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APPENDIX C
SSA's FUNCTIONS AND INFORMATION FLOWS
1
.
This appendix is organized by the types of services that the Social Security
Administration (SSA) performs. These services are carried out through a variety of physical
facilities that include:
.
Approximately 1,300 district offices (DOB)
37 teleservice centers (TSCs), including 4 megasites
10 regional offices
6 program service centers (PSCs)
3 data operation centers (DOCs)
132 hearing offices
The Title XVI Folder Servicing Operation
A headquarters complex which separately houses:
-
l
the central management/administrative/staff components
the Office of Central Records Operations
the National Computer Center (NCC)
the Office of Disability and International Operations (ODIO)
MAJOR SERVICES
Most services provided by the SSA involve more than one of these facilities. The SSA
also interacts with other federal and state agencies such as the U.S. Department of the
Treasury, the Internal Revenue Service (IRS), State Disability Determination Services, and the
Health Care Financing Administration (HCFA) for Medicare payments.
In the following sections we list the major services that the SSA's computer systems must
support with an indication of how the task is carried out, which facilities are currently
involved, and the associated volume of work. We have identified 17 different types of tasks.
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Getting a Social Security Number
The process of getting a social security number (SSN) is called enumeration. The current
standard method for obtaining one requires that every applicant must provide the SSA with
evidence of age, identity and U.S. citizenship or lawful alien status. In aciciition, any
individual age 18 or older must consent to a face-to-face interview with a SSA staff when
applying for a new number.
Increasingly, enumeration of newborns is being done through a process by which parents
elect to apply for a SSN for their newborns as part of the birth registration process. If
parents choose to use this process, the states provide certain basic identifying information to
the SSA electronically, an SSN is assigned, and a card is mailed to the parents. Currently,
SSNs can be secured through the enumeration-at-birth (EAB) service in 38 states. EAB will
be fully operational in ~ more states by early 1990. California will begin participation in
1991; the remaining 3 States are still evaluating their position.
As of 198S, the SSA had issuer! 326,850,000 SSNs. The typical yearly enumeration
workload is 12 million to 13 million requests; approximately 40 percent of these requests are
for assignment of a new SSN. In fiscal year 198S, changes in the tax laws that required
enumeration of dependents significantly increased the enumeration workload: about 23
million requests for social security cards were processed that year. Workloads are expected to
stabilize back to typical levels after 1990.
Getting an SSN is now done by an on-line entry of a request to a batch program.
Applicants usually receive their card in 2 weeks. This function is a candidate for full on-
line validation and processing of the requests, even though the actual document would still
have to be mailed to the applicant's residence.
Card Replacement and Information Updates
More than half of the enumeration workload involves requests for replacement SSN cards
to reflect name changes or to replace cards that have been lost or damaged. Application for
replacement cards can be obtained by phone or by visiting a field office. Since the applicant's
identity must be verified, the applicant must either visit a field office or mail to the office
original proof of identity. Field office personnel make an on-line request for a replacement
card to be issued. The requests are processed in batch mode at the NCC and the new card is
mailed from the NCC within a few days.
Obtaining General Information
Information such as brochures on benefits or procedures can be obtainer! from field
offices or by using the national 800 telephone number to reach a teleservice center (TSC).
During high call periods, TSCs collocated with district offices (DOB) may use DO personnel
to handle some of the telephone workload. In addition, calls received by a TSC during a
period of high local workloads may be switched to remote TSCs. However, personnel at the
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remote TSCs may not be as well informed about specific local questions. For example,
questions about the black lung program resulted in a sizable workload in West Virginia but
are rare in other states.
there are public
~ . . ~ . .
The demand for general information increases greatly when
announcements or legislative changes, but the request rate is reduced when users tong the lines
busy. The general information workload is difficult to predict, but it can be a significant
burden to the available telephone line facilities. It can overload access circuits, increasing the
rate of busy signals, which lead to customer dissatisfaction.
Crediting of Earnings Records
The SSA must maintain accurate records of an individuals earnings in order to determine
both eligibility for program benefits and benefit payment amounts. At present the SSA
maintains over 332 million separate earnings records in its master earnings file. Over 10p
million accesses are made to this file every year for processing claims, responding to requests
for earnings statements, and for other activities.
