HI 01120: New Initial Determinations Using Beneficiary Information

Effective Dates: 10/15/2012 - Present

TN 4 (07-10)

B. What Evidence is Needed to Support Use of a More Recent Taxable Year to Determine IRMAA

D. How to Record Evidence Provided on EVID Screens

A. Policy

A beneficiary may request and qualify for the use of a more recent tax year to determine IRMAA based on a reduction in MAGI after the beneficiary or his spouse has received a settlement payment from a current or former employer. The settlement payment has to be a result of an employer or former employer’s closure, bankruptcy or reorganization in order to qualify as an LCE under this category. All LCE reports only apply to the reporting spouse. Do not extend the use of the more recent tax year to the non-reporting spouse. If the non-reporting spouse is also affected by the LCE, the non-reporting spouse is responsible for contacting SSA.

B. What Evidence is Needed to Support Use of a More Recent Taxable Year to Determine IRMAA

If the beneficiary alleges he or his spouse received a settlement from an employer or former employer, in the tax year we used and has had a significant reduction in his MAGI for the current or a more recent tax year than we used to determine IRMAA, SSA will need MAGI and tax filing status information for the tax year he is asking SSA to use and proof of the settlement and reason for the settlement.

A beneficiary may submit the following tax information:

An estimate of MAGI and tax filing status for the tax year they are requesting SSA to use (current year or PY-1), or
A signed copy of the PY-1 tax return (or a filed amended tax return with an IRS letter of receipt for PY-1) if PY-1 tax return shows a significant reduction in MAGI.

SSA will accept as proof of the settlement any evidence submitted by the beneficiary that clearly documents the event such as:

A statement from an employer,
Court document showing settlement and terms, or
Statement from the employer’s attorney stating settlement and terms,

NOTE : If the beneficiary provides an estimate of MAGI, process the request using the estimate. Request the beneficiary to submit a signed copy of the tax return once it has been filed with the IRS. Once the filed tax return is received follow the procedures listed in HI 01120.065. If a beneficiary alleges electronic filing, ask the beneficiary to print and sign a copy of the electronic return. If a beneficiary is updating a MAGI estimate, follow the procedures listed in HI 01120.065.

C. How to Process the Request

If	Then
The beneficiary states that he or his spouse received a settlement from an employer or former employer in the tax year we used, and has had a significant reduction in his MAGI for the current tax year	Evaluate the evidence of the settlement statement. Obtain MAGI and tax filing status information from the beneficiary for the tax year to be used. NOTE: Two separate premium year inputs are necessary with all LCEs. Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.019) On the IRMN screen Enter the Beneficiary's Own SSN. In the “Select the Desired Option” field select “1” Establish Input the premium year that the new initial determination request is for. In the “Select the Desired Function” field select “1” Life Changing Event Input the Tax Year the beneficiary requests we use to determine the IRMAA. Press Enter The PYTY screen appears when there is data on file for the tax year requested and it is displayed under the Highest Probative Value Data Field. (For an explanation of Highest Probative see MSOM T2PE 008.019.) If you select “1” Use Highest Probative Data, the system will process the determination using that data on file. The data will be propagated to the IRMA screen. If you select “2” New Tax Data, the system will process the determination using the new information provided as long as the value of the data is of higher value than the information on file. Press Enter. On the IRLC screen In the “Select Life Changing Event” Field select “5” Work Stopped. NOTE: Work stoppage will be used as a work around until the PCOM screens can be updated In the “Date of Life Changing Event” field enter the date of the settlement payment (Month and Year) Show Proof as “1” Proven Document on the remarks line employer settlement Press Enter On the IRMA screen Input the beneficiary's alleged adjusted gross income and tax exempt income for the tax year the beneficiary is requesting to use. NOTE: If selection “1” Use Highest Probative Data on the PYTY was selected, the information will be propagated and cannot be changed. On the “Select Type” field select the appropriate tax source based on the information provided by the beneficiary. See MSOM T2PE 008.005. On the “Select Filing Status” field enter the appropriate filing status for the beneficiary. Show Proof as “1” Proven Press Enter. The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the determination based on the information entered. The IRMN Screen will display an alert to go to the EVID screen to document proofs submitted for the event reported. Pressing any “PF” key or the “Enter” key from the IRMN screen, will take you to the Shared Processes Menu. Record any evidence provided on the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). See HI 01120.030D.

Then

The beneficiary states that he or his spouse received a settlement from an employer or former employer in the tax year we used, and has had a significant reduction in his MAGI for the current tax year

Evaluate the evidence of the settlement statement.
Obtain MAGI and tax filing status information from the beneficiary for the tax year to be used.

NOTE: Two separate premium year inputs are necessary with all LCEs.
Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.019)
On the IRMN screen
- Enter the Beneficiary's Own SSN.
- In the “Select the Desired Option” field select “1” Establish
- Input the premium year that the new initial determination request is for.
- In the “Select the Desired Function” field select “1” Life Changing Event
- Input the Tax Year the beneficiary requests we use to determine the IRMAA.
- Press Enter

The PYTY screen appears when there is data on file for the tax year requested and it is displayed under the Highest Probative Value Data Field. (For an explanation of Highest Probative see MSOM T2PE 008.019.)
- If you select “1” Use Highest Probative Data, the system will process the determination using that data on file. The data will be propagated to the IRMA screen.
- If you select “2” New Tax Data, the system will process the determination using the new information provided as long as the value of the data is of higher value than the information on file.
- Press Enter.
On the IRLC screen
- In the “Select Life Changing Event” Field select “5” Work Stopped.
  
