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Developing Past Work for Title II Disability Beneficiaries February 2012

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Developing Past Work for Title II Disability Beneficiaries February 2012. Learning Objectives. After this training, CWICs should be able to: Describe the CWIC’s role in developing past wages and/or self-employment income;

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learning objectives
Learning Objectives

After this training, CWICs should be able to:

  • Describe the CWIC’s role in developing past wages and/or self-employment income;
  • Identify and describe the steps CWICs must take in order to recognize when past work has not been developed;
  • Describe the process SSA uses to collect and verify past wages or self-employment income; and
  • Describe the protocol CWICs should use for collecting past earnings information and developing past work.
the cwic s role in developing past work supporting the beneficiary to manage benefits
The CWIC’s Role in Developing Past Work: Supporting the Beneficiary to Manage Benefits
  • Explaining the work CDR process and helping the beneficiary understand the importance of developing work since entitlement.
  • Teaching the beneficiary what documents to save (or retrieve) to verify wages or earnings from self-employment.
  • Supporting the beneficiary in retrieving past wage data.
  • Supporting the beneficiary with making the wage report including completion of the SSA 820/821
the cwic s role in developing past work helping prepare for a work cdr
The CWIC’s Role in Developing Past Work: Helping Prepare for a Work CDR
  • Evaluating wages or NESE to estimate if and when TWP months were used and if the TWP has ended.
  • Estimating the beginning and end dates of the Extended Period of Eligibility (EPE).
  • Recognizing when work incentives might apply and assisting beneficiary to document applicable work incentives.
  • Estimating if gross earnings or self-employment income might represent SGA and if/when monthly benefits should have been ceased.
recognizing when past work has not been developed
Recognizing When Past Work Has Not Been Developed

Step 1: Ask probing questions about past work during the initial information gathering process.

  • Start by explaining that you need to know about past work in order to provide accurate advice about how future work will affect benefit.
  • Stress that it is very important to be as accurate as possible about past work.
  • Ask if ANY work has been performed since entitlement – wage employment, self-employment , paid internships or other.
  • Gather dates of employment, hours worked and wage rates.
  • Ask if an income tax return was filed indicating any earned income or self-employment income.
  • Ask if wages were reported and if so, how they were reported.
  • Ask if beneficiary ever completed an SSA 820/821.
recognizing when past work has not been developed1
Recognizing When Past Work Has Not Been Developed

Step 2: Check beneficiary reports of past work against BPQY (version 4.0).

  • Look at IRS wages from date of entitlement onward – be watching for missing years or years of earnings not reported by the beneficiary.
  • Review 5 most recent years’ monthly verified earnings.
  • Check TWP usage.
  • Check last work review action.
  • Compare the information provided on the BPQY with the information provided by the beneficiary.
indicators that past work is undeveloped
Indicators that Past Work is Undeveloped
  • IRS annual earnings are listed, but not all of these earnings show in the 5 most recent years’ earnings.
  • IRS earnings average over the applicable TWP guideline, but no TWP usage is indicated on BPQY.
  • Last work review action is prior to years with IRS earnings.
  • IRS earnings average over the applicable SGA guideline, but month of cessation is left blank.
  • Beneficiary alleges earnings but nothing shows on the BPQY or most recent IRS years are missing.
beneficiary s description of past work does not match bpqy
Beneficiary’s Description of Past Work Does Not Match BPQY
  • Send beneficiary a copy of the BPQY and call or meet to go over it together.
  • Gently probe into discrepancies between beneficiary’s allegation of work and what shows on the BPQY – use a non-judgmental approach.
  • Ask permission to contact SSA to investigate discrepancies. Get a signed SSA 3288 and fax it to the CR, WIL or AWIC.
  • Ask specific questions to determine what SSA has and has not developed through contact with CR, WIL or AWIC.
developing past work cwic protocol
Developing Past Work – CWIC Protocol
  • Help the beneficiary document past earnings on a month-by-month basis if possible.
  • Begin with SSA’s “preferred” wage verification sources and systematically work down to secondary sources as needed.
  • CWICs should actively support beneficiaries through the process of collecting past wage data – help strategize on ways to find wage information and check in frequently to assess progress.
  • If the beneficiary cannot find wage documentation, help reconstruct monthly earnings estimates.
ssa s primary sources of wage verification
SSA’s Primary Sources of Wage Verification
  • Pay Stubs (or equivalent) - Copies are permitted in most cases.
  • Disability Control File (DCF) Verified Monthly Earnings – If the wages were previously reported and are posted to the DCF no further verification is needed.
  • Supplemental Security Income Record (SSR) Verified Monthly Earnings – Be careful to count wages when EARNED, not when received.
  • Monthly Wage Verification from Employer – This includes direct contact with the employer or using The Work Number, Verify Job System and Verify Direct.
what to do when preferred sources of verification do not exist
What to do when Preferred Sources of Verification DO NOT Exist
  • If the beneficiary has NO record of monthly wages and it is not possible to get this information directly from the employer, CWICs must work with SSA to develop secondary sources of wage verification.
  • Secondary sources generally only provide ANNUAL earnings figures instead of monthly amounts.
  • Check first to see if SSA has access to annual wage information from within its own system.
  • If nothing is available, the CWIC will need to work directly with the beneficiary to try to gather annual wage information.
secondary sources of verification
Secondary Sources of Verification

