The Agency has adopted alternative signature methods to the traditional signature. For redetermination (RZ) processing the two approved signature alternatives are attestation and witnessed signature. Alternative signature methods are used in the Consolidated Claims Experience (CCE). RZs completed by third parties, other than representative payees, are excluded from the alternative signature process. Alternative signature methods cannot be used with cases excluded from CCE. For these cases the signed paper RZ form must be retained.
NOTE: All references to redeterminations and/or RZs also apply to amendments to redeterminations.Witnessed signature is the action taken by an Agency employee of annotating CCE that they received a paper redetermination or amendment with a signature, and the SSI individual had not previously signed the RZ by attestation. Once the annotation is made, the signed paper form is not retained in the RZ file. Instead, it is returned to the individual with the appropriate cover notice.
For personal contact RZs (SI 02305.031A.) the interviewer:
confirms the SSI individual's intent to complete and sign the RZ; provides a copy and reviews the penalty clause; andattests to the individual's agreement to sign the RZ by annotating the ATTEST issue in CCE per SI 02305.003E.
The act of attesting to these facts is documentation of the individual's signature. Attestation is deemed equivalent to a wet signature.
When a paper or printout RZ is filed with a signature and the SSI individual has not previously signed the application or another RZ by attestation, an Agency employee will annotate CCE by receipting in the ATTEST issue in the Development Worksheet page.. This documents that the employee received the RZ form containing a signature. The electronic annotation is deemed equivalent to a signature. Once the annotation is made, the signed paper form is not retained in the RZ folder. The form is returned to the individual with the appropriate cover notice.
Use attestation as the signature for RZs processed through the CCE. If the SSI individual or representative payee insists on signing the RZ with a signature (or if you have a “wet” signature RZ initiated prior to 11/20/2004), follow witnessed signature procedures once you receive the signed RZ. See SI 02305.003D.
Print a cover notice with the RZ summary ONLY when requesting evidence. See GN 00201.015F.1.f.
Interviewer responsibilities are the same for RZs as they are in Title XVI applications. Interviewers must:
Inform SSI individuals that a signature is no longer required for personal contact (SI 02305.031A.) RZs processed in CCE.
the individual's intent to provide requested information to the Agency to enable the Agency to determine continuing SSI eligibility; and
the information the individual supplied is correct under penalty of perjury; and the individual's agreement to sign the RZ form. Read the scripted language in SI 02305.003F.2 and SI 02305.003F.3. Confirm the individual's intent to complete and sign the RZ. Complete the RZ form.Review the penalty of perjury language with the individual SI 02305.003F.3.
Provide the individual with a copy of the RZ cover notice (see SI 02305.003G.1.) containing the penalty of perjury language. This RZ cover notice can be printed from the Print Options (Printing and Signatures page) page..
NOTE: Print an automated personalized cover notice with the RZ summary ONLY if you are requesting evidence.
You must print the RZ cover notice before you post the receipt of the RZ. If you do not, you will not be able to print the RZ personalized cover notice from the Printing and Signatures page; you will have to prepare a Document processing system (DPS) notice instead.
Start of the interview
“During this interview, we are going to ask you questions to make sure that you/name of recipient still qualify (qualifies if name of recipient is used) for SSI benefits. At the end of the interview we will ask you to confirm the truthfulness of your answers under penalty of perjury. We will record your response. You should be aware that you can be held legally responsible if you give us false or misleading information.”
End of the interview — Review of printed output
“Here is a printed copy of the information that will be used to determine if you/name of recipient still qualify (qualifies if name of recipient is used) for SSI benefits. Please review all the information carefully and let us know right away if anything needs to be corrected or if any of the information changes.”
Obtain affirmation of the individual's intent to complete the RZ form and their understanding of the penalty clause
“Do you understand that the information you gave us and that you examined will be used to determine if you/name of recipient still qualify (qualifies if name of recipient is used) for SSI? Do you declare under penalty of perjury that this information is true and correct to the best of your knowledge?”
