POMS Reference

SI 02305: Redeterminations of Eligibility and/or Payment Amount

TN 58 (07-08)

A. Policy - Required Use of the RZ WIZ with Limited Issue Cases

The RZ WIZ must be used with all Limited Issues (LIs). The RZ WIZ must also be used with all RZs, LI and wage-related diary interviews, and wage-related diaries. See Completing RZs in MSSICS or on Paper Forms SSA-8202-BK and SSA-8203-BK, (SI 02305.071).

B. Scheduling Frequency

The following explains RZ frequency selection.

1. Unredetermined Case (UC) Profile

The following is how the UC profile is determined.

  • Selected 3 months after the initial payment or changes in eligibility status (1619(b) cases); and

  • Must be in current pay, force pay, force due, or 1619(b) status for the current computation month.

2. PE Profiles

The following is the frequency of PE profiles:

Profile Category

Frequency

HEP

Annually

MEP

Annually

LEP 1619 (a)

Annually

LEP Deemed Income Cases

Annually

All other LEP

Every six years

C. Policy - Release Schedule for Priority Diaries Associated with LIs or RZs

The following provides the release schedule for priority diaries (i.e., DI, 5B, 5H, SB, K6, K7, J3, J5, U5, S2, S7, KB, KC, KE, K8, K9, KP, KZ, D8, R8, 3D and I8) associated with LIs or RZs:

1. DI Diary

Most DI (dedicated account monitoring required) diaries are set in the October release of each FY. Others are set during the small redetermination and limited issue releases in subsequent months and posted to the DIAR segment of the SSID with the diary maturity date. See limited Issue Cases, (SI 02305.011) and DI Diary and the Redetermination/Limited Issue Process, (GN 00605.208) for instructions on processing this diary. If the case with the DI diary is selected for LI development, it is identified as such by a selection indicator of Z in the CRZD segment of an SSI query.

2. 5B Diary

IRS interface (5B) diaries are released in October, February, and June. IRS informational alerts identifying amounts above the tolerance are available on SUMS/MCAS MI Central. See Internal Revenue Service (IRS) Interface – General, (SI 02310.045) through IRS Interface – Special Situations, (SI 02310.049) for a description of the IRS match and processing instructions. Alert data (including informational alerts) are available on an interface database and are retrievable through SUMS/MCAS MI Central by the SSN/IRS/SSID Query Screen under the Workload Listing section for RZs and LIs. (For information on the use of this query, click on the RZ/LI Users' Guide on the RZ/LI Listing page.)

3. 5H Alert

IRS/SSR Pension (5H) alerts are in conjunction with 5B workloads. See Pension Interface (5H diary), (SI 02310.052) for processing instructions. Alert data (including informational alerts) are available on an interface database and are retrievable through SUMS/MCAS MI Central by the SSN/IRS/SSID Query Screen under the Workload Listing section for RZs and LIs. (For information on the use of this query, click on the RZ/LI Users' Guide on the RZ/LI Listing page.)

4. SB Diary

SSA conducts a computer match between SSI records in current and force payment/force due status and the Bureau of the Public Debt's (BPD's) savings security instrument registration file. The diaries are released in October and April. See Savings Security Instrument Match (SB Diary), (SI 02310.015) for processing instructions.

5. K6/K7 Diaries

Most MEF/SSR earned income (K6/K7) diaries are released in October and April but may be released at other times during the FY. See Master Earnings File (MEF) Match (K6 and K7 Diary), (SI 02310.055) for processing instructions.

6. J3/J5 Diaries

These diaries are set when the recipient’s/deemor’s wage amount shown on the Supplemental Security Record (SSR) is greater than the wage amount shown on the MEF. The J3 diary generates when the discrepancy between the SSR and the MEF is greater than $1,000 annually for the recipient or deemor. The J5 diary generates when the discrepancy between the SSR and the MEF is greater than $2,000 annually for the deemor. See Earned Income, (SI 00820.001) for processing instructions.

Beginning with September 2008, the J3/J5 diaries will generate in March and September each year.

7. U5 Diary

Unemployment compensation (U5) diaries are released in October, January, April and July each year. See Unemployment Compensation Match (U5 Diary), (SI 02310.065) for processing instructions.

