TN 6 (11-09)

A. Procedure - FTC development

1. FTC -- medical issue cases

A streamlined FTC process for medical Continuing Disability Reviews (CDRs) was implemented in the field offices (FOs) on January 27, 2007. If the FO annotates the FTC decision to the Disability Control File (DCF) on or after January 27, 2007, the streamlined FTC process applies.

EXCEPTION: See DI 13015.005A.4 for an exception to the streamlined CDR FTC process, i.e., a Disability Determination Services (DDS) determination is needed to determine if entitlement/eligibility to extended Medicare benefits should continue, and the beneficiary fails to cooperate).

a. Title II cases and concurrent cases

In an FTC case determined by the FO involving a medical issue, the FO will implement the streamlined FTC process if the beneficiary fails to cooperate. The FO will make an FTC determination resulting in the non-payment of benefits only after the Social Security Administration (SSA) fulfills its responsibility for requesting and obtaining information. (See DI 13015.001D.2.)

Record the FO FTC action on the DCF. (See DI 13015.005A.2.d. for instructions on DCF coding. Also, see Modernized System Operations Manual (MSOM), MSOM CDR 001.007 for more detailed procedures on the DCF. This will result in benefits to the Title II beneficiary automatically being placed in a non-payment status.

Suspend benefits effective the first month that does not cause an overpayment after SSA fulfills its responsibility of requesting and obtaining information.

NOTE: If the DCF input fails to effectuate suspension, a manual MACADE action is required by the processing center (PC). (See DI 40525.001B.2. and DI 40525.001C.2.).

b. Title XVI adult, child or age-18 redetermination case

A recipient’s failure to comply with an SSA request for necessary information or evidence will lead to a determination of ineligibility (N20). For detailed policy and procedures on failure to provide information (N20), see SI 02301.235. An FTC determination resulting in the non-payment of benefits will be proper only after SSA fulfills its responsibilities for requesting and obtaining information and after applying the Goldberg/Kelly due process procedure. For detailed and specific information and instructions, which include policy and procedures, see SI 02301.300

For childhood cases involving FTC, see DI 13015.005A.2.a. and DI 25205.020.

2. Steps for FTC development

If, 15 calendar days after the initial request for information (containing the required 30 day closeout language) is sent and the beneficiary/payee fails to comply with our request for necessary information or evidence needed to complete the CDR, the FO will implement the following procedures.

a. Step 1 – exhaust all efforts/leads-including a personal contact attempt

Before suspending benefits, the FO will exhaust all efforts to contact the beneficiary/payee and follow-up on requests. Assist and obtain requested information when possible. For an overview of the FTC/WU determination process, which includes specific information about general development issues, see DI 13015.001D.2., SI 02301.235I, and SI 02301.235J.

There are certain special personal contact efforts that are required in childhood cases.

• Attempts to contact responsible party

  In possible FTC situations, make two attempts at different times on different days to contact the child/payee by telephone. A busy signal does not constitute an attempt. If telephone contact is unsuccessful or not possible, send a call-in letter with a follow-up letter sent between 10 and 20 days after the initial request. Document all contact efforts. See DI 13015.250.

• When to attempt contact with another responsible adult or agency

  Because children are not ordinarily in a position to pursue their claims independently, special efforts must be made in FTC cases to identify and contact another adult or agency responsible for the child’s care.

  If the child/payee is not providing the requested information or cooperating, use all available information in file and/or provided by the payee to determine whether there may be another responsible party who can help the child.

  A child welfare or other agency with legal custody is the responsible party of choice, but, if an agency does not have legal custody, the FO may find that the child lives with and/or is cared for by several adults, any one of whom may be willing and able to assist the child.

  If available information indicates there are potential sources of assistance, but does not suggest a particular individual, a telephone call to the household may in many cases be the most productive approach to determine from whom to request assistance. If there is more than one party who may be able and willing to assist, the FO should use its discretion in deciding which party to contact.

  A good-faith effort to locate and contact a responsible party is required. If efforts to contact a potential responsible party are unsuccessful, or the party contacted proves unable or unwilling to provide the needed information/cooperation, the FO is not required to conduct a further search for yet another potential responsible party.

