HomeMy WebLinkAbout990951.tiff RESOLUTION
RE: APPROVE AGREEMENT AND EXHIBIT 1 FOR REPORTING TO SOCIAL SECURITY
ADMINISTRATION AND AUTHORIZE CHAIR TO SIGN - SOCIAL SECURITY
ADMINISTRATION
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement and Exhibit 1 for
reporting to the Social Security Administration between the County of Weld, State of Colorado,
by and through the Board of County Commissioners of Weld County, on behalf of the Sheriff's
Office, and the Social Security Administration, with terms and conditions being as stated in said
agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement and
Exhibit 1, copies of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Agreement and Exhibit 1 for reporting to the Social Security
Administration between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Sheriff's Office, and the Social
Security Administration be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement and Exhibit 1.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 28th day of April, A.D., 1999.
BOARD OF COUNTY COMMISSIONERS
LD COUNTY, CO ORA O
ATTEST: /J4/
�I E'I 4 a
�.. �
.�� Dale K. Hall, Chair
Weld County Clerk to tip •13' -
� (t,' _ 'lzQ i,G -i- .�. i_.< t4.-, c
fib
��// 9 iR O,_ �^ arbara J. Kirkmeyer, Pro-Ter
BY: Cc w -, !A •. C is 'Y L ' /
Deputy Clerk to the B:- kJ A � ,,,,z -c,.....„... < <✓/"x-e
George ( axter
AP AS TO FORM:
?Gene �G
ounty Attorney .4:. -/(/ 2) A
Glenn Vaal-
990951
;- SO0019
TO: Dave Malcom, Weld County Sheriff's Office
FROM: Bruce T. Barker, Weld County Attorney
' eDATE: April 23, 1999
RE: Social Security Administration Agreement
COLOR ADC)
Attached is the original Agreement between the Social Security Administration ("SSA") and
the Weld County Jail which I received from Kim Fliethman last week. The Agreement is
pursuant to the provisions of 42 U.S.C. § 1382. That section authorizes the SSA to enter into
agreements such as these for the purpose of obtaining information regarding those persons
who are receiving Supplemental Security Income ("SSI") payments while being incarcerated.
42 U.S.C. § 1382(e)(1)(A) prohibits an"inmate of a public institution" from receiving SSI.
The Agreement will provide for Weld County Jail staff to report to the SSA the following
information concerning inmates: Social Security Number, name, date of birth, confinement
commencement date, "such other identifying information as designated," and the Facility
Identification Code. The data so supplied will be matched against the Supplemental Security
Income Record. 42 U.S.C. § 1382(e)(I) allows the SSA Commissioner to pay money to the
Weld County Jail for such information, if the information is reported within a certain time
frame.
You may recall that in September, 1995, we received the Recommendation of the United
States Magistrate Schlatter in the case of Glover and Pigg v. Weld County Sheriff s
Department, et al; Civil Action Number 94-K-545, United States District Court. A copy of
that Recommendation is attached. Mr. Glover and Mr. Pigg sued the Sheriff's Department on
the basis that the Weld County Jail staff had illegally obtained their Social Security Numbers
in violation of the Privacy Act, 5 U.S.C. § 552 a(b). That section requires that any "local
government agency which requests an individual to disclose his Social Security Account
Number shall inform that individual whether that disclosure is mandatory or voluntary, by
what statutory or other authority such number is solicited, and what uses will he made of it."
Although Magistrate Judge Schlatter found that the Jail staff had violated this section, he also
stated that there was no civil remedy for Mr. Glover and Mr. Pigg. In essence, this means that
although the Privacy Act requires certain disclosures prior to obtaining the Social Security
Number of any inmate entering the facility, if the Jail staff does not make such disclosure,
there is no penalty for the mistake.
The Glover and Pigg case raised in my mind whether the Jail staff would be violating the
Privacy Act if such a disclosure is not made in the course of obtaining the Social Security
Number of inmates for the purpose of complying with the SSA Agreement. I called Mr. Bill
Browne of the Office of Program Benefits Policy, SSA, about my concern. He reminded me
that 42 U.S.C. § 1382(e)(I) has an exemption to the Privacy Act for any information
exchanged pursuant to the Agreement. The only concern I have about this exemption is that
it does not say that:the exemption applies to the original inquiry to the inmate about his or her
Social Security Number. Mr. Browne stated that this issue came up a number of years ago in
990951
Dave Malcom, Memo
April 23, 1999
Page 2.
the Dallas Regional Office and it was decided then that the SSA would leave it up to the local
jurisdiction how it wanted to interpret the exemption.
