SSR 76-2: SECTION 202(d) and 205(j) (42 U.S.C. 402(d) and 405(j)) -- APPLICATIONS -- FILING FOR ALL BENEFITS

20 CFR 404.603 and 404.613

SSR 76-2

Where only evidence concerning individual's intent with respect to scope of application is statement "I apply for insurance benefits payable to me," held, such statement would not support finding that such individual had manifested intent to apply for benefits on behalf of individual for whom such applicant later served as representative payee.

A question has been raised as to whether the application for a lump-sum death payment filed by the widower of a deceased wage earner may also serve as an application for child's insurance benefits on behalf of the children of the wage earner. Such application contains the following statement:

I hereby apply for the lump-sum death payment and for any insurance benefits payable to me under Title II of the Social Security Act, as amended. (Emphasis added)

There is no statement on the application form with respect to the identity, or even the existence, of the subject children.

The precise question was as follows:

The question presented is whether the application by the widower may be treated as an application on behalf of one or more of the children since, under applicable regulations, the widower may have been the proper party to execute an application on behalf of the children and since benefits for the children may have been 'paid' to the widower as their representative payee under section 205(j) of the Social Security Act.

The Social Security Act provides, with exceptions not relevant here, that to be entitled to a benefit, an individual must file an application therefor. Thus, section 202(d)(1) of the Social Security Act, as amended, provides that an individual shall be entitled to a child's insurance benefit if such individual, inter alia, "has filed application for child's insurance benefits." The courts have held that a claimant would not meet this "substantive" requirement for filing an application unless he has, in a manner consistent with the Act and regulations, manifested an intent to claim a Social Security benefit. Bender v. Celebrezze, 332 F.2d 113 (7th Cir., 1964); McNally v. Fleming, 183 F. Supp. 309 (D.N.J., 1960); Medalia v. Folsom, 135 F. Supp. 19 (D. Mass., 1955). Thus in instances where a written statement (which later is perfected by a subsequently executed prescribed form) may be considered an "application," section 404.613 of Social Security Administration Regulations No. 4 (20 C.F.R. 404.613) provides that such written statement must indicate an intention on the part of the applicant to claim monthly benefits.

The same "filing" requirements must be met where, under section 404.603 of Regulations No. 4, a party other than the claimant files an application for benefits on behalf of the claimant. The party filing the application must identify the individual claiming the benefit and manifest in writing an intent to claim benefits on his behalf.[1]

Whether an individual intended to claim a Social Security benefit and the scope of his application for a benefit are issues of fact which generally must be resolved by the appropriate trier of fact within the Social Security Administration. However, where the only evidence concerning the individual's intent with respect to the scope of his application is the statement on the application, "I apply for benefits payable to me," such statement would not be sufficient to find that the individual had manifested an intent to apply for benefits on behalf of another individual, even though the applicant could have been "paid" benefits as the representative payee for such other individual had such other individual later become entitled to a benefit.[2]

First, the statement "I apply for benefits payable to me," would not, by itself, indicate that the individual filing the application is acting in a representative capacity. Without any such indication, it is assumed that the individual is acting on his own behalf. Unless SSA finds on the basis of other contemporaneous evidence that the applicant manifested an intent to apply for benefits in a representative capacity, an application with a statement thereon like that involved here may serve only as an application for the individual who filed it.

Further, while benefits may be "paid" in limited circumstances to the representative payee of an entitled individual under section 205(j), such payee does not thereby become entitled to such benefits and such benefits may not be considered to be benefits "payable to him." Under the provisions of section 202(d) of the Act, it is clear that, whether the child files the application himself or the filing is done by another person acting on behalf of the child, the child legally is the person "entitled" to child's insurance benefits and such benefits are "payable" to the child rather than to its parent or to any other person acting on the child's behalf. This is manifest from a reading of section 202(d) and of section 205(j), which concerns representative payment. Section 205(j) provides:

(j) When it appears to the Secretary that the interest of an applicant entitled to a payment would e served thereby, certification of payment may be made, regardless of the legal competency or incompetency of the individual entitled thereto, either for direct payment to such applicant, or for his use and benefit to a relative or some other person.

And, finally, even if the words "I apply for benefits payable to me" could be interpreted to mean that the applicant was filing in a representative capacity for an individual on whose behalf the applicant may have been "paid" benefits as the individual's representative payee, such words would not indicate with any certainty the identity of the purported "claimant." A determination concerning when to institute representative payment and who to select as the representative payee is ultimately within the sound discretion of the Secretary. (Section 205(j) of the Act provides only that the Secretary "may" institute representative payment and implicitly that he "may" select one individual from several potential payees where it appears to him that the interest of an applicant entitled to a payment would be served thereby.) If the only manner in which an undisclosed claimant could be identified for purposes of the "substantive" application requirement would be through the selection of another person as his representative payee, (such selection being within the discretion of the Secretary) and if such "other" individual would not be selected until the claimant had been determined to be entitled, it would follow that an application for benefits by a "potential" payee for an undisclosed claimant would never sufficiently identify the claimant to serve as an application on behalf of the claimant.

Accordingly, on the basis of the foregoing, if the only evidence manifesting the applicant's intent is the statement on his application, "I apply for insurance benefits payable to me," such applicant has not filed for benefits on behalf of another individual.

[1] The only category of benefits where an individual other than the claimant commonly must execute an application on behalf of the claimant is child's insurance benefits. Thus, the legend on the application for child's insurance benefits read as follows:

"I hereby apply, on behalf of the child or children listed in item 3 below, for all insurance benefits payable to them under Title II of the Social Security Act, as amended. (If you are applying on your own behalf, answer the questions on this form with respect to yourself.)"

Where a proper party has filed on behalf of a claimant one of the prescribed application forms other than the form for child's insurance benefits, that party must indicate on the application form that he is filing in a representative capacity. Such process is described in Claims Manual section 2030. Otherwise, there would be no basis for SSA to find that such applicant had filed the application on behalf of another person in addition to, or instead of, himself.

[2] For such entitlement, other requirements would, of course, have to be met: the individual applying would have to be a proper party to apply on behalf of such other individual under section 404.603 of Regulations No. 4, and such other individual would have to meet all other entitlement requirements at a time within the life of the purported application.

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