The Agency obtains earnings information by processing the data submitted by employers
as required by Internal Revenue Service (IRS) form W-3, which is a summary of the
information individuals received from their employers on IRS form W-2. The SSA processes
all W-3 information for transmittal to the IRS including information on FICA contributions
paid. The SSA records data about the wage and selfemployment income for which FICA
contributions are due, as well as noncovered earnings, pension payments, and other non-FICA
information. W-3 data may be submitted by employers on magnetic media or on paper forms.
Paper W-3's are sent to the DOCs for scanning or keying to magnetic tape; the information is
then transmitted to the NCC for processing. Data on magnetic media are received directly by
the NCC. Approximately 235 million wage items were processed in fiscal year 1988. Of these,
148 million were reported on magnetic media, and 87 million were on forms W-3.
Wage amounts are posted to the employee's earning record on an annual basis. Earnings
reports are due to SSA by January 30 of the year following the year in which earnings were
paid but a 30 day grace period is permitted before earnings reports are considered late. The
posting of these earnings is now accomplished by July of the same year, 5 months after the
last annual earnings report is received in February. Earnings reports received late from
employers may not be posted on time. In addition, earnings postings are subject to correction
as past tax records are corrected. Public Law 95-216, enacted in December 1977, was
responsible for changing the agency's earnings reporting requirements from quarterly to
annually.
Earnings records containing yearly total earnings are accessible on-line for the years 1951
to the present. Detailed records containing a breakdown of earnings under different
employers are accessible on-line for 1978 to the present. Earnings before 1951 are not on-
line; however, the importance of pre-1951 information is diminishing.
Because wage amounts are posted in the year following the one in which they are earned,
neither the last nor current yearns earnings may be available when a retirement claim is made.
If a claimant has not accumulated enough quarters of coverage to qualify for benefits unless
the current yearns earnings are credited to his/her record, these earnings must be documented
separately. In addition, the use of current earnings levels in the computation of benefits may
result in a higher benefit amount.
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Determination of Medicare Part A Payments
The apportionment of monies to the three SSA trust funds--Olci Age and Survivors
Insurance (OASI), Disability Insurance (DI), ant! Health Insurance (HI)--is prescribed by law
on the basis of total wages reported. Certification of total wage amounts reported is made to
the Secretary of the Treasury. This information is shared with the HCFA, in effect providing
them with information concerning Medicare Part A payments.
Obtaining Benefit Estimates
In order to assist inclividuals in planning for their retirement, the SSA provides benefit
estimates on request. Generally, benefit estimates are provided through two mechanisms:
1.
2.
The Personal Earnings and Benef it Statement (PEBES)--This service provides
individuals with a record of their earnings to date and an estimate of retirement,
disability, and survivors' benefits. The disability and-survivors' benefit estimates
assume a current death or onset of disability and are based on posted earnings;
anti the requester's projected
retirement estimates use both the posted earnings
future earnings.
The service is initiated by submitting a completed form SSA-7004-PC-OPR to the
SSA. An SSN holder can request the form via the SSA's national 800 telephone
number or can obtain it from any of the SSA's district offices. Completed forms are
mailed by the SSN holder to one of the SSA's three DOCs. The DOC keys the
information in a batch process and transmits it to the NCC overnight using a remote
job entry (RJE) service. The NCC processes the data and sends the information to
a contractor, who prints and mails the PEBES to the SSN holder.
Although the capability exists for personnel in a modern DO to enter the request on-
line for immediate processing at the NCC, this service is not made available to the
public because of processing capacity limitations at the NCC.
Before the introduction of PEBES, the average yearly number of requests for
earnings statements from individuals was 3.3 million. In the first 7 months of fiscal
year 1989, the SSA received 4.6 million requests for PEBES.
Pre-retirement processing at DOs--Individuals who are close to retirement age may
contact an SSA office to find out what benefit payment they can expect to receive
when they retire. Getting immediate complete benefit payment information is not
always possible, since, as explained above, current year earnings must be documented
separately and pre-1951 earnings are not on-line. However, a DO can provide an
unedited earnings summary, allowing an inquirer to verify that earnings were posted
correctly, and does, of course, determine the exact amount of a benefit payment
during the development of a claim once one has been fileci.