I think it best to comply with the Privacy Act in the course of our inquiries to the inmates
about their Social Security Numbers. This would include letting each inmate know that the
disclosure is voluntary, that the information is being sought pursuant to the Agreement
promulgated in accordance with 42 U.S.C. § 1382, and that his or her Social Security
Number, along with the name and date of birth of the inmate will be forwarded to the SSA for
determination of the continuation of SSI.
As to the Agreement itself and the approval and signature thereof, I suggest that Ed or
someone on his behalf sign as the "Reporter." I see that Exhibit 1 requires the signature of
the Board of County Commissioners. I will make certain the Board approves Exhibit 1 and
have Dale Hall sign as Chairman.
Please feel free to call me at extension 4390 if you have an -questions regarding this
Memorandum or the attached.
1 i
Brucel/Barker
Weld County Attorney
BTB/db:Memo/SSA
Attachments
pc: Don Warden
ecy 9Y.
•
THE SOCIAL SECURITYEBETWEEN
ADMINISTRATION I QQ) 1' t Y Cl o T
AND THE
IALQ1d, 1^'`
(insert reporting entity me; e .g. , State of, County of, etc. )
Article I, Purpose & Leaal Authority
This agreement is entered into by the parties in accordance with
section 1611 (e) (1) (I) of the Social Security Act (the Act) . The
agreement provides the terms and conditions under which the
reporting entity (Reporter) will provide to the Social Security
Administration (SSA) information about certain confined
individuals, on its own behalf and/oz' on behalf of other
facilities/institutions for whom itwill report as identified in
Article III 5. 1 of this agreement and under which SSA will pay
facilities/institutions for information that results in the
suspension of payments to certain confined individuals receiving
Supplemental Security Income (SSI) payments under title XVI of
, 0 . 4e Act, 42 U.S . C. 1381 et sea. The responsibilities of each
party to the agreement are also provided.
Title XVI of the Act sets forth the conditions under which
individuals are eligible for SSI payments .
Section 1611 (e) (1) (A) of the Act provides, with certain
exceptions, that an individual shall not be eligible for SSI
payments for any month throughout which he or she is an inmate of
a public institution.
Section 1611 (e) (1) (I) (i) of the Act authorizes SSA to enter into
an agreement described in that section with a specified type of
interested State or local institution (such as a jail, prison, or
other penal institution or correctional facility or other
institutions in which people are confined by court o`fder at
public expense)': Section 1611 (e) (1) (I) of the Act provides the
general terms and conditions under which, pursuant to the
agreement, the Reporter will provide information about confined
individuals to SSA.
Section 1611 (e) (1) (I) (ii) exempts this agreement, and information
exchanged pursuant to this agreement, from the provisions of the
Privacy Act, 5 U. S .C. 552a, including those relating to computer
matches .
Article II, Definitions
A. "Confined individuals" are individuals who are confined to a
facility/institution described in Article I of this agreement
under authority of law at any time during the period covered
by this agreement .
GQn G S7
•
B. "Disclosure" means the release of information (data) with or
without the consent of the individual (s) to whom the
information pertains .
C. "Facility Identification Code" means the six digit code that
SSA will assign to a facility or institution which confines
individuals and is covered by this agreement. This code must
be furnished with each submission of inmate data to SSA
concerning the facility/institution' s confined individuals in
order for SSA to process any incentive payments due the
facility/institution under this agreement .
D. "Record" means any item, collection, or grouping of
information about an individual ,.ghat is maintained by an
entity including, but not limited to, the individual' s
criminal history, name, Social Security number (SSN) , date of
birth, gender, date of confinement, place of confinement and
prisoner or inmate status .
E. "Reporter Identification Code" means the four digit code
assigned by SSA to the Reporter that is party to the
agreement and that will report information on its own behalf
and/or on behalf of other facilities/institutions identified
in this acreement .
F. "Throughout a month" means that an individual is confined in
an institution as of the first instant of a calendar month
and stays through the last instant of the month.
