POMS Reference

SI 02006: Windfall Offset and Effect on Title XVI Payments

TN 15 (10-01)

A. INTRODUCTION

This section summarizes step-by-step procedures and provides worksheets to assist FO's in subtracting the authorized fees for representatives (attorneys and non-attorneys) from retroactive title II benefits in offset cases, as required by SI 02006.200 and SI 02006.205. Title XVI offset will seldom apply after 09/07/95.

See subsection SI 02006.210B. for the chart of step-by-step procedures and subsections SI 02006.210C.SI 02006.210F. for the exhibits of worksheets SSA-2894 and SSA-2877 and charts of completion instructions and notes.

The worksheets SSA-2894 and SSA-2877 (see SI 02006.210D. and SI 02006.210F.) should be locally reproduced.

B. PROCEDURE - DEVELOPMENT OF FEE ADJUSTMENT

STEP

ACTION

1

Is the fee authorized and known at the time you are ready to process offset?

If yes - compute title II offset using the adjusted title II income determined as explained in step 4, below. Take no other actions or steps.

If no - compute offset using the reported title II amounts without regard to a fee. (See SI 02006.205B.2.b. and SI 02006.205C.3. for required notices.) Tickle the case for 90 days pending receipt of the fee determination notice (see SI 02006.205B.2. and SI 02006.205C.2.) Follow up after 30 days per SI 02006.205C.2. Proceed to step 2 when a copy of the notice or information is received.

2

Upon receipt of a fee authorization notice in fee petition cases or when the claimant/representative notifies you that a fee has been determined, or upon completion of preparation of the notice based upon the title XVI past-due benefits, use the notice as the source of the needed fee information (per SI 02006.202.)

NEVER USE THE FACT OF WITHHOLDING OR THE AMOUNT WITHHELD AS THE BASIS FOR THIS ACTION.

In fee agreement cases, use the information on the MBR in the ATTY Fee line for the authorized Title II portion of the fee for the primary and any auxiliaries. Then compute the title XVI portion of the fee per SI 02006.203.

Proceed to step 3.

3

Evaluate the fee petition notice per the guidelines in SI 02006.202B.3.
SI 02006.202B.5., or as appropriate.

Proceed to step 4.

4

  • Obtain SSI, MBR, and PHUS queries to obtain the information needed (per SI 02006.205D.).

  • Complete SSA-2894, “Offset Case Authorized Fee Worksheet” (Exhibit 1) and subtract the entire fee from the title II benefits beginning with the first month they were regularly due (SI 02006.200C.1.).

NOTE: For fee agreement cases the “fee” means the total amount of the title II fee plus the title XVI fee. For fee petition cases this means the total amount authorized in the notice.

5

Is this a title II or title XVI offset case?

  • If title II, proceed to step 6.

  • If title XVI, proceed to step 12.

6

To evaluate per SI 02006.200C.2., determine whether the amounts of title II income remaining (column D on the SSA-2894) are different from any of the type W amounts posted for the months of the offset period.

If yes, proceed to step 7.

If no, proceed to step 11.

7

The requirements in SI 02006.200C.2.b. apply. Determine the affected months. These are:

  • Each month in the offset period that, after subtraction (as shown in column D on the SSA-2894) has a remaining title II amount of zero or less than the type W posted, and the following 2 months of SSI eligibility.

NOTE: These are months in which the unchanged type W amount did not, in the original title II offset computation, yield countable income (CI) that stopped payment computation (e.g., for the month of December 1997, a Federal benefit rate of $484 but CI of $500 based on type W of $520 and no State supplementary payment (SSP) involved).

  • Proceed to step 8.

8

As required by SI 02006.200C.2., compute the month-by-month changes. Complete SSA-2877, Adjusted Title II Income and Title II Offset Worksheet, (Exhibit F.) for the affected months. This worksheet can be used to simultaneously compute “new” FAM's and SAM's for the affected months, and also the difference between these amounts and the previously computed amounts that were based on the original type W income. The previously computed amounts are the WFA and WSA on the SSR in automated title II offset cases and the new FAM and new SAM in manual (SSA-4346-U2) computation cases. (See SI 02006.215B.1.a. which explains why in some cases the title II type A or W postings cannot be changed and when systems computations cannot be used.) Process the total underpayments (Federal and SSP) manually as computed in section F. of the SSA-2877. See step 9.

If preferred when computation of the countable income is complex, use the RMA personal computer computation program in place of columns C. through E.6. of the SSA-2877. Remember to use the adjusted title II income less the fee. Keep in mind the COLA coordination rules (see SI 02005.010 -
SI 02005.015).

Proceed to step 9.

9

  • See SI 02006.215B. for an explanation of systems limitations and payment methods. In the absence of systems limitations, correct the offset by deleting and reposting. Otherwise, issue an A-OTP for the total underpayment amount.