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Initiating Retirement Benefits
This process normally begins when an applicant for OASI benefits calls or visits an SSA
office. Although many individuals still prefer to visit an office for assistance, most initial
OASI claims can be handled through telephone and mail contact. To establish a claim each
person must file an application and submit the evidence needed to establish entitlement (em.,
evidence of identity, age, marriage, divorce, and current year earnings).
In 1988? the SSA received 3.1 million OASI applications for workers and family members.
There were 38.6 million OASDI beneficiaries as of ' September 30, 1988; of these, 34.5 million
receiver! OASI benefits. The beneficiary population is expected to increase during the next
20 years as life expectancies increase end' baby boomers reach retirement age.
All fielc! offices have access to a modernized claims system (MCS), which provides for
automated entry and control of claims data. Approximately 99 percent of all initial claims
can be taken using the MCS screens. Of these 99 percent, approximately 80 to 85 percent can
be completely adjudicated in MCS; that is, the SSA can collect all application data, control the
development process, ant! trigger an award or disallowance in the Claims Automated
Processing System (CAPS). The other 15 or 20 percent of claims taken through MCS require
that adjudication be triggered via a paper form.
Field' offices 'now have final authority to authorize award/disallowance on 99 percent of
claims, with the other I percent requiring authorization in a processing center. Claims such
as those involving clual entitlement are typically processed through the Manual Adjustment,
Credit and Award Process (MADCAP), usually triggered via a paper input document from the
processing center.
Disability Claims
Individuals who have earned sufficient quarters of coverage and who meet the definition
of being disabled under Title IT of the Social Security Act are eligible for benefit payments
under the DI program. Because eligibility for benefits is partially based medical information,
which is subject to interpretation, the adjudication of disability benefits is more complex than
of OASI benefits. "
As in OASI claims, an applicant for Disability Insurance (DI) applies for benefits with
the SSA, which determines if the applicant's work record qualifies him or her for disability
benefits. The state Disability Determination Section (DDS) requests medical evidence and
makes the initial determination of disability. Once all determinations of eligibility have been
made, the DO triggers payment of benefits (or a disallowance notice) via an automated system.
In most cases, before entitlement to disability benefits can begin, the applicant must serve a
waiting period of 5 full calendar months, during which time no benefits are paid.
Claimants who are dissatisfied with the disability decision maple in their case can avail
themselves of an appeals process. Reconsideration of the case by the DDS is the first of four
levels of administrative appeal available to the claimant. After administrative appeals have
been exhausted, the claimant may' take his or her case to the appeal. The following is an
approximate breakdown of the disposition of the initial claims received in fiscal year 1988:
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36%
35%
15%
14%
100%
Approved
Disapproved and not appealed
Disapproved, appealed and denied
Disapproved, appealed and granted
Records are established and maintained on the SSA's Master Beneficiary Record for disability
beneficiaries by the CAPS and MADCAP systems, as they are for OASI beneficiaries. The
paper folders that document their claims, however, are maintained by the Office of Disability
Operations until the beneficiary reaches age 59, at which time the folder is transferred to the
PSC. A DI beneficiary's benefits are converted from DI to OAST when the beneficiary attains
age 65.
After an individual is determined to be disabled, the law requires a periodic review to
determine whether the individual continues to be disabled. These continuing disability
reviews (CDRs) are scheduled based on the likelihood of medical improvement. If
improvement is expected, a CDR is generally scheduled between 6 and 24 months after
entitlement. If improvement is possible but not predictable (most cases), a CDR is set for 3
years after entitlement. If improvement is not expected a CDR is set for seven years from
entitlement. The beneficiary and medical sources are contacted for evidence, and the DDS
determines whether disability continues or has ceased. If disability continues another CDR
is set. When a CDR is due the case is system controlled and alerts are generated for individual
states based on budgeted workloads. The reviews themselves are done manually requiring
folder movement, beneficiary and medical source contact, and evaluation of evidence. In
fiscal year 1989 the SSA did 337,000 medical CDRs. In addition, 29,000 work issue CDRs were
performed to determine whether these individuals had returned to work at a level indicating
substantial gainful activity.
