective with the earliest possible month. If there is potential entitlement to two or more Title II benefits with the same retroactivity, the individual must file for the highest benefit available. This amount will generally be the current monthly benefit payable (MBP). If there is any question about what the highest current MBP is, the Title XVI CR should consult the Title II CR. If the claimant/recipient then becomes eligible to a Title II benefit with a higher MBP he/she should be required to file for it unless, in order to file for it, he/she must withdraw a current claim and pay money back.

b. Examples

EXAMPLE 1- Potential Dual Title II Entitlement, Choose Higher Benefit:

Mrs. Rivet receives retirement insurance benefits (RIB) and has a primary insurance amount (PIA) of $700. She works, has excess earnings, and is subject to the annual earnings test. Her husband, who is eligible for SSI disability, was previously married and widowed, and not insured based on his own work history.

The PIA on Mr. Rivet’s deceased wife’s record is $550. He is potentially entitled as a remarried widower on her record to an MBP of $456. He is also potentially entitled to husband's benefits based on Mrs. Rivet’s record with a MBP of $262. For Title XVI purposes, Mr. Rivet is required to file only for the remarried widower's benefit because that is the record with the highest monthly benefit payable.

EXAMPLE 2- RIB and DIB Entitlement, Elect RIB due to WC Offset of the DIB: Mr. McHose is 62 years old and is filing for SSI disability payments. He is receiving Workers' Compensation (WC) benefits. His RIB PIA is $700 and DIB PIA is $720. If he elected RIB, his benefit would be $560. If he elected DIB, his DIB benefit would be $720, but his DIB monthly benefit payable would be reduced to $350 because of WC offset. To maintain SSI eligibility, Mr. McHose is required to elect payment of the RIB because it results in the highest monthly benefit amount payable. In such a case, however, he remains technically entitled to DIB so that he will also become entitled to Medicare after his 24-month qualifying period.

EXAMPLE 3- Potentially Entitled as Auxiliary on more than one Record—Determine Highest Auxiliary Benefit:

Mr. Hall receives RIB and his PIA is $400. He has 4 minor children. Each receive $50 per month in auxiliary benefits on his record. One of Mr. Hall’s children is disabled, lives with his natural mother in a separate household, and receives SSI payments. The child's mother filed for her Title II disability benefits. It is not apparent to the Title XVI CR whether the child is already receiving the highest benefit available. In this case, the Title XVI CR should consult the Title II CR to determine whether the child is receiving the highest benefit available.

2. Electing month of entitlement

If a claimant/recipient can select the month in which benefits begin, whether retroactively or prospectively, direct him/her to elect the earliest month regardless of the impact on other benefits from that program.

NOTE: Election of a later month of entitlement to qualify for higher ongoing benefits or to protect benefits paid to other individuals is cause for denying or suspending SSI eligibility. A later election will result in the loss of SSI eligibility until such time as the election is changed or the option for change is no longer available.

EXAMPLE: Mrs. King became eligible for SSI payments in 1/07. A redetermination in 12/07 uncovers the fact she was potentially eligible for widow's benefits as of 1/07. A widow's application is taken. The SSI open application results in Mrs. King receiving $750 in retroactive benefits after Title XVI offset is applied and a reduced widow's benefit of $126 per month. Mrs. King remains eligible for SSI. In this case, if she had elected a month of entitlement later than 1/07, Mrs. King would be ineligible for SSI for failure to file for the earliest month.

3. Survivor's benefits for spouses and other dependents

Certain pensions/retirement programs permit an individual to elect survivor's benefits for dependents by electing a reduced retirement benefit. Advise the claimant/recipient that he/she must elect the higher current benefit to retain SSI eligibility. Election of the lower benefit will result in the loss of SSI eligibility until such time as the election is changed or the option for change is no longer available.

NOTE: For purposes of this section, in situations where a spouse refuses to sign a waiver, the SSI claimant/recipient meets the filing requirement when he/she takes the reduced retirement benefit.

