I-5-4-47.Medellin v. Shalala

Table of Contents
I Purpose
II Background
III Guiding Principles
IV Definition of the Medellin Class
V Preadjudication Actions
VI Processing and Adjudication of Medellin Claims
VII Case Coding
VIII Inquiries
Attachment 1 Teletype Instruction IT-67-91; Issued December 16, 1991
Attachment 2 Medellin v. Shalala Partial Consent Judgment; Dated December 16, 1993
Attachment 3 Example: Notice of Important Information — No Relief (Other Reason)
Attachment 4 Example: Notice of Important Information — No Relief to Survivor (Other Reason)
Attachment 5 Example: Notice to Deny Request for Payment of Underpayment — (Respondent Not an Eligible Survivor)
Attachment 6 Example: Notice of Change of Payment — No Current Eligibility
Attachment 7 Example: Notice of Underpayment Due a Survivor
Attachment 8 Example: Notice of Important Information — No Relief (FO Determines No Loan Exists)
Attachment 9 Example: Notice of Important Information — No Relief to Survivor (FO Determines No Loan Exists)

ISSUED: May 5, 1995


I. Purpose


This Temporary Instruction (TI) sets forth procedures for implementing the parties' December 1, 1993 partial consent judgment that was approved by the United States District Court for the Western District of Missouri on December 16, 1993, in Medellin v. Shalala.


Adjudicators throughout the country must be familiar with this TI because class members who now reside outside of the State of Missouri must have their cases processed in accordance with the requirements of the Medellin consent judgment.


II. Background


On September 10, 1990, plaintiffs filed a statewide class action in Missouri challenging the Secretary's loan policy that restricted the definition of “loan” in 20 CFR § 416.1103(f) to transactions that involved an exchange of money and resulted in treating advances of food or shelter as income for Supplemental Security Income (SSI) purposes.


On December 16, 1991, following adverse decisions in the Fifth and Ninth Circuits in Hickman v. Bowen, 803 F.2d 1377 (5th Cir. 1986) and Ceguerra v. Secretary, 933 F.2d 735 (9th Cir. 1991), SSA announced a policy reinterpretation, through teletype instruction IT-67-91, effective December 17, 1991, that permitted bona fide loans of food or shelter to be treated in the same manner as cash loans (i.e., disregarded) when computing SSI eligibility and benefit amounts (Attachment 1). IT-67-91 noted the applicability of the one-year timeframe for reopening prior determinations or decisions based on this change of position.


On June 10, 1992, the district court certified a class in Medellin consisting of: 1) all SSI applicants or recipients who resided in Missouri at the time their SSI applications were denied, or at the time their SSI benefits were reduced or terminated, between July 12, 1990, and December 31, 1991, because the Secretary counted as income in-kind support and maintenance (IKSM) that the applicant or recipient was obligated to repay under a loan agreement; and, 2) all SSI applicants and recipients who resided in Missouri during the period July 12, 1990, to September 10, 1990, and were either appealing or could have appealed a determination or decision that resulted in or upheld a denial, reduction or termination of SSI benefits that occurred because the Secretary counted as income IKSM that the applicant or recipient was obligated to repay under a loan agreement while a resident of Missouri.


On September 8, 1992, SSA published Social Security Ruling (SSR) 92-8p to provide a uniform national policy interpretation on the treatment of advances of IKSM and to further implement the December 1991 policy change.


On December 18, 1992, the district court issued an order granting plaintiffs' motion for summary judgment and revising its class certification order to address the effect of the Secretary's policy change on the merits of potential class member claims. The court found that the Secretary's former loan policy was invalid but that the Secretary's change in position had rendered plaintiffs' action moot with respect to inclusion of those individuals who had “pending or available administrative claims” as of December 16, 1991. However, the court also found that those individuals with “lapsed claims,” i.e., those individuals whose SSI benefits had been denied, reduced or terminated and who failed to exhaust fully the available administrative remedies and/or seek judicial review prior to December 16, 1991, were improperly excluded from the class because they would be unable to benefit from the Secretary's change in policy. Thus, the court modified the class definition set forth in its order of June 10, 1992, concluding that waiver of exhaustion of administrative remedies was appropriate regardless of whether the individual had presented a timely § 405(g) action. The court concluded that November 10, 1986, the date on which the Fifth Circuit invalidated the Secretary's former loan policy in Hickman, was a reasonable opening date for the class because the Hickman decision should have put the Secretary on notice that the validity of its former policy was in question.


On February 11, 1993, the court denied the Secretary's motion to alter or amend the order of December 18, 1992. The Secretary filed a timely notice of appeal in the United States Court of Appeals for the Eighth Circuit with respect to the inclusion of “lapsed claims” in the class definition but did not appeal the inclusion of live claims. The merits of plaintiffs' complaint was no longer at issue because of the Secretary's December 1991 change of position. The parties signed a partial consent judgment on December 1, 1993, for the purpose of proceeding with implementation of relief for those individuals with live claims.


On December 16, 1993, the district court approved the parties' partial consent judgment (Attachment 2). The partial consent judgment requires that the Secretary apply the new loan policy to all individuals who meet the class definition set forth in the district court's June 10, 1992 order; however, individuals with “lapsed claims,” i.e., those individuals who failed to fully exhaust the available administrative remedies and/or seek judicial review between November 11, 1986, and July 11, 1990, who were added to the class by the district court's order of December 18, 1992, were excluded from relief under the partial consent judgment.


On April 28, 1994, the Eighth Circuit reversed the district court's order of December 18, 1992, with respect to inclusion of individuals with lapsed claims in the Medellin class. By this action, the partial consent judgment became descriptive of the full scope of relief available in the Medellin class action.


III. Guiding Principles


Under Medellin, the Secretary will make a new eligibility determination for persons who: 1) respond to notice informing them of the opportunity for review; and 2) are determined to be class members under the partial consent judgment after screening (see Part V. (Preadjudication Actions) below). The Mid-America Program Service Center (MAMPSC) or the SSA field office (FO) (i.e., district office or branch office) servicing the claimant's residence, as appropriate, will screen cases to determine class membership.


The FO will make a new eligibility determination at the reconsideration level regardless of the final level at which the case was previously decided. Individuals who receive adverse determinations will have full appeal rights (i.e., Administrative Law Judge (ALJ) hearing, Appeals Council and judicial review). Generally, the partial consent judgment does not require any change in OHA's adjudicatory policies because, since December 16, 1991, OHA adjudicators have been excluding bona fide loans based on advances of food or shelter in computing SSI eligibility and benefit amounts. However, under the partial consent judgment, the Secretary will recognize and accept as determinative and final any prior decision of the Secretary at any administrative level that there did exist a bona fide loan based on the advance of food or shelter and honor that determination without further inquiry.


IV. Definition of the Medellin Class


Except as noted below, for purposes of implementing the December 16, 1993 partial consent judgment, Medellin class members include all SSI applicants and recipients who, between July 12, 1990, and December 31, 1991, inclusive, resided in Missouri and received a determination or decision at any administrative level (initial, reconsideration, ALJ hearing or Appeals Council review) that denied their SSI applications or reduced or terminated their SSI benefits because SSA counted as income IKSM that the applicant or recipient was obligated to repay under a loan agreement. Medellin class members also include all past or present residents of Missouri who, between July 12, 1990, and September 10, 1990, inclusive, were appealing or could have appealed a determination or decision that resulted in or upheld a denial, reduction or termination of SSI benefits that occurred because SSA counted as income IKSM that the applicant or recipient was obligated to repay under a loan agreement while a resident of Missouri.


EXCEPTIONS:

A person is not a class member under the partial consent judgment in Medellin if


(1) the individual is a former resident of Missouri and received a determination or decision between July 12, 1990, and December 31, 1991, inclusive, but the individual was not a resident of Missouri at the time the determination or decision was issued; or


(2) the individual's income (after excluding bona fide loans of food or shelter) or resources preclude SSI eligibility or additional payment.


NOTE:

Class membership is not precluded by a prior decision that became final prior to the class timeframe and reduced an individual's SSI benefits based on the receipt of IKSM even though the individual alleged that the support was made pursuant to a loan of food or shelter. Subsequent applications decided within the class timeframe would still be subject to relief consideration.


V. Preadjudication Actions


A. Notification


On March 30, 1994, SSA began sending notices to all potential class members in Medellin as identified by computer run. The notice included a reply form and a postage-paid return envelope addressed to the MAMPSC. Individuals had/have 60 days from the date of receipt of the notice to contact SSA by completing and returning the reply form, by telephone, in writing or in person to request that SSA readjudicate their claims under the terms of the partial consent judgment. Receipt of notice is presumed to have occurred 5 days after the date on the notice, unless the individual can show it was not received within the 5-day period.


All untimely responses are sent to the respondent's servicing FO to develop good cause for the untimely response. Good cause determinations are based on the standards in 20 CFR § 416.1411 and SSR 91-5p. If good cause is not established, the field office sends the appropriate notice.


B. Identifying Medellin Class Members Entitled to Relief


1. MAMPSC Responsibilities


Upon receipt of a reply form, MAMPSC obtained an SSID query for the respondent. MAMPSC did not routinely obtain the claim folder. MAMPSC attempted to telephone each respondent, briefly explain the Medellin case and ask each respondent if he or she considered the food or shelter received to be the basis for a loan. If the respondent did not allege a loan, MAMPSC documented the allegation on a report of contact and issued a notice (see Part V. B. 3. below) advising the respondent that he or she is not a class member under the Medellin court case. MAMPSC forwarded the case information and a copy of the notice to the servicing FO.


If a respondent alleged a loan based on an advance of food or shelter, or if a questionable situation arose, MAMPSC advised the respondent that the local FO would contact him or her for further information. MAMPSC documented the discussion on a report of contact and forwarded the case information to the servicing FO for further development.


If MAMPSC was unable to contact a respondent by telephone, it forwarded the case information to the servicing FO for further action.


MAMPSC's involvement in implementation concluded in 1994 after screening and processing most of the original responses. Any remaining responder case are being handled by the servicing FO.


2. FO Responsibilities


The FO initiates contact with a respondent to explain the Medellin partial consent judgment, and asks each respondent if he or she considers the food or shelter received to be the basis for a loan, when:


  • MAMPSC is unable to contact a respondent by telephone;

    
    
  • a reply form is returned to the FO rather than to MAMPSC; or

    
    
  • an individual not previously sent a Medellin notice contacts the FO to inquire about potential relief.

    
    

The FO contacts a respondent to develop for good cause when a reply is made more than 70 days after the date of the Medellin notice. The FO screens the cases of Medellin respondents to eliminate cases from loan development in which the claimant is deceased and there is no identifiable survivor who could be eligible to receive an SSI underpayment.


