Addendum 0960-0133

9

SSA-8508 Explanation of Changes

OMB No. 0960-0133

We replaced the lines on the form with text boxes for ease of recording and capturing information. This was done on every page of the form. These revisions were made in order for the form to be in line with the Quality Review Manual System. The form was also revised for ease of recording information.

Page #1: Face sheet

• Above Field Review Documentation, we placed “Case Excluded?” and request for the Exclusion code at the top of the form.

• We removed “Type of Review” since this form is designated for Stewardship only and no other types of reviews are completed on this form.

Page #2 (Element 1-Interview)

• Under the Evidence viewed, we removed all items associated with special development. This will no longer be needed.

• We took the information pertaining to the SI/ES identity and created a table for ease of recording the recipient’s allegation.

Page #3 (Element 1-Verification)

• We removed the statement that reads: File includes POMS development required when SSN not issued prior to age 12.

• We added checkboxes for “Allegation of Age Accepted,” “Age verified,” and “Does not meet age requirement” to right-hand column.

• We added a block to record the type of verification obtained that pertains to Citizenship/Alien Status.

• We added a checkbox for “Does not meet Citizenship/Alien Status” to right-hand column.

• Removed “No material age discrepancy” and “Material Discrepancy found” from the conclusion column, since discrepancies are suppose to be resolved upon completion of each case.

Page #4 (Element 3: Marital History- Interview)

• Added a block for allegations of no marriages.

• We replaced the lines with a table, and also added DOB/PLB if the SSN of the Spouse is unknown.

• We modified the information requested on the table to make it easier to provide by adding checkboxes for spouse or parents per line and giving checkboxes with choices in the Event column.

• We created a text box for Evidence Viewed, and removed the categories “Type,” “Names,” “Event date,” “Issue Date,” and “Issuing Agency.”

• Added Yes/No checkboxes for Contributions, Entitlement and “Does SI live with an unrelated member of the opposite sex?” questions.

• We added a statement to solicit the date of onset. The statement now reads: “If disabled, date the SI first became disabled.”

• We’ve also added a section to record the names of parents who are disabled, deceased, or over the age of 62 (For potential T2 eligibility)

Page # 5 (Conclusion column)

• We removed the block that pertains to “Material discrepancy found” all discrepancies should be resolved.

• Added checkbox “Potential T2 Entitlement Referral:”

Page #6 ( Element 4 Non-Household-Interview)

• We added a block at the top of the interview section that shows: NA if the section is not an issue for the sample period. (QRMS 7504.B.1)

• Added a question to ascertain if the SI is currently residing at the facility

• We removed both “last date SI/ES was out of the U.S.” and “Number of residences over last 3 years.”

• Created table to record the dates of absence from the facility and if there were multiple residences during the review period.

Page #7 (Element 4-Verification)

Institution

• Added NA at the top of the page to indicate that the Verification element is not applicable.

• We created a table to record pertinent information for institutional care

• We removed the question: “Size/number of residents” as this is not material to the review.

• We removed the question: “Total monthly cost” and replaced it with “Other Third Party Source/Amount” which we moved up from its location below “Tax-Exempt organization.”

Non-Institution

• We removed “placement by” and “supervised by”, as this is not material to the review, QRMS does not mandate that these questions need to be asked.

• We placed “Amount of Room and Board” in the new Non-Institution chart, and also added a block for “Other Third Party Source/Amount.”

Total Costs

• Removed “Amount of pymt for room and board” as that information is requested at the top of the page.

Page #8 ( Element 5-Household-Interview)

• We created a table to capture the names, relationship, and ages of the household members who are residing with the Sampled Individual during the review period. We added “SSN” for purposes of obtaining necessary queries for ineligible children, who may not be on the SSR or MSSICS.

• There are two sections with a series of questions. The first section applies only if the SI/Spouse has rental liability/home ownership. The second section applies when the SI/spouse do not have rental liability or home ownership. We created tables for these two sections.

Page #9 ( Element 5-Household-Interview continued)

• Added “(Yr/monthly amount)” to the Property Tax line on the chart.

• We removed “Household member(s) not contacted because” block.

• We revised the language for the contributions question to make it more generalized. Also, added the reference to the SSA-795 for the information regarding outside contributions.

• We added the request for the source of the subsidy.

