Citations:

Section 1621(e), 1631(b)(1) of the Social Security Act; 20 CFR 416.535; 20 CFR 416.537- 416.538; 20 CFR 416.543-416.570.

TN 5 (10-09)

A. Definition of overpayment

There are three elements in the definition of overpayment:

• Payment was made;

• Over a period of time (at least 1 month); and

• More than the correct amount was paid.

B. Definition of overpayment resolution

Overpayment resolution is a continuous, ongoing process. Resolution begins when a debt is detected. It ends when we account for the entire amount of the debt by one or more of the following:

• Recovery (through refund, adjustment of payments, or installment payments).

• Waiver.

• A determination that the debt either did not exist, or is uncollectible.

C. Policy for overpayment resolution

Prompt initiation of the overpayment resolution process will maximize the amount of debt recovered.

1. Payment made

Payments include any federally administered State supplementary payment. A payment is made when the Social Security Administration (SSA) certifies payment to the Treasury Department.

2. Payment not made

Payment has not been made if the proper party (e.g., the eligible individual, his or her representative payee, etc) does not receive it or if it is returned.

3. Overpayment period prior to April 1982

An overpayment period began with the first month of the first quarter for which there was a difference between the amount paid and the amount due.

The overpayment period ended either

1. With the most recent closed quarter, i.e., the month immediately preceding the calendar quarter in which we made the determination of overpayment (or underpayment); or

2. Within the quarter in which we made the determination, when that quarter was effectively closed by one of the following events.

   • We suspended an individual’s eligibility to receive payments for other than excess income; and

   • We terminated eligibility to receive payments when there was no excess income in the current quarter.

4. Overpayment period beginning with April 1982

An overpayment period begins with the first month for which there is a difference between the amount paid and the amount due. It ends with the month we notify the overpaid individual.

5. Changing the overpayment period

An overpayment period, once established, remains the same. If we determine a second or subsequent reason for overpayment in a previously established overpayment period, we change the basis or amount of the overpayment but not the overpayment period.

NOTE: We do not split overpayments of more than $1,000 into two or more smaller amounts in order to administratively waive each of the smaller amounts. We will administratively waive the overpayment only if the original overpayment is less than $1,000.01, refer to SI 02260.030B.2.

6. Overpayment determination

The overpayment determination covers the entire overpayment period (that is all months of excess payments or additional amounts due). We have not made an initial determination of overpayment until we notify the overpaid individual.

7. Determination of liability for repayment

The determination of liability for repayment of an overpayment is as much a part of the determination of overpayment as is the fact of and the amount of the overpayment determination. Appeal rights attach to our liability determination.

Once we have detected an overpayment and determined liability for its repayment, the liable individual(s) must be notified.

IMPORTANT: We delay notification when we suspect that fraud caused the overpayment.

D. Effect of a subsequent overpayment covering a prior overpayment period

A subsequent determination of an overpayment can disturb an existing overpayment period if the subsequent overpayment either

• Increases the amount of the overpayment, or

• Causes a period of ineligibility in the existing overpayment period.

EXAMPLE

On June 30th, a SSI recipient reports the receipt of a private pension check. The pension is for $100 per month and was first received in May. Because it is too late to affect the July SSI payment, an $80 overpayment occurs.

During a scheduled redetermination in November, the same individual reports that he was an inmate of the county jail (a public institution) the entire month of July. Therefore, the month of July is now a month of ineligibility instead of a month where a reduced payment is due. While the subsequent overpayment (due to a period of institutionalization) covers the same months as the prior overpayment it also increases the amount of the overpayment for July from $80 to the entire amount of the July check.

E. Applying the rules of administrative finality

1. Do not apply the rules of Administrative Finality to cases involving fraud.

2. Make any revision to a prior overpayment determination only under the rules of administrative finality. These rules permit the recovery of overpayments which occurred more than 2 years in the past as long as the determination was made timely.

3. If the rules of administrative finality permit the determination of an overpayment more than 24 months in the past, post this overpayment to the Supplemental Security Record (SSR).

4. If the SSR shows an overpayment, assume that any changes made to the system which resulted in the overpayment being computed were properly made within the rules of administrative finality. For more information about administrative finality, see SI 04070.001.

5. To generate an automated overpayment notice (AONS), follow the instructions in SM 01301.365.

F. Individuals from whom you may attempt recovery of an overpayment

1. We will attempt recovery of an overpayment only from the following individuals:

   1. The overpaid recipient.

   2. The representative payee.

   3. The spouse of the overpaid individual, but only for that part of the overpayment period when the spouse was a member of the eligible couple.

   4. Under certain circumstances, the sponsor of an alien recipient.

   5. The estate (or distributees) of any of the following:

      • The recipient,

      • The representative payee

      • The recipient’s spouse

      • The recipient’s sponsor

2. Do not attempt recovery from a third party

   Never attempt to recover an overpayment from an individual or institution (i.e., a third party) that is not liable for repayment.

   However, you may:

   • Accept a refund offered by a third party from his or her own funds.