Example 1 : If an individual enters an institution on April
30 and is released on June 3 , the individual would be
confined throughout May.
Example 2 : If an individual enters an institution on May 1
and is released on June 30, the individual would not have
been confined in an institution throughout either May or
June .
Under the SSI program, an individual who is confined in a public
institution is considered as remaining confined in a public
institution if he is transferred from one such institution to
another or if he is temporarily absent for a period of not more
than 14 consecutive days . Also, an individual is considered
confined in an institution throughout a month if he is confined
in the institution as of the beginning of a month and dies in the
institution during the month.
Article III, Description of Records to be Matched
A. General
1 . The Reporter will identify confined individuals for SSA.
3
2 . SSA will determine which of these confined individuals are
receiving SSI payments .
B. Source of Reporter Records
1 . These records are compiled from ff4-etd ec2 (the
Reporter must list all of the facilities/institutions
that are covered by this agreement for which it will
report) .
2 . The following are the data elements that the Reporter
must provide for confined individuals :
a. Social Security number (provide all numbers the
individual has been knot to use) ;
b. Name (provide all names the individual has been known
to use) ;
c. Date of birth (known or alleged) ;
d. Confinement commencement date;
e. Such other identifying information as designated in
the attached guide; and
f. Facility identification code .
3 . All records will be prepared and transmitted as
prescribed in Article IV with clear identification of the
facility/institution that is the source of such records.
C. SSA Records
SSA will match the data from the Reporter for the purpose
described in this agreement . The data will be matched
against the Supplemental Security Income Record (SSR)
HHS/SSA/OSR 09-60-0103 .
Article IV, Functions to be Performed
The information on confined individuals must be provided
electronically (i . e . , a computer tape, cartridge, or diskette) .
Compliance with this specification is mandatory. SSA will allow
the Reporter 12 months from the effective date of this agreement
to comply with this specification. During this 12-month period,
SSA will accept paper reports from the Reporter. SSA will not
accept paper reports for the purpose of this agreement after the
12-month period.
The Reporter agrees that it will furnish SSA with an electronic
file (or paper reports if appropriate) containing the data
4
elements listed in Article III B . 2 above on individuals whose
confinement commences on or after March 1, 1997. The first
submission of data, whether done electronically or by paper, will
be a total inmate population report . After the first report,
these files are to be submitted for each calendar month with data
only for those individuals who are admitted to the
facility/institution at any time during the period from the first
day of the reporting month to the last day of such month. '
•
In addition to the first submission of the total inmate
population and the subsequent monthly reports required under this
IPMOU, SSA requests the Reporter to submit, at the end of each
calendar year, a complete list of all inmates who entered the
facilities/institutions for whom it „r`eports . SSA will use this
annual report to identify inmates wlio may have filed for SSI
after a Reporter' s monthly report or whose application for SSI
payments had not been adjudicated at the time the data was
processed. Compliance with this request helps SSA in its efforts
to ensure that SSI payments are made only to those eligible under
the law. Incentive payments will be paid, based on the
provisions in this IPMOU, if SSI payments are suspended as a
result of data exchanged in the annual report .
The instructions for creating the electronic file are attached.
Once the SSN is validated, and the identity of the confined
individual is verified based on SSA' s records, SSA will :
1 . Determine if the individual is receiving SSI;
2 . Verify that the individual has been confined throughout a
calendar month;
3 . Notify the individual of the suspension action and provide
the individual with an opportunity to contest the planned
action under applicable regulations;
4 . Suspend SSI payments as required by law;
5 . Pay the appropriate facility/institution as specified under
Article V.
The Reporter agrees to send the data to one of the following
addresses .
•
Send tapes or cartridges to:
SSA
Tape Operations Section
Attention: Outside Agency
National Computer Center
6201 Security Blvd.
Baltimore, MD 21235
•
Send diskettes to :
1.7 SSA, D'ES
Metro West Bldg.
P .O. Box 1600
Baltimore, MD 21201
Send paper to :
SSA, DES
Metro West Bldg.