• We removed the question “Number of residences during last 3 years”

• We removed “Amount of cash contributions and loans of ISM $_______ (see SSA-795 in file)” as it is redundant since we generalized the question above to include any outside contributions.

Page 10 (Element 5, household interview continued)

• Added a question at the top of the page that reads: Has the SI resided at the current residence address for the entire review period? Yes/No

If not, complete the applicable living arrangement changes below:

• We removed the blocks that indicated “None” for each statement of living arrangement changes. This is because, we added the above question. If the Sampled individual alleged that they have not lived at their current residence during the entire review period, then these questions need to be addressed, however if the SI alleged that they have lived at the current residence during the entire review period, no further information is needed in this section.

Page 11 (Element 5-Verification)

• We removed the request for “LA/ISM Established” from under the chart for Collateral Sources as it is redundant.

• We removed the section on “average household expenses” this is because it is duplicating information. This information can be captured on a SSA-795 (OMB Control No. 0960-0045), and that would be the required verification anyway.

• We added: SSA-795 in file pertaining to HH expenses, as well as the checkboxes for Bill/Receipts requested (both unavailable and available).

• We added a table that is titled: “QRA Determination” and based on the field review findings, the QRA can record the following information:

  • Number of HH members

  • Total HH Expenses

  • SI’s pro-rata share

  • SI’s contribution

  • Other HH member’s contribution

  • Inside ISM (including VTR)

  • Outside ISM

• We created a table to record the Living Arrangement/ISM determination for the Review period months

• We removed the words “Rent-free” from the right-hand column (under “Rental liability”).

Page #12 (Element 6-Unearned Income-Interview)

• We created a table to record the SI/MI allegation of unearned income for each of the review period months and reordered some of the categories.

• We removed the listing for Bank Deposits, Private Pension and Assistance Based on Need from the chart.

• We left a section on the bottom of the page to record any evidence presented during the interview by the SI/MI

Page #13 (Element 6-Verification)

• We organized the information in tables, removed the block for “Place” as it is no longer necessary, and added the word “Organization” after “Name/Title”

• We added blocks for the amounts

• We added “Source of Income” under “Name of Child,” and moved “Excluded court ordered support payments made by ineligible spouse/parent” to the bottom of the page

• We added “Deeming applies” to the right-hand column

• We also added the title “FINDINGS” to the top of the page

Page #14 (Element 7- Earned Income; Interview)

• We created two tables, one for the Sampled Individual and the other for the Material Individual to record allegation regarding employment.

• We removed “Type of Work” as it is not considered material to the review, and “Employee” as it is redundant.

• In the tables, we included a section to record “Employer name/address and Dates of employment”

• We removed the “Evidence” line from the Review Period Earnings, but left a blank space for that information.

• Under Earned income Exclusions, we added: None, Cafeteria Plan and Court Ordered Payments. Also, we organized this section and the next in tables.

• In the left-hand column, we removed “Retro: Y__ N__”

• For the last three questions, we reorganized them into a table, added “Yes/No” checkboxes as well as requests for “union ID,” “dates of service” and an explanation of the pending claim.

Page #15 (Element 7-Earned Income Verification; Interview)

• We created a table for “Collateral contact made,” and added spaces for the amounts.

• We removed “See summary/copy of tax return” from the list of established earned income.

Page #16 (Element 8-Liquid Resources; Interview)

• We removed the words “Type of Resource” from above the Allegations list.

• We reordered the information requested on the Allegations list. For each type of resource, we added Yes No check boxes; we removed the “Miscellaneous” line from the chart, and added spaces for different amounts of cash on hand.

• We created more space to record any positive account allegation, and removed the need to record “ID” and “Encumbrances”

• We added a blocks to check if the SI alleges receiving SSI or T2 benefits direct deposit, and removed the block for “No accounts alleged.”

• We added a place to record a TID (Tax identification number) in the event that the SI alleges they do not have an SSN. This would be used to verify bank account information through acuity.

• We restated the question regarding the SI/MI’s name on another person’s bank account.

• We removed the space for “mortgage, pers, loan from.”

Page #17 (Element 8-Liquid Resources; Verification)

• We removed the statements at the top of the page that read: “SI has been in an institution/non institutional care facility for at least 3 years- no reason to doubt negative allegation” and “Collateral contact made (Include patient account)”

• We organized this section that would allow the reviewer to better record the verification/findings of Liquid resources.