3. Notice to Non-Class Members


MAMPSC or the FO sends the appropriate notice (Attachments 3 - 5), modified to fit the circumstances of the case, to any individual who is not a class member under the Medellin partial consent judgment because the individual:


  • does not allege an advance of food or shelter as the basis for a loan (Attachment 3 or 4);

    
    
  • has income (after excluding bona fide loans based on advances of food or shelter) or resources that preclude SSI eligibility or additional payment (Attachment 3 or 4);

    
    
  • was not a past or present resident of the State of Missouri who received a determination or decision at any administrative level that was issued between July 12, 1990, and December 31, 1991, inclusive (Attachment 3 or 4);

    
    
  • is deceased and there is no survivor who is eligible to receive an SSI underpayment (Attachment 5).

    
    

NOTE:

An individual who wishes to challenge a determination that he or she is not eligible for Medellin relief for any reason other than he or she is not a survivor eligible to receive an underpayment may do so only through class counsel, as explained in the notice (Attachments 3 - 4). An individual who wishes to challenge a determination that he or she is not a survivor eligible to receive an underpayment receives an initial determination with the right to request reconsideration (Attachment 5).


VI. Processing and Adjudication of Medellin Claims


A. FO Adjudication of Medellin Claims


The FO will conduct the first Medellin review. The new eligibility determination made by the FO will be a redetermination at the reconsideration level, regardless of the administrative level at which the Medellin claim(s) was previously decided, with full appeal rights (i.e., ALJ hearing, Appeals Council and judicial review). Prior determinations or decisions which had counted as income advances of food or shelter received under a bona fide loan will be reopened and revised, as appropriate.


If the FO determines that a claimant received food or shelter under a bona fide loan agreement, the FO will recompute the claimant's SSI benefits for any month(s) in the retroactive period in which the claimant was charged IKSM, calculate the amount of the underpayment, if any, make systems input and issue the appropriate notice advising the claimant regarding any change in payment and of his or her further appeal rights (Attachments 6 - 7).


If the FO determines that the food or shelter a claimant received was not received pursuant to a bona fide loan agreement, the FO will issue a notice advising the claimant of this determination and of his or her further appeal rights (Attachments 8 - 9).


B. OHA Adjudication of Medellin Claims


The following instruction applies to Medellin readjudication cases in which the claimant requests a hearing or Appeals Council review. OHA should not receive any unadjudicated Medellin claims for possible consolidation with a current claim pending in OHA because the claims generally will not have common issues. Except as otherwise noted in this instruction, hearing offices and OHA Headquarters will process Medellin cases according to all other current practices and procedures including critical case procedures (see HALLEX I-2-1-40 and I-3-1-51), coding, scheduling, developing evidence, routing, etc.


NOTE:

Adjudication of Medellin claims does not take priority over processing critical cases. The Medellin workload should not slow down the processing of such claims.


1. Type of Review and Period to Be Considered


The type of review to be conducted is a redetermination. For initial SSI claims and appeals of determinations on initial claims, adjudicators will apply the December 1991 policy change represented by IT-67-91 beginning with the month of the effective date of filing, even if it precedes July 12, 1990.


For post-eligibility situations, adjudicators will apply the December 1991 policy change represented by IT-67-91 retroactively to the first month covered by the determination that reduced or suspended benefits because SSA counted as income food or shelter that the claimant received under a bona fide loan agreement.


NOTE:

Because Medellin redeterminations are being made pursuant to a court-approved settlement, the ordinary rules of administrative finality (20 CFR §§ 416.1487ff.) do not apply. However, any reopenings and revisions made subsequently on these same cases will be subject to administrative finality, unless the subsequent reopenings are also made pursuant to the partial consent judgment.


2. Loans of IKSM


Medellin does not require any change in OHA's adjudicatory policies because, since December 17, 1991, OHA adjudicators have been excluding bona fide loans of food or shelter in computing SSI eligibility and benefit amounts. However, under the Medellin partial consent judgment, the Secretary will recognize and accept as determinative and final any prior decision of the Secretary, made at any administrative level, that there did exist a bona fide loan, and the Secretary will honor that determination without further inquiry.


3. Class Member is Deceased


If a class member is deceased, the usual survivor and substitute party provisions apply, and the existing procedures for determining distribution of any potential underpayment should be followed.


VII. Case Coding


HO personnel will code prior claims into the Hearing Office Tracking System (HOTS) and the OHA Case Control System (OHA CCS) as “reopenings.”


To identify class member cases in HOTS, HO personnel will code “ME” in the “Class Action” field. No special identification codes will be used in the OHA CCS.


VIII. Inquiries


HO personnel should direct any questions to their Regional Office. Regional Office personnel should contact the Division of Field Practices and Procedures in the Office of the Chief Administrative Law Judge at (703) 305-0022. Headquarters personnel should contact the Division of Litigation Analysis and Implementation at 305-0708.


Attachment 1. Teletype Instruction IT-67-91; Issued December 16, 1991

TELEGRAPHIC MESSAGE [Transmitted 12/16/91]
NAME OF AGENCY

PRECEDENCE

ACTION:  PRIORITY

INFO:

SECURITY CLASSIFICATION

UNCLASSIFIED

ACCOUNTING CLASSIFICATION

HHSS

DATE PREPARED

12/3/91

FILE
FOR INFORMATION CALL

NAME

Stephen H. Fear

PHONE NUMBER

59824

TYPE OF MESSAGE

__     __     __

SINGLE BOOK MULTIPLE-

            ADDRESS

THIS SPACE FOR USE OF COMMUNICATION UNIT

 

MESSAGE TO BE TRANSMITTED (Use double spacing and all capital letters)

TO:

FM: SSA, OSSI

TO: ALL SSA RCS

TO: ALL SSA ARCS

TO: ALL SSA PSC/ODIO/INTPSC

TO: OPIRQS/OPIRSOS

TO: SSA ADS

TO: ALL DOS/BOS/TSCS

TO: OPIR

TO: OMPI

TO: HCFA

TO: OHA

EMERGENCY SSI INSTRUCTIONS OSSI-92-008 [IT-67-91]

SUBJECT: POLICY REINTERPRETATION - APPLICABILITY OF LOAN POLICY TO ADVANCES OF FOOD AND/OR SHELTER

MANUAL REVISION TO FOLLOW SHORTLY IN POMS SI 00835.480.

  SECURITY CLASSIFICATION
 

PAGE NO.

1

NO. OF PGS.

5

STANDARD FORM 14 Previous editions usable NSN 7540-00-684-0964 14-103
REVISED 11-90
GSA FPMR (41 CFR 101-25.206





TELEGRAPHIC MESSAGE  
NAME OF AGENCY

PRECEDENCE

ACTION:  PRIORITY

INFO:

SECURITY CLASSIFICATION

UNCLASSIFIED

ACCOUNTING CLASSIFICATION

HHSS

DATE PREPARED

12/3/91

FILE
FOR INFORMATION CALL

NAME

Stephen H. Fear

PHONE NUMBER

59824

TYPE OF MESSAGE

__     __     __

SINGLE BOOK MULTIPLE-

            ADDRESS

THIS SPACE FOR USE OF COMMUNICATION UNIT

 

MESSAGE TO BE TRANSMITTED (Use double spacing and all capital letters)

TO:

POLICY REINTERPRETATION

EFFECTIVE IMMEDIATELY, FOOD AND/OR SHELTER THAT AN INDIVIDUAL RECEIVES FROM THE HOUSEHOLD IN WHICH HE OR SHE LIVES AND HAS AN OBLIGATION TO PAY FOR AT A FUTURE DATE MAY BE THE BASIS OF A LOAN. DISREGARD THE BAN IN SI 00835.480 C.2. AGAINST TREATING SUCH ADVANCES AS LOANS.

ASKING ABOUT A LOAN AGREEMENT — INITIAL CLAIMS AND REINSTATEMENTS

IF AN INDIVIDUAL WHO IS APPLYING FOR BENEFITS OR BEING REINSTATED AFTER A PERIOD OF INELIGIBILITY IS NOT PAYING A PRO RATA SHARE OF THE HOUSEHOLD FOOD AND/OR SHELTER EXPENSES, ASK IF HE OR SHE WILL HAVE TO PAY THE HOUSEHOLDER BACK FOR IT. DOCUMENT THE ANSWER OVER THE INDIVIDUAL'S SIGNATURE. A YES ANSWER IS A LOAN ALLEGATION.

DETERMINING WHETHER A BONA FIDE LOAN EXISTS

FOLLOW SI 01120.220 AND APPLICABLE REGIONAL INSTRUCTIONS TO

  SECURITY CLASSIFICATION
 

PAGE NO.

2

NO. OF PGS.

5

STANDARD FORM 14 Previous editions usable NSN 7540-00-684-0964 14-103
REVISED 11-90
GSA FPMR (41 CFR 101-25.206





TELEGRAPHIC MESSAGE  
NAME OF AGENCY

PRECEDENCE

ACTION:  PRIORITY

INFO:

SECURITY CLASSIFICATION

UNCLASSIFIED

ACCOUNTING CLASSIFICATION

HHSS

DATE PREPARED

12/3/91

FILE
FOR INFORMATION CALL

NAME

Stephen H. Fear

PHONE NUMBER

59824

TYPE OF MESSAGE

__     __     __

SINGLE BOOK MULTIPLE-

            ADDRESS

THIS SPACE FOR USE OF COMMUNICATION UNIT

 

MESSAGE TO BE TRANSMITTED (Use double spacing and all capital letters)

TO:

DOCUMENT AN ALLEGED LOAN AND TO DETERMINE WHETHER IT IS BONA FIDE. DO NOT USE FORMS SSA-2854 AND SSA-2855 FOR IN-KIND LOAN DEVELOPMENT. IF THE ADVANCE OF FOOD AND/OR SHELTER IS THE BASIS FOR A BONA FIDE LOAN, IT IS NOT INCOME.

LOAN AMOUNT SPECIFIED

IF THE INDIVIDUAL GIVES A DOLLAR AMOUNT FOR THE LOAN, COMPLETE SHARING DEVELOPMENT (SI 00835.160) OR EARMARKED - SHARING DEVELOPMENT (SI 00835.170), AS APPLICABLE, USING THE LOAN AMOUNT AS THE AMOUNT OF THE INDIVIDUAL'S CONTRIBUTION. COUNTABLE ISM MAY BE CHARGED IF THE AMOUNT OF THE CONTRIBUTION IS LESS THAN THE PRO RATA SHARE.

LOAN AMOUNT NOT SPECIFIED — OPERATING ASSUMPTION FOR INITIAL CLAIMS AND REINSTATEMENTS

IF NO DOLLAR AMOUNT HAS BEEN SPECIFIED (FOR EXAMPLE, IF THE AGREEMENT IS THAT "WE ARE GOING TO FIGURE OUT WHAT I OWE

  SECURITY CLASSIFICATION
 

PAGE NO.

3

NO. OF PGS.