In fiscal year 198S, 1.2 million workers applied for DI benefits; there were 4.1 million DI
beneficiaries in the same year. Approximately 23 percent of these beneficiaries receive their
payments through a representative payee.
Supplementary Security Income
The SSA also administers Title XVI of the Social Security Act to ensure a minimum level
of income for needy aged, blind, and disabled people. Federal funding for this program, the
Supplemental Security Income (SSI) program, comes from general revenues rather than from
the social security trust funds. The federal payment rate and eligibility requirements are
uniform nationwide, but almost all states provide supplements, at varying rates, to the federal
oavment. In fiscal Year 1988 nearly 1.3 million SSI applications were taken bY the SSA. At
the end of that year, there were 4.5 million Title XVI beget iciaries, over 66 percent of whom
were blind and/or disabled. Payments in calendar year 1988 totaled $13.8 billion; of this
amount, $10.S billion came from federal funds and $3.0 billion from state supplemental funds.
Because eligibility for the SSI program is based on need rather than a person's history of
Includes all levels of appeals, beginning with reconsideration
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earnings as documented in SSA's records, establishment of eligibility can be much more
complex under Title XV] than under Title II. In addition, the SSA must redetermine payee
eligibility on a periodic basis. This is done in a variety of ways, ranging from payee
completion of a simple form to complete reverification of eligibility by field office personnel.
In the case of the needy disabled, the disability determination process is the same as that
used for disabled claimants under Title XVI.
The SSI system is automated for both claims and postentitlement actions. However, input
data for the claims process (and certain other processes) are still captured on paper forms and
transcribed for data entry in coded format. In addition, programmatic software code has not
been modernized. The SSA is currently developing the functional requirements for a
modernized SST system.
The SST master file, called the Supplemental Security Record (SSR), is distinct from the
master file of Title lI beneficiaries (the MBR). A new copy of the file is sent to the Treasury
Department each month. An annual crosscheck flags individuals listed in multiple payment
systems.
Dependents' Benefits
If a retiree has an eligible spouse and/or children, each eligible family member can
receive a payment based on the retiree's earnings. Children are eligible up to age IS or to any
age if the child was disabled before attaining age 22. Disabled widow~er) over age 50 may
also be eligible on a deceased beneficiary's record. This results in a higher total payment to
the family than would accrue to the retiree alone. When the spouse is eligible for retirement
benefits based on his or her own earnings record as well as that of the retiree, benefits are
computed on both records. If the SSA determines that the spouse would receive more benefits
if entitled on the retiree's record alone, the spouse receives his or her own benefit payment
plus an amount which when added to this payment will make the spousal payment equal to
what he or she would have received if entitled to benefits solely on the retirees record. This
action ensures that the spouse receives the highest benefit for which he or she is eligible.
In cases such as these, where a comparison of two individual~records is needed, manual
processing is usually necessary through the MADCAP system. On-line access to multiple
earnings records facilitates the computation.
Benefits may also be paid to eligible dependents in the case of the death or disability of
the covered individual. The most common case is one in which the retiree dies and leaves a
surviving wife. These cases are processed through the MADCAP system. Most of them are
finally adjudicated at the DO, although some very complex cases and some involving systems
alerts will be forwarded to a processing center for adjudication. The results of the processing
are entered into the automated system; if changes in the status of the case arise subsequently,
a manual recomputation is required.
Medicare Part B Funds Processing
The SSA withholds the premiums for Medicare Part B from the benefit payments of
individuals who have chosen Part B coverage and who are in current pay status. The records
are flagged, and several batch processing programs at the NCC perform funds transfer
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documentation and reconciliation. Premiums from individuals who are in conditional,
deferred, or uninsured status are collected by HCFA through its seperate operations for
billing entitlement and remittances (SOBER) billing system.
Updating Postentitlement Personal Information
Information that affects entitlement to benefits, benefit payment amount, or receipt of
payment must be reported to the SSA. Types of postentitlement information normally
reported include the following:
.
.
Changes in name or address
· Changes in marital status
Requests for electronic funds transfer or changes in EFT account
information
· Post-entitlement earnings
Changes in status of dependents
· Notification of death
.
The SSA's postentitlement workload also includes responding to inquiries from
beneficiaries.