8. S2 Diary

State wage match (S2) diaries are released in October, January, April and July each year. See State Wage Record Match (S2 Diary), (SI 02310.062) for processing instructions.

9. S7 Diary

The S7 diary is set when there are discrepancies between the wage amount shown on the Supplemental Security Record (SSR) and the wage amount shown on the Office of Child Support Enforcement (OCSE) database. The S7 diary is set when the recipient’s wage amount on the SSR is $250 or more per quarter greater than the amount shown on the OCSE database. The S7diary is also set when the deemor’s wage amount is $500 or more per quarter greater than the wage amount shown on the OCSE database. See Monthly Wage Reporting, (SI 00820.143) for processing instructions.

Beginning with September 2008, the S7 diary will generate in March, June, September and December each year.

10. D6 Diary

Effective October 2005 (FY 2006) the death (D6) diary no longer generates a LI, or a RZ.

The D6 diary was set for a deceased eligible/ineligible spouse, parent, or essential person when a death input is made to the record but no RZ initiation data or initiation/completion data were transmitted. Previously when a D6 diary generated, the case was released as a profile D MEP RZ during the next RZ merge run.

11. KC/KE/K8/K9 Diaries

Critical birthday (KC/KE/K8/K9) diaries are set in October of the fiscal year of the year of age attainment. The cases are released as LIs in the month before the month of age attainment. See Critical Birthday Diaries – Supplemental Security Income (SSI), (SI 02309.001), Attainment of Age 65 by Ineligible Spouse, Parent or Essential Person – K8/K9 diary – Supplemental Security Income (SSI), (SI 02309.005), and Gerontology Limited Issue KC Diary (SI 02309.006) for processing instructions.

12. KB Diaries

Most KB diaries are set in October of the fiscal year and are selected as profile K MEP scheduled RZs the month of age 18 attainment. Cases meeting KB criteria after the October redetermination merge have the diary set in a subsequent monthly redetermination merge. To help avoid multiple RZs in a fiscal year, if the record has a priority select diary and a KB diary with a future date, the record is selected as a LI case for development of the priority select diary. The RZ is delayed until the month the KB diary matures.

EXAMPLE: In October a record is set with a 5B diary and a KB diary (because the recipient will turn age 18 the following March). The 5B diary is released for LI development in October. The KB diary is released as a profile K RZ in March.

REMINDER: Coordinate age 18 disability redeterminations (see Public Law (PL) 104-193 Title XVI Childhood and Age 18 Disability and Redetermination Cases, (DI 23570.001) through Disability Redetermination Flag – Exhibit, (DI 23570.110) and Public Law (PL) 104-193 – General, (DI 11070.001) through Case Returned From the DDS, (DI 11070.040)) with profile K redeterminations to avoid multiple contacts with recipients. Also, coordinate dedicated account monitoring processing with profile K RZs.

13. KC Diaries

The recipient or eligible spouse will attain age 90 by the end of the fiscal year. This is a new LI. Pursuing a LI for Title XVI only recipients who are age 90 or older will:

  1. ensure processing occurs as part of our program integrity workloads,

  2. provide tracking, and

  3. remove the agency’s dependency on a stand-alone regional website. Example: The RZ run treats the KC diary the same as other RZ/LI diaries.

If the case has a high score, then it receives an RZ selection. If the case has a low score, then it receives a diary limited issue (Profile = X, Selection Indicator =X). If the case has a reason for delay, the RZ run delays its selection to minimize multiple contacts per year.

14. KZ Diary

Insured status (KZ) diaries are set in October if the recipient is within 4 quarters of being eligible for Title II retirement benefits on his/her own record. See Processing the Insured Status (KZ) Diary – Supplemental Security Income (SSI), (SI 02309.010) and Overview of Redetermination Related Diaries and Alerts, (SM 01501.250B) for processing instructions.

NOTE: KZ diaries are also set for potential disability benefits. However, KZ disability insured status diaries will not be set for recipients under age 65 who do not meet either the 20/40 requirement for disability benefits or the special insured status requirements for individuals who become disabled prior to age 31.

15. D8 Diary

Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (D8) diaries are released monthly. This match identifies recipients whose admission to a medical facility has not been reported. See Title XVI Facility Match (D8 diary), (SI 02310.064) for processing instructions.