Start of the interview
"Durante esta entrevista, le haremos preguntas para asegurarnos que [usted/elnombre de la persona que recibe beneficios] continua teniendo derecho a losbeneficios de Seguridad de Ingreso Suplementario. Al finalizar la entrevista,le pediremos que confirme la veracidad de sus respuestas bajo pena de perjurioy registraremos su respuesta. Usted debe estar consciente de que puede ser considerado legalmente responsablesi nos brinda información falsa o fraudulenta."
End of the interview — Review of printed output
“Aquí esta una copia impresa de la información que se usará para determinar si [usted/el nombre de la persona que recibe beneficios] continúa teniendo derecho a los beneficios de Seguridad de Ingreso Suplementario (SSI). Por favor, revise toda la información cuidadosamente y déjenos saber inmediatamente si algún dato necesita corrección o alguna información cambia."
Obtain affirmation of the individual's intent to complete the RZ form and their understanding of the penalty clause
“¿Entiende usted que la información que nos ha dado y ha examinado será usada para determinar si [usted/el nombre de la persona que recibe beneficios] continúa teniendo derecho a los beneficios de Seguridad de Ingreso Suplementario (SSI)? ¿Declara usted bajo pena de perjurio que esta información es cierta y correcta según su mejor entendimiento?"
Start of the interview
“During this interview, we are going to ask you questions to make sure that you/name of recipient still qualify (qualifies if name of recipient is used) for SSI benefits. At the end of the interview we will ask you to confirm the truthfulness of your answers under penalty of perjury. We will record your response. You should be aware that you can be held legally responsible if you give us false or misleading information.”
End of the interview — Review of printed output
“You will receive a printed copy of the information that will be used to determine if you/name of recipient still qualify (qualifies if name of recipient is used) for SSI benefits. Retain this summary for your records. Review all the information carefully and let us know right away if anything needs to be corrected or if any of the information changes.”
Obtain affirmation of the individual's intent to complete the RZ form and their understanding of the penalty clause
“Do you understand that the information you have provided will be used to determine if you/name of recipient still qualify (qualifies if name of recipient is used) for SSI? Do you declare under penalty of perjury that this information is true and correct to the best of your knowledge?”
Start of the interview
“"Durante esta entrevista, le haremos preguntas para asegurarnos que [usted/el nombre de la persona que recibe beneficios] continúa teniendo derecho a los beneficios de Seguridad de Ingreso Suplementario (SSI). Al finalizar la entrevista, le pediremos que confirme la veracidad de sus respuestas bajo pena de perjurio y registraremos su respuesta. Usted debe estar consciente de que puede ser considerado legalmente responsable si nos da información falsa o fradulenta."
End of the interview — Review of printed output
"Usted recibirá una copia impresa de la información que se usará para determinar si [usted/el nombre de la persona que recibe beneficios] continúa teniendo derecho a los beneficios de Seguridad de Ingreso Suplementario (SSI). Guarde esta copia en sus archivos. ¿Entiende usted que debe revisar toda esta información cuidadosamente y nos debe avisar inmediatamente si algo necesita ser corregido o si alguna información cambia?"
Obtain affirmation of the individual's intent to complete the RZ form and their understanding of the penalty clause
“¿Entiende usted que la información que nos ha brindado será usada para determinar si [usted/el nombre de la persona que recibe beneficios] continúa teniendo derecho a los beneficios de Seguridad de Ingreso Suplementario (SSI)? ¿Declara usted bajo pena de perjurio que esta información es cierta y correcta según su mejor entendimiento?"
The ATTEST issue automatically propagates to the Development Worksheet and should be receipted in with the date of the attestation interview. Based on your personal identification number (PIN), the first six letters of your surname and first initial will propagate to the Remarks section of the Development Worksheet page. The ATTEST issue and your name will be retained electronically in the REMARKS field of the ATTEST issue. This will be deemed the equivalent of the individual's signature on the RZ form.
When a signature is received, annotate the Development Worksheet by receipting the ATTEST issue. Return the signed RZ form to the SSI individual. Use the witnessed signature RZ cover notice (See SI 02305.003G.2.). This RZ cover notice informs the individual that the Agency will not retain the paper RZ form.
When the SSI individual/payee makes changes or corrections to the RZ summary and answers affecting payment amount or eligibility are changed, an amendment is required. See the list below. Printing an amendment for other changes is not required.
Following is a list of changes that require an amendment: