BASIC (04-01)

A. Introduction

SSA receives reports from numerous sources: interviews; informants; system interfaces and alerts; and computer matches with Federal and State agencies. Regardless of the source, all reports are either first-party or third-party reports. A first-party or third-party determination is necessary in order to make a decision about:

• what information needs to be obtained from the reporter;

• whether the event being reported can be processed; and

• what actions need to be taken as a result of the report.

B. Definitions

1. Adverse Action

An SVB post-qualification or postentitlement adverse action is a determination that results in:

• SVB reduction or suspension;

• SVB termination of entitlement; or

• SVB disqualification.

2. First-Party Report

A first party report is:

• An event reported by the beneficiary, representative payee or agent (e.g., lawyer); a relative, friend or neighbor acting on behalf of the SVB beneficiary at the beneficiary's request; or

• An event detected by a Supplemental Security Income Record (SSR) interface with the Master Beneficiary Record (MBR).

3. Third-Party Report

A third-party report is any report not meeting the definition of a first-party report.

C. Policy

The source of the report must be established in order to determine whether a report is a first or third-party report.

1. Person Making the Report Alleges to be the SVB Beneficiary

If the person reporting an event alleges to be the SVB beneficiary, the following information must be obtained from and provided by the reporter:

• the beneficiary's name;

• the beneficiary's address;

• the beneficiary's telephone number; and

• the beneficiary's SSN.

2. Person Making the Report Alleges to be Someone Other Than the SVB Beneficiary

If the person reporting an event alleges to be someone other than the beneficiary (including a representative payee), the following information must be obtained from and provided by the person making the report::

• the beneficiary's name, address and SSN;

• the reporter's name, address and phone number;

• the relationship of the reporter to the beneficiary; and

• a reasonable explanation as to why he or she is reporting on behalf of the beneficiary (i.e., why is the event not being reported by the beneficiary?).

D. Procedure

1. All Reports on SVB Claims

The office where the report of the SVB post-qualification or post-entitlement event is filed/received will:

• obtain and document the facts about the event reported (e.g., the event being reported, when the event will take place or occurred, etc.);

• identify the reporter and obtain information from the person/organization making the report per VB 01501.010C;

• determine the office responsible for processing the report (See VB 00901.015 for jurisdiction and routing); and

• fax and then mail the report to the office with SVB jurisdiction if the report is filed in an office not having jurisdiction.

2. Reports Received in CPS or FO With SVB Jurisdiction

The CPS or FO having jurisdiction of the SVB claim will:

• obtain a current SSR (and/or access the San Francisco Intranet Site to verify that SVB is involved;

• determine whether the reported event adversely affects SVB qualification, entitlement or benefits;

• consider whether the report affects the entitlement and/or benefits being administered by SSA under another program (e.g., title II, title XVI, etc.);

• determine if additional facts are needed about the event being reported;

• determine whether the report is a first- or third-party report per VB 01501.010D.3. and VB 01501.010D.4.; and

• determine whether capability and/or representative payee development is warranted.

3. First-Party Reports

Treat the report as a first-party report if the reporter provides the information required in VB 01501.010C. and the reporter is:

• the beneficiary,

• the beneficiary's representative payee,

• an agent (e.g., a lawyer or accountant), or

• a relative, friend or neighbor who is acting at the request of the beneficiary.

4. Third-Party Reports

Treat the report as a third-party report in all situations not meeting the first-party report requirements. The following will also be treated as a third-party report:

• Reports that would otherwise be treated as a first-party report, but the reporter cannot/does not provide all the required elements in VB 01501.010C.;

• Reports appearing to meet the first-party report criteria but the event occurred 6 or more months ago;

• Reports appearing to meet the first-party report criteria but there are indications that the report is inaccurate.