  Some specific examples of possible contacts are:

  Child lives with the uncooperative payee and another parent, relative, or other adult

  If the child lives with an uncooperative payee and a parent, the parent should be contacted. If the child lives with both parents, one of whom is the uncooperative payee, the other parent should be contacted. (A non-custodial parent, i.e., a parent who does not live with the child, should not be contacted unless named in the file as a potential source of assistance.)

  Besides the payee, one or more other adults who are not the child’s parents but who live in the same household may, in some cases, take responsibility for a child. In FTC situations, if the uncooperative payee, or information in the file, indicates that another adult in the household does take responsibility for the child’s care, the FO should contact that individual to request the needed information or cooperation. (The FO should be alert to whether there may be such other responsible adults in the household in any contacts with the payee who has not yet provided the necessary information.); or

  Child lives with someone other than the payee

  If the payee is not cooperating, and the child lives with someone else, that person should be contacted. For example, if the child’s mother is the payee but the child lives with his or her grandmother, the grandmother may be able to assist the child in completing the review; or

  Child regularly cared for in another household

  If the child is frequently in the care of a relative (or possibly a non-relative, if there is clearly a parental-type relationship with the child) who does not live in the same household, that person may be an appropriate source of assistance; or

  Child welfare or other agency has legal custody of the child

  An agency with legal custody is responsible for providing the information we need (even if the payee is someone else, e.g., a foster parent). Contact is normally made with whoever has physical custody, but if that person is uncooperative, the needed information or assistance must be requested from the party with legal custody.

  Uncooperative payee

  As soon as it appears that the child’s payee is missing, no longer acting for the child, or is uncooperative, follow the instructions in GN 00504.100 to determine the need for a new payee.

  If the uncooperative payee is entitled as a young wife (B2) or widowed mother (E) and the only child in his/her care is the disabled minor child or the disabled adult child who is suspended due to FTC, benefits to the B2 or E are suspended effective with the month of suspension of the disabled child per SM 03020.050B. (See OS 00501.030 for the list of beneficiary identification codes (BIC)).

b. Step 2 – verify address

There are many reasons why a beneficiary/payee does not respond to SSA’s requests for information or evidence. Failure to respond may occur when benefits are being electronically transferred to a bank, and the beneficiary/payee has failed to keep SSA informed of his/her current address or whereabouts, (e.g., a move, hospitalization or incarceration). Another reason for failing to comply with SSA’s requests occurs when the disabled beneficiary is no longer in the custody of the payee, and the payee has failed to notify SSA.

To ensure that SSA has made every reasonable effort to contact the beneficiary/payee, the FO representative will:

• Query the Supplemental Security Record/Master Beneficiary Record (SSR/MBR) for a more current address. If a better address is not shown then;

• Try calling the beneficiary/payee at the most recent telephone number of record.

• If no telephone number is shown, contact the local directory assistance for a telephone number.

• If the beneficiary/payee cannot be reached via the telephone and the beneficiary has direct deposit, contact the financial institution (FI) of record for a current address.

• If a better address is not obtained from the FI then;

• Send form SSA-L2001 to the Post Office (PO) servicing the address of record.

• While waiting for a response from the PO, proceed to DI 13015.005A.2.c. and DI 13015.005A.2.d. (See SI 02301.240D.1.)

c. Step 3 – beneficiary/payee fails to comply

• When a beneficiary fails to comply, develop capability and consider the need for a payee only if there is an indication that the beneficiary may not be managing benefits and meeting needs.

• When a capable beneficiary fails to comply with our request for necessary information or evidence and all attempts to obtain the information have been exhausted, annotate the FTC status to the Disability Control File (DCF). This will result in the benefits of the Title II beneficiary and auxiliaries and/or Title XVI recipient being placed in non-payment status. To accomplish the suspension, follow the applicable procedures in DI 13015.005A.2.d.

• When unable to locate/contact the payee, consider the beneficiary’s circumstances and whether it would be appropriate to ask the beneficiary or individuals who care for the beneficiary about the payee’s whereabouts and/or suitability.

• As soon as it appears that a payee is missing, no longer acting for a beneficiary, or is uncooperative, follow instructions in GN 00504.100 to determine the need for a new payee. Reevaluate capability for legally competent beneficiaries. When developing payee suitability, be alert to the possibility that a payee may have previously served or is currently serving for other individuals (see GN 00502.115).