5

STANDARD FORM 14 Previous editions usable NSN 7540-00-684-0964 14-103
REVISED 11-90
GSA FPMR (41 CFR 101-25.206





TELEGRAPHIC MESSAGE  
NAME OF AGENCY

PRECEDENCE

ACTION:  PRIORITY

INFO:

SECURITY CLASSIFICATION

UNCLASSIFIED

ACCOUNTING CLASSIFICATION

HHSS

DATE PREPARED

12/3/91

FILE
FOR INFORMATION CALL

NAME

Stephen H. Fear

PHONE NUMBER

59824

TYPE OF MESSAGE

__     __     __

SINGLE BOOK MULTIPLE-

            ADDRESS

THIS SPACE FOR USE OF COMMUNICATION UNIT

 

MESSAGE TO BE TRANSMITTED (Use double spacing and all capital letters)

TO:

LATER AND I AM GOING TO PAY IT OUT OF MY SSI"), ASSUME THAT THE LOAN AGREEMENT COVERS THE INDIVIDUAL'S PRO RATA SHARE OF THE FOOD AND/OR SHELTER EXPENSES, AS APPLICABLE. DO NOT DEVELOP HOUSEHOLD EXPENSES FOR THE PURPOSE OF DETERMINING THE AMOUNT OF THE LOAN. THIS OPERATING ASSUMPTION DOES NOT APPLY IN CONTINUING ELIGIBILITY SITUATIONS.

TYPE H INCOME INPUT

IF NO ISM IS BEING CHARGED BECAUSE OF A BONA FIDE LOAN, INPUT A TYPE H INCOME AMOUNT OF ZERO AND TYPE H ID OF “A LOAN” (SEE SM 01005.193 FOR TYPE H INCOME INPUT INSTRUCTIONS).

RT DIARY INPUT AND DEVELOPMENT

IF NO ISM IS BEING CHARGED BECAUSE OF A BONA FIDE LOAN, SET AN RT DIARY FOR 3 MONTHS AFTER THE ESTIMATED FIRST MONTH OF PAYMENT (SEE SM 01005.230 FOR DA FIELD INPUT INSTRUCTIONS).

  SECURITY CLASSIFICATION
 

PAGE NO.

4

NO. OF PGS.

5

STANDARD FORM 14 Previous editions usable NSN 7540-00-684-0964 14-103
REVISED 11-90
GSA FPMR (41 CFR 101-25.206





TELEGRAPHIC MESSAGE [Transmitted 12/16/91]
NAME OF AGENCY

PRECEDENCE

ACTION:  PRIORITY

INFO:

SECURITY CLASSIFICATION

UNCLASSIFIED

ACCOUNTING CLASSIFICATION

HHSS

DATE PREPARED

12/3/91

FILE
FOR INFORMATION CALL

NAME

Stephen H. Fear

PHONE NUMBER

59824

TYPE OF MESSAGE

__     __     __

SINGLE BOOK MULTIPLE-

            ADDRESS

THIS SPACE FOR USE OF COMMUNICATION UNIT

 

MESSAGE TO BE TRANSMITTED (Use double spacing and all capital letters)

TO:

WHEN THE DIARY MATURES, DO PRO RATA SHARE DEVELOPMENT BEGINNING WITH THE MONTH AFTER THE INDIVIDUAL FIRST RECEIVED PAYMENT, USING THE AVERAGING INSTRUCTIONS IN SI 00835.475 D.

ADMINISTRATIVE FINALITY

ONE YEAR REOPENING OF PRIOR DETERMINATIONS FOR CHANGE-OF- POSITION POLICY APPLIES (SEE SI 04070.040 C.3.).

 

 

        /S/        

RHODA M. G. DAVIS
ASSOCIATE COMMISSIONER
FOR SUPPLEMENTAL SECURITY INCOME

PUBLISHED INSTRUCTIONS ARE TARGETED TO REACH USERS BY 7/31/92.

FILE CODE: SI 1-3.2.5

  SECURITY CLASSIFICATION
 

PAGE NO.

5

NO. OF PGS.

5

STANDARD FORM 14 Previous editions usable NSN 7540-00-684-0964 14-103
REVISED 11-90
GSA FPMR (41 CFR 101-25.206





Attachment 2. Medellin v. Shalala Partial Consent Judgment; Dated December 16, 1993


IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF MISSOURIWESTERN DIVISION

SONIA MEDELLIN, et al., )  
  )  
Plaintiffs, )  
  )  
v. ) Civil NO. 90-0806-CV-W-6
  )  
DONNA E. SHALALA, )  
SECRETARY OF HEALTH )  
AND HUMAN SERVICES, )  
  )  
Defendant )  
 
PARTIAL CONSENT JUDGMENT
 

     UPON agreement and stipulation of the parties, it is hereby ORDERED, ADJUDGED and DECREED as follows:


     A plaintiff class was certified on June 10, 1992, and subsequently modified on December 18, 1992. Under the Court's modified order, the class definition includes all SSI applicants or recipients residing in the State of Missouri who have made or will make a claim for SSI benefits and received or will receive a decision from the defendant denying his or her claim at any administrative level in whole or part since November 10, 1986, on the basis that the applicant/recipient received in-kind support which defendant considered income, although the individual was obligated to repay the amount under a loan agreement.


     On December 18, 1992, the court granted plaintiffs' motion for summary judgment. The final judgment of the district court was entered on March 3, 1993. Defendant filed a timely notice of appeal on April 30, 1993, challenging the district court's inclusion of claims lapsing prior to July 12, 1990, in the class. Defendant did not appeal the judgment on the merits or the inclusion of persons in the class who had live claims1 on or after July 12, 1990. The purpose of this Partial Consent Judgement is to provide the following relief for the class members not subject to the pending appeal:


  1. Effective December 17, 1991, defendant began treating in-kind advances of food and/or shelter in the same manner that cash loans and credit purchases are treated under 20 C.F.R. § 416.1103(f), with the result that bona fide in-kind loans are no longer charged as income to SSI applicants and recipients. On December 16, 1991, the Secretary issued teletype instructions IT-67-91 (Exhibit 1) to provide the appropriate operating components of the Social Security Administration (SSA) with guidance on implementing the change of position regarding treatment of in-kind loans. In July 1992, the Secretary issued POMS instructions to implement the change of policy (Exhibit 2), and subsequently published Social Security Ruling (SSR) 92-8p in 57 Fed. Reg. 40918 (September 8, 1992) which further explains the new policy. (Exhibit 3) Defendant agrees to apply this change of policy, as explained in IT-67-91, SSR 92-8p and the applicable POMS, to all individuals who meet the class definition set forth in the court's June 10, 1992 order. Under the court's order, class members must meet the following requirements:

    
    

    (1) The member shall be a SSI applicant or recipient residing in the State of Missouri who has made or will make a claim for SSI benefits; and

    
    

    (2) The member received or will receive a decision from defendant denying his or her claim at any administrative level in whole or part; and

    
    

    (3) The basis for this denial must be that the applicant/recipient received in-kind support which defendant considered income, although he or she was obligated to repay the amount under a loan agreement or business arrangement; and

    
    

    (4) The putative member must have had a § 405(g) claim, based upon facts satisfying the above three factors, that arose no more than sixty (60) days prior to September 10, 1990 (the filing date of plaintiffs' complaint).

    
    
  2. By this agreement, all class members with claims lapsing between November 10, 1986, and July 12, 1990, are excluded from relief pending final resolution of all appeals of the court's December 18, 1992, certification order. This judgment applies to the class certified by the court order of June 10, 1992, and specifically includes: (1) SSI applicants and recipients who resided in Missouri at the time their SSI applications were denied, or at the time their SSI benefits were reduced or terminated between July 12, 1990, and December 31, 1991, because the Secretary counted as income in-kind support and maintenance that the applicant or recipient was obligated to repay under a loan agreement; and (2) SSI applicants and recipients who resided in Missouri during the period July 12, 1990, to September 10, 1990, and were either appealing or could have appealed a determination or decision that resulted in or upheld a denial, reduction or termination of SSI benefits that occurred because the Secretary counted as income in-kind support and maintenance that the applicant or recipient was obligated to repay under a loan agreement while a resident of Missouri.

    
    
  3. Within 120 days of the date this agreement is signed by both parties, SSA (Social Security Administration) will identify potential class members entitled to redeterminations pursuant to this agreement from its computer records. Within 150 days of the date this agreement is signed by both parties, SSA will send by first class mail a copy of the attached notice (Exhibit 4) to individuals whom SSA identifies from its computer records as potential class members. SSA will bear the costs of such notification. The notices will include a self-addressed postage-paid return envelope for mailing the reply form to SSA.

    
    
  4. To qualify for consideration for relief, an individual must contact SSA within 60 days of the date he or she receives the notice unless he or she can establish good cause for not contacting SSA within the 60 day period. Defendant will assume that an individual receives a notice five days after the date on the notice, unless he or she can show that it was not received within the five day period. 20 C.F.R. § 416.1401. Individuals receiving notice under this paragraph may request class membership by mailing the reply form to the address provided, by telephone, in writing, or in person at any Social Security office. To decide whether an individual has established good cause for missing the deadline to request review under this agreement, defendant will apply the criteria in 20 C.F.R. § 416.1411 and Social Security Ruling 91-5p.

    
    
  5. With respect to notices that are returned as undeliverable, SSA will attempt to obtain updated addresses from the Missouri Department of Social Services (DSS). Any attempt by SSA to obtain updated addresses is subject to the requirements of the Privacy Act, as amended by the Computer Matching and Privacy Protection Act, 5 U.S.C. § 552a. SSA will not be obligated to bring legal proceedings to gain access to such data system records. SSA will mail notices to potential class members for whom new addresses are provided by the DSS.

    
    
  6. SSA will instruct those persons making class membership findings that class membership is not precluded by a prior decision reducing an individual's SSI benefits based on the receipt of in-kind support and maintenance even though the individual alleged that the support was made pursuant to a loan of food and/or shelter.

    
    
  7. (a) SSA will screen the claim of each individual who timely responds to the notice discussed in paragraph three to ascertain whether the individual could become eligible or re-eligible for SSI and/or receive additional SSI if he or she were to meet the criteria under paragraph one. SSA will inform the individual in writing of the outcome of the screening and a copy of this notice will be sent to counsel for plaintiffs.

    
    

    (b) For each requester who is found to have met the criteria in (a), SSA will determine whether the individual meets the criteria in paragraph one and properly requested review under paragraph four. If SSA finds that a requester does not meet the criteria of paragraph one, SSA will notify the individual and explain why the requester is not a class member. A copy of this notice will be sent to counsel for plaintiffs. If SSA determines that the requester did not properly request review under paragraph four, SSA will notify the individual and explain that the request for review was not timely. A copy of this notice will be sent to counsel for plaintiffs.