  • Add an uncollectable (N TAC) decision through the Overpayment Decision (UOPD) screen in Direct SSR Update. See SM 01311.280B. and MSOM BUSSR 004.008 .

  • Suppress any systems generated notice for the overpayment created by completing the CMSC screen. See MSOM MSSICS 023.006 .

  • Proceed to step 10.

10

  • Use the instructions in SI 02006.200C.2.b. (There is no remaining title II from before the offset period that can be counted as income in the PMA month.) If this change is material, adjust the type A UM for the month(s) retroactive title II benefits were received and posted to the SSR to the regularly due title II income amount. See SI 02006.201.

  • Process any underpayment or correction of an overpayment amount along with the actions taken per step 9.

STOP HERE

11

  • Instructions in SI 02006.200C.2.a. apply. This is a title II offset case in which the amounts of title II income remaining on the SSA-2894 are the same as the type W UM amounts posted to the SSR for each of the months of the offset period. Since the amounts are the same, there is no change in the title II offset computations. Verify this before proceeding.

  • Go to step 15.b. (same procedure as for title XVI offset cases).

12

Title XVI offset was initially applied. If this is a title XVI offset case, determine whether the amounts of title II income remaining (column D on the SSA-2894) are different from any of the type G amounts posted to the SSR for the months of the offset period.

  • If no, proceed to step 15.

  • If yes, proceed to step 13.

13

CAUTION: In an initially denied case in which an underpayment could be due, all development which had previously been deferred may be required prior to further action. See SI 02006.005 for appropriate tolerances. If an IAR authorization form is in the file, follow SI 02003.000. See SI 02006.215A.1. Determine whether the system could compute and release an underpayment caused by the change in type G UM to the title II income remaining amounts shown in column D on the SSA-2894:

  • If yes, transmit the changed type G UM amounts and suppress the notice.

  • If no, compute manually to pay via A-OTP.

  • In either case, combine the action with any required per step 14. Also prepare notices per SI 02006.215A.3. See step 14.

14

SI 02006.200C.2.b. applies. There is no remaining title II from before the offset period that can be counted as income. If this change is material, adjust the type A UM for the month(s) retroactive title II benefits were received. See SI 02006.201. Process any underpayment or correction of an overpayment along with the actions taken per step 13.

STOP HERE.

15

  1. SI 02006.200C.2.a. applies. You are at this step because you have a title XVI offset case in which the amounts of title II income remaining on the SSA-2894 are the same as the type G UM amounts posted to the SSR for each of the months of the offset period. Since the amounts are the same, there is no change in the title XVI offset computations. Verify this before proceeding to b.

  2. SI 02006.200C.2. and SI 02006.201 apply. The type A UM for the month of receipt of the retroactive (retro.) title II check posted to the system must be adjusted if the change would make a difference in SSI determinations: The change makes no difference if the regularly due title II received each month is enough to cause ineligibility or the individual is ineligible in the month(s) of receipt of the retro. title II for other reasons. In this case, send a notice of no change per SI 02006.215A.3. Otherwise, per SI 02006.200B.1., use the total retro. remaining for months before SSI DOE (column E. of the SSA-2894) as the retro. amount (PMA) to add to the regularly due title II (CMA) to determine the correct type A UM amount for the month of receipt.

CAUTION: If retro. title II was received in more than 1 month, see SI 02006.200B.2. Transmit the changed type A UM, suppress the systems notice, and prepare the notices required per SI 02006.215A.3. (See SI 02006.215B.2. for title II offset cases.)

NOTE: Follow the special notice procedures in NL 01001.010 if the notice will be sent to a claimant, beneficiary, or representative payee who alleges being blind or visually impaired.

STOP HERE.

C. PROCEDURE — COMPLETION OF THE SSA-2894

STEP

ACTION

1

Enter the requested data in sections I. and II.

  • Identify a month by using its numerical abbreviation, e.g., for January 1988, use “1/88.”

    Refer to the MBR query for the title II entitlement data for item 1. Enter the effective month and amount of each MBP.

 

  • For item 2, the entry is the month after the original MOET. This is the date the first title II check would have been received if it had been received when due.

  • For items 3 and 4, if the first title II payments were in 1984 or later, use the PHUS query to identify the dates and amounts. Item 3 is the date the first monthly title II check really was received. If the data is essential for the first payments before 1984, the data may have to be obtained from the title II claims file.

  • For item 5, refer to the notice or other proof of the fee determination for the fee amount and the name and address of the representative. Remember to show the total fee (title II + title XVI) in fee agreement cases.

  • For items 6-10, refer to the appropriate fields of the SSR query. To decide if development was curtailed in a denial, refer to the SSI claims file.

2

Section III. provides lines to list separately only 18 months. The months that should be listed separately are those where part of the authorized fee is subtracted from the title II. Other months should be grouped together if the amount of title II regularly due is the same (the amount entered in column B). If the lines do not suffice despite this consolidation, complete the listing on the back of the worksheet after entering “Section III. (continued).”