• When a new payee is needed but cannot be found quickly, pay benefits immediately to an incapable beneficiary after securing an SSA-11, unless one of the exceptions in GN 00502.001 applies. If direct payment is not permitted, then follow instructions in GN 00504.105 through GN 00504.110 to suspend benefits until a payee can be found. Do not determine FTC for an incapable beneficiary unless the payee is the legal guardian. Secure CDR information from the beneficiary during the direct payment interview.

d. Step 4 – suspension action - beneficiary/payee fails to provide any of the necessary information or evidence requested

Send a follow-up letter by certified mail to the address of record requesting the needed information. If no response is received within 15 calendar days of the date of the follow-up letter, and no better address has been obtained as a result of Step 2 above, make the following inputs to the DCF to suspend benefits.

• Title II only and concurrent case suspension inputs:

  From the SSA Main Menu select: “32” (DISABILITY CONTROL FILE).

  On the CDR Selection Menu (MCDR) screen select “2-FO UPDATE” and BIC, if other than A (see OS 00501.030).

  On the CDR Entitlement Screen (ECDR) screen enter a CDR type of “5” (Title II/concurrent medical CDR in the SELECT field.

  On the CDR FO Input (IFOA) screen enter “04” for Failure to Cooperate (FTC) and the FO of jurisdiction in the “OFFICE RESPONSIBLE FOR NEXT ACTION” field. (See MSOM CDR 001. 007 for more detailed procedures on the DCF.)

  This DCF action will result in benefits to the beneficiary automatically being placed in a non-payment status (TII LAF S0/TXVI PS N20). Non-payment will be effective with the first month that does not cause an overpayment.

  If the DCF input to suspend benefits fails, an alert is generated that goes to the PC for their action (see SM 03005.110).

  The suspension notice will be automatically generated when the transaction is processed. If the beneficiary does not cooperate during the 12-month suspension period, benefits are automatically terminated effective the 13^th month. No benefit continuation will be offered.

  The DCF input also automatically updates the SSR with the FTC payment status (N20 – Title XVI-failure to provide necessary information) following the payment status overlay rules per SM 01305.001. There could be a delay of several days for this automatic update to the SSR to occur. The Medical Issue (MG) field in the Disability Data segment (DISB) of the SSR will also update with a code of “F” to show FTC status. The combination of payment status N20 with the MG code of F will identify the case as being FTC.

  Enter the remark “N20 - MED CDR FTC” in the DCF remarks section. (See MSOM CDR 001.007 for more detailed procedures on the DCF.)

  Enter the remark "N20 - MED CDR FTC" in the Remarks field of the SSR per SM 01301.841 in non-MSSICS cases or by using the SSR Remarks screen (CRMK) in the Modernized Supplemental Security Income Claims System (MSSICS) cases (MSOM MSSICS 023.003).

  NOTE: When Title II benefits are suspended, the beneficiary’s Medicare entitlement continues, but the beneficiary will be billed separately for the monthly Medicare premiums. If the Title II benefits are terminated due to FTC, the Medicare entitlement ends. The Medicare termination is effective with the end of the month after the month in which the beneficiary is notified that his or her entitlement to benefits will end.

  If the DCF input to suspend benefits fails, an alert is generated which goes to the PC for their action (see SM 03005.110).

• Title XVI only suspension inputs:

  From the SSA MainMenu select: “32” (DISABILITY CONTROL FILE).

  On the MCDR screen select “2-FO UPDATE” and enter the SSN.

  On the ECDR screen enter the appropriate code for a TXVI adult case, a TXVI childhood case, or an age 18 redetermination case in the SELECT field.

  On the IFOA screen enter “04” for Failure to Cooperate (FTC) and the FO of jurisdiction in the “OFFICE RESPONSIBLE FOR NEXT ACTION” field.

  Enter the remark “N20 – MED CDR FTC” in the DCF remarks section. (See MSOM CDR 001.007 for more detailed procedures on the DCF.)

  Enter the remark “N20 – MED CDR FTC” in the Remarks field of the SSR per SM 01301.841 in non-MSSICS cases or by using the SSR Remarks screen (CRMK) in MSSICS cases (MSOM MSSICS 023.003).

