SI 00510: Requirement to File for Other Program Benefits
TN 8 (12-07)
A. Procedure — VA Benefits — General
Explore potential eligibility for a VA payment if the claimant/recipient is a:
Veteran; or
Surviving child (see SI 00830.314B.6.) or an unmarried widow or widower of a veteran or service person (individual who died while in service); or
Dependent parent (see SI 00830.314C.9.) of a disabled veteran or service person; or
Surviving parent (see SI 00830.314C.10.) of a veteran or service person who died from a service-connected cause; and
The criteria in SI 00510.010B. or SI 00510.010C. of this section are met.
REMINDER: When referring an individual to the VA, advise him/her to telephone first to obtain information on filing requirements and proofs he/she may need to bring.
B. Procedure — VA Pension
Refer an individual for VA pension payments (based on a nonservice-connected disability) if all of the following conditions are met:
The veteran or deceased service member served at least 90 days, at least one of which was during a wartime period; and
The veteran is permanently and totally disabled or is age 65 or older;
The individual being referred is a veteran, surviving spouse, or surviving child; and
The individual has not alleged, in a signed statement, having previously filed for VAIP (see SI 00510.005A.4).
EXCEPTION: Do not refer an individual who has been eligible for a VA pension since before 1979 and who is a resident of one of the States listed in SI 00510.005A.4.
NOTE: The wartime periods are:
WWI |
4/6/1917 - 11/11/1918 |
WWII |
12/7/1941 – 12/31/1946 |
Korea |
6/27/1950 - 1/31/1955 |
Vietnam |
8/5/1964 - 5/7/1975 |
(Persian) Gulf War |
8/2/1990 – through a date to be set by law or Presidential Proclamation (per Dept. of Veteran’s Affairs). |
Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom |
2001- present. Note: This war period is not yet listed on the Dept. of Veteran’s Affairs website. Refer claimant to VA Benefit Counselor at 1-800-827-1000. |
C. Procedure — VA Compensation
Refer an individual for VA compensation payments if the veteran or deceased service person suffered a service-connected disability (even though minor) or died.
D. Procedure — Workers' Compensation Payments
If an individual alleges either injury on the job or has what appears to be a work-related impairment, refer him/her to the appropriate agency for assistance (see SI 00830.235).
E. Procedure — Foreign Work or Service Benefits
If an individual alleges working in or serving in the military of a foreign country, apply the guidelines in GN 01701.005 to obtain the necessary information to determine if the individual might qualify for benefits payable by the foreign country or by SSA as a result of a totalization agreement.
If there is no totalization agreement, refer to Social Security Programs Throughout the World and Social Security in Other Countries websites, and RS 02610.015 for additional guidelines.
F. Procedure — Other Pensions
1. Private Sector
Refer an individual for a private sector pension if the individual or former spouse:
Worked for a private employer with a pension plan;
Was age 25 or older during such employment; and
Is not or was not already receiving a pension from the employer (or union) based on that employment.
NOTE: If existence of a pension plan is uncertain, consult the FO pension plan precedent file discussed in SI 00510.010I. If the individual's eligibility for the private sector pension is still uncertain, refer him/her to the employer.
2. Public Sector
Refer an individual for a public sector pension when the individual or former/deceased spouse (or a deceased parent when the claimant/recipient is a child) is not or has not received a pension based on this employment and meets the guidelines below.
a. Federal Civilian Employment
An individual may be eligible for a Federal pension if the worker did not withdraw employee contributions to the pension plan, and was employed under the:
Civil Service Retirement System (CSRS), for a minimum of 5 years;
Federal Employees Retirement System (FERS), for a minimum of 18 months.
NOTE: Often Federal employees covered under CSRS who are ill will take an extended leave of absence without pay, and may file for SSI. Do not require such individuals to file a claim with OPM unless it is clear that they have terminated their job status.
b. Employment in the Federal Uniformed Services (Military)
An individual may be eligible for a military service pension if the service person served a minimum of 20 years.
c. Employment by a State or Local Government
An individual may be eligible for a State or local government pension if the worker:
Was employed for a minimum of 5 years, or employed, regardless of the length of time, either by a State or as a teacher in a public college or university; and
Did not withdraw employee contributions or withdrew employee contributions but was either a teacher in a public college or university or was employed by a State or local police/fire department.
NOTE: If the individual is uncertain about whether contributions were withdrawn, refer him/her to the former employer or contact the employer to resolve any questions.
G. Procedure — Eligibility Uncertain
If the adjudicator questions an individual's potential eligibility for another benefit:
Check the precedent file,
Consider contacting the organization involved, or
Use evidence in the claimant's/recipient's possession to resolve the issue.
If the individual is not potentially eligible, document the file with the reason why.
If eligibility for the other benefit remains uncertain, refer the individual to the appropriate source.
H. Procedure — When Not To Refer
1. No Apparent Eligibility
If an individual does not meet the basic eligibility requirements for a benefit per A. - G. above:
Do not refer, and
Document the file with the reason.
2. Prior Denial
If the individual alleges having filed previously and been denied for reasons other than failure to pursue, accept his/her signed statement regarding the denial, unless there is evidence to the contrary.
3. Contributions Withdrawn
If an individual alleges that he/she or the employee (if a deceased spouse) withdrew his/her contributions from a public sector pension, accept the individual's signed statement regarding the withdrawal unless:
The employee was a teacher in a public college or university or was employed by a State or local police/fire department (and no precedent exists which states that, once funds are withdrawn, no benefits are payable); or
There is evidence to the contrary (e.g., the FO precedent file indicates funds may not be withdrawn).
4. Application Pending
If an individual alleges an application for the other benefit is pending:
Send the SSA-L8050-U3 to the benefit source, and
Set up a diary to control for receipt of the SSA-L8050-U3 per SI 00510.025C.2.
I. Procedure — Use of Precedent File
1. General
Use the precedent file to reduce the number of repeat contacts and to maintain information regarding Federal, State, local, company or union pension plans. Note that information in the precedent files is used to determine whether referrals to the benefit source should be made.
IMPORTANT: Do not use these precedents to determine whether the person is entitled to the other benefit.
2. File Organization
Keep pension plan information as a separate precedent or incorporated with other precedent data, e.g., the sick pay plan precedent file for the same company or agency.
a. File Content
Include the following data for each employer:
b. General Identification
Employer's name and address
Name and phone number of the person who can supply pension information
c. Pension Plan
Existence of a pension plan
Statement as to whether or not employees contribute and, if they do, what happens to those contributions upon termination of employment for reasons other than retirement or disability
Vesting requirements
The pension plan provisions for survivors and/or dependents (including divorced spouses)
d. Union
Whether or not there is a union
If so, does the union provide a pension?
The name, address, and local phone number of the union
The conditions to qualify for the pension
The union contact for additional information on the pension (including the phone number)
e. Any Other Pertinent Information
Date pension information was obtained and recorded
3. File Maintenance
Each time you use the precedent file, check the date the precedent was established. If the precedent file has not been updated within the last 12 months, update it based on contact with the employer.