SI 02260.006: Personal Conferences
Effective Dates: 08/07/2018 - Present TN 20 (08-18)
- SI 02260.006 Personal Conferences
- A. Background of personal conferences
In Page v. Schweiker, the Federal District Court for the Middle District of Pennsylvania held that an individual who requests a waiver of recovery of a Supplemental Security Income (SSI) overpayment is entitled to an opportunity for a personal conference with a decision maker from the Social Security Administration (SSA) when the waiver cannot be approved based on the initial waiver request. Current nationwide policy, consistent with the decision in Page v. Schweiker, provides that an SSI debtor is entitled to an opportunity for a personal conference before SSA may deny a waiver request.
- B. Policy for personal conference and folder review
SSA is required to provide SSI debtors an opportunity to review the information in its files that is relevant to the overpayment and the proposed decision before it may deny a waiver request. This requirement does not change: * The waiver process when we approve a waiver; or * Any waiver processing up to the point when you informally determine, based on current information (i.e., the file, the waiver request, and any documentation submitted) you cannot approve the waiver request.
- 1. Who can conduct a personal conference?
* Customer Service Representatives (CSRs), Claims Specialists (CSs), and higher-level positions may conduct the pre-waiver decision personal conference. * The position authorized to conduct the personal conference (decision maker) is the same as for making the overpayment disposition decision (management review requirements). For management review requirements, see SI 02220.005C. * Unlike Title II, any position and any grade level authorized to recommend or approve an overpayment disposition may conduct a pre-waiver decision personal conference. * The decision maker conducting the personal conference can be and usually is the decision maker who makes the waiver determination after the personal conference.
- 2. The decision maker must not have participated in the overpayment proceedings
The liable individual is entitled to a fair and full hearing before an impartial decision-maker. Therefore, a field office (FO) employee who has participated in the overpayment proceedings in a case cannot be a decision-maker for the pre-decision personal conference. For more information on who is liable for repayment of an overpayment, see SI 02201.020 and SI 02201.021. * Participation in the case means an FO employee has made a determination about any fact that is material to the pending waiver determination, which includes fault, ability to repay, and credibility of the overpaid person. * If the decision maker reviewed the waiver request, the case file, and any supporting evidence, such as pay stubs, financial information, etc.; then made the preliminary determination to deny the waiver request, he or she is considered to have participated in the overpayment proceedings. * If the decision maker merely developed the underlying changes to the record that caused the overpayment, then he or she did not participate in the overpayment proceedings. * While an initial overpayment notice is a determination that an overpayment exists, mere preparation of this notice does not constitute participation in the overpayment if the author made no determinations about facts at issue in the waiver determination. EXAMPLE: As part of a scheduled redetermination, you verified the SSI recipient's earned income. The income verification revealed that the recipient earned more than we estimated. When you input the verified wages, the system computed an overpayment.
- However, you did not participate in the overpayment proceedings because you did not make a preliminary determination concerning any factor at issue in a request for waiver (e.g., without fault and whether recovery would defeat the purpose; or be against equity and good conscience).
- Under these circumstances, you may conduct a personal conference.
3. Actions when all employees at the appropriate grade levels have been involved with the overpayment proceedings When all employees at the appropriate grade levels have been involved with the overpayment proceedings, such that they cannot be the decision maker on a waiver request, arrange to transfer the case to a nearby FO. Advise the debtor or his or her representative that the transfer is necessary.
- In rare cases, you may need to arrange for an authorized employee from another office to travel to the servicing FO to conduct the conference.
“Rare cases” include, but are not limited to situations when the: * Distance between offices is too great for the recipient to travel due to physical or mental limitations; or * Recipient or witness’ financial circumstances prohibit his or her travel to an office further away than the servicing office. 4. Statements by person requesting the personal conference Part of the waiver decision process is to assess whether the statements of the overpaid individual are consistent with the other evidence regarding the waiver request. Offer the individual a face-to-face interview or a choice of telephone contact or video conference in place of a face-to-face interview.
- 5. The personal conference folder review
Prior to the personal conference, the overpaid individual (and his or her payee or representative) has the right to: * Review the folder and any information that we used to calculate the overpayment, including electronically stored information; and * Review the applicable overpayment and waiver laws and regulations found in §1631(b) of the Social Security Act (the Act), and Title 20 of the Code of Federal Regulations (CFR), §416.537 and §416.538. The decision maker for the case must be prepared to answer questions. If the individual asks for a telephone or video conference, you must mail a copy of the relevant overpayment documents to him or her for review prior to the conference. Prior to mailing, remove any material that refers to another person or does not relate to the overpayment or waiver request.