    
    
  8. If SSA determines that an individual is not a class member based on a procedural defect in requesting review or because the individual does not meet prongs one or four of the class definition contained in paragraph one, and the individual disputes that determination plaintiffs' counsel shall contact a designated person within the Office of the General Counsel, Department of Health and Human Services, and the parties will attempt to informally resolve the dispute. The Secretary will make available to plaintiffs' counsel the files of any persons denied class membership at a mutually acceptable location in Kansas City, Missouri. Plaintiffs' counsel shall review the files within 60 days of the date the files are made available to them. The court shall retain jurisdiction to resolve class membership disputes of this nature which the parties are unable to resolve.

    
    
  9. Defendant further agrees to:

    
    
    1. Recognize and accept as determinative and final any prior determination of the Secretary at any administrative level for those members of the group as defined in paragraph one, that a bona fide loan of food and/or shelter existed, and to honor that determination without further inquiry; and

      
      
    2. Provide the right to a determination on the issue of the existence of a bona fide in-kind loan for individuals (1) who timely request review under paragraph four, and (2) who could become eligible or re-eligible for SSI and/or receive additional SSI if the individual were to meet the criteria under paragraph one. Determinations made under this paragraph will be afforded the appeal rights set forth in 20 C.F.R. Part 416, Subpart N.

      
      
  10. Individuals described in paragraph 9(b) will be contacted by SSA and informed of their right to submit evidence in support of their claims. An appointment will be made to interview an individual, if SSA finds that an interview is necessary, or if an individual requests an interview. Individuals can request an interview by telephone, in writing, or in person at any Social Security office. SSA will make determinations on individuals' claims that they received loans of food and/or shelter. A copy of the determination will be sent to class counsel.

    
    
  11. When an individual described in paragraph 9(b) does not have an active claim pending at any administrative level at the time of the interview, SSA will review the loan allegation as though it were a request for reconsideration.

    
    
  12. With respect to individuals who are class members, for all months for which it is determined that such individuals received food and/or shelter pursuant to a bona fide loan, SSA will determine the class members' SSI benefit amounts and/or eligibility without counting such food and/or shelter as income and inform the individual in writing of that determination. If the determination results in a reinstatement of benefits, the first month to which the determination applies is the first month for which benefits are reinstated.

    
    
  13. Within 150 days of the date this agreement is signed by both parties, and every 90 days thereafter, defendant shall submit a written report to the court and to plaintiffs' counsel, which includes the following information:

    
    
    1. The number of individuals to whom the notification under paragraph three was sent.

      
      
    2. The number of individuals who responded to the notices described in paragraph three.

      
      
    3. The number of individuals determined to be class members.

      
      
    4. The number of individuals determined not to be class members.

      
      
  14. SSA will distribute POMS instructions reasonably necessary to carry out the terms of this partial consent judgment. A draft of proposed Medellin POMS will be provided to class counsel for comment prior to finalization. The Secretary will consider but is not bound by class counsel's comments. At the same time as such instructions are sent to all appropriate offices, divisions, levels, departments, etc., of the Social Security Administration, SSA will also send plaintiffs' counsel the final instructional materials.

    
    

  15. SSA agrees to recompute Donald Langley's SSI benefits for December 1988 through July 1989, and for October 1989, and December 1989 without counting as income in-kind support and maintenance that he received as a loan.

    
    
  16. Plaintiffs agree that if the Secretary should lose her appeal of the lapsed claims issue before the Eighth Circuit Court of Appeals, they will not pursue implementation of relief for lapsed claims until the time for seeking certiorari to the Supreme Court has run, and if certiorari is sought by the Secretary, until much time as all final appeals in the case have been resolved.

    
    
  17. The court shall retain jurisdiction over this matter for the enforcement of the provisions of this Partial Consent Judgment.

    
    

     LET JUDGMENT BE ENTERED ACCORDINGLY


     Dated this 16th day of December, 1993.

   
   
   
 

_____________/s/_______________
FERNANDO J. GAITAN, JR.
United States District Judge

   
   
   

_____________/s/_______________
MARIA T. DUGAN, Bar #39638
Legal Aid of Western Missouri
600 Lathrop Building
1005 Grand Avenue
Kansas City, Missouri 64l06-2216
(816) 474-6750

________12/1/93____________
Date

   

_____________/s/_______________
JAMES MARSHALL SMITH, Bar #25688
Legal Aid of Western Missouri
600 Lathrop Building
1005 Grand Avenue
Kansas City, Missouri 64106-2216
(816) 474-6750


ATTORNEYS FOR PLAINTIFFS


MARIETTA PARKER
United States Attorney

________12/1/93____________
Date

   

_____________/s/_______________
GAY L. TEDDER, Bar #34846
Assistant United States Attorney
1201 Walnut Street
Suite 2300
Kansas City, Missouri 64106-2149
(816) 426-3130

ATTORNEYS FOR DEFENDANT

___________________________
Date

   
   
   
   

Exhibit 1 - [See IT-67-91 at Attachment 1]

 

 

Explanation of Acronyms Designating Addresses of Teletype IT-67-91— Medellin, et al.

Acronym Explanation
   
SSA RCS Social Security Administration Regional Commissioners
   
SSA ARCS Social Security Administration Assistant Regional Commissioners
   
SSA PSC/ODIO/INTPSC Social Security Administration Program Service Centers; Office of Disability and International Operations; International Program Service Center
   
OPIRQS/OPIRSOS Office of Program and Integrity Quality Review Specialists; Office of Program and Integrity Satellite Office Specialists
   
SSA ADS Social Security Administration Area Directors
   
DOS/BOS/TSCS District Offices; Branch Offices; Teleservice Centers
   
OPIR Office of Program and Integrity Reviews
   
OMPI Office of Operations Management and Program Integration
   
HCFA Health Care Financing Administration
   
OHA Office of Hearings and Appeals
   
   
   
   

Exhibit 2

   

TRANSMITTAL NO. 29
SSA Pub. No. 68-0500835
July 1992

Audience:
DO/BO/TSC: CR, CR, TXVI, DRI,
FR, OA, OS, RR, SR, TSC-SR;
PSC: IMPS

Originating Office: OSSI

   
 

PROGRAM OPERATIONS MANAUAL SYSTEM

Part 05 - Supplemental Security Income

Chapter 008 - Income

Subchapter 35 - Living Arrangements

and In-Kind Support and Maintenance

 

New Material

No. of
Pages

Discard

No. of
Pages

       
Table of Contents   Table of Contents  
(SI E00835.381-SI E00835.483 ...1 (SI E00835.381)..... 1
SI E00835.481C.1-SI E00835.E.9 ..35    
       
  ____________________________________________________
                 ACTION NOTES
   
 

SI 00835-480 C.2.—Add “-PRIOR TO JANUARY 1991” to the subsection title. At the end of the sentence, add “See SI E00835.481 for instructions for periods after December 1990.”

SI 00835.481—Add “See SI E00835.481 for instructions for periods after December 1990.”

  ____________________________________________________
 

Background

 

As a result of several challenges in the courts to our policy of not recognizing loans of in-kind support and maintenance (ISM) from within a household, the Commissioner decided to change the policy. On December 16, 1991, a teletype (IT-67-91) was released to all field offices to implement the policy change nationwide.


This transmittal manualizes and expands on the instructions in that teletype. It also includes additional instructions for implementing the policy change for residents of the Fifth and Ninth Circuit Courts. This transmittal also provides instructions for effectuating the U.S. District Court's decision in the case of Gale R. Johnson, et al. v. Sullivan regarding loans of ISM from within a household for residents of Idaho.

U.S. Department of
Health and Human Services
Social Security Administration
Office of Policy
SSA Pub. No. 68-0500835
I.C.N. 993545

Effective Date: Upon Receipt


Selective Distribution
J68/PSC

This transmittal obsoletes teletype IT-67-91. It contains new material and section E00835.481 should be read in its entirety by all field offices serving Idaho residents.

 

Explanation of Manual Changes

 

E00835.431 Loans of Food and/or Shelter from Within a Household


This new section supplements the instructions in POMS SI 00835.481 on contributions for residents of the Fifth Circuit (Louisiana, Mississippi, and Texas). Those instructions were required as a result of SSA's acquiescence in the court case Hickman v. Bowen. As a result of the change in policy on loans of ISM from within a household, national policy is now the same as the policy ordered by the Circuit Court of Appeals in the Fifth Circuit.


This new section provides that when food and/or shelter that an individual receives from the household in which he/she lives must be paid for at a future date, we will no longer determine that the individual receives ISM from the household, provided that the advance of food and shelter is a bona fide loan. This policy is effective beginning with December 17, 1990.


This section also provides instructions for applying the policy to residents of the Fifth Circuit as a result of the Hickman Acquiescence Ruling, and to residents of the Ninth Circuit as a result of the Circuit Court of Appeals decision in Ceguerra v. Secretary. (The Ninth Circuit includes Alaska, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, the Northern Mariana Islands, Oregon, and Washington.) In lieu of an acquiescence ruling that would otherwise be required under SSA acquiescence policy, the Commissioner decided to issue a Social Security Ruling (SSR) to change national policy on loans of ISM. (That ruling had not yet been published in the Federal Register when this transmittal was printed. Field offices will be notified in a future NEWS item when the ruling is published. The date of publication and ruling number may be filled in at that time.) Special rules apply to requests for application of the new policy to a determination or decision that was made on or after the court of appeals' decision applicable to the claimant's State of residence.

 

E00835.432 Loans of Food and/or Shelter from Within a Household—Idaho Residents


This new section provides special instructions for processing cases of class members under the Johnson, et. al. v. Sullivan court case. These instructions are limited to residents of Idaho.


E00835.483 Developmental Procedures for Johnson Cases


This new section provides instructions for developing the nonmedical factors or eligibility and payment amount in Johnson cases. These instructions allow use of streamlined verification and documentation, similar to those used to process Zebley cases.

 

 

 

 

TM 29 7-92                    Table of Contents
__________________________________________________________________________

E00835.00 LIVING ARRANGEMENTS AND IN-KIND SUPPORT AND MAINTENANCE

Section


Rental Subsidies for Residents of New York,
Connecticut, and Vermont .................................................E00835.381
Loans of Food and/or Shelter from Within a Household .......................E00835.481
Loans of Food and/or Shelter from Within a Household
Idaho Residents ..........................................................E00835.482
Developmental Procedures for Johnson Cases .................................E00835.483



TM 29 7-92 INCOME SI E00835.481C.1.
____________________________________________________________________________
     

E00835.481 LOANS OF FOOD AND/OR SHELTER FROM WITHIN A HOUSEHOLD

     
CITATIONS:   Regulations, 20 CFR 416.1103(f); Social Security Rulings, SSR 92- ___
     
A. POLICY— GENERAL   SSA traditionally had held that a household's advance of food and/or shelter to a household member is not a loan. SSA has been under court orders in the Fifth and Ninth Circuits to recognize advances by a household of food and shelter to household members as a loan, where there was an obligation to repay its value. On December 16, 1991, SSA issued a teletype (IT-67-91) to adopt this policy nationally.
     
