TN 15 (04-15)

Citations:

Social Security Act §1631(b)(1)(A)

20 CFR §416.552 and §416.556

A. Policy for overpayment waivers due to excess resources

A recipient must be without fault in causing an overpayment before we will consider approving his or her waiver request. In some cases, a recipient’s excess resources may exceed the statutory limit by such a small amount that we will find the recipient to be without fault.

1. Waiver provisions when countable resources exceed the limit by $50.00 or less

We may determine an overpaid recipient to be without fault if his or her countable resources exceed the resource limit by $50.00 or less, unless we determine the overpaid recipient willfully and knowingly failed to report the value of his or her resources accurately and timely. To determine if the recipient willfully and knowingly failed to accurately and timely report the value of his or her resources, the evidence must clearly show that the recipient (and spouse, if any) was fully aware of:

• the excess resources, and

• his or her reporting responsibilities.

To determine if an overpaid recipient willfully and knowingly concealed the value of his or her resources, consider the factors in SI 02260.010B.5.

If an overpaid recipient exceed the resource limit by $50.00 or less and you determine him or her to be without fault in causing the overpayment, you may waive recovery of the overpayment. To determine how to process a waiver for excess resources for each month of the overpayment period, see SI 02260.035E in this section.

2. Waiver provisions when countable resources exceed the limit by $50.01 or more

If an overpaid recipient exceed the resource limit by $50.01 or more and you determine him or her to be without fault in causing the overpayment, determine the repayment amount for each month of the overpayment period by following the steps in SI 02260.035E in this section.

B. Situations which indicate fault

Consider the following indicators to determine if an overpaid recipient (and spouse, if any) was at fault:

• Willful misstatement or concealment of material facts or committed fraud. For fraud and similar fault, see SI 04070.020;

• Knowingly supplied incorrect information;

• Duplicate payments;

• Conditional payments; or

• Similar overpayments occurred in the past.

For information on developing fault, see SI 02260.010.

1. Subsequent SSI overpayments

If a recipient incurred a similar overpayment in the past and received an explanation of both the cause of the overpayment and his or her reporting responsibilities, the recipient generally is at fault for the current overpayment. When determining whether the recipient is at fault you must consider all aspects of the current and prior overpayment situation.

NOTE: If a recipient is subsequently overpaid for exceeding the resource limit by $50.00 or less and you find him or her to be without fault in causing the overpayment, add another waiver decision of “EXCESS RESOURCES WITHIN TOLERANCE” on the UOWV screen in the Modernized Supplemental Security Income Claims System (MSSICS). For information on waiver decisions see MSOM BUSSR 004.009.

2. Eligible SSI couple

The fault determination applies to both members of the eligible couple if there is clear evidence that both members willfully and knowingly concealed the correct amount of their resources.

C. Waiving recovery when SSI overpayment is due to excess resources

1. Applying a waiver monthly

Make a separate waiver determination for each month when there are multiple months in which the overpayment resulted solely from excess resources of $50.00 or less.

The following example illustrates a scenario where an overpaid recipient possessed countable resources over the $2,000 resource limit -

Example :

You discovered an overpayment during a redetermination (RZ) in December 2013 where the recipient’s resources exceeded the statutory limit by the amounts shown in the table. As excess resources on October 1, 2013 and December 1, 2013 are below the $50.00 limit, waive recovery of the overpayment for October 2013 and December 2013. Pursue recovery of the overpayment for November 2013 because the excess resources are more than $50.00.

2. Overpayment recovery

If you waive recovery of an overpayment caused by resources exceeding the resource limit by $50.00 or less, you must:

• Explain to the overpaid recipient both the cause of the overpayment and the SSI reporting responsibilities;

• Document that you have explained the reporting responsibilities and that the overpaid recipient understands his or her reporting responsibilities on:

  1. the Report of Contact (DROC) screen in the MSSICS, or

  2. through the Non Disability Repository for Evidentiary Documents (NDRed) for non-MSSICS cases.

     NOTE: Documentation is necessary because future overpayment disposition determinations may depend on whether we previously informed the recipient of his or her reporting responsibilities.