  The DCF input automatically updates the SSR with the FTC payment status (N20 – Title XVI-failure to provide necessary information) following the payment status overlay rules per SM 01305.001. There could be a delay of several days for this automatic update to the SSR to occur. The MG field in DISB of the SSR will also update with a code of “F” to show FTC status. The combination of payment status N20 with the MG code of F will identify the case as being FTC.

• Beneficiary/recipient moves to another FO jurisdiction while in suspense

  If the beneficiary/recipient moves to another FO jurisdiction while in suspense (and continues to fail to cooperate), transfer the case on the DCF to the new FO. This transfer will not reinstate benefits.

• B2 or E entitled, last child in care suspended

  If the disabled minor child or the disabled adult child is the last child in care for the B2 or E and the disabled child is suspended, suspend benefits to the B2 or E in the same month. A manual action is necessary. (See SM 03020.050B for additional information.)

e. Step 5 – reinstatement of benefits, beneficiary/payee cooperates

• Title II cases

  Beneficiary/payee cooperates

  If the beneficiary/payee complies with our request for necessary information within 12 months and is otherwise eligible for Title II benefits, reinstate benefits and follow normal CDR processing instructions for completing the medical CDR. Retroactive benefits are paid to the beneficiary and auxiliaries starting with the first month of suspension, if all other factors of entitlement are met.

  Update the DCF with the current CDR status and transfer the case to the DDS. This transfer action on the DCF will set an action item on the DCF which will trigger an MBR update record to resume benefits.

  NOTE: The beneficiary does not have to file an appeal to have benefits reinstated.

• Title II only and concurrent case reinstatement inputs:

  Select SSA Mainframe: “32” (Disability Control File).

  On the MCDR screen, select “2” (FO Update) and enter the SSN.

  On the ECDR screen, enter ”5” for a Title II case or concurrent case.

  On the IFOA screen enter “2” for Transfer case (WU/FTC) and destination information including: the office responsible for the next action, claim folder indicator, and request to establish DDS record.

• If the case is concurrent, the FO must also take the steps outlined in the “SSR coding necessary for reinstating payments” section which follows in DI 13015.005A.2.d.

• If the DCF input to reinstate benefits fails, an alert is generated which goes to the PC for their action (See SM 03005.110).

• Procedure – reinstating Title II benefits if case cannot be transferred to DDS (manual reinstatement required)

  If the beneficiary/payee complies with our request for necessary information, but the case cannot be transferred to the DDS (e.g., there is an administrative delay on forwarding CDRs the DDS(s)), benefits need to be reinstated if the beneficiary is otherwise eligible for Title II benefits. The FO should contact the PC to have them initiate manual reinstatement via MACADE.

• Title XVI cases

  Recipient/payee cooperates

  If the recipient complies with our request for necessary information and is otherwise eligible for Title XVI benefits, reinstate benefits per SI 02301.210 and follow normal CDR processing instructions for completing the medical CDR.

  NOTE: The beneficiary does not have to file an appeal to have benefits reinstated.

• Title XVI case reinstatement inputs:

  Select SSA Mainframe “32” (Disability Control File)

  On the MCDR screen, select “2” (FO UPDATE) and enter the SSN

  On the ECDR screen, enter the appropriate code for a Title XVI adult, a Title XVI childhood case or an age 18 redetermination case.

  On the IFOA screen, enter “2” for Transfer case (WU/FTC) and destination information including: the office responsible for the next action, claim folder indicator, and request to establish DDS record.

  (See MSOM CDR 001.007 for more detailed procedures on the DCF.)

• SSR coding necessary for reinstating payments

  If N20 is on the SSR and the recipient cooperates, remove the N20 payment status. This will update the Medical Issue (MG) field in the DISB of the SSR with a code of “P” showing that FTC status has been removed.

  Remove any SSR remarks that may refer to the case as being FTC.

• Procedure – reinstating payments if case cannot be transferred to DDS

  If the recipient/payee complies with our request for necessary information, but the case cannot be transferred to the DDS (e.g., there is an administrative delay on forwarding CDRs to the DDS(s)), payments need to be reinstated if the recipient is otherwise eligible for Title XVI payments. The FO should use MSSICS to reinstate payments.

f. Step 6 – document all efforts to contact recipient/payee

The FO must document all efforts taken to contact the recipient/payee on an SSA-5002 Decision Documentation Sheet (Exhibit in DI 13015.250).