  NOTE: Work stoppage will be used as a work around until the PCOM screens can be updated
- In the “Date of Life Changing Event” field enter the date of the settlement payment (Month and Year)
- Show Proof as “1” Proven
- Document on the remarks line employer settlement
- Press Enter
On the IRMA screen
- Input the beneficiary's alleged adjusted gross income and tax exempt income for the tax year the beneficiary is requesting to use. NOTE: If selection “1” Use Highest Probative Data on the PYTY was selected, the information will be propagated and cannot be changed.
- On the “Select Type” field select the appropriate tax source based on the information provided by the beneficiary. See MSOM T2PE 008.005.
- On the “Select Filing Status” field enter the appropriate filing status for the beneficiary.
- Show Proof as “1” Proven
- Press Enter.

The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the determination based on the information entered.

The IRMN Screen will display an alert to go to the EVID screen to document proofs submitted for the event reported. Pressing any “PF” key or the “Enter” key from the IRMN screen, will take you to the Shared Processes Menu.
Record any evidence provided on the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). See HI 01120.030D.

D. How to Record Evidence Provided on EVID Screens

If	Then
The beneficiary provides a statement or letter from an employer.	Access the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). Select “OTHER” as the document submitted as proof. The letter should state the date of the settlement. Record that date as the “Document Event Date.” For “Issuance/Recordation Date” show “Y.” For “Date Issued” show the date on the letter from the employer. For Document Type enter: Letter from employer. For “Place Document Created” show the city and state of the employer. On the “Comment” line enter: name of the employer (do not abbreviate)-reason for settlement -employee: name of beneficiary or spouse. EXAMPLE – Delta airlines-reorganization-John Q Public
The beneficiary provides a court document showing settlement and terms.	Access the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). Select “OTHER” as the document submitted as proof. The letter should state the date of the settlement. Record that date as the “Document Event Date.” For “Issuance/Recordation Date” show “Y.” For “Date Issued” show the date on the letter from the employer. For Document Type enter: Court Order For “Place Document Created” show the city and state of the district court issuing the order. On the “Comment” line enter: name of the employer (do not abbreviate)-reason for settlement -employee: name of beneficiary or spouse. EXAMPLE – Delta airlines-reorganization-John Q Public
The beneficiary provides a statement from the employer’s attorney stating settlement and terms	Access the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). Select “OTHER” as the document submitted as proof. The letter should state the date of the settlement. Record that date as the “Document Event Date.” For “Issuance/Recordation Date” show “Y.” For “Date Issued” show the date on the letter from the attorney. For Document Type enter: Letter from employer’s attorney. For “Place Document Created” show the city and state of the employer’s attorney. On the “Comment” line enter: name of the employer (do not abbreviate)-reason for settlement -employee: name of beneficiary or spouse. EXAMPLE – Delta airlines-reorganization-John Q Public

Then

The beneficiary provides a statement or letter from an employer.

Access the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).
Select “OTHER” as the document submitted as proof.
The letter should state the date of the settlement. Record that date as the “Document Event Date.”
For “Issuance/Recordation Date” show “Y.”
For “Date Issued” show the date on the letter from the employer.
For Document Type enter: Letter from employer.
For “Place Document Created” show the city and state of the employer.
On the “Comment” line enter: name of the employer (do not abbreviate)-reason for settlement -employee: name of beneficiary or spouse.

EXAMPLE – Delta airlines-reorganization-John Q Public

The beneficiary provides a court document showing settlement and terms.

Access the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).
Select “OTHER” as the document submitted as proof.
The letter should state the date of the settlement. Record that date as the “Document Event Date.”
For “Issuance/Recordation Date” show “Y.”
For “Date Issued” show the date on the letter from the employer.
For Document Type enter: Court Order
For “Place Document Created” show the city and state of the district court issuing the order.
On the “Comment” line enter: name of the employer (do not abbreviate)-reason for settlement -employee: name of beneficiary or spouse.

EXAMPLE – Delta airlines-reorganization-John Q Public

The beneficiary provides a statement from the employer’s attorney stating settlement and terms

Access the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).
Select “OTHER” as the document submitted as proof.
The letter should state the date of the settlement. Record that date as the “Document Event Date.”
For “Issuance/Recordation Date” show “Y.”
For “Date Issued” show the date on the letter from the attorney.
For Document Type enter: Letter from employer’s attorney.
For “Place Document Created” show the city and state of the employer’s attorney.
On the “Comment” line enter: name of the employer (do not abbreviate)-reason for settlement -employee: name of beneficiary or spouse.

EXAMPLE – Delta airlines-reorganization-John Q Public

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POMS Reference

HI 01120: New Initial Determinations Using Beneficiary Information

A. Policy

B. What Evidence is Needed to Support Use of a More Recent Taxable Year to Determine IRMAA

C. How to Process the Request

D. How to Record Evidence Provided on EVID Screens