B. POLICY—LOANS OF FOOD AND/OR SHELTER   Food and/or shelter that an individual receives from the household in which he/she lives and has an obligation to pay for at a future date may be a loan.
     
C. POLICY—EFFECTIVE DATE   The new policy has an effective date of December 17, 1990 but may apply earlier than that in some cases.
     
1. Applying the New Policy Under Administrative Finality Rules—All States   a. Initial Determinations Made on or After December 17, 1990
    The initial determination, reconsidered determination, ALJ decision, or AC decision pertaining to the application, whichever is most recent, will be reopened based on a request made within 1 year of the notice of the initial determination.
    The new policy then applies beginning with the month of the effective date of filing, even if it precedes December 1990.
     
    b. Redeterminations Completed on or After December 17, 1990
    The initial or reconsidered determination, ALJ decision, or AC decision pertaining to the redetermination will be reopened based on a request made within 1 year of the notice of redetermination.
    Apply the new policy beginning with the month of the notice of redetermination. However, see c. below regarding deemed determinations that usually can be revised for months prior to the month of the notice of redetermination.
     
c. Deemed Determinations   A deemed determination (as defined in SI 04070.030) will be reopened based on a request made within 1 year of the first day of the month to which it applies.
    The new policy then applies beginning with that month.
     
2. Applying New Policy Under Readjudication Rules — Louisiana, Misssissippi, and Texas   a. Initial Claims - Initial Determinations, Reconsidered Determinations, ALJ Decisions, and AC Decisions Pertaining to Them
    If the most recent of these determinations was made during the period November 10, 1986 through November 14, 1988 (the date of the court decision in Hickman v. Bowen through the date the Hickman Acquiescence Ruling (AR) was published), there is no time limit on when the individual may request application of the new policy. The rules in GN 03501.015 on readjudication apply to such requests.
    In readjudicating one of these determinations, the new policy applies to all months covered by the initial determination, including months prior to the court's decision.
     
    b. Redeterminations - Initial Determinations, Reconsidered Determinations, ALJ Decisions, and AC Decisions Pertaining to Them
    If the most recent of these determinations was made during the period November 1, 1986, through November 14, 1988 (the first day of the month of the court decision in Hickman v. Bowen through the date the Hickman AR was published), there is no time limit on when an individual can request application of the new policy to it.
    The new policy then applies beginning with the month of the notice of redetermination.
     
c. Deemed Determinations   Deemed determinations are not subject to readjudication.
    REMINDER: See 1.c. above if reopening a deemed determination under the rules of administrative finality would benefit the individual.
     
3. Applying New Policy Under Readjudication Rules — Arizona, Alaska, California, Guam, Hawaii, Idaho, Montana, Nevada, Northern Mariana Islands Oregon, and Washington   a. Initial Claims—Initial Determinations, Reconsidered Determinations, ALJ and AC Decisions Pertaining to Them
    Same as 2.a. above, except that the determination to be readjudicated must have been made from May 15, 1991 (the date of the court decision in Cequerra v. Secretary of Health and Human Services) through _______, 1992.
     
    b. Redeterminations—Initial Determinations, Reconsidered Determinations, ALJ and AC Decisions Pertaining to Them
    Same as 2.b. above, except that the determination to be readjudicated must have been made from May 1, 1991 through _______, 1992 (the first day of the month in which the Cequerra court decision was rendered through the date SSR 92-__ was published), and the new policy then applies beginning with the month of the notice of redetermination.
     
    c. Exception for Residents of Idaho Who Are Members of the Johnson Class
    Same as a. and b. above, except that an individual who was a resident of Idaho as of January 31, 1992 may request application of the new policy to a determination or decision made from April 1, 1978 through _____,1992.
    IMPORTANT: See SI E00835.482 for instructions for residents of Idaho who are Johnson class members.
     
    d. Deemed Determinations
      See 2.c. above.
     
D. PROCEDURE   Follow these procedures to apply this new policy in both initial claims and posteligibility cases.
     
1. Determine Whether a Bona Fide Loan Exists   If a loan is alleged, follow SI 01120.220 and applicable regional instructions to determine whether the advance of food and shelter constitutes a bona fide loan.
    NOTE: It is not necessary to specifically ask whether the food and shelter is a loan except in initial claims and reinstatements.
    If an individual who is applying for, or who is requesting reinstatement of, SSI benefits is not paying for food and/or shelter that he/she receives from the household in which he/she lives:
   
  • Ask whether the individual has an agreement to pay back the householder (or other household member).

    NOTE: A yes answer is a loan allegation.

  • Document the answer over the individual's signature.

  • Document the file according to SI 01120.220 F.

  • Do not use Forms SSA-2854 and SSA-2855 for in-kind loan development.

     
    IMPORTANT: Subsequent evidence that the individual did not pay for food and/or shelter determined to be a loan does not negate the determination that it was a valid loan, unless State law requires that loan repayment begin within a specified period of time. See regional instructions on loan development.
     
2. Determine ISM   Follow the procedures below to determine the existence and amount of ISM from within the household, when there is a bona fide loan of food and/or shelter.
     
    a. Household Operating Expenses
     
    Develop household operating expenses and determine whether the loan covers the value of the food and/or shelter received.
     
    If the loan does not cover the value of the food and/or shelter being received, see c. or d. below to determine countable ISM.
     
    b. Developmental Tolerance for Initial Claims and Reinstatements
     
    If the loan agreement does not specify a dollar amount (if, for example, the individual and the householder have agreed to figure out the amount owed when the individual is paid his SSI), assume that the loan agreement covers the individual's pro rate share of the household's food and/or shelter expenses. It is not necessary to develop household expenses if the only reason for doing so is to determine the amount of the loan.
     
    Do not apply this tolerance in continuing eligibility cases.
     
    c. Both Food and Shelter Received from the Household
    Apply the value of the one-third reduction (VTR) when the claimant receives both his/her food and shelter from within the household (and does not have ownership or rental liability), and the loan does not cover his/her pro rate share of the household operating expenses.
     
    d. Food or Shelter Not Provided by the Household
     
    When the VTR cannot apply because of
     
   
  • separate purchase of food, or

    
    
  • separate consumption, or

    
    
  • earmarked sharing, and

    
    
  • the loan does not cover the cost of the food or shelter received from the household.

     
    determine the amount of countable ISM by subtracting the amount of the loan from the value of the food or shelter received.
     
3. Systems Input — Unearned Income (UM)   If no ISM is being charged because of a bona fide loan, input an unearned income type “M” entry (see SM 01005.193) with a zero amount and an identification entry of “A LOAN.”
     
    If a reduced amount of ISM is being charged because of a bona fide loan, e.g., in an earmarked sharing situation where the recipient receives food from someone outside the household, but has promised to pay the householder back for the shelter he has received, input the type “H” entry with the appropriate dollar amount and the identification entry “A LOAN.”
     
4. Diary Input and Development   If ISM is reduced or eliminated because of a bona fide loan and the developmental tolerance in 2.b. above applies, set an RT diary in the DA field for 3 months after the estimated first month of payment (or reinstated payment). (See SM 01005.230 for DA field input instructions.)
     
    When the diary matures, develop inside ISM per SI 00835.520 beginning with the month after the first month of payment.
     
E. REFERENCE  
     
     
     
     

Exhibit 3

Social Security

Ruling

__________________________________________________________________________
SSR 92-8p EFFECTIVE/PUBLICATION DATE: 09/08/92 __________________________________________________________________________



General Information



Social Security Rulings (SSRs) are published under the authority of the Commissioner of Social Security and make available to the public a series of precedential decisions relating to Federal old-age, survivors, disability, supplemental security income, and black lung benefits programs. SSRs may be based on case decisions made at all administrative levels of adjudication, Federal court decisions, Commissioner's decisions, opinions of the Office of the General Counsel, and other policy interpretations of the law and regulations. SSRs are first published in the Federal Register. SSRs are effective upon publication, and the effective date is shown on the first page of each Ruling. Although SSRs do not have the force and effect of the law or regulations, they are binding on all components of the Social Security Administration, in accordance with section 402.35(b)(2) of Social Security Regulations and are to be relied upon as precedents in adjudicating other cases. An SSR may be superseded, modified, or revoked by later legislation, regulations, court decisions, or Rulings.


SSRs are published on a flow basis and may be purchased by annual subscription or by individual copy from the Superintendent of Documents, U.S Government Printing Office, Washington, D.C. 20402. A Cumulative Edition, reproducing all of the SSRs published in 1990 and 1991 that have not been superseded or rescinded, may also be purchased from the Superintendent of Documents. Since the cost of these publications and subscription changes periodically, the current price will be supplied upon request to the Superintendent of Documents. A check or money order covering the price of the publication should accompany the order. SSRs from 1960 through 1989 are available to the public, free of charge, upon request to the Social Security Administration, Office of Regulations, 3-8-5 Operations Building, 6401 Security Boulevard, Baltimore, MD 21235. Requests for free copies of the SSRs must include the requester's street address rather than a post office box.

__________________________________________________________________________

U.S. Department of
Health and Human Services
Social Security Administration
Office of Policy



Distributed on list 179

Social Security

Ruling

__________________________________________________________________________
SSR 92-8p EFFECTIVE/PUBLICATION DATE: 09/08/92 __________________________________________________________________________

POLICY INTERPRETATION RULING


TITLE XVI: SSI LOAN POLICY, INCLUDING ITS
APPLICABILITY TO ADVANCES OF FOOD AND/OR SHELTER


Purpose: This Ruling defines a loan for SSI purposes. It also explains when the proceeds of a loan count as resources under the SSl program, when they do not count as income, and how SSA treats a loan agreement when the lender is an SSI applicant or recipient. Social Security Ruling (SSR) 78-26 previously addressed these issues.


In addition, this Ruling reinterprets SSI regulations to permit treating, as the basis for a loan, food or shelter that an SSI applicant or recipient receives from someone in whose household he or she lives and has an obligation to pay for at a future date.


This Ruling supersedes SSR 78-26.


Citations (authority): Sections 1611 and 1631(e)(1)(B) of the Social Security Act, as amended, Regulations No. 16. Subpart K, sections 416.1103(f) and 416.1133(a).


Background: The Social Security Act, at section 1612(a)(21(A), provides that unearned income includes in-kind support and maintenance. Regulations, at 20 CFR 416.1121(h), define in-kind support and maintenance as food, clothing, and shelter furnished to an SSI applicant or recipient. Regulations, at 20 CFR 416.1103(f), provide that the proceeds of a loan are not income.