16. KP Diary

The system sets a KP diary in October of the fiscal year when one member of an eligible couple attains age 62 to 64 later in the fiscal year and does not receive Title II benefits, but the other member of the couple does receive Title II benefits. The diary is set for the month before the month of age attainment. Both members of the couple must be in current pay status (C01). The diary is set once each FY. See Detecting Entitlement to Title II Spouse’s Benefits KP Diary, (SI 02309.007) for processing instructions.

17. R8 Diary

The conserved funds diary (R8) is set to identify cases where the WBDOC processed an annual representative payee accounting report showing conserved funds in excess of $2000 for an individual or $3,000 for a couple. The WBDOC employee inputs the CF field in the REPY segment of the SSR and the LI is selected in the next RZ merge run. See Verification Requirements – Conserved Funds (R8) Diary, (SI 01140.021) for processing instructions.

18. 3D Diary

The Department of Homeland Security (DHS) transmits listings to SSA of those individuals who have been removed from the United States. SSA matches the data against the SSR monthly and posts a 3D diary.

See Processing Alerts from Computer Matches, (SI 02310.007) and DHS Match – Removal From the United States (3D Diary), (SI 02310.018) for descriptions of the DHS match as well as for processing instructions.

19. I8 Diary

The Department of Homeland Security (DHS) transmits listings to SSA of individuals who have voluntarily left the United States and have received a re-entry permit. SSA receives this information monthly and posts an I8 diary. This match was effective July 2005. See DHS Match – Voluntary Leaving the United States (I8 Diary), (SI 02310.017) for a description of this DHS match as well as for processing instructions.

20. KV Diary

The KV diary sets yearly for potential Department of Veterans Affairs (VA) pension payments. The system identifies SSI recipients who are:

  • In current pay status (C01), force pay, or 1619(b) status; and

  • Potentially eligible for, but not receiving a VA pension.

If the case has a high score, then it receives an RZ selection. If the case has a low score, then it receives a diary limited issue (Profile = X, Selection = X). If the case has a reason for delay, the RZ run delays its selection to minimize multiple contacts per year.

D. Policy - Release Schedule for LIs without Priority Diaries

1. Net Earnings from Self-employment

Net earnings from self-employment (NESE) cases are released in April when the prior year's NESE tax records are available. See How to Verify Net Earnings from Self – Employment (NESE), (SI 00820.220) through How to Estimate NESE for Current Taxable Year, (SI 00820.230) for processing instructions. These LIs are identified in the CRZD segment of a SSID by the selection indicator of C. There is no diary to identify these cases.

NOTE: If a record containing NESE is selected for a higher priority RZ that cannot be delayed (profiles K or W) and cleared earlier in the fiscal year, it will be reselected in April as an LI for development of the NESE issue.

2. Continuing Type F Income

SSI recipient cases with continuing type F (TANF/Title IVE Foster Care) unearned income are released each month for LI development to terminate TANF on the record for the recipient. Processing instructions for different types of F income are located in Income Based on Need (IBON), (SI 00830.170); Aid to Families with Dependent Children (AFDC), (SI 00830.400) through Adoption Assistance, (SI 00830.415); Refugee Cash Assistance, Cuban and Haitian Entrant Cash Assistance and Federally Reimbursed General Assistance payments to Refugees, (SI 00830.645); Bureau of Indian Affairs General Assistance, (SI 00830.800) and Bureau of Indian Affairs Adult Custodial Care and Child Welfare Assistance Payments, (SI 00830.810).

These cases are identified in the CRZD segment of an SSID by the selection indicator of F. There is no diary to identify these cases.

IMPORTANT: To prevent multiple selections of the same case for development of continuing type F income, refer to LIs with Continuing Type “F” Income, (SI 02305.024), for input requirements.

3. Payment Continuation Cases (Goldberg/Kelly)

NOTE: Many N07/N08 cases previously paid manually via the GK process are controlled via the Statutory Benefit Continuation software and are in PS C01. These cases get the cost of living adjustment (COLA) increase without FO intervention and are eligible to be selected for RZs in the October big merge. LIs for cases being paid under manual GK procedures pending an appeal decision are released for development in November, December, and January of each fiscal year. Development includes determining:

  • If an appeal decision has been rendered on all issues and

  • Whether Goldberg Kelly payment continuation still applies.