- 6. The personal conference decision
The personal conference is an independent and thorough examination of all the evidence related to the overpayment and the requested waiver. The decision requires a wholly independent attitude without prejudice by the decision maker. The decision maker is bound by the requirements of the Act, the CFR, and the policies and procedures in the POMS. The decision maker cannot depart from the listed authorities.
- 7. Waiver denial appeal after a personal conference
After a personal conference, the first level of appeal for an SSI waiver denial is reconsideration. This is different from a Title II waiver denial where the first level of appeal is a hearing. This difference is the result of different regulations. The decision maker for the reconsideration of the SSI waiver denial cannot be the decision maker who made the initial determination to deny the waiver. For SSI reconsideration information, see SI 04020.030B.2.
- C. Procedures for scheduling and conducting personal conferences
- 1. If you are unable to obtain overpayment documentation
If you are unable to obtain documentation of the cause and/or the calculation of the overpayment, and you have nothing to support the determination that the overpaid person is at fault in causing the overpayment, find the individual not at fault. For more information about who is liable for an overpayment, see SI 02201.020 and SI 02201.021.
- Do not determine the individual's ability to repay the overpayment.
- Waive the overpayment because recovery is against equity and good conscience in this case.
- 2. Scheduling the personal conference
- a. Liable person lives in the US
If you cannot approve an overpayment waiver request in full, do not send a waiver denial notice. Prepare a notification of the proposed waiver denial on a notice of Personal Conference & Folder Review (Waiver/Recon), found in the Overpayment section of the Document Publishing System (DPS). * The notice to schedule the personal conference will not include appeal rights because you have not made an initial determination on the waiver request. * Send the initial notice of proposed waiver denial. * Include dates for the folder review and the personal conference. * The date of the scheduled conference must allow for at least five workdays for the recipient to review his or her file.
- The recipient may waive the five-day period for review by asking to review the information on the day of the personal conference.
- If the recipient is unwilling or unable to come to the conference site (most often an SSA office), he or she may choose to have the personal conference conducted by telephone or videoconference.
For procedures to follow when the recipient declines the opportunity for a folder review and/or personal conference, or does not appear for the personal conference, see SI 02260.006C.3. See SI 02260.006C.4. regarding the person’s options for how to conduct the personal conference and the FO’s responsibilities.
- b. Liable person lives outside the United States (U.S.)
- The agency will not hold a face-to-face personal conference outside the U.S. To obtain a personal conference, the individual requesting waiver must return to the U.S., or choose to have the conference by telephone or video conference.
- Follow the same procedures as for a U.S. resident, but allow sufficient time for foreign mail delivery and travel to the U.S.
- 3. Liable person declines a folder review or a personal conference or does not appear for the personal conference
- * If the liable person declines the offer of folder review, he or she retains the right to a personal conference.
- * If the liable person declines the folder review and the personal conference, make the waiver decision based on the evidence in the file.
- Input the waiver decision using the Direct SSR Update MSSICS (UODC, UOPD, and UOWV screens), see MSOM BUSSR 004.007, MSOM BUSSR 004.008, and MSOM BUSSR 004.009., prepare the notice of waiver decision (see SI 02260.006D.2.) and document the file (see SI 02260.006C.5.).
- * If the liable person does not appear for the personal conference, contact him or her by telephone to determine whether he or she wants to reschedule or decline the personal conference.
- Reschedule the conference if requested. If unable to contact the recipient by telephone, send a notice of Personal Conference & Folder Review (Resched) to reschedule the conference. Explain in the notice rescheduling the personal conference that failure to appear will result in SSA making the waiver determination based on the evidence we already have.
- * If the liable person does not attend or declines the second scheduled conference, make the waiver decision based on the evidence in the file. Input the waiver decision using the Direct SSR Update MSSICS (UOPD, UODC, and UOWV) screens. See MSOM BUSSR 004.008 through MSOM BUSSR 004.009, and document the file (see SI 02260.006C.5.).
* Send a Personal Conference Refused or a Personal Conference Letter (No Show) DPS notice. * When the person does not appear for the personal conference, prepare and send a notice of Personal Conference (Waiver Allowed/Denied) or Partial Waiver Approval (Personal Conference Decision) if you fully or partially deny the request for waiver.