   • Accept a third party refund consisting of the overpaid individual's own funds, but only if the third party (for example, a legal representative) has the authority to dispose of the overpaid individual’s funds.

G. Recovery efforts

1. Attempt recovery first against the individual who was overpaid.

2. If there is representative payment, attempt recovery from:

   1. The individual only if the overpaid funds were used for his or her support and maintenance and the representative payee was not aware of the facts causing the overpayment.

   2. The representative payee only if the overpaid funds were not used for the overpaid individual's support and maintenance.

   3. NOTE: If a misuse determination has been made, the representative payee is personally liable for repayment of any misused funds.

   4. For information on misuse of benefits, see GN 00604.000

   5. A representative payee (or his or her estate) is solely liable for repayment of payments he or she received on behalf of a deceased recipient for month(s) after the month of the recipient’s death. This policy was effective December 4, 2008.

   6. Both the individual and the payee if the overpaid funds were used for the overpaid individual's support and maintenance and the representative payee was aware of the facts causing the overpayment.

   7. Attempt recovery against an eligible spouse for the eligible individual's overpayment only if:

   • The eligible spouse was a member of the eligible couple when the overpayment occurred;

   • The eligible spouse and eligible individual were living together when the overpayment occurred; and

   • Recovery from the eligible individual is not possible.

3. If a deceased overpaid individual had a liable representative payee attempt recovery from the representative payee before attempting recovery from the deceased's estate.

4. If a deceased overpaid individual is survived by a spouse and has left an estate, first attempt recovery from the estate.

5. For recovery priority in sponsor-to-alien deeming situations, see SI 02220.065.

6. Third-party Refunds: Accept a refund from the funds of a non-liable third-party. If the third party has the authority to dispose of the overpaid individual’s funds, accept a third-party refund consisting of the overpaid individual’s own funds.

H. Requests for relief from repayment of an overpayment

1. Rights of liable individuals

• All individuals who are liable for repayment of an overpayment have the right to:

• Appeal the determination of overpayment as well as their liability for repayment.

• At any time request that repayment of all or part of the overpayment be waived or the rate of repayment be changed.

• Offer a compromise settlement to repay a substantial amount of the overpayment if we waive recovery of the remaining balance.

For information on the compromise settlement process, see SI 02220.017 and SI 02260.001.

2. Reconsideration

The liable individual(s) can question the existence of and the amount of the overpayment. This is done by requesting reconsideration within 60 days of the date the initial overpayment notice. If the request is made more than 60 days from the date of the initial request, you must determine whether the individual has established good cause for his or her delay before you can accept and process the reconsideration. For policy and procedures on processing a request for reconsideration, see GN 03102.100.

3. Waiver

A request for waiver is a request for release from the liability for repayment.

The liable overpaid individual(s) can request waiver even after the appeal period has passed or the overpayment has been completely recovered.

At any point in the overpayment recovery process, the liable individual(s) can request that the recovery of his or her overpayment be waived.

To grant a request for waiver the liable individual must be without fault in causing the overpayment and recovery or adjustment would

1. Defeat the purpose of title XVI; or

2. Be against equity and good conscience; or

3. Impede effective or efficient administration of the title XVI program.

For information on the waiver of a SSI overpayment, see SI 02260.000.

4. Negotiated rate of repayment

If you cannot waive recovery of the overpayment, the liable individual can negotiate a rate of repayment.

After adjustment (in current pay cases) or recovery (refund, cross-program adjustment or periodic installment payments) begins, the liable individual retains the right to request a different rate of repayment.

In nonpay overpayment cases, you always will negotiate the rate of repayment.

5. Compromise offer

In certain non-pay overpayment situations, you may accept an offer by the liable individual to repay a substantial part of his or her overpayment in return for our agreement to waive recovery of the remaining balance of the overpayment. For information on a compromise settlement, see SI 02220.030.

I. Fraud suspected

If you suspect that an overpayment was the result of fraud,

Stop or suspend all recovery efforts, including sending the initial overpayment notice and follow the instructions in SI 02201.007.

J. References

• MSOM BUSSR 004.006 - Update Sequence Data (UOSD)

• SI 02201.005 - Supplemental Security Income (SSI): What Is An Overpayment?

• SI 02201.007 - Supplemental Security Income (SSI): Overpayment Fraud

• SI 02220.000 - Recovery Procedures for Supplemental Security Income Overpayments

• SI 02220.005 - Documenting the Supplemental Security Income (SSI) Overpayment

• SI 02220.010 - SSI Overpayment -- Notifying the Individual

• SI 02220.017 - SSI Overpayment – Request for a Different Rate of Adjustment, Reconsideration or a Waiver

• SI 02220.020 - Cross Program Recovery (CPR) of SSI Overpayments from Monthly Title II Benefits

• SI 02220.030 - SSI Overpayment – Compromise Settlement

• SI 02260.000 - Waiver Provisions for Supplemental Security Income (SSI) Overpayments

• SI 02260.001 - Basic Requirements Concerning Supplemental Security Income (SSI) Overpayment Waiver

• SI 04070.000 - Administrative Finality – SSI