NOTE: After the beneficiary is in suspense for 12 months, benefits are terminated effective the 13^th month. The case does not require a medical determination by the DDS. The termination notice includes information about the appeals process. See GN 03102.100 for the appeals policies.

3. FTC - manually closing the CDR on DCF for Title II FTC termination cases

Title II FTC termination cases do not automatically close on the DCF after the beneficiary is in suspense for 12 months and benefits are terminated effective the 13^th month. The FO must manually close the Title II FTC CDR issue on DCF by annotating a STOP CDR (see MSOM CDR 001.007, CDR FO Input Screen (IFOA)):

• From the MCDR screen, enter 2=FO UPDATE

• Enter the SSN and BIC (if other than "A")

• On the ECDR screen, enter the appropriate CDR type in the SELECT field

• On the IFOA screen, enter 5=SSR/MBR/STOP CDR

4. FTC - Title II extended Medicare cases

The streamlined CDR FTC process discussed in DI 13015.005A.1 does not apply to Title II cases where the beneficiary has been terminated due to work and a medical CDR determination by the DDS is necessary to determine if entitlement/eligibility to extended Medicare benefits should continue. By the implementing regulations, the streamlined CDR FTC process applies only to Title II and Title XVI cases when an individual fails to cooperate in the CDR process. It does not apply to Title XVIII cases to determine if entitlement/eligibility for extended Medicare benefits should continue.

Since the streamlined CDR FTC process does not apply:

• Use the Disability Review Establishment (DRES) screen (MSOM CDR 001.016) in the DCF to establish a medical CDR on the case (see DI 13010.610).

• Transfer the medical CDR to the DDS via the IFOA screen in the DCF. DO NOT input FTC on the DCF. (This is a regular transfer, not an FTC transfer.)

• Include a remark on the CDR Remarks Input Screen (IRMK) in the DCF such as "Medical CDR Decision needed by DDS for extended Medicare-Streamlined FTC does not apply."

• Include the following statement in EDCS Messages/Alerts, “FTC Case – Need DDS Medical Determination. DO NOT RETURN TO FO, streamlined FTC process does not apply.”

5. FTC -- work issue cases

a. Title II cases

When work is the sole issue, make a substantial gainful activity (SGA) determination whenever possible using any available evidence of earnings. Use all methods and sources of wage verification outlined in DI 10505.005C. through DI 10505.005F.

• Prepare an SSA-833-U3 SGA cessation or continuance determination, if appropriate, (see DI 13010.170), and effectuate following established procedures (see DI 13010.000).

• In rare instances, such as an individual in a position to control or suppress earnings who fails to cooperate, there may be insufficient evidence to make a work issue determination. If the evidence is insufficient to determine whether or not the individual is engaging in SGA:

  • Provide due process per DI 13010.185.

  • ,Prepare an SSA-833-U3 with the cessation month based on FTC (see DI 13015.010A.2.) to terminate benefits (LAF T9), when the designated response time has expired.

  • Input the cessation via the Postentitlement Online System (POS) (see MSOM T2PE 003.024)

b. Title XVI cases

Follow 1619 procedures outlined in SI 02302.030.

6. FTC - medical and work issues combined

When both work and medical issues are involved, prepare a work issue determination whenever possible based on available evidence as outlined in DI 13015.005A.2. Once documentation of work issues is complete, and did not result in a termination of cash benefits, proceed with the medical CDR. If the beneficiary fails to cooperate, take the necessary steps to place the beneficiary in suspense, following the procedures in DI 13015.005A.1.

B. Procedure - WU development

1. Follow instructions in GN 02605.055 for undeliverable correspondence. If whereabouts are still unknown, then:

2. Attempt phone contact with any other authorized person or auxiliaries (Title II cases only) who are being paid. Advise them of the need for the individual's location and that benefits may be suspended (in Title XVI) or terminated (in Title II cases), if the individual cannot be located. If the line is busy, try again on a different day at a different time. If this line of inquiry is not productive, then:

3. Attempt to contact any one of the following, based on leads in the file--the payee (if one has been designated), relatives, friends, landlord, neighbors, merchants, employers, shelters for the homeless, financial institution if direct deposit is involved (many banks will forward mail from SSA offices), city and/or State welfare agencies, and any medical sources and institutions to which the individual was previously admitted.