In 1978, the Social Security Administration (SSA) published SSR 78-26, setting forth its policy regarding the treatment of loans under the SSI program. SSR 78-26 gave the following information:


When an individual borrows and receives money through a lending process, as a borrower, or receives money as repayment on an outstanding loan (lender), a determination must be made whether such money is considered a resource or income for SSI eligibility and payment purposes. Since inception of the SSI program, proceeds of a loan have not been considered income to the borrower because of the obligation to repay. Existing regulations do not spell this out. Similarly, since inception of the SSI program, outstanding loans made by an SSI applicant or recipient from money available to him/her have been considered a countable resource to the extent there has been a negotiable instrument showing existence of a loan agreement. This is because a negotiable instrument is convertible to cash and, therefore, meets the definition of a resource for SSI purposes. In such a case, the negotiable instrument would be a countable resource to the lender.


Existence of a negotiable instrument, however, is not the sole criterion of a bona fide loan. The interpretation of a bona fide loan for SSI purposes is that where a borrower receives money (from relatives, friends or others) a loan is created if there is an understanding between the parties that the money borrowed is to be repaid and it is recognized as an enforceable contract under State law. The transaction which creates a loan can be in the form of a written or oral agreement if enforceable under State law. Absent a negotiable instrument, a bona fide loan must still be convertible to cash in order to be considered a resource for SSI purposes.


Under this policy interpretation, a householder's advance of food or shelter to a household member could not be treated as a loan because it did not involve an actual advance of cash.


In 1986, in Hickman v. Bowen (803 F.2d 1377), the Fifth Circuit Court of Appeals ruled that there was no jurisdiction for treating cash and in-kind income differently under 20 CFR 416.1103(f). Since both are income, both could be the subject of a loan. The court concluded that food or shelter provided by a householder to a household member is a loan if the household member is obligated to repay the debt.


In 1988, SSA issued Acquiescence Ruling (AR) 88-7(5) to implement the Hickman decision for individuals residing in the States in the Fifth Circuit (Louisiana. Mississippi, and Texas). AR 88-7(5) instructed that when an SSI claimant or recipient alleges receiving in-kind support and maintenance, that in-kind support and maintenance will be considered a loan and its value will not be considered for the purpose of calculating SSI benefits, but only if the applicant or recipient can demonstrate that the in-kind support and maintenance received was, in fact, loaned to him or her in realistic anticipation of repayment, that he or she intends to repay the debt, and that under the terms of SSR 78-26 a bona fide loan agreement has been made.


In 1991, in Cequerra v. Secretary of Health and Human Services (933 F.2d 735), the Ninth Circuit Court of Appeals issued an opinion which adopted the rationale of the Fifth Circuit Court of Appeals in Hickman. Absent a change in national policy, SSA acquiescence policy would thus require the issuance of another acquiescence ruling similar to AR 88-7(5) for individuals residing in the Ninth Circuit (Alaska. Arizona, California. Guam, Hawaii, Idaho, Montana, Nevada, Northern Mariana Islands, Oregon, and Washington).


In view of these recent court decisions, SSA has decided to reinterpret its regulations on the treatment in the SSI program of advances of food and shelter to an SSI applicant or recipient by an individual in whose household he or she is residing.


Policy Interpretation: For purposes of determining when a loan is not considered income and when a loan is considered a countable resource under the SSI program, the following policies apply:


  1. A loan means an advance from lender to borrower that the borrower must repay, with or without interest. A loan can be cash or an in-kind advance in lieu of cash. For example, an advance of food or shelter can represent a loan of the pro rata share of household operating expenses. This applies to any commercial or noncommercial loan (between reIatives, friends, or others) that is recognized as enforceable under State law. The loan agreement may be oral or written, as long as it is enforceable under State law.

    
    
  2. Any advance an SSI applicant or recipient receives that meets the above definition of a loan is not income for SSI purposes since it is subject to repayment. Any portion of borrowed funds that the borrower does not spend is a countable resource to the borrower if retained into the month following the month of receipt.

    
    
  3. When money or an in-kind advance in lieu of cash is given and accepted based on any understanding other than that it is to be repaid by the receiver, there is no loan involved for SSI purposes. It could be a gift, support payments, in-kind support and maintenance, etc., and must be treated as provided for in the rules applicable to such items.

    
    
  4. If there is a bona fide loan as defined in (1) above, there is a rebuttable presumption that the loan agreement is a resource of the lender for SSI purposes.

    
    

    For example, an SSI applicant or recipient reports making a loan to a relative. The loan agreement is oral. The oral agreement is found to be binding under State law. Accordingly, the loan is presumed to be a resource of the lender because it can be converted to cash if the lender calls for repayment from the borrower. The lender can rebut this presumption by showing that the loan cannot be converted to cash—for example, because the borrower died without leaving an estate.

    
    
  5. Money a lender receives as repayment of a loan (which meets the definition of a resource) reduces the outstanding loan balance and is considered a countable resource to the lender inasmuch as the repayment amount represents a return of part of the loan principal; i.e., the total value of the resource, which is the repayment amount plus the outstanding loan balance, remains unchanged.

    
    
  6. Interest on a loan is counted as unearned income to the lender in the month of receipt and, if retained, is a resource as in (2) above.

    
    

Documentation: Evidence must be obtained with respect to the existence of a bona fide loan agreement. The burden of proof with respect to the bona fide nature of the loan is with the applicant or recipient.


Effective Date: The effective date of this Ruling is the date of its publication in the FederaI Register. Determinations made before that date regarding advances of food or shelter may be reopened and revised subject to the rules of administrative finality of 20 CFR 416.1488(a).


The AR for the Hickman decision (AR 88-7(5)), is being rescinded through a separate publication in the FederaI Register. However, anyone to whom the Hickman AR would have applied, had it remained in effect, may request application of the policy contained in this Ruling to determinations made by SSA between the date of the Fifth Circuit Court of Appeals decision (November 10, 1986) and the date this Ruling is published in the FederaI Register if he or she first demonstrates that application of this Ruling could change the prior determination or decision. In addition, anyone to whom a Cequerra AR would have applied, had one been issued, may request application of this Ruling to determinations made by SSA between the date of the Ninth Circuit Court of Appeals decision (May 15, 1991) and the date this Ruling is published in the FederaI Register if he or she first demonstrates that application of this Ruling could change the prior determination or decision.

 

 

 

 

Exhibit 4

SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
Important Information

REPRESENTATIVE PAYEE NAME FOR
RECIPIENT'S NAME
Street Address
City/State/Zip Code


Date:

Claim Number:

SSA
FIELD OFFICE NAME
Street Address
City/State/Zip Code
Telphone Number

Please read this letter carefully. If you think we owe you money, please let us know right away.


We are writing to tell you that we may owe you money because of a recent court case about Supplemental Security Income (SSI). The name of the case is Medellin v. Sullivan. This case is about the way we figure SSI for some people. As a result, you may be able to get SSI or more SSI. We may owe you money even if you are no longer an SSI recipient.



WE COUNT FOOD AND SHELTER FROM OTHERS AS INCOME



If you live in your own home and someone else who lives with you gives you food or pays for your food or shelter, we count that help as income. If you live in someone else's home or apartment, we count the food and shelter you receive from the person you live with if you do not pay for it. We used to count this help as income even if you had to pay back the people who helped you with your food and shelter.



HOW THE MEDELLIN CASE MAY AFFECT YOU



The Medellin case says that we should not count the help you received for your food and shelter if the help you received was intended to be a loan. It could be a loan even if you did not put the loan in writing. If you are not sure if you had a loan, you should contact us anyway.



YOU MAY BE DUE SSI OR MORE SSI



Under the Medellin case, Missouri residents may be able to get SSI or more SSI if:


  • You received help with your food or shelter (or both); and

    
    
  • we counted this help that you received with your food or shelter when we decided if you could get SSI or when we figured the amount of your SSI payment; and

    
    
  • you and the person who helped you agreed that you had to pay them back for all the help you received; and

    
    
  • sometime after July 7, 1990 you received a letter from us telling you that we were counting the help you received with your food or shelter (or both), or

    
    

  • sometime after July 11, 1990 you were appealing our decision to count this help as income, or

    
    
  • sometime after July 11, 1990 you could have appealed our decision to count this help as income.

    
    
    
    

WHAT YOU SHOULD DO IF YOU THINK MEDELLIN APPLIES TO YOU



If you think we owe you money because of the Medellin case, you must contact us within 65 days of the date of this notice. You can do this by sending the enclosed "Medellin v. Sullivan Reply Form" to us in the return envelope provided, or by calling or visiting your local Social Security office.



WHAT WE WILL DO



When we hear from you, we will:


  • ask you for information we need to figure out whether the help you received was a loan

    
    
  • use the facts to see if you can get SSI or more SSI.

    
    

If we decide that the help you received was a loan, then we may owe you SSI money. We will figure the amount we owe you, and will send you a letter explaining the amount and when to expect your payment.


If we decide that you are not eligible for any more SSI, we will send you a letter explaining the reason(s), and what to do if you disagree.



IF YOU HAVE ANY QUESTIONS



If you have any questions, you may call your local Social Security office. The address and telephone number of your local office is printed at the top of the first page of this letter.


Be sure to tell us that you got a Medellin letter. It will help us answer your questions.


Also, you may write or visit any Social Security office. If you visit a local Social Security office, bring this letter with you. You may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.



IF YOU NEED MORE INFORMATION OR HELP



If you need help reading this letter or deciding what you should do, you can ask a friend, a relative, or a lawyer. You may be eligible for free legal advice from Legal Aid of Western Missouri, Inc. Their telephone number is (816) 474-6750. REMEMBER, if you think we owe you money, please fill out the enclosed “Medellin v. Sullivan Reply Form” and send it to us right away, or call or visit your local Social Security office.


If we do not hear from you within 65 days of the date of this notice, we might not be able to help you.


Enclosure:


Medellin v. Sullivan Reply Form

 

 

 

 

DEPARTMENT OF HEALTH AND HUMAN SERVICES


Social Security Administration



__________________________________________________________________________
MEDELLIN v. SULLIVAN REPLY FORM
__________________________________________________________________________
IMPORTANT
YOUR CASE WILL BE DROPPED UNLESS WE HEAR FROM YOU
__________________________________________________________________________


Name
Address
City, State, Zip

Date:

Social Security Number:

IF YOU WANT THIS CLAIM REVIEWED, PLEASE SIGN AND DATE THIS FORM AND RETURN IT IN THE SELF-ADDRESSED, PRE-PAID ENVELOPE.


SIGNATURE______________________ DATE___________________


Enter the area code and the telephone number where we can call you.