P.O. Box 1600
Baltimore, MD 21201
Article V, Incentive Payment Process
In accordance with section 1611 (e) (1) (1) (i) (II). of the Act, SSA
will pay an incentive payment to a facility/institution covered
by this agreement for information on a confined individual which
the Reporter furnishes to SSA within the time periods specified
below, provided that the confined individual is :
o Eligible for an SSI payment for the month preceding the first
month throughout which the confined individual is in such
facility/institution; and •
o Determined by SSA to be ineligible for an SSI payment for such
first month as a result of the information provided by the
Reporter under this agreement .
SSA will pay such facility/institution:
o $400 if the Reporter furnishes the information on a confined
individual described above to SSA within 30 days after the
date the individual' s confinement in such facility/institution
begins; or 7�� _„� Cc
o $200 if the Reporter furnishes such information to SSA after
30 days after such date but within 90 days after such date.
If SSA cannot validate the SSN of a confined individual, no
further action will be taken by SSA.
SSA will not pay an incentive payment for information concerning
a confined individual i,f, prior to SSA' s receipt of the
information, SSA has already determined that the individual is
ineligible for SSI payments .
Payments made by SSA under this agreement represent incentive •
payments accruing as a result of SSA' s efforts in processing the
6
data provided pursuant to this agreement when such data results
in the suspension of SST payments to confined inmates . The time
vo to complete the verification process, any case development
necessary to determine whether an individual' s SSI payment must
be suspended and the time to complete the due process
requirements that must be accorded an individual subject to a
suspension action may vary from case to case and may represent
several months .
SSA will pay incentive payments to a facility/institution on a
monthly basis by electronic transfer of funds . The facility/
institution will name a financial institution and provide the
information required on the attached Automated Clearing House
(ACH) Vendor/Miscellaneous Payment Enrollment Form (SF 3881) to
receive its incentive payments by electronic transfer of funds.
SSA will provide the Reporter with a notice of the amount of the
incentive payment, the payment date and the total number of
suspended individuals . Disputes involving these incentive
payments will be considered by the Regional Prisoner Coordinator
designated in Article IX. The Reporter should forward a written
request describing the dispute in detail to the Regional Prisoner
Coordinator designated in Article IX within 30 days of its
receipt of the relevant incentive payment notice .
Article VI, Records Usaae, Duplication and
Redisclosure Restrictions •
SSA agrees to use the information provided by the Reporter only
to determine which of the confined individuals are receiving SSI
payments and to suspend these SST payments as required by law.
SSA will adhere strictly to the provisions of section
1611 (e) (1) (I) of the Act in any usage, duplication, or
redisclosure of information provided by the Reporter under this
agreement.
As required by section 1611 (e) (1) (ii) (II) of the Act, SSA may
redisclose the information obtained pursuant to this agreement to
any Federal or Federally assisted cash, food, or medical
assistance .program, for eligibility purposes .
Article VII, Notice, Verification and Opportunity
to Contest
SSA agrees to verify information obtained under this agreement
prior to initiating any adverse action against an individual .
Pursuant to its applicable SSI regulations, SSA will inform the
individual by written notice that it has received specified
information indicating that the individual is confined under the
jurisdiction of a named prison system or is an inmate of a public
institution throughout a calendar month beginning (month/year)
and that, by law, SSI payments must be suspended. SSA will
7
afford the individual the opportunity to contest and submit
information concerning the planned action and to appeal a
determination by SSA to suspend SSI payments in accordance with
applicable regulations .
Article VIII, Term of the Agreement
This agreement supersedes any previous agreement (s) between SSA
and the facility/institutions identified in this agreement
effectuating the exchange of prisoner information for the purpose
of enforcing section 1611 (e) (1) (A) of the Act .
This agreement shall be effective upon the signatures of both
parties and shall remain in effect uttil terminated by either of
the parties . The agreement may be germinated upon written
notification by either party 90 days in advance of the
termination date .