- 4. Folder review and personal conference
- a. Folder review by liable person
- * Prior to the review, remove material that relates to another person or does not relate to the overpayment or waiver request;
* Furnish copies of any requested material from the claims folder and relevant sections of the Act and CFR;
- * Do not charge the recipient for furnishing documents;
- * If, after the folder review, the person decides he or she does not want a personal conference, see SI 02260.006C.3;
- * If the Postal Service returns the scheduling letter as undeliverable, develop a current address. (See SI 02220.051 for suggestions on developing a new address);
- * If you cannot obtain a new address, make the waiver decision based on the evidence you have;
* Input the waiver decision using the Direct SSR Update MSSICS (UOPD, UODC, and UOWV) screens. (See MSOM BUSSR 004.007 through MSOM BUSSR 004.009); and * Prepare the notice and document the file with the decision, see SI 02260.006C.5.
- For additional information regarding conducting the personal conference with the person, see GN 02270.009.
- b. Selecting the conference site
- Provide a suitable private space in the FO. If the individual cannot come to the conference site (e.g., he or she is incapacitated or in prison), the FO can conduct the personal conference by telephone or videoconference.
- Consider conducting personal conferences at locations other than the FO on a case-by-case basis. Use another location only in circumstances where a claimant has exhausted all other means of obtaining a personal conference, or where conducting a personal conference by any other means would be so inadequate, owing to a claimant’s physical or mental condition, as to infringe upon the person’s right to a full and fair hearing on the waiver request.
* If there is a legitimate reason (e.g., he or she is incapacitated or in prison) that the recipient cannot come to the conference site or participate in a telephone or videoconference, and SSA cannot go to the person, make the waiver decision based on all information in the file. * For overpayment decision inputs, see MSOM BUSSR 004.008, Overpayment Decisions (UOPD) and MSOM BUSSR 004.009), Waiver (UOWV). * If the individual refuses, without a legitimate reason (as described above), to come to the first and second scheduled conferences (or states that he or she will not attend any personal conference) and refuses the offer of a telephone or videoconference, he or she forfeits the opportunity for the personal conference. * Make the waiver decision based on all available evidence in the file. * Prepare the notice and document the file with the decision. * For notice, documentation and distribution of the personal conference decision, see SI 02260.006C.5.
- c. Conducting the conference
- Before starting the conference explain to the liable person that the decision maker was not previously involved in the case and the decision is based on the evidence presented as well as that in the file.
- The purpose of the conference is to provide the liable person an opportunity to present his or her case and to furnish evidence to support it.
* Identify all participants and explain the roles. Determine whether the liable person has reviewed the file. * If he or she has not reviewed the file and now wants to do so, provide the opportunity. * Document that the liable person has not reviewed the file, but now wants to review the file. * Provide the applicable law and regulations regarding the overpayment and waiver. * Provide an oral summary of the evidence already in the file. * Invite the liable person to present his or her case. * Advise the liable person that SSA cannot compel the presence or testimony of a witness at the personal conference. * If the recipient continues to demand the presence of witness(es) (whom you cannot compel to appear) at the personal conference, escalate the case to a hearing. * Inform the liable person if we require additional evidence to make a decision. If the liable person insists on a personal conference but, despite all efforts, we cannot hold the conference: * Make the waiver decision based on the information in file. * Input the waiver decision using the Direct SSR Update MSSICS (UOPD, UODC, and UOWV) screens. * For direct SSR input of a waiver decision, see MSOM BUSSR 004.008 through MSOM BUSSR 004.009. * Prepare the notice and document the file with the decision. * For documenting the file with an overpayment decision, see SI 02260.006C.5.
- 5. Notice, documentation, and distribution of the personal conference decision
For MSSICS cases, the decision maker must document all of the personal conference decision information on the DROC screen. For both MSSICS and non-MSSICS cases, the technician must fax all supporting documentation into NDRed. If the case is not in MSSICS: * Prepare, date, and sign the special determination (form SSA-553). * Document the personal conference decision in either a MSSICS DROC or form SSA-553. * Include sufficient information on the determination to document the file that the interviewer provided the liable person an opportunity to review his or her folder; and whether he or she attended the personal conference. * Include whether the liable person reviewed the file and whether he or she contested any of the information reviewed. * Review the updated information obtained since the preliminary waiver decision determination in file or the proposed denial waiver notice. * Note in your personal conference decision if anything was confirmed or refuted as a result of the personal conference or additional evidence submitted, and whether new information affected the final determination. * The determination documents the explanation entered on the DPS Personal Conference (Waiver Allowed/Denied) notice. For instructions on completing the SSA-553, see GN 01010.365. The post personal conference determination should describe the appropriate fault and recovery decisions and explain the decision by citing evidence in the record:
- * Was the liable party at fault in causing the overpayment according to SI 02260.010 and SI 02260.015?
