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HomeMy WebLinkAboutMINUTES - 03081988 - 1.3 (2) s Ute, tQ BOARD OF SUPERVISORS FROM: Ernest E. Bradford Veterans Service Officer Vx)sLQ DATE: March 1, 1988 co 1� SUBJECT: SOCIAL SECURITY ADMINISTRATION AGREEMENT �vu SPECIFIC REQUESTS) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION Approve the attached agreement with the Commissioner of the Social Security Administration so that we may have access to certain Social Security information. Authorize Ernest E. Bradford, Veterans Service Officer, to sign the agreement. FINANCIAL IMPACT There are no additional county funds required. BACKGROUND We would like to enter into an agreement with the Social Security Administration so that we may have access to certain Social Security information. This is the type of agreement that the Social Service Department and other county offices already have. To make the agreement formal, we need to sign a contract (copy attached) . �r CONTINUED ON ATTACHMENT: __X YES S IGNATUR RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER S 1 GNATURE S ACTION OF BOARD ON APPROVED AS RECOMMENDED _X_ OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT its^ AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ORIG. : Veterans MAR Resources Center n D 8 ,�yQ� CC: Social SecurityAdministration ATTESTED County Administrator PHIL BATCHELOR, CLERK OF THE BOARD OF County Auditor SUPERVISORS AND COUNTY ADMINISTRATOR BY 382 783 M _ _ . -,DEPUTY RF!AGREEMENT !!� BETWEEN NOV 12 1987 C0141-IISSIONER OF THE SOCIAL SECURITY ADMINISTRATIOEiEN AND VRkN$ RESOURCES CENTS CONCORD, CALIFORNIA THE AGENCY KNOWN! AS Contra Costa County Veteran's RPRnurrp r.,xntgr. t Pursuant to section 1106(a) of the Social Security Act and Regulation No. 1 (20 CFR Part 401 ) , the Commissioner of the Social Security Administration, hereinafter referred to as the Commissioner, and the agency known as Contra Costa County Vete ' hereby agree to t e o owing: Article I DEFINITIONS For the purposes of this agreement - A. The tern "Commissioner" means the Commissioner of the Social Security Administration or delegate. B. The term "agency" means any agency of a Federal , State, political subdivision of a State (e.g. , county or borough) , or other local government that is responsible for the administration and conduct of an income maintenance or health maintenance program, and any non-governmental entity which conducts or administers such program on behalf of such a governmental agency. C. The term "disclosure" Means the release of information (data) with or without consent of the individuals about whom the information pertains. D. The terry, " health maintenance program" means a noncommercial program designed to provide an individual with nealth care (both prevention and treatment) or to subsidize the cost of such care (i.e. , Medicare, Medicaid) . NOTE: A commercial insurance company may administer such a program for a State or local agency. E. The term "income maintenance program" means a noncommercial program designed to provide an individual with basic necessities of life (e.g. , food, clothing, shelter, utilities) or to supplement the individual 's income to permit the purchase of such necessities (i.e. , subsidized housing, food stamps, AFDC, general assistance, Title XX services, energy assistance, worker's compensation, unemployment compensation, State supplementation) . Article II PURPOSE A. The agency and the Commissioner recognize the necessity of an efficient information exchange system between the agency and the Social Security Administration (SSA) . B. This agreement defines the third party query procedure as an integral part of the overall information exchange between the agency and SSA and requires that both parties will adhere to the following provisions. Article III i FUNCTIONS TO BE PERFORMED BY THE AGENCY The agency shall : A. provide SSA with the necessary identifying information concerriing those individuals about whom data are requested. Specific requirements for the request are discussed in the third party (TPQY) handbook (POMS SM 10802). B. Use TPQY information to determine eligibility. benefit amount and other elements of benefit status in income/health maintenance programs specified fn Article I . C. Not redisclose TPQY information outside of the agency without consent, as outlined in D. below. D. Obtain the signed and dated written consent of the individual , the legal guardian or parent of a minor, or the legal guardian of an adult declared incompetent by a court, for all redisclosures of TPQY information outside the agency. 