(AREA CODE) __________________ TELEPHONE NO. ____________


If your address is different than shown above, or if your Social Security Number is different, please write in below your correct address and/or your correct Social Security Number


__________________________________________________________________________
ADDRESS (NUMBER AND STREET, APT.NO., P.O. BOX or RURAL ROUTE)

______________________________________________ _______________________
CITY and STATE ZIP CODE

____________________________________________
SOCIAL SECURITY NUMBER



Privacy Act Notice


The Social Security Act (Section 205(a) of title II, 702 of title VII, 1631(e)(1)(A) and (B) of title XVI, and 1869(b)(1) and (c) of title XVIII allows us to collect the information on this form. We will use this information to process your claim. You do not have to give us this information, but without it we may not be able to process your claim. Information may be disclosed to another person or to another government agency for the Administration of the Social Security program or for the administration of programs requiring coordination with the Social Security Administration. These and other reasons why information about you may be used or given out are explained in the Federal Register. If you want to learn more about this, contact ant Social Security office.


1 A live claim for purposes of this class, is one which was pending at any administrative level or in federal court on or after July 12, 1990, or one for which the period to appeal an administrative or judicial decision had not run on July 12, 1990.


Attachment 3. Example: Notice of Important Information — No Relief (Other Reason)

Social Security Administration  
Supplemental Security Income  
Important Information  
  Office Address:
   
  Telephone Number:
   
  Date:
   
  Social Security Number:
  999-99-9999
   
Claimant  
Street Address  
City, State Zip Code  
   

You asked us to look at your Supplemental Security Income (SSI) case to see if we owe you money because of the Medellin court case. This case changes how we count help you receive from someone you live with if you do not pay for it. The Medellin case says that we should not count the help you received (food or shelter or both) if the help you received was intended to be a loan.


The information we have shows that you are not ____(1)____ because of the Medellin case for the following reason(s):____(2)____.


If You Disagree With Us


If you disagree with us, you or your lawyer may contact the attorneys for the Medellin case. If you don't have a lawyer, there are groups that can find you one. We can give you the names of these groups.


The attorneys for the Medellin case will answer your questions about class membership. If they think we are wrong, we may change our minds and look at your case again. The attorney for the Medellin case is Legal Aid of Western Missouri, 600 Lathrop Building, 1005 Grand Avenue, Kansas City, Missouri 64106-2216. Their telephone number is (816) 474-6750.


If You Have Any Questions


If you have any questions, you may call your local Social Security office. If you call or visit our office, please have this letter with you.


Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.


   
  (MAMPSC Manager's or FO Manager's Name)
  Manager

cc: Legal Aid of Western Missouri

Fill-ins

1 - Choice 1: eligible to receive SSI payments
  Choice 2: due more SSI payments
   
2 - Choice 1: When we contacted you, you told us that the (food/food and shelter/shelter) you received did not have to be paid back. It was not intended to be a loan.
   
  Choice 2: The amount of your income was still too high after we subtracted the amount we counted for the help (you) received. (List all other income counted.)
   
  Choice 3: We find that (your) resources were more than $ (appropriate dollar amount for resource limit) for (month/year) through (month/year that resources exceed the limit).
   
  For you to receive (more) SSI payments, the resources that (you) own cannot be worth more than $ (appropriate dollar amount). We call this amount the resource limit.
   
  Resources are the things that (you) own such as cash, stocks, bank accounts, certain types of life insurance, buildings and land on which (you) do not live. We do not include as resources the home in which (you) live, one car used for necessary activities, and some other things.
   
  Choice 4: To be eligible for Supplemental Security Income payments under the Medellin case, (you) must have lived in the State of Missouri for one or more months during the period July 12, 1990, through December 31, 1991. Our records show that (you) did not/do not meet this requirement because you were/are living in (name of State/foreign country).
   
  Choice 5: (Other — fill in appropriate explanation.)
   
   

Attachment 4. Example: Notice of Important Information — No Relief to Survivor (Other Reason)


Social Security Administration  
Supplemental Security Income  
Important Information  
  Date:
   
  Office Address:
   
  Telephone Number:
   
  Deceased Claimant's Name:
   
  Social Security Number:
  999-99-9999
   
Survivor's Name  
Street Address  
City, State Zip Code  
   

You asked us to look at (name of deceased)'s Supplemental Security Income (SSI) case to see if we owe you money because of the Medellin court case. This case changes how we count help (name of deceased) received from someone (he/she) lived with if (he/she) did not pay for it. The Medellin case says that we should not count the help (name of deceased) received (food or shelter or both) if the help (he/she) received was intended to be a loan.


The information we have shows that you are not eligible to receive the SSI because of the Medellin case for the following reason(s): ____(1)____.


If You Disagree With Us


If you disagree with us, you or your lawyer may contact the attorneys for the Medellin case. If you don't have a lawyer, there are groups that can find you one. We can give you the name of these groups.


The attorneys for the Medellin case will answer your questions about class membership. If they think we are wrong, we may change our minds and look at your case again. The attorney for the Medellin case is Legal Aid of Western Missouri. The address is 600 Lathrop Building, 1005 Grand Avenue, Kansas City, Missouri 64106-2216. Their telephone number is (816) 474-6750.


If You Have Any Questions


If you have any questions, you may call your local Social Security office. If you call or visit our office, please have this letter with you.


Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.


   
  (FO Manager's Name)
  Manager

cc: Legal Aid of Western Missouri


Fill-ins


— (name of deceased)      — (he/she)

1 - Choice 1: When we contacted you, you told us that the (food/food and shelter/shelter) you received did not have to be paid back. It was not intended to be a loan.
   
  Choice 2: The amount of (name of deceased)'s income was still too high after we subtracted the amount we counted for the help (he/she) received. (List all other income counted.)
   
  Choice 3: We find that (name of deceased)'s resources were more than $ (appropriate dollar amount for resource limit) for (month/year) through (month/year that resources exceed the limit).
   
  For (name of deceased) to have received (more) SSI payments, the resources that (he/she) owned could not be worth more than $ (appropriate dollar amount). We call this amount the resource limit.
   
  Resources are the things that (he/she) owned such as cash, bank accounts, life insurance, buildings and land (he/she) did not live on and some other things. We do not include as resources the home a person lives in, one car used for necessary activities and some other things.
   
  Choice 4: To be eligible for Supplemental Security Income payments under the Medellin case, (name of deceased) must have lived in the State of Missouri for one or more months during the period July 12, 1990, through December 31, 1991. Our records show that (he/she) did not meet this requirement because he/she was living in (name of State/foreign country).
   
  Choice 5: (Other — fill in appropriate explanation.)
   
   

Attachment 5. Example: Notice to Deny Request for Payment of Underpayment — (Respondent Not an Eligible Survivor)

Social Security Administration  
Supplemental Security Income  
Important Information  
  Date:
   
  Office Address:
   
  Telephone Number:
   
  Deceased Claimant's Name:
   
  Social Security Number:
  999-99-9999
   
Responder's Name  
Street Address  
City, State Zip Code  
   

You asked us to look at ____(1)____ Supplemental Security Income (SSI) case to see if ____(2)____ was due any money because of the Medellin court case. Our records show you do not meet the requirements for receiving any SSI money that may be due ____(3)____.


Who Can Receive SSI Due A Deceased Person


We can pay SSI money due a deceased person only to certain survivors. You must be a surviving spouse who was living with the SSI recipient at any time in the month the recipient died or have lived with him or her in any of the six months before the month of death.


If the SSI recipient was an SSI child, you must be a surviving parent(s) who was living with the child as described above.


Even if you meet the above requirements, you may still not receive the SSI money if we sent the first SSI payment to a State assistance agency. This can happen if the recipient had agreed in writing to have the first SSI payment sent to that agency because it paid money to him or her while waiting for SSI payments to begin.


Our records show you are not eligible to receive the SSI payment because ____(4)____.


Do You Disagree With The Decision?


If you disagree with the decision, you have the right to appeal. We will review your case and consider any new facts you have.


  • You have 60 days to ask for an appeal.

    
    
  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

    
    
  • You must have to have a good reason for waiting more than 60 days to ask for an appeal.

    
    
  • To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out this form.

    
    

How To Appeal


There are two ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide your case.


  • Case Review. You have the right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case. This is the only kind of appeal you can have to appeal a medical decision.

    
    
  • Informal Conference. You'll meet with the person who decides your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

    
    

If You Want Help With Your Appeal


You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.


If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.


You or your lawyer may also contact the attorney in the Medellin case, Legal Aid of Western Missouri. The address is 600 Lathrop Building, 1005 Grand Avenue, Kansas City, Missouri 64106-2216. Their telephone number is (816) 474-6750.


If You Have Any Questions


If you have any questions, you may call, write or visit any Social Security office. If you call or visit our office, please have this letter with you.


Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

   
  (FO Manager's Name)
  Manager

cc: Legal Aid of Western Missouri


Fill-ins

1  — Name of deceased person, possessive
   
2  — Choice 1: he
  Choice 2: she
   
3  — Name of deceased person
   
4  — Give reason the respondent is not an eligible survivor. For example, if the respondent is the surviving parent of an adult child, explain that the child must have been under age 18/22 and living with the parent in the month of his or her death or in the preceding 6 months. See SI 02101.003ff. for other reasons for being ineligible.
   
   

Attachment 6. Example: Notice of Change of Payment — No Current Eligibility

Social Security Administration  
Supplemental Security Income  
Notice of Change In Payment  
  Date:
   
  Office Address:
   
  Telephone Number:
   
  Social Security Number:
  999-99-9999
   
Recipient  
Street Address  
City, State Zip Code  
   

We are writing to tell you about changes in your Supplemental Security Income (SSI) payments. The following chart shows the SSI money due you for the months we changed. As you can see from the chart, we are only changing your payments for months in the past. The rest of this letter will tell you more about this change.


Your Payments Will Be Changed as Follows:

From Through Amount Due
    Each Month
     
     
     
Month/Year Month/Day/Year $$.00
     

Information About Your Payments


We are sending you a check for $$.00. This is money due you for Month/Year through Month/Year.


You should receive the check no later than Month/Day/Year.


Why Your Payments Changed


We owe you SSI money because of a court case called Medellin. The Medellin case changes how we count help you received (food or shelter) from other people you lived with when you had agreed to pay these people back for the help. Because you had agreed to pay for the help you received, we should not have counted that help as income when we figured your SSI payments for the months shown above.


Your SSI Is Based On These Facts [Following is an example. The actual facts of the particular case should be included here.]


You had monthly income which must be considered in figuring your eligibility as follows:


  • Your Social Security benefits—before deductions for Medicare premiums, if any—of $$.00 for Month/Year and $$.00 for Month/Year.

    
    

Information About Your Back Payments


  • We are sending you an SSI check for $$.00 in Month/Year. We will not count the back payment toward your resource limit for 6 months after you receive it.

    
    
  • On Month/Day/Year, we will then count any money that is left as part of your resources. But the things you buy with the money may count as resources the month after they are bought. You can ask us which things count as resources. You cannot get SSI if your resources are worth over $2,000.

    
    

Things to Remember


  • Your payments may change if your circumstances change. Therefore, you are required to report any change in your situation that may affect your SSI payment. For example, you should tell us if you move, if anyone else moves from or into your household, if your marital status changes, if income or resources for you or members of your household change, or if you go to work.