Some sources available to SSA include:

  • The Detailed Earnings Query (DEQY) - lists yearly earnings by employer;
  • Disability Control File (DCF) unverified monthly wage postings;
  • Online Child Support Enforcement postings;
  • Earnings report from reliable governmental sources (worker’s compensation, Unemployment Insurance, etc.)

Sources CWICs may need to help with include:

  • W-2 Forms, 1099 Forms or completed tax returns;
  • Last pay stub for a year from employers that lists year-to-date earnings; and
  • Earnings reports from another reliable source (VR agency, EN, supported employment provider, One-Stop Center, etc.)
verifying self employment income
Verifying Self-Employment Income
  • SSA uses annual tax returns to verify self-employment income (SEI).
  • SSA counts NET earnings from self-employment (NESE) which is the profit from the business multiplied by a factor of .9235 to account for the extra self-employment tax .
  • To determine SGA, SSA will average the COUNTABLE NESE (less work incentives) over the number of months the beneficiary operated the business in the year.
  • Month-by month verification of SEI is only necessary during the TWP. Remember that TWP months are used if the beneficiary works in the business for 80 or more hours, regardless of earnings.
missing wage data
Missing Wage Data
  • When no monthly breakdowns are available or there are gaps in wage data, CWICs need to help beneficiaries reconstruct monthly earnings. The goal is to make the most accurate estimate using the information available.
  • See POMS DI 10505.005, for detailed instructions on ways to reconstruct monthly wages using partial information.
  • If there is not enough information to reconstruct monthly earnings, SSA will divide the gross countable annual wages by the number of months the beneficiary alleges he/she worked in that year.
how ssa reconstructs wage data
How SSA Reconstructs Wage Data

If all the beneficiary knows is the wage rate and the months worked, SSA reconstructs monthly wages in this manner:

