SI 02305: Redeterminations of Eligibility and/or Payment Amount
TN 56 (10-07)
REMINDER: Use DISCO whenever there is potential entitlement to title II benefits for a SSI recipient.
A. Introduction
This section provides procedures for developing recipient allegations to potential eligibility for Title II benefits. The questions on the paper forms and MSSICS screens help identify recipients who are not receiving Title II benefits but are potentially eligible for them. It also identifies those who are already receiving Title II benefits but may be entitled to a higher or additional benefit amount on their own or another's account number.
B. Description of RZs Completed on MSSICS Screens
Opening a “REDETERMINATION with or without RECAPs” event creates a MSSICS “path” that will guide the interviewer to the appropriate screens to document allegations and evidence relating to potential eligibility for Title II benefits.
C. Description of Form SSA-8202-BK - Question 14
Question 14 on the SSA-8202-BK — Please answer the following questions:
“Are you age 62 or older?”
“If you are age 50 or older, are you a widow (er)?”
“If you are age 50 or older and divorced, is your divorced spouse deceased?”
“If you were disabled before age 22, do you have a parent who is age 62 or older or disabled, or deceased?”
D. Description of Form SSA-8202-OCR-SM
There is no question on the SSA-8202-OCR-SM specifically designed to obtain information about eligibility or potential eligibility for title II benefits.
E. Description of Form SSA-8203-BK - Question 26
Question 26 on the SSA-8203-BK duplicates Question 14 on the SSA-8202-F6.
F. Description of Form SSA-3988-OCR-SM - Question 16
Question 16 on the SSA-3988-OCR-SM
“Are you age 62 or older?”
“If you are age 50 or older, are you a widow(er)?”
“If you are age 50 or older and divorced, is your divorced spouse deceased?”
“ Were you disabled before age 22 ?”
Do you have a parent who is age 62 or older or disabled or deceased?”
G. Description of Question 16 of Form SSA-3989-OCR-SM
Does the child have a parent who is age 62 or older, disabled, or deceased?”
H. Policy
During the RZ process, the interviewer must explore potential eligibility for all classes of Title II entitlement on the recipient's SSN and the records of others. If the recipient is potentially eligible for Title II benefits or a higher Title II benefit than he/she is currently receiving, e.g., spouse's, widow's, or childhood disability benefits, the interviewer must explain the filing for other benefit requirements in SI 00510.001 - SI 00510.030 and ask the recipient if he/she wishes to file. If the recipient wishes to file for Title II see GN 00204.027 and SI 00601.035 for determining whether or not an open Title II application exists. If the Title II application resulting from the filing of the Title XVI application was properly adjudicated and the recipient is potentially entitled to Title II during the RZ process, the RZ serves to protect the Title II filing date. See GN 00204.015 for determining the filing date based on a RZ. Also, see GN 00204.012 for closing out the protective filing.
NOTE: If the individual files a Title II application, the claims adjudicator must review all protective filing documentation and make a filing date determination per GN 00204.007.
If the recipient does not wish to file for Title II benefits or files but does not elect full retroactivity, follow the filing for other benefit procedures in SI 00501.001 - SI 00510.030. If the individual does not comply with the filing for other benefit procedures, you must suspend SSI benefits.
If someone other than the claimant is named on the RZ and is potentially entitled to Title II benefits, see GN 00204.015 for when the RZ serves to protect the individual's filing date or if the naming of the individual should be treated as a lead. If the individual named is potentially eligible for SSI benefits, see SI 00601.025 for when the RZ can serve as a protective filing for SSI.
I. Procedure
Protective filing and lead closeout procedure:
1. Recipients' allegations do not indicate potential eligibility for Title II
If recipients' allegations do not indicate potential eligibility for Title II, no further action is required to develop potential eligibility for Title II benefits. See GN 00203.025 for instructions on processing Medicare only applications.
2. Recipients' allegations indicate potential eligibility for Title II or potential for an increased Title II benefit
If recipients' allegations indicate potential eligibility for Title II or potential for an increased Title II benefit on another SSN, explain the filing for other benefit requirements and ask the recipient if he/she wishes to file. If yes, take an application. If an application is not filed immediately, issue a protective filing closeout notice to closeout the protective filing, e.g., teleclaim is taken and sent to the claimant for signature along with the SSA-L566 notice. See SI 00510.001 - SI 00510.030 for when to issue the SSA-L8051 notice. If no, follow the filing for other benefit procedures. If the recipient does not comply with the filing for other benefit requirements, suspend SSI benefits.
3. If the SSI recipient is receiving Title II and is entitled to a higher benefit on another SSN but refuses to file for the higher benefit
If the SSI recipient is receiving Title II and is entitled to a higher benefit on another SSN but refuses to file for the higher benefit, follow the filing for other benefit procedures in SI 00510.00 - SI 00510.030. If the claimant does not comply, suspend SSI benefits.
J. References
GN 00201.005 General Application Taking Practices
GN 00204.010 Protective Filing
GN 00202.020 Leads
GN 00204.012 How to Dispose of a Protective Writing