Article IX, Persons to Contact
A. The SSA contact for questions concerning this incentive
payment agreement is the Regional Prisoner Coordinator in
SSA' s
TbtJ eir Regional Office at the following address :
.-- ,•-k1/(
/9 1 SA 1 -L-E
rN.atl'J-*C
B. The SSA contact for policy questions concerning the incentive
payment provision is :
William Browne
Office of Program Benefits Policy
3-A-26 Operations Building
6401 Security Boulevard
Baltimore, MD 21235
(410) 965-7685
FAX (410) 966-9214
C. For technical questions concerning the computer operation
itself, contact :
Paul Swanenburg
Chief, Data Exchange Branch
3-L-16 Operations Building
6401 Security Boulevard
Baltimore, MD 21235
(410) 965-5454
FAX (410) 966-1371
•
t/6. The Reporter contact for the incentive payment provision is :
NAME Linda Quade
ADDRESS Weld County Sheriff 's Office 910 10th Avenue Greeley
TELEPHONE 970-356-4015 x 4634
FAX 970-353-8551
vi The Reporter contact concerning technical questions regarding
the electronic file process is:
NAME Frank Bishop
ADDRESS Greeley Police Dept 915 10th Street Greeley
TELEPHONE 970-350-9631
FAX
4. The Reporter contact for questions concerning the incentive
payment accounting information is :
NAME Linda Quade
ADDRESS Weld County Sheriff's Office 910 10th Avenue Greeley
TELEPHONE 970-356-4015
FAX
Article X, Signature
In witness whereof, the parties execute this agreement,
FOR T C AL SECURITY
DATE
(TITLE)
✓ FOR THE O T
BY _ DATE '30""7 7
(TITLE)
Completing the SF-3691
Agency Information
This information must be completed by the requesting
agency.
Pavee/Company Information
This information must be completed by the vendor. The
Taxpayer Identification Number (TIN) must be provided on all
future invoices with the intent to use for payment purposes
as well as the collection and reporting of delinquent, debt
in accordance with the Debt Collection Improvement Act of
1996 .
Financial Institution Information
This information can be completed by the vendor or the
vendor' s Financial Institution fFI) . The following must be
completed:
o Name and address of FI
o ACH Coordinator--A contact at the bank in the
ACM Department , if applicable
o Phone Number of the Bank Contact
o 9 Digit Routing Transit Number (RTN) - -This number
uniquely identifies any FI and is used to direct the
payments to the designated receiving FI . The FI can
provide this information.
o Depositor Account Title--Name of the account , if
different from the vendor' s name
o Depositor Account Number--Vendor' s Account Number
o Type Of Account-- Checking or Savings
o Signature & Title of Authorized Official--
Signature from someone who authorizes SSA to
have this FI information for deposit of payments .
Could be vendor or FI personnel .
o Telephone Number--Telephone number of the person who
signed the form
After the agency receives this information, a zero dollar entry
will be processed to verify accurate bank information. There is
an 11 day waiting period for verification. After positive
verification, your payments will submitted by direct deposit .
**NOTE : If you' re already enrolled in direct deposit, you need
not submit a new form. If there are any changes in your
bank information, you must notify the agency at the
number in the agency information section.
ACH VENDOR/MISCELLANEOUS PAYMENT
ENROLLMENT FORM
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-
related information processed through the Vendor Express Program. Recipients of these payments should bring
this information to the attention of their financial institution when presenting this form for completion.
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FEDERAL PROGRAM AGENCY:
SOCIAL SECURITY ADMINISTRATION
AGENCY IDENTIFIER: AGENCY LOCATION CODE (ALC): ACH FORMAT:
SSA 28040001 a CCD+ 0 CTX D CTP
ADDRESS:
SOCIAL SECURITY ADMINISTRATION
P.O. BOX 47, BALTIMORE, MARYLAND 21235
CONTACT PERSONS NAME: TELEPHONE NUMBER:
CHRISTINA LILLY, OFFICE OF FINANCE, SSA (410) 965-6119
ADDITIONAL INFORMATION:
P�k'Yk�l#>K AIfl• h$FDRMIITIOII
NAME: SSN NO. OR TAXPAYER ID NO.