• Add the waiver decision of “EXCESS RESOURCES WITHIN TOLERANCE” on the UOWV screen in MSSICS. (For overpayment waiver input instructions see MSOM BUSSR 004.009).

• Use the Document Processing System (DPS) to prepare the “Notice of Administrative Waiver Excess Resources.” You can find the notice in the DPS overpayment folder.

D. Excess resources rules

The following are three waiver rules that apply to SSI overpayments that result from excess resources. Rule number 1 is standard waiver policy, applicable to all SSI overpayments. Rules number 2 and 3 are two unique waiver rules that only apply to overpayments resulting from excess resources. You may waive all or part of an SSI overpayment due to excess resources if one or more of the waiver rules apply and the recipient requests a waiver. Apply these rules in the following sequence.

1. Rule 1

The recipient is without fault and recovery of the full amount of the overpayment would:

• Defeat the purpose of SSI. (For instructions on defeat the purpose of SSI see SI 02260.020); or

• Be against equity and good conscience due to having relinquished a valuable right or having changed a financial position for the worse. (For instructions on waiver against equity and good conscience see SI 02260.025); or

• Impede effective or efficient administration of SSI. For instructions on impede effective or efficient administration of SSI see SI 02260.030.

2. Rule 2

The recipient is without fault and countable resources in any month of the overpayment period exceed the resource limit by $50.00 or less. In this instance, waive the overpayment for all months in which resources did not exceed the limit by more than $50.00, per SI 02260.035A.1. in this section.

3. Rule 3

The recipient is without fault and it is against equity and good conscience to recover the full amount of the overpayment because the total overpayment in months (not including months where Rule 2 resulted in a waiver) is greater than the amount that the resources exceeded the resource limit. For an explanation, see SI 02260.035E in this section.

E. Excess resources SSI overpayment

After determining that the recipient is without fault use the following steps to make a waiver determination. For more information on waiver determinations, see SI 02260.015.

Example of applying the excess resource rules:

Mr. Smith sells his excluded automobile on September 10, 2013. The proceeds of the sale caused his resources to exceed the resource limit beginning October 1, 2013. During a redetermination in February 2014, you determined that we overpaid Mr. Smith during the 5-month period, October 2013 through February 2014. Beginning March 2014, you suspended Mr. Smith for excess resources. The following chart shows his monthly SSI payments and countable resources during the overpayment period.

Mr. Smith received an automated overpayment notice explaining that he was overpaid $3,130 for the period October 2013 through February 2014. Mr. Smith requested a waiver of his overpayment. You determined that Mr. Smith was without fault in causing the overpayment. He also has the ability to repay the money. Mr. Smith did not relinquish a valuable right or change his financial position for the worse. As a result, you may not waive the entire overpayment using Rule 1 in SI 02260.035D.1. in this section.

You can waive the $1000.00 that Mr. Smith was overpaid for the months of January 2014 and February 2014 using the under $50.00 waiver provision in SI 02260.035A.1. in this section and Rule 2 in SI 02260.035D.2. in this section.

Compare the remaining overpayment balance of $2,130.00 paid in October 2013 through December 2013, to the single month in the overpayment period that has the biggest difference between countable resources and the resource limit ($1,100 in November 2013). Since the total overpayment balance is greater than the month with the maximum amount of excess resources, you can waive $1,030.00 of the total remaining $2,130.00 overpayment that occurred from October 2013 through December 2013 and recover $1,100.00 from Mr. Smith, see Rule 3 in SI 02260.035D.3. in this section.

NOTE: Any overpayment waiver approval decision with an over payment period of $2,000.00 or more requires supervisory approval see SI 02220.005. For overpayment waivers greater than $20,000 see SI 02220.005.

F. References

• SI 02260.010 Development of Without Fault for a SSI Overpayment Waiver

• SI 02260.015 Establishing Without Fault for SSI Overpayment

• SI 04070.020 Fraud and Similar Fault - SSI

• SI 02260.025 SSI Overpayment Waiver – Against Equity and Good Conscience

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

• MSOM BUSSR 004.009 Waiver (UOWV)