• We included a block to check pertaining to Negative bank searches (“Geo Search did not identify additional accounts”)

• We included a table to record any other type of liquid resources that were discovered and verified during the review, i.e. safe deposit boxes, savings bonds, etc. and created space to record the balances of those resources for the each month of the review period.

Page #18 (Element 9-Non Liquid Resources: Interview)

• We added: Home Property Ownership Yes No

• We removed the “Unknown” block from the Ownership listing.

• We added: Non-Home Property Ownership Yes No

• We removed “Commercial property (non-farm) used by SI or MI,” “CMV,” and “Encumbrances” from the chart; and added “Burial Plot/Crypt/Location/Value Designated for” to the chart.

• We organized the information on this page in a table, for ease of recording recipient allegation.

• We added “since 12/14/1999” to the question regarding Transfer of property.

Page #19 (Element 9-Non Liquid Resources: Verification)

• We removed the sentence “SI has been in an institutional/noninstitutional care facility at least 3 years – no reason to doubt negative allegations” from the top of the page.

• Under Alpha listing, we added: Contact Method Personal Visit Letter

Telephone

• Removed “Nonhome (including burial plot) ownership” and “Nonhome
  (including non-excluded burial plot) ownership”

Page #20 (Element 10-Vehicles: Interview)

• We organized the information in tables for ease of recording allegations

• We removed “Additional information to verify value/use/ownership,” “Handicapped equipped,” and “Duration of ownership.”

Page #20 (Element 11-Life Insurance Policy Interview)

• We organized the information in tables.

• We removed “Insured” from the chart as well as “Inf. Allgd” and “Particip” from below “Policy Viewed.”

• We removed: “If policy is not paid up, what is the premium amount and frequency of payment?”

• We also removed the need to list the premium amount and frequency of payment for a policy that is not paid up.

• We removed: “If yes, does supplemental contract exist?”

Page #21 (Element 11- Findings)

• We removed the block for “Encumbrances”

• In the right-hand column, we replaced the words “Value under limit” with “Transportation”

• We created a chart to show the insurance policies, and made room for four policies to be listed

• For the purposes of the mock-up, we were unable to format this revised information onto one page; however, once we receive approval, SSA’s Forms Management Team will reformat the entire form in order to correct for issues like this one (see Note below).

Page #22 (Element 12- Resources)

• We added the question “Does SI own any other non-liquid resources, (items of unusual value)?” and the text box in which to list those resources.

Page #22 (Element 13- Representative Payee)

• We replaced “Repy” with “Selection Date” in the left-hand column.

Page #23 (Element 13- Fraud)

• We rearranged the blanks (formerly used to collect this information) on this page into charts for ease of recording the information.

Page #24 (Element 16- Interview)

• We created a chart for this information.

• We replaced “Type of Course” with “Full time Yes No”

Page #24 (Element 17- Interview)

• We added more space to record allegation of more than one eligible child and or ineligible children.

• We split eligible and ineligible children into two charts as one requires more information than that other.

• We removed the following fields from the charts: Place of Birth; Date of Issue; and Date Recorded.

• We replaced “Record Type, ID#” with “Evidence Viewed.”

• We removed “CG DM O” from the section.

Page #25 (Element 18- Relationship)

• In the second section of the right-hand column, we replaced “Material discrepancy” with “Student Status verified.”

• We removed the “None required” block and the need to provide SSNs for children from the third section.

• In the third section of the right-hand column, we replaced “Material discrepancy” with “Age Verified.”

• In the fourth section, we moved “Evidence Viewed” from above “Numident in file” to the bottom of the chart.

• In the fourth section of the right-hand column, we replaced “Material discrepancy” with “Relationship verified.”

Upon approval of these changes, SSA’s Forms Management Team will format the revised SSA-8508 to make sure it follows the Agency’s formatting.

Please note: The mock-up of the revised SSA-8508 was not completed using the specialized software SSA’s Forms Management Team uses to create or revise public use forms. On the mock-up the pagination does not reflect what the final version will look like. SSA’s Forms Management Team will format the revised SSA-8508 so that there are no duplicative page numbers, and so that all of the information which should be on a specific page appears on that page.