* If yes, who was at fault and how did you reach this conclusion? For example, did the debtor: * Fail to report information timely that was relevant to his or her eligibility or payment amount; * Receive duplicate payments for one or more months; or * Conceal or misstate facts affecting his or her eligibility or payment amount?
- * If no, why was he or she not at fault?
- * If the recipient or payee was not at fault, refer to the evidence in the file to explain why the recovery met or did not meet the criteria for either:
- * Impede effective or efficient administration of title XVI of the Act (SI 02260.030);
- * Against equity and good conscience (SI 02260.025);
- * Defeat the purpose of title XVI of the Act (SI 02260.020); or
* Adverse changes in financial circumstances following a waiver denial (SI 02260.040)
- Further action by the decision maker will depend on the type of waiver decision. Waiver approval notices are usually systems generated (see NL 00803.205). For a list of exclusions, see NL 00801.010. Waiver denial notices are always manual (see NL 00803.210).
- The decision maker prepares and issues the notice of waiver decision if the notice is not automated. DPS personal conference notices include:
- * Personal Conference (Waiver Allowed/Denied);
- * Personal Conference and Folder Review (Resched);
- * Personal Conference and Folder Review (Waiver/Recon);
- * Personal Conference Appointment Letter;
- * Personal Conference Letter (No-Show); and
* Personal Conference Refused; and * Waiver Denial (Defeats the Purpose Does Not Apply). If the liable individual is a legal guardian or representative payee, send a manual notice of the approved waiver request to the liable legal guardian or representative payee. For waiver decision notices, see NL 00803.200, Notice of Waiver Decision – General. For a complete list of circumstances that require a manual notice, see NL 00801.010B.2.
- a. Waiver approval specific actions
When making a decision to waive overpayment recovery:
- * Post the approved waiver decision to the SSR using MSSICS Direct SSR Update and the UOWV screen. For waiver input instructions, see MSOM BUSSR 004.009; and
* Refund any funds recovered for the overpayment period covered by the approved waiver request. Use the A-OTP process to refund the recovered amount. For instructions on the A-OTP process, see SM 01901.005 and MSOM BUSSR 004.003 through MSOM BUSSR 004.009 and MSOM BUSSR 003.022;
- * If the approved waiver covers months in which payments were adjusted to recover the waived overpayment, refund the amount withheld;
- * Do not refund funds if there is either another collect decision (i.e., different period of overpayment) or an unresolved overpayment;
- b. Partial waiver approval or denial specific actions
* When we decide to deny a waiver request in full or approve waiver of recovery for part of the overpayment, enter the denial or partial approval using Direct SSR Update (UOWV) screen. See MSOM BUSSR 004.007 through MSOM BUSSR 004.009. * Prepare and send a DPS notice of Personal Conference (Waiver Denied) or Partial Waiver Approval (Personal Conference Decision) following the personal conference if you fully or partially deny the request for waiver. c. Waiver denial after a request for access to financial information (AFI) When making a decision to deny a waiver request after considering the ‘recovery defeats the purpose’ waiver provision, and if SSA received financial information through Accuity: * Send the DPS notice titled, “Waiver Denial (Defeats the Purpose Does Not Apply)” to the overpaid individual. If the liable adult has a representative payee, you must send the notice to the liable individual, not the representative payee. * Explain to the overpaid individual that, while he or she may contact Accuity with questions concerning the financial information they provided to SSA, the overpaid individual must submit any appeal request on the waiver decision to SSA, not to Accuity.
- D. References
* SI 02201.020 Supplemental Security Income (SSI): Who is Liable (Responsible) for Repayment? Living Overpaid Individual * SI 02201.021 Supplemental Security Income (SSI): Who is Liable (Responsible) for Repayment? Overpaid Individual is Deceased
- * SI 02220.005 Documenting the Supplemental Security Income (SSI) Overpayment
- * SI 02220.051 SSI Overpayment - Efforts to Locate an Overpaid Individual in Non-payment Status
- * SI 04020.030 Developing and Processing SSI Reconsideration Requests
* SM 01901.005 When to Use One-Time Payments (OTPs)
- * GN 02270.009 Folder Review by the Person for Personal Conference
- * GN 01010.365 Formal and Informal Determinations
- * NL 00801.010 Manually Prepared Notices
- * NL 00803.200 Notice of Waiver Decision – General
x← This means that the line was removed and was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.