POMS Reference

SI 02305: Redeterminations of Eligibility and/or Payment Amount

TN 54 (11-06)

A. List of Forms/Letters

The following forms/letters include specific language explaining the possible consequences of a recipient's/rep payee's failure to comply with our requests within 30 calendar days from the date of the notice:

Number of Letter or Form

Name of Letter or Form

SSA-L3074-U2

Supplemental Security Income Notice of Appointment Not 1619 (b)

SSA-L3075-U2

Supplemental Security Income Notice of Appointment 1619(b)

SSA-8202-F4-INST and SSA-8202-F4-NFS

Important Facts about Your Supplemental Security Income

SSA-L8003-U2

Request for Information/Evidence Not 1619 (b)

SSA-L8004-U2

Request for Information/Evidence 1619 (b)

B. Procedure Recipient Fails to Respond to a FO Request

Use extreme caution before suspending recipients because of their failure to respond to FO requests for information/evidence. If recipients (including 1619 eligible)/rep payees do not respond within 15 calendar days from the date of the FO written request or within 5 calendar days after an appointment date on a request, take the following actions:

STEP

ACTION

1

Obtain a SSID and a SMSG MBR Query. (See MSOM QUERIES 006.026), any in-office records, or staff knowledge on the case that may indicate the recipient has special needs that may have been overlooked when scheduling an appointment or mailing out an RZ form for completion and return.

EXAMPLE: Look for coding in the ID, DB, DISB, CG, and/or LPW fields on the SSID.

2

Were there any intervening actions taken on the case since the FO request?

EXAMPLE: A FO other than the servicing FO conducted an RZ as the result of a walk-in.

IF YES, determine the appropriate action to take.

IF NO, go to step 3.

3

See SI 02301.235F through SI 02301.235J for procedures on following-up on our requests for information. The individual has 30 days to submit the requested information. If all follow-up attempts are unsuccessful, go to step 4.

4

Suspend recipients for failure to cooperate (payment status code N20) per instructions in SI 02301.235A and SI 02301.235A.

NOTE: Inputting the N20 suspense code will cause the RZ to drop off the SUMS/PEODS and the SSR. This will occur in the second RZ merge run after it is placed in nonpay. Do not input an RZ completion code via 1719B if the case is suspended for failure to cooperate. To close out an open MSSICS RZ event when the RZ has been removed from the SSR because of nonpay payment status input a manual clearance. If the MSSICS RZ or LI event is not manually cleared, the RZ will remain pending on SUMS/PEODS and will continue to count as a pending RZ for the FO even though it is no longer pending on the SSR. It will become an “abandoned” RZ if the MSSICS pending file is not locked by the manual clear action.

C. Procedure Recipient Responds after Suspense Action

If the recipient responds after the determination of ineligibility is made, do the following:

STEP

ACTION

1

Reinstate the recipient as soon as information shows that he/she is currently eligible per SI 02301.210B. Reinstate payments for any previous month for which the individual met the eligibility requirements. Follow reinstatement instructions in SI 02301.210. See SI 02301.220 on when to use payment status N05 for past non-pay periods of unconfirmed eligibility.

2

Obtain a current SSID.

3

Conduct a RZ using the profile criteria shown in the pre-RZ SSID, if available, or conduct an unscheduled RZ on a paper form or in MSSICS.

NOTE: Completing all of the development for an RZ is not necessary to reinstate payments. If the RZ cannot be completed immediately, always input an initiation date to prevent the RZ from being removed from the SSR. However, do not input clearance data to the SSR or close an open RZ event until all development is complete. If the RZ results in continued suspension of payments input the appropriate suspension code as soon as possible.

4

See SI 02305.059 for instructions on inputting case development and decision data for non-MSSICS redeterminations and MSOM MSSICS 025.001 A and B for MSSICS redeterminations.

NOTE: If the RZ cannot be completed immediately, always input an initiation date so the system will continue to show it as pending.

D. References