Weld County Sheriff ' s Office 84-6000813
ADDRESS:
910 10th Avenue
Greeley , CO 80631
CONTACT PERSONS NAME: TELEPHONE NUMBER:
Linda Quade ( 970 ) 356-4015
EI1 lFIG31�L ii T ccrOw lHFpRNI'llGlt a
/ NAME:
Nr rwt c - R�l1-,k ,^n7nZ^acln RT A Laca77o
ADDRESS:
PO Box 5247 , Denver, CO 80274
ACH COORDINATOR NAME: (BANK REP.) TELEPHONE NUMBER:
Jill Sauter ( 970 ) 284-5536
NINE-DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACCOUNT TITLE:
Weld Count: Colorado Treasury Collection and ( lea_ rina_ Ar,1j�nn+
DEPOSITOR ACCOUNT NUMBER:
442-8004375
TYPE OF ACCOUNT; X CHECKING O SAVINGS
SIGNAT% AND Ti13 E: OF ALITHORI7.£5 CFf#CIA1. TELEPHONE NUMBER
CC JLD 8E THE S AS ACIt COORDINATOR)
OMB NO. 1510-0056 , EXPIRATION DATE: 06/30/93 NSW 7540-01-274-9925
SF 3881 (REV. 12/40) PRESCRIBED BY DEPARTMENT OF TREASURY 31 USC 3322, 31 CFR 210
3881-102 AGENCY COPY
P-erbV-1-4n I 1 9 if
*aoi y- Cock/
E. EXHIBITS
1 . EXHIBIT 1 - - COMPUTER MATCHING PRIVACY AND PROTECTION
ACT AGREEMENT
AGREEMENT BETWEEN
THE SOCIAL SECURITY ADMINISTRATION
AND THE
(Source Jurisdiction)
Article I , Legal Authority
This agreement and any accompanying addenda set forth the terms
under which the (Source Jurisdiction) hereinafter referred to as
(ti �lq Ce.c -Q;L., agrees to furnish information to the Social Security
Administration, hereinafter referred to as SSA, pursuant to
sections 202 (x) (1) , 202 (x) (3 ) , 1611 (e) (1) (A) , and 1631 (f) of the
Social Security Act (Act) , 42 U. S .C. §§ 402 (x) (1) , 402 (x) (3) ,
1382 (e) (1) (A) , and 1383 (f) . These statutory provisions : prevent
SSA from paying benefits to any individual for any month during
which such individual is confined to a jail, prison or other
penal institution or correctional facility pursuant to his or her
conviction of an offense which is punishable by confinement for
more than 1 year, regardless of the actual sentence imposed
(title II of the Act) ; prevent SSA from paying benefits to
certain other individuals for any month during which such
individuals are confined by court order at public expense in
connection with such an offense (title II of the Act) , or require
nonpayment of benefits to any individual for any month throughout
which the individual is confined in a public institution
(title XVI of the Act) . Further, the agreement sets forth the
responsibilities of SSA and (Source Jurisdiction) under the
Privacy Act of 1974 , as amended by the Computer Matching and
Privacy Protection Act of 1988 , with respect to information
obtained pursuant to the agreement, and takes into account SSA' s
responsibilities under section 1106 of the Act .
SSA will also use the information provided by (Source
Jurisdiction) under authority of sections 205 (j ) (1) (A) , 205
(j ) (5) , 1631 (a) (2) (A) (iii) and 1631 (a) (2) (E) of the Act, which
require SSA to revoke certification for payment of benefits to
representative payees under certain circumstances and investigate
and monitor the performance of such representative payees . (See
also 20 C. F.R. 404 . 2050 ; 416 . 655) . The incarceration or
confinement of a representative payee is a circumstance which SSA
will consider under the above referenced representative payee
provisions .
The agreement also sets forth the responsibilities of SSA and
(Source Jurisdiction) with respect to information obtained
pursuant to the agreement . This agreement and any accompanying
addenda supersede any similar agreement entered into previously
under the above-cited statutory provisions by (Source
Jurisdiction) and SSA concerning computerized records of confined
individuals or inmates of public institutions .
Article II , PuLpose
The purpose of the agreement is to establish conditions for a
matching operation which will identify individuals described in
this agreement and any addenda to this agreement who :
o Are subject to the title II benefit nonpayment provisions in
section 202 (x) (1) of the Act affecting prisoners and certain
other individuals in the old-age, survivors and disability
insurance programs administered by SSA, and/or
o Are subject to the title XVI supplemental security income
(SSI) eligibility restrictions in section 1611 (e) (1) (A) of
the Act applicable to individuals in public institutions
under the SSI program which provides payments to aged, blind
and disabled recipients with income and resources at or below
levels established by law and regulations, and/or
o Are subject to the above provisions of the Act applicable to
individuals serving as representative payees on behalf of
other entitled beneficiaries .
As the recipient agency using the match results in its programs,
SSA will publish in the Federal Register the notice of this
matching program, as required by the Privacy Act .