4. Lump sum or annuity

When a claimant/recipient can choose a lump sum or an annuity as a payment method for the other program benefit, advise him/her that he/she must choose the annuity. A one-time total withdrawal of pension plan funds in this situation does not comply with the statutory requirements that mandate application for an annuity or a pension (i.e., money payment at some regular interval (see SI 00510.001E). With the focus on maximizing the use of other benefits to provide ongoing benefits, recommend conversion of lump-sum applications in appropriate situations.

• Request for a Lump Sum Payment: Where an application has been made for a lump sum withdrawal of the monies on which a potential annuity is based and the benefit source permits the individual to change his/her decision and apply for the annuity, the claimant/recipient must pursue the change to be eligible for SSI payments. If the benefit source does not permit such a change, accept the claimant's/recipient's word that the decision is irreversible, absent evidence to the contrary.

• Retroactive Title II Benefit Lump Sum Payment: Although filing for full retroactive Title II benefits may result in a lump sum payment, this payment represents the amount of the past due Title II benefits and is not a fund which determines future regular payments. Receipt of the Title II retroactive payment may reduce but will not cause ineligibility for prospective Title II payments.

• Lump Sum Only Payments: Do not require a claimant/recipient to file when only a lump sum payment is available. In this situation, the payment is a resource (see SI 01120.210). (This does not include a lump sum death payment under Title II.) Since Title XVI is a current needs program, all sources of available support (unless otherwise excluded) are considered in determining eligibility. This is true even when current needs compel an individual to sacrifice future pension benefits.

E. Policy — establishing eligibility after denial/suspension

If denial or suspension of payments has occurred because of failure to pursue other benefits, and in the case of a suspension, it was not for 12 consecutive months, establish or reestablish eligibility when:

• The other benefit is no longer available; or

• The individual takes the necessary steps to obtain the other benefit(s).

1. Other benefit is no longer available

If the other benefit is no longer available, and in the case of a suspension, it was not for 12 consecutive months, establish or reestablish eligibility beginning with the month following the month the other benefit is no longer available. The reasons for unavailability may include a limited time period for filing which has expired or withdrawal of a lump sum payment from a pension fund.

EXAMPLE: On 5/6/07, a redetermination of Ms. Gardner's SSI eligibility indicated that she would be eligible to receive an annuity from a private sector plan on 5/18/07. An SSA-L8050-U3 was mailed to Ms. Gardner on 5/6/07, notifying her to apply for the pension within 30 days.

When the FO followed up with Ms. Gardner 20 days later, they learned that she had opted to withdraw the lump sum benefit on 5/13/07 which served as a basis for the pension. Ms. Gardner is not eligible for SSI for May because she elected to receive a lump sum payment rather than an annuity. Since the decision to withdraw the lump sum is irreversible, Ms. Gardner would be eligible for SSI beginning 6/1/07 (assuming all other eligibility factors are met, including resource limitations as outlined in SI 01120.210).

2. Individual takes necessary steps

If the individual takes the necessary steps to pursue the other benefit, and in the case of a suspension, it was not for 12 consecutive months, establish or reestablish eligibility on the day the individual takes the necessary steps and prorate payment for the first month of eligibility/reinstatement. See SI 02005.008A.4.e regarding proration of payments.

EXAMPLE:

Ms. Carey, age 65, applied for SSI payments on 3/24/07. She returned to the FO on 4/6/07 to submit additional documentation supporting her claim. The CR gave Ms. Carey an SSA-L8050-U3 (dated 4/6/07) notifying her to apply for a private sector pension which, according to the FO precedent file, was available to her at that time. Ms. Carey was found to be eligible for SSI payments as of 3/24/07.

When the FO followed up with Ms. Carey on 4/21/07 to determine if she had filed for the pension, they learned that she had not filed for the benefit and had no intention of doing so. Consequently, it was determined that Ms. Carey was ineligible for SSI beginning April 2007.

On 6/9/07, Ms. Carey returned to the FO with a letter dated 6/8/07 from her former employer stating that she inquired about pension benefits on 6/5/07. The letter also advised that Ms. Carey was not entitled to a pension because she had not work long enough for the company. The FO prorated and reinstated Ms. Carey’s benefits beginning 6/5/07.

F. References

• Failure to Apply for and Pursue Other Program Benefits, SI 02301.215

• Proration, SI 02005.008