    
    
  • This decision refers only to your claim for SSI payments.

    
    
  • This determination replaces all previous determinations for the above periods.

    
    

Do You Disagree With The Decision?


If you disagree with the decision, you have the right to appeal. A person who hasn't seen this case will look at it. That person will be an Administrative Law Judge. In the rest of our letter, we'll call this person an ALJ. The ALJ will correct mistakes and look at any new facts you have before deciding this case. We call this a hearing.


  • You have 60 days to ask for a hearing.

    
    
  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

    
    
  • You'll have to have a good reason for waiting more than 60 days to ask for a hearing.

    
    
  • You have to ask for a hearing in writing. We'll ask you to sign an SSA form HA-501, called “Request for Hearing.” Contact one of our offices if you want help.

    
    

How A Hearing Works


A hearing works like this.


  • The ALJ will tell you the time and place for the hearing.

    
    
  • The ALJ will explain the law in your case. The ALJ will state the known facts and tell you what has to be decided.

    
    
  • You can tell the ALJ why you think we're wrong. You can give the ALJ more facts. You can bring people to say why you're right.

    
    
  • The ALJ can make people come to your hearing in person and bring important papers. You can question these people at your hearing.

    
    
  • We'll ask if you want to go to the hearing in person. If you say you want to go, you should attend if at all possible. If you change your mind or if you can't get to the hearing, you should tell us. You should know that your being there may help the ALJ decide your case.

    
    

If You Want Help With The Hearing


You can have a friend, lawyer or someone else help you. There are groups that can find you a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.


If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.


You or your lawyer may also contact the attorney in the Medellin case, Legal Aid of Western Missouri. The address is 600 Lathrop Building, 1005 Grand Avenue, Kansas City, Missouri 64106-2216. Their telephone number is (816) 474-6750.


If You Have Any Questions


If you have any questions, you may call, write, or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (Claims Representative's name). (His/Her) telephone number is (xxx) xxx-xxxx.


Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

   
  Name
  Title

cc: Legal Aid of Western Missouri


Attachment 7. Example: Notice of Underpayment Due a Survivor

Social Security Administration  
Supplemental Security Income  
Important Information  
  Date:
  Office Address:
   
  Telephone Number:
   
  Deceased Claimant's Name:
   
  Social Security Number:
  999-99-9999
   
Survivor's Name  
Street Address  
City, State Zip Code  
   

We are writing to tell you that we can pay you some Supplemental Security Income (SSI) money we owe to (name of deceased). The following chart shows the SSI money due (name of the deceased) for the months we changed. As you can see from the chart, we are only changing (name of deceased)'s payments for months in the past. The rest of this letter will tell you more about this.


Information About Your Payments

From Through Amount Due
    Each Month
     
     
     
Month/Year Month/Day/Year $$.00
     

We are sending you a check for $$.00. This is money due (name of deceased) for Month/Year through Month/Year. We can pay this money to you because you are (name of deceased)'s surviving (spouse/parent).


You should receive the check no later than Month/Day/Year.


Why We Owe You SSI


We owe you SSI money because of a court case called Medellin. Also, you are (his/her) surviving (spouse/parent). The Medellin case changes how we count help (name of deceased) received (food or shelter) from other people (name of deceased) lived with when (he/she) had agreed to pay these people back for the help. Because (he/she) had agreed to pay for the help (he/she) received, we should not have counted that help as income when we figured (his/her) SSI payments for the months shown above.


The SSI Payment Is Based On These Facts


(Name of deceased) had monthly income which must be considered in figuring (his/her) SSI as follows: [Case facts would be tailored for actual notice].


  • (His/Her) Social Security benefits—before deductions for Medicare premiums, if any—of $$.00 for Month/Year and $$.00 for Month/Year.

    
    

Do You Disagree With The Decision?


If you disagree with the decision, you have the right to appeal. We will review your case and consider any new facts you have.


  • You have 60 days to ask for an appeal.

    
    
  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

    
    
  • You must have to have a good reason for waiting more than 60 days to ask for an appeal.

    
    
  • To appeal, you must fill out a form called “Request for Reconsideration.” The form number is SSA-561. To get this form, contact one of our offices. We can help you fill out this form.

    
    

How To Appeal


There are two ways to appeal. You can pick the one you want. If you meet with us in person, it may help us decide your case.


  • Case Review. You have the right to review the facts in your file. You can give us more facts to add to your file. Then we'll decide your case again. You won't meet with the person who decides your case. This is the only kind of appeal you can have to appeal a medical decision.

    
    
  • Informal Conference. You'll meet with the person who decides your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

    
    

If You Want Help Your Appeal


You can have a friend, lawyer or someone else help you. There are groups that can find you a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.


If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.


You or your lawyer may also contact the attorney in the Medellin case, Legal Aid of Western Missouri. The address is 600 Lathrop Building, 1005 Grand Avenue, Kansas City, Missouri 64106-2216. Their telephone number is (816) 474-6750.


If You Have Any Questions


If you have any questions, you may call, write or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (Name of SSA Representative). The telephone number is shown at the top of the letter.


Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

   
  Name
  Title

cc: Legal Aid of Western Missouri


Fill-ins


— (name of deceased)


— (he/she)



— (his/her)


— (spouse/parent)


— (name of SSA representative)


Attachment 8. Example: Notice of Important Information — No Relief (FO Determines No Loan Exists)

Social Security Administration  
Supplemental Security Income  
Important Information  
  Date:
  Office Address:
   
  Telephone Number:
   
  Social Security Number:
  999-99-9999
   
Claimant  
Street Address  
City, State Zip Code  
   

You asked us to look at your Supplemental Security Income (SSI) case to see if we owe you money because of the Medellin court case. This case changes how we count help you receive from someone you live with if you do not pay for it. The Medellin case says that we should not count the help you received (food or shelter or both) if the help you received was intended to be a loan.


The information we have shows that you are not ____(1)____ because of the Medellin case for the following reason(s):


You did not receive a loan of food or shelter because ____(2)____.


Do You Disagree With The Decision?


If you disagree with the decision, you have the right to appeal. A person who hasn't seen this case will look at it. That person will be a Administrative Law Judge. In the rest of our letter we'll call this person an ALJ. The ALJ will correct mistakes and look at any new facts you have before deciding this case. We call this a hearing.


  • You have 60 days to ask for a hearing.

    
    

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

    
    

  • You'll have to have a good reason for waiting more than 60 days to ask for a hearing.

    
    

  • You have to ask for a hearing in writing. We'll ask you to sign an SSA form HA-501, called “Request for Hearing.” Contact one of our offices if you want help.

    
    

How A Hearing Works


A hearing works like this.


  • The ALJ will tell you the time and place for the hearing.

    
    

  • The ALJ will explain the law in your case. The ALJ will state the known facts and tell you what has to be decided.

    
    

  • You can tell the ALJ why you think we're wrong. You can give the ALJ more facts. You can bring people to say why you're right.

    
    

  • The ALJ can make people come to your hearing in person and bring important papers. You can question these people at your hearing.

    
    

  • We'll ask if you want to go to the hearing in person. If you say you want to go, you should attend if at all possible. If you change your mind or if you can't get to the hearing, you should tell us. You should know that your being there may help the ALJ decide your case.

    
    

If You Want Help With The Hearing


You can have a friend, lawyer or someone else help you. There are groups that can find you a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.


If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.


You or your lawyer may also contact the attorney in the Medellin case, Legal Aid of Western Missouri. The address is 600 Lathrop Building, 1005 Grand Avenue, Kansas City, Missouri 64106-2216. Their telephone number is (816) 474-6750.


If You Have Any Questions


If you have any questions, you may call, write, or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (Claims Representative's name). (His/Her) telephone number is (xxx) xxx-xxxx.


Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.


   
  (FO Manager's Name)
  Manager

cc: Legal Aid of Western Missouri


Fill-ins

1  — Choice 1: eligible to receive SSI payments
   
  Choice 2: due more SSI payments
   
2  — Fill in reason no loan was found to exist.
   
   

Attachment 9. Example: Notice of Important Information — No Relief to Survivor (FO Determines No Loan Exists)

Social Security Administration  
Supplemental Security Income  
Important Information  
  Date:
  Office Address:
   
  Telephone Number:
   
  Deceased Claimant's Name:
   
  Social Security Number:
  999-99-9999
   
Survivor's Name  
Street Address  
City, State Zip Code  
   

You asked us to look at (name of deceased)'s Supplemental Security Income (SSI) case to see if we owe you money because of the Medellin court case. This case changes how we count help (name of deceased) received from someone (he/she) lived with if (he/she) did not pay for it. The Medellin case says that we should not count the help (name of deceased) received (food or shelter or both) if the help (he/she) received was intended to be a loan.


The information we have shows that you are not due SSI because of the Medellin case for the following reason(s):


(Name of deceased) did not receive a loan of food or shelter because ____(1)____.


Do You Disagree With The Decision?


If you disagree with the decision, you have the right to appeal. A person who hasn't seen this case will look at it. That person will be a Administrative Law Judge. In the rest of our letter we'll call this person an ALJ. The ALJ will correct mistakes and look at any new facts you have before deciding this case. We call this a hearing.


  • You have 60 days to ask for a hearing.

    
    

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

    
    

  • You'll have to have a good reason for waiting more than 60 days to ask for a hearing.

    
    

  • You have to ask for a hearing in writing. We'll ask you to sign an SSA form HA-501, called “Request for Hearing.” Contact one of our offices if you want help.

    
    

How A Hearing Works


A hearing works like this:


  • The ALJ will tell you the time and place for the hearing.

    
    

  • The ALJ will explain the law in your case. The ALJ will state the known facts and tell you what has to be decided.

    
    

  • You can tell the ALJ why you think we're wrong. You can give the ALJ more facts. You can bring people to say why you're right.

    
    

  • The ALJ can make people come to your hearing in person and bring important papers. You can question these people at your hearing.

    
    

  • We'll ask if you want to go to the hearing in person. If you say you want to go, you should attend if at all possible. If you change your mind or if you can't get to the hearing, you should tell us. You should know that your being there may help the ALJ decide your case.

    
    

If You Want Help With The Hearing


You can have a friend, lawyer or someone else help you. There are groups that can find you a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.


If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.


You or your lawyer may also contact the attorney in the Medellin case, Legal Aid of Western Missouri. The address is 600 Lathrop Building, 1005 Grand Avenue, Kansas City, Missouri 64106-2216. Their telephone number is (816) 474-6750.


If You Have Any Questions


If you have any questions, you may call, write or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for (name of SSA Representative). (His/Her) telephone number is (xxx) xxx-xxxx.


Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

   
  (FO Manager's Name)
  Manager

cc: Legal Aid of Western Missouri


Fill-ins


— (name of deceased)


— (he/she)


— (name of SSA representative)


1—Fill in reason no loan was found to exist.