The main body of this agreement by itself applies only to
prisoners covered by section 202 (x) (1) (A) (i) ; i .e, individuals
confined pursuant to a conviction for an offense punishable by
imprisonment for more than 1 year and any affected individuals
covered by the above-referenced representative payee provisions .
Separate addenda are attached to include within the terms of this
agreement any other confined individuals covered by provisions of
section 202 (x) (1) (A) (ii) and individuals who are residing in
public institutions and are covered by section 1611 (e) (1) (A) .
The (Source Jurisdiction) component responsible for the activity
covered by this agreement is the w (d (°L Taj L--- .
The responsible SSA component is the Office of Program Benefits
Policy. SSA contact persons for specific agreement activities are
described in article XV of this agreement .
Article III , Definitions
A. "Source Jurisdiction" means the agency disclosing records to
be used in this matching program.
B . "Disclosure" means the release of information (data) with or
without the consent of the individual (s) to whom the
3
information pertains .
C. "Incarcerated Individuals" are individuals who are under a
sentence of confinement, pursuant to conviction of an offense
punishable by imprisonment for more than 1 year (regardless of
the actual sentence imposed) , to a jail, prison or other penal
institution or correctional facility, including any facility
which is under the control and jurisdiction of the agency in
charge of the penal system or any facility in which convicted
criminals can be incarcerated.
D. "Confinement" , for purposes of individuals whose records are
covered by this agreement, refers to incarceration in a jail,
prison or other penal institution or correctional facility
pursuant to conviction for an offense punishable by
imprisonment for more than 1 year (an expanded definition
pertaining to additional confined persons may be included in
addenda, if any, to this basic agreement) .
An individual may be considered confined even though he/she is
temporarily or intermittently outside of that facility; e .g. ,
on work release, attending school, hospitalized. However,
such an individual is not considered confined during any month
throughout which the individual is residing outside such
institution at no expense (other than the cost of monitoring)
to the institution or the penal system or to any agency to
which the penal system has transferred jurisdiction over the
individual .
E. "SSN" means Social Security number.
F. "Recipient Agency" means the agency receiving records from a
Source Jurisdiction for use in a matching program.
G. "Record" means any item, collection or grouping of information
about an individual that is maintained by an entity including,
but not limited to, the individual' s criminal history, name,
Social Security number, date of birth, gender, dates of
confinement, place of confinement and prisoner status .
Article IV, Description of Records to be Matched
A. General
o The Source Jurisdiction will identify incarcerated
individuals (and individuals described in any addenda to
this agreement) for SSA;
o SSA will determine which of these individuals are receiving
Social Security benefits and/or SSI payments or are serving
as representative payees for benefit recipients .
4
B. Source Jurisdiction Records
o These records are compiled from
(describe the ultimate source of the Source Jurisdiction' s
records as thoroughly as possible) .
o The content of the records is described in article VI .
o All records will be prepared and transmitted as prescribed
in article VI with clear identification of the record
source .
C. SSA Records
The incoming prisoner records will be matched with data from
these SSA systems of records : The Master Beneficiary Record
(MBR) HHS/SSA/OSR 09-60-0090, the Supplemental Security Income
Record (SSR) HHS/SSA/OSR 09-60-0103 , and the Master Files of
Social Security Number Holders and SSN Applications
HHS/SSA/OSR 09-60-0058 (Alphident) and the Master
Representative Payee File (MRPF) HHS/SSA/ORSI 09-60-0222 .
Article V, Justification and Anticipated Results
of the Matching Program
This matching activity is necessary as the Social Security Act
requires non-payment of benefits to certain individuals affected
by this matching program. Matching is believed to be the most
efficient and comprehensive method of collecting and comparing
this information. Computer matching is also believed to be the
most efficient means of accomplishing this . There is no other
administrative activity that could be employed to accomplish the
same purpose with the same degree of efficiency.
SSA expects to save approximately J1g mi ) licr, nationally over the
period of 18 months by performing the matching program. Based on
experience with previous matches conducted for the same purpose,
SSA estimates that its national costs for this program will be
J,'1mid,(47 . The Source Jurisdiction does not expect any savings
to result from the program. The Source Jurisdiction' s estimated
costs are $_
Article VI, Functions to be Performed
A. The Source Jurisdiction agrees to furnish SSA with an
electronic file/record containing data on incarcerated
individuals as defined in article III (and other individuals
described in any addenda to this basic agreement) . These data
are to be submitted Orloti){;1t (insert time frame, monthly
reporting preferred) showing the individuals admitted during
the reporting period. The data are to be submitted to SSA as
5
soon as possible after the end of the reporting period taking
into account the time needed to have the required data
elements entered into the prisoner data base .