Beneficiaries may contact the SSA by phone, by mail, or by visiting a field office. Most
phone reports/inquiries are received and handled by personnel at the teleservice center (TSCs).
If a postentitlement event can be handled with a system input, the teleservice representative
(TSR) handles it to completion. If the event will require extensive development, the TSR
refers the item to a field office by administrative message.
Personnel in both field offices and TSCs make nearly all inputs to the system
interactively. However, while the on-line transactions access the master files as part of the
data collection process, most on-line transactions do not directly modify the SSA's databases.
Rather, they update on-line pending files that feed batch update processes. Most of the SSA's
master files are updated on a daily basis. The only exceptions to the batch update processes
are certain critical systems that require immediate update to their databases. In addition, the
DDS database is updated on-line by the states DDSs.
The SSA's automated master files are maintained at the NCC. Two backup tape copies
are created: one is kept at the NCC, and the other is kept off-site in a secure facility.
Some postentitlement information reports result in documentation in the claims folder
as well as modification of the database. The SSA has over 70 million active and inactive
claims folders. High-activity folders remain in SSA office space (merged files) at the
processing centers. Low-activity folders are maintained in SSA warehouse space or in record
centers managed by the National Archives and Records Administration (NARA) (active files).
Folders are maintained in merged or active file space until all beneficiaries are no longer
currently entitled to benefits. At that time the folders are put in archive storage at an NARA
site pending eventual destruction. Postentitlement access to low-activity files number
approximately 7 million per year.
c,
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-Cost-of-Living Adjustments
Nearly all benefits payment records must be modified to reflect annual cost-of-living
adjustments. These adjustments, which used- to take 2 continuous weeks of automated
processing, are now accomplished in 24 hours. The processing is wholly performed at the
NCC.
Check Production
Benefits are paid monthly to over 40 million beneficiaries. Magnetic tapes that document
new payment records ant! changes to existing payment records to be made to beneficiaries are
sent monthly to the U.S. Department of Treasury. The Treasury processes the tapes against
copies of master payment tapes that it maintains. Payments are made by the Treasury in
check form or by EFT, as desirer! by the beneficiary. The number of OASDI benefit payments
maple by EFT was 16.6 million in 1986, or 44.1 percent. As of July 1989, 48.2 percent of
OASDI ant! 16.4 percent of SSI payments were made by EFT.
Beneficiaries continue to receive payments until a "delete" request from the SSA is
processed by the Treasury. Should a processing failure occur at the NCC, payment tapes from
the previous month would be used by the Treasury to issue payments. Since these tapes would
not reflect any changes made during the current month, overpayents anti underpayments
would result. Such incorrect payments wouic! be corrected as soon as updated payment tapes
could be produced by the SSA.
Payment Inquiries
Inquiries regarding missing or incorrect payments are directed to the DOs or the TSCs
by calling the 800 number telephone service. Because payments are made on a monthly basis
and since inquiries generally are received soon after payments are made, this workload is very
cyclic.
Information about Death from State Records
The SSA obtains information from states concerning the deaths of beneficiaries using
an automated State death-match operation. This data exchange helps the SSA ensure that it
does not continue to make benefit payments to deceased beneficiaries.
Handling of Overpayments and Underpayments
Of the over 400 million payments made in 1986, approximately 3.6 million were incorrect.
Overpayments and underpayments are caused by a number of factors. Many payment amounts
are incorrect because reports of changes in beneficiary status are sometimes incorrect, delayed,
or not received. Chief among the types of information whose receipt affects payment amounts
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are notification of death, changes in status of surviving dependents, and reports of
beneficiary earnings.2 In addition, delays and errors within the SSA's processes and revisions
of disability claims determinations after appeal can result in overpayments and
underpayments.
Numerous remedies for overpayments are available including offset of benefit payments
(for current beneficiaries). Collection efforts for overpayments are made by debt collection
staffs at the PSCs, primarily using manual collection methods. Debt collection workloads are
directly dependent on the volume of incorrect payments.
2Legislation sets limits on the amounts a beneficiary may earn before his or her benefits
are affected. The 19901imits are as follows:
Monthly Annually
Age 65 and older $780 $9~360
Under age 65 $570 $6,840
. .,
Representative terms from entire chapter:
field office