Benefit amounts must be recomputed and corrected based on an appeal decision, COLA and, if applicable other changes not under appeal per How to Correct the PPL During Appeal (Including COLA), (SI 02301.325), SSI Computations – Title II/Title XVI COLA Coordination, (SI 02005.010), and Providing Due Process Notification for Title XVI – Only Cases, (DI 28080.025). Payment continuation cases are identified in the CRZD segment of an SSID by the selection indicator of G. There is a K1 diary on the SSR to identify these cases.

Apply the COLA, if applicable, and clear the LI by RZ field input.

E. Procedure on Organizing RZ’s, LIs and Manual Deemed Income Workloads

Organize your redetermination cases following the order of priority below. Treat RZs and LIs with the same priority in the redetermination workload.

Order of Priority

  1. Profile C with priority diary

  2. LI with priority diary

  3. Profile E and M

  4. Profile K

  5. Profile C without a priority diary

  6. Profile B, UC 1, and W with priority diaries

  7. Profile A with priority diary

  8. LI without priority diary

  9. 1619(a) cases with a special action code A

  10. Profile UC 1 and W without priority diaries

  11. Profile A and B without priority diaries

NOTE: You may use the (StaRZ and Stripes the Next Generation (SSTNG) ) system to select your workload using profiles and diaries. The intranet site contains user instructions.

F. Procedure - Coordinating Interviews

1. Release Schedule in Manual Deemed Cases

A list of manual deemed income cases is produced in October and is placed on the intranet at: http://nynet.ny.ssa.gov/deemlist/ . The purpose of this website is to provide on-line access to the deeming list. This list, updated annually in October, is a read-only file of records with deemed income that requires manual computation by the field offices. Central Office will announce when the list is made available to FOs.

The manual deeming list is used to control cases where manual payment computation changes are necessary due to COLA increases. Cases on this list are NOT controlled by SUMS/MCAS MI Central and there is no SSR diary to identify these cases. For instructions on deemed income cases, see Deeming of Income from an Ineligible Spouse, (SI 01320.400), Deeming of Income from Ineligible Parent, (SI 01320.500), and Aliens Subject to Sponsor-to-Alien Income Deeming, (SI 01320.900).

2. Developing Rep Payee Suitability

  • Review the Representative Payee (REPY) segment of the pre-RZ SSID.

  • Develop rep payee suitability if the Type of Payee (T) Code is OTH and the Custody (CU) code is SEL.

  • Identify these cases by action code O on SUMS/MCAS MI Central.

  • Perform a face-to-face interview with the rep payee and the SSI recipient present unless the interview would be clearly unproductive.

EXAMPLE: The recipient is comatose, or the interview would impose undue personal hardship on either the recipient or payee (due to hospitalization, work and/or traveling a great distance to interview, etc.). See Developing Rep Payee Suitability During RZs, (SI 02305.123) for detailed instructions on rep payee suitability development.

3. Rep Payee Accountability Interview Required

If a SSA-623F6 (Representative Payee Report) or SSA-624F5 (Representative Payee Evaluation Report) requiring an FO interview is pending, coordinate the RZ and the rep payee accounting interview.

NOTE: Identify pending cases on SUMS/MCAS MI Central with an action code of T or on a SSID with a PA code of 2 in the REPY segment. See Representative Payee Data – REPY, (SM 01601.565).

If the recipient and/or his/her rep payee work, conduct a telephone interview.

If the RZ qualifies for mail out handling, do not require a personal contact RZ because of the accounting interview.

4. CDR Interview Required

If a CDR is required, coordinate the RZ or LI interview with the CDR interview whenever possible.

5. Childhood Disability Redetermination Required

If a childhood disability redetermination is required, coordinate the non-medical RZ or LI interview with the disability redetermination interview whenever possible.

6. Dedicated Account Monitoring Required

If the DI diary is associated with an RZ instead of being selected as a LI, coordinate the RZ and dedicated account monitoring.

The SUMS/MCAS MI Central Users' Guide is located under Workload Listings. The URL for SUMS/MCAS MI Central follows.

http://mi.ba.ssa.gov/emis/mgmnt/cfe/default.cfm . See Diaries - RZs and LIs, (SI 02305.023).