4. If whereabouts cannot be discovered, take the following steps:

Title II cases, folder is in FO:

• Prepare a determination on an SSA-5002 indicating the event which initiated the CDR, all efforts made to contact the individual, including dates and results of the efforts, and justification for cessation.

• If a work issue is involved, prepare a work issue determination whenever possible based on available evidence as outlined in DI 13015.005A.2. Once documentation of work issues is complete, and did not result in a termination, proceed with the WU determination.

• Send due process notice to the last known address (see DI 13015.095).

• Prepare a Form SSA-833-U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal - Title II) cessation determination.

• Annotate a "W" in Item 11 of the SSA-833-U3 immediately following "Reason for Cessation."

  Enter paragraph T23 in Item 29 of the SSA-833-­U3

  Input cessation via the Post-entitlement System (POS), see MSOM T2PE 003.024.

• Annotate the IFOA screen in the DCF indicating WU, see MSOM CDR 001.007.

Title II cases - folder is not in FO:

• Do not prepare an SSA-833-U3.

• Send due process notice (see DI 13015.095) and suspend via POS, see MSOM T2PE 003.024.

• Forward material to PC under cover of an SSA-882 with "Whereabouts Unknown" annotated in the "Remarks" section.

Title XVI cases - regardless of folder location:

• Send notice of planned action to last known address.

• Suspend payment by placing the case in pay status S06 (see SM 01305.001 for payment status codes and SI 02301.240 for information on suspending eligibility).

• Update the DCF by annotating a STOP CDR if the individual is not located after 12 months of suspension. Include a remark on the CDR Remarks Input Screen in the DCF such as “T16 Whereabouts Unknown case. Unable to locate the beneficiary after 12 months of suspension.”

NOTE: For concurrent cases, follow the Title II/Title XVI instructions outlined in DI 13015.005B.4., as applicable.

C. Policy - FTC/WU cessation and suspension determinations

1. FTC – medical issue - determining whether to suspend benefits

For Title II and/or Title XVI cases in which the individual fails to cooperate by providing the necessary CDR information or evidence requested by the FO, payments will be suspended using the instructions outlined in DI 13015.005A.2.

If the beneficiary does not cooperate during the 12 month period of suspension, disability benefits will be terminated effective the 13^th month. If the Title II disability benefits terminate, the Medicare entitlement will end. The Medicare termination is effective with the end of the month after the month in which the beneficiary is notified that his or her entitlement to benefits will end. The case does not require a medical determination by the DDS. No benefit continuation will be offered (see DI 13015.015).

See DI 13015.005A.4 for Title II cases where the beneficiary fails to cooperate and benefits have been terminated due to work and a medical CDR determination by the DDS is necessary to determine if entitlement/eligibility to extended Medicare benefits should continue.

2. FTC medical issue – Title II benefits terminated for other than FTC

If the Title II benefits terminate for another reason during the 12 month period of FTC suspension and then the beneficiary cooperates, the benefits that were withheld for FTC can be released to the beneficiary and auxiliaries.

Example: A disabled adult child (DAC) is put in FTC suspense effective 03/07 (projected termination month is 03/08). The DAC marries and disability benefits are terminated 09/07. In 10/07, the DAC goes to the FO and provides all the information that was requested for the medical CDR. The DAC requests that benefits from 03/07 through 08/07 be released to him since he cooperated prior to the end of the 12 month suspension. The benefits are released.

3. WU - determining whether to cease or suspend benefits

In cases in which the individual's whereabouts are unknown, Title II benefits will terminate on the basis of a WU disability cessation determination (SSA-833-U3) prepared by the FO. Cease per the medical improvement review standard (MIRS) exception described in DI 13005.005B.

Title XVI benefits are suspended in pay status S06 until the individual is located.

See chart in DI 13015.005B.4 for handling varied FTC/WU situations.

4. Cessation and suspension status and codes chart

The following chart indicates the proper benefit status and related payment status codes based on various FTC/WU determinations.

NOTE: Whenever FTC/WU results in an S06 suspension for Title XVI, annotate this in the remarks portion of the SSID.