1 . Volume of Records to be Matched
The Source Jurisdiction will provide identifying
information on approximately .SoO incarcerated
individuals (and individuals described in any addenda to
this agreement) within its jurisdiction.
2 . Accuracy of Records to be Matched
Source Jurisdiction Records :
The Source Jurisdiction estimates that about Me)
V percent of the names and SSNs that it will provide to SSA
will be accurate . This estimate is based on
. The names and SSNs will be
obtained from ?TA/L RE ao,Qb5
SSA Records :
Based on internal consistency checks and SSN/name
verification procedures before a payment record is
created, SSA estimates that at least 99 percent of the
name and SSN information on the MBR and the SSR is
accurate .
3 . SSA Data Elements to be Matched
o M3R: The individual' s SSN and payment status ;
o SSR: The individual' s SSN, confinement, and payment
status .
o Alphident : The individual' s name, date of birth and
gender.
NOTE : Before the match is conducted in SSA' s central
office, the incoming SSNs will be verified using
the Enumeration Verification System (EVS) , and only
SSNs considered verified will be used in the match.
The EVS is described in the attached EVS User' s
Package for Prison Systems .
Alphident Use
The Alphident file is used under this agreement to locate
individuals in SSA' s records where a prison system has
indicated to SSA that one or more individuals is/are
incarcerated, and has either failed to provide an SSN for
6
the named individual (s) or provided the wrong SSN. The
Alphident allows SSA to locate the SSN by utilizing all
electronic systems currently available .
The name and date of birth codes provided by the prison
system are matched against SSA' s Alphident file . Where
both of these codes match similar codes on only one record
in SSA' s file, SSA assumes that the SSN which SSA has in
its file associates with the matched name and date of
birth belonging to the person named in the prison system' s
files . SSA then treats the individual whose SSN was
generated through the Alphident as it does individuals
whose SSN was provided by the prison and matched SSA' s
records . That is, SSA follows the procedures detailed in
the matching agreement for information resulting from a
match before adjusting an individual' s title II or title
XVI benefits .
In addition to the above process, SSA uses a second
process to locate SSNs in circumstances where none of the
records on SSA' s file match both the name and date of
birth given for an individual on the prison system' s file .
If a single SSN is located for an individual whose name in
SSA' s records matches the name given in a prison system' s
files, SSA assumes that the SSN associated with the
matching record belongs to the person named in the prison
system' s files despite the inconsistent dates of birth.
SSA then considers this a matched item and follows the
procedures detailed in the matching agreement before
adjusting title II or title XVI benefits .
B. The Source Jurisdiction agrees to provide the following data
elements for each incarcerated individual :
o Name (if there is more than one name per individual, make a
separate entry for each name)
o SSN
o Date of Birth
o Gender
o Dates of Confinement
o Place of Confinement (i .e . , provide SSA with the address (es)
of prison (s) where the prisoner (s) can be located, or use
SSA' s four-character, alphanumeric correctional facility
address codes as the prisoner location code, or any codes
agreed upon by SSA and the Source Jurisdiction)
o Status - incarcerated individual, certain other individual
7
confined in an institution at public expense, or other
confined individual (NOTE: This element is requested for all
individuals described in the basic agreement and any addenda
required. )
o Any and all other data elements or combinations thereof as
specified by SSA and found in the most current EVS package .
C. The Source Jurisdiction agrees to send the records to one of
the following addresses .
In sending electronic files to SSA, the address is :
Tape Operations Section
Attention: Outside Agency
National Computer Center, SSA
6201 Security Blvd.
Baltimore, MD 21235
In sending disk records to SSA, the address is :
SSA, DOS, DES
Metro West Bldg.
P.O. Box 1600
Baltimore, MD 21201
Article VII, Records Usage, Duplication
and Redisclosure Restrictions
SSA agrees to the following limitations on the use of the incoming
electronic files, the data contained therein and the records