In some situations it may be necessary to adjust one or more months of current benefits if the total fee is not used up by adjusting the retroactive title II benefits.

  • Column A, begin with the first month title II was regularly due (item 2 of section I.) or the SSI date of eligibility (item 6 of section II.) whichever is earlier.

  • Column B, enter the amount based on the data in item 1 of section I., keeping in mind that MBP's are regularly due the month after they are effective.

  • Column C., enter the amount in column B. or the remaining amount of the authorized fee for the last month part of the fee is subtracted. This is the amount of money that you are using each month to adjust for the attorney fee. Adjust the full amount of the title II benefit until you use up the attorney fee. Usually the last month you adjust will be a partial month adjustment only.

  • Column D., enter the difference of column B. minus column C. This is the amount of type W or type G income remaining for each month after the adjustment.

 

  • Complete column E. only for months before the SSI date of eligibility (item 6. in section II.). Enter the amount in column D. or, for an entry of a group of months, the amount in column D. times the number of months.

  • Total the entries in column C. and check to make sure this total is the same as the authorized fee in item 5. of section I. If it isn't, correct section III. as necessary.

  • Total the entries, if any, in column E. and enter the result.

  • Answer the questions in F. by checking “Yes” or “No.”

D. EXHIBIT — SSA-2894

To view this form, go to SSA-2894.

E. PROCEDURE - NOTES FOR FILLING OUT SSA-2877

COLUMN

NOTE

A

List all months affected by the adjusted type "'W” or “G” income. If the windfall offset computation is out of balance (an excess or negative offset applies), then list all months in the windfall period.

NOTE: Columns B - D2 = SSI Eligibility Computation

B

Use amount of title II income remaining, if any, as shown in column D on the SSA-2894.

C

If the Federal living arrangement is B and there is no corresponding J income in the UMIH segment of the SSID (usually a record not in RIC G), include the VTR.

 

If column B equals zero, then column C equals the total of the UMC and the ENC from the CMPH segment of the SSID.

 

If column B equals the type W income in the UMIH segment of the SSID for the same month, then column C equals the total of the WUM and the WEN from the WCMP segment of the SSID.

 

If column B is greater than zero but less than the corresponding type W entry in the UMIH segment of the SSID, then column C equals the total of the UMC and the ENC from the CMPH segment of the SSID plus the total* from column B.

 

*Determine whether any or all of the $20 general income exclusion can be used to reduce the total in column B.

 

This is the new FCI based on the attorney fee adjustment.

X

The Federal payment amount for Federal living arrangement A, based on the date in column A.

D1

Compare the amount in column C with the amount in column X. If eligible, enter “E.” If ineligible, enter “N” in this column and zero in the FAM (column E3).

D2

If ineligible, enter zero in the SAM (column E6).

NOTE: Column D3 - E6 = SSI Payment Computation

D3

If eligible, enter the budget month (BM).

 

If column B equals zero then the BM is the same as the BM in the CMPH segment of the SSID.

E1

FBR for the month in column A or, if the Federal living arrangement is D, enter $30 (or $25 for months before 7/88) in column E1.

 

If there is no OS for this variation, enter zero in column E6.

E2

If the amount is available for the BM in column C, enter the amount from column C. Otherwise, obtain it from the SSID.

 

Consider COLA coordination (SI 02005.015) if title II income is received.

E3

Enter the remainder of column E1 minus column E2.

E5

Enter the remainder, if any, of column E2 minus column E1.

E6

Enter the remainder of column E4 minus column E5.

NOTE: Columns F1 - F6 = Computation of the underpayment to be paid by one-time payment (OTP).

F1

Enter the amount from column E3 unless proration is involved (pre-September 1996). If proration applies and column B equals zero, then the FAM equals the FAM in the CMPH segment of the SSID. Otherwise, determine the prorated amount per SI 02005.005.

F2

If offset is automated, enter the WFA from the WCMP segment of the SSID. If offset is manual, enter the new FAM from the SSA-4346 offset worksheet. This is the amount the recipient would have been due if title II had NOT been adjusted for attorney fees and had been paid when it was due.

F3

Enter the remainder of column F1 minus column F2. This is the amount of the federal underpayment for this month.

F4

Enter the amount from column E6 unless proration is involved. If proration applies and column B equals zero, then the SAM equals the SAM in the CMPH segment of the SSID. Otherwise, determine the prorated amount per SI 02005.005 E. or F.

F5

If offset is automated, enter the WSA from the WCMP segment of the SSID. If offset is manual, enter the new SAM from the SSA-4346 offset worksheet.

F6

Enter the remainder of column F4 minus column F5. This is the amount of the OSS underpayment for this month.

F. EXHIBIT—SSA-2877

To view this form, go to SSA-2877.