1. Written consent must specify the items of information to be redisclosed by the agency and the period of time to which the consent applies, and must comply W th the provisions of 45 CFR . 5b.9(a) . 2. The consent statement will contain language approved by SSA and may be included as part of an application or other document. 3. The consent statement will be retained by the agency for a minimum of 2 years beyonc the life of consent statement. 4. If the individual in question is a minor, consent will be obtained from his or her parent or legal. guardian. If the individual in question is an adult whom a court has declared legally incompetent, consent will be obtained from his or her legal guardian. E. Permit SSA to make onsite inspections to ensure that adequate safeguards are being maintained. F. Perform such other functions as may be required by regulations or agreed upon by the Commissioner and agency which are necessary to carry out the provisions of this agreement. Article IV FUNCTIONS TO BE PERFORMED BY THE COMMISSIONER The .Commissioner shall : A. Permit disclosures of TPQY data to agencies for determining a recipient's eligibility, benefit amount or other elements of benefit status under income/health maintenance programs specified in Article I. f. e 3 B. Provide, based upon the agency's request, the information contained " in its records regarding individual 's social security number, social security eligibility, supplemental security income eligibility, benefit amounts, payment status, entitlement dates, termination dates, date of birth, date of death, Supplementary Medical Insurance option, Hospital ; Insurance option, and address. No tax return information will be disclosed. �. Not disclose to any individual or organization any information or records received from the agency. pursuant to the provisions of this agreement except as permitted by Federal law (e.g., section 1106 of the Social Security Act, the Privacy Act (5 U.S.C. 5520, the Freedom of Information Act (5 U.S.C. 522) , and regulations promulgated thereunder) . D. Perform such other functions as may be required by regulations or agreed upon by the Commissioner and the agency which are necessary to carry out the provision of this agreement. Article Y USE OF THIRD PARTY QUERY SYSTEM A. The TPQY system will be used to obtain payment and eligibility data for applicants and recipients of the health and income maintenance programs specified in Article I when BENDEX/SDX information is not available. B. The TPQY system will not entirely supplant the SSA-1610 (Public Assistance Agency Request for Information) presently used to request and cormunica u such information. The SSA-1610-U2 may be used by public assistance agencies: 1. To resolve any conflict between other evidence and data shown in the TPQY. files, e.g., an identification problem. 2. To secure retroactive historical data not provided by the TPQY. SSA offices will accept neither written nor telephone requests for SSA-1610-U2 information unless they fall within the exception categories above or involve emergency situations. Article VI OTHER DATA EXCHANGE SYSTEMS Participation in the TPQY system will not limit or exclude access to information properly obtainable through any other manual or automated system except as indicated in Article Y above. Use of the BENDEX/SDX systems should be considered before use of the TPQY system and should be considered the primary source of information. 