Transcript Department of Special Education and Disability Policy

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;
• 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
• 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 selfemployment.
• 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
• 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
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
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
• 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
• 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
• 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
1. Pay Stubs (or equivalent) - Copies are permitted in
most cases.
2. Disability Control File (DCF) Verified Monthly Earnings –
If the wages were previously reported and are posted
to the DCF no further verification is needed.
3. Supplemental Security Income Record (SSR) Verified
Monthly Earnings – Be careful to count wages when
EARNED, not when received.
4. 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
• 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
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
• 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
• 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
If all the beneficiary knows is the wage rate and the
months worked, SSA reconstructs monthly wages in this
manner:
1.
2.
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
• 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
• 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
• 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
• 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
• 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
• 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
• 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 allinclusive. 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
• 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
• 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
• 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!