  • Multiply the wage rate by 173 (average monthly hours for full time work); or if work was part time, establish an estimated number of hours worked per month. For example, if the beneficiary indicates half time work, use 173/2 = 86.5 hours per month.
  • Multiply the monthly estimate by the number of months worked in the year and compare this figure to the verified annual wages. Reconcile or adjust monthly estimates as necessary.
more wage reconstruction strategies
More Wage Reconstruction Strategies
  • If the beneficiary can only provide an hourly wage rate, SSA determines the approximate hours worked by dividing the verified annual wages by the rate. They divide this figure by the number of months the beneficiary alleges he/she worked to establish a monthly estimate.
  • If a weekly wage rate can be determined, SSA multiplies this by 4.333 to determine estimated monthly wages. SSA will reconcile this with verified annual earnings and adjust as necessary.
verifying wages that are more than 4 years old
Verifying Wages That Are More Than 4 Years Old
  • If no verified wage information is in the DCF or the SSR and the beneficiary has not retained pay records, SSA assumes that old wages will not be easily verified through employer contact.
  • CWICs should still instruct the beneficiary to contact the employer (if possible) to retrieve month-by month wage data or use any preferred source of wage data.
  • If this is not possible, CWICs should advise on other ways to collect wage information from secondary sources.
  • It is important to collect the most accurate data possible to avoid incorrect TWP/SGA determinations.
tips for developing accurate wage data
Tips for Developing Accurate Wage Data
  • Remember to develop wages when they are EARNED, not when they are PAID. Data from pay stubs may have to be divided by the number of days worked.
  • In-kind items received in lieu of pay are counted as earned income.
  • Countable earnings do NOT include sick pay, vacation pay, reimbursement for business expenses or any other income that is NOT remuneration for work performed.
  • Be careful with self-employment cases. SSA counts NESE, not gross income from the business. Ask about number of hours worked to determine TWP months.
cwic role in determining usage of twp and epe months
CWIC Role in Determining Usage of TWP and EPE Months
  • Estimating TWP and EPE months
  • Examine work activity month-by-month—don’t assume!
  • Understand that TWP information on BPQY is only what SSA knows from beneficiary reports—SSA does not assume TWP and EPE use.
  • Use tracking chart to demonstrate TWP and EPE use as part of BS&A.
what to do if wages appear to be sga
What to do if Wages Appear to be SGA
  • If the evidence is clear that gross wages are below the SGA guideline, no further development is necessary. Wage information may be sent to SSA for TWP analysis.
  • If earnings are over the SGA guideline, check for work incentives potential (Unsuccessful Work Attempts, Impairment Related Work Expenses, Subsidy or Special Conditions).
  • Interview the beneficiary using the 820/821 forms to detect potential for work incentives usage. Give examples to help the beneficiary understand what information the forms are seeking. Further development may be necessary in some cases.
identifying potential unsuccessful work attempt uwa cases
Identifying Potential Unsuccessful Work Attempt (UWA) Cases
  • Watch for short periods of SGA level wages (1-6 months) with breaks in between.
  • More than 6 months of SGA level work cannot be UWA.
  • Ask beneficiaries about breaks in SGA level work – what happened to cause the wages to stop or be reduced?
  • Remember that the UWA criteria for work lasting 0-3 months is less stringent than the criteria which applies to work lasting 4-6 months. More development will be required for the 4-6 month cases.
  • Document the reason for the break in employment on the SSA 820/821 use additional comments space to explain as needed.
developing irwes
Developing IRWEs
  • Ask beneficiaries about expenses they incurred because of working that are related to the disability – give examples and ask probing questions!
  • Remember that the list of IRWEs in the POMS is not all-inclusive. If an expense seems to meet all 5 criteria for an IRWE, help the beneficiary submit the IRWE evidence to SSA for a determination.
  • There is no required IRWE request form. Use the template on the VCU NTC website to describe the IRWE, or simply help the beneficiary write a description and attach it to the 820/821 .
developing subsidy special conditions
Developing Subsidy & Special Conditions
  • Start by going through the questions on the SSA 820/821.
  • If an employer-based subsidy appears to be in evidence, use the SSA 3033 to gather more information from the employer.
  • Help the beneficiary get the SSA 3033 form completed by the employer. CWICs may need to talk directly to the employer, but ONLY with a signed release from the beneficiary (signed 820/821 meets this requirement)
  • If special conditions are in evidence, the beneficiary may need to gather information from the agency providing services. CWICs should assist as needed.
reminders about work cdrs and sga determinations
Reminders about Work CDRs and SGA Determinations
  • CWICs assist with providing the information needed for TWP/SGA determinations, but only SSA can make these determinations.
  • Help the beneficiary understand what to expect in terms of TWP/EPE usage and whether work is likely to be considered SGA.
  • The beneficiary must be actively engaged in verifying wages and developing work incentives – the CWIC cannot do this in isolation.
  • CWICs must be mindful of their ethical obligations when helping beneficiaries develop and document past work activity.
final words
Final Words
  • Developing past work is a critical part of a CWIC’s job.
  • Developing past work must be done in close collaboration with SSA and the beneficiary.
  • If past work is undeveloped, there is no way to know which work incentives remain available to a beneficiary.
  • Full BS&A development cannot occur until all past work has been thoroughly examined and work incentives usage verified.
  • CWICs must complete this work with all due diligence – no shortcuts!