4 Article VII CONFIDENTIAL NATURE AND LIMITATION$ ON USE OF INFORMATION AND RECORDS The Corivoissioner and the agency shall adopt policies and procedures to ensure that informa ton contained in their respective records and obtained from each other or from others in carrying out their functions under the Agreement shall be used and disclosed solely as provided in section 1106 of the Social Security Act,. the. Privacy Act of 1974, and the Freedom of Information Act, and regulations promulgated thereunder. It is agreed: 1. To restrict access to the data to only those authorized employees and officials who need it to perform their official duties in connection with intended programs; 2. To store the data in an area that is physically safe from access by unauthorized persons during duty hours as well as nonduty hours or when not in use; 3. To process the data under the immediate supervision and control of authorized personnel in a manner which will protect the confidentiality of the data, and in such a way that unauthorized persons cannot retrieve the data by means of computer, remote terminal , or anther means; 4. To advise all personnel who will have access to the data of the confidential nature of the information, the safeguards required to protect the information and civil sanctions for noncompliance contained in the Federal statutes and any relevant State statutes; and, S. To permit SSA to 'make onsite inspections to ensure that adequate safeguards are being maintained. Article VIII TERM OF AGREEMENT This agreement shall begin on and end on . It will automatically be renewed or successive periods of one year unless the agency gives written notice of its intention not to renew at least 60 days before the end of the current period. Article IX MODIFICATION AND TERMINATION OF AGREEMENT A. This agreement may be modified at any time by a written modification mutually. agreed upon by both parties. B. This agreement may be terminated at any time with the mutual Consent of both parties. Either party may singly terminate the agreement upon 90 days written notice to the other party. In witness whereof, the parties hereby execute this agreement this 19 . THE COMISSIDNER OF THE SOCIAL SECURITY ADMINISTRATION by (Title) Contra Costa County V4PranlsCenter . (Agency) _. by- e 2425 Bisso Lane, Suite 105 Concord CA 94520 (Address) - s Enclosure TIQT-B�Tt-tESP011SE* REC 1234567 ABC 12273 1234 M%5678910- ' /. MSG-1234567 M-06/14/64 TPQT Ali-123-45i789A ID-JO11 S PIZ 8D-001+ .�. STATUS hilt TSS . IAO-08/13/64 SSACCS-11O LM-08/13/44 Sit TU W-08/13/84 3, INPUT SOCIAL ISCGMSTY WOMM 123-45-6789A MANZ C -3 0-91 0S= COW 12345 ..,v "3RD PARTY Ci DY CONFIDII+TTIAL SOCIAL SWRITY DATA-CLAIM '1&i8 12S-45-6789A f; INDIVIDUALS OWN SOCIAL SECv1RM NUNBER: 123-45-47" . CLARA JONES FINALE TORN: 11/20/24 XXTITLiD:12/80 DM:12/03/84 7, WALTER JONES FOR CLARK JOKES 1200 MAIN ST VALLAS, n 75202 t. PATHM STATUS COM: C - MWITS PAID I MET MONTHLY BIWIT IT PATAUZ: $231.00 *v, SPECIAL PAT DATE: 10/83 PRIOR DOE AMO=: $474.30 N. SPECIAL MONTHLY PATXW: $209.00 BLACK 1AW PAMUNT STATUS CODE N-*ONPAY BUCK LUNG &DWIT IF PAYABLE $9999,00 ti. MSG-1234567 Vrg-N/14/84 TPQY AN-123-45-6789A ID-00W 'iRi- PG-002+ N DUAL ZNTITLB?CNT 11U 013tt 132-45-67898 &WEFIT XISTORT: DATE: GROSS BDWIT 12/83 $245.60 CREDITED - 08/83 $221.20 NOT CREDITED A. MEDICARE DATA ENTITLED TDtltINATED MRSIUM BUY-IN CODE START STOP -,Z HOSPITAL P SURANCE 12/82 12/84 80.00 jr. SUPPLDMNTAL INSURANCE 12/82 12/84 $14.60 403 12/82 12/84 /Z DATE DISABILITY SEDAN: 06/79 TPQY-SSR-RZSPONSB* ��. MSG-1234567 DTEt08/14/84 TPQT AN:123-45-6789 ID-JQlt`'A UN- PC-003 At. INPUT SOCIAL SECURITY WMER 123-45-6789A MME C JONES USER COVE 12345 • 3RD PARTY QUERY CONFIDENTIAL SUPPI.Fli WAL SECURITY INCOME DATA ON 123-45-6789 CLARA JOKES VXKALZ SOON: 11/20/24 ILIGI514t 1!/82 DIED:12/03/84 .w. APPLICATION DATE: 12/02/82 TYPE OF PERSON: DISAXLED INDIVIDUAL N' CITIZ=/ALIZN CODE: A RESIDENCY: 12/82 TiQT-SSE-MPMZ (CON'T) ik• !AILING ADORESS: WALTER .PONES FOR CLARA JONES 1200 MIN DALLAS, TI 75202 _ RESIDENCE: 2140 TUNKIL RD MLLAS, Tx 75206 NET CURRENT DOWIT FOR 08/01/84 - PSD Aff s $30.00 STATE AM $0.00 Z� PAYMM RISTORT OF NET BENEFITS PAID: DATE: FEDERAL AMT: STATE AMT: TYPI Of PATMOT • 04/01/84 $ 50.00 $ 0.00 RECURRING 01/02/84 $ 10.00 $ 0.00 A&GUL IR DIiUWATMM 01/01/84 $ .51.00 $ 0.00 RiCURRING 01/01/84 $ 51.00 $ 0.00 =ODSTITM& 09/01/83 $ 89.00 s 0.00 OVERPATMENT RICOYIRY. . 06/01/83 $ 0.00 $ 0.00 MOM an .rf. PATMENT STATUS CODE: COI - PAT 30 • DISABLED WILL NOT AZAR ON ACTUAL RZSPONSE NOTE: FIELD IDENTIFIERS WILL NOT AMAR fat FIELDS WI?60UT DATA, PITH TME ExCETTION OF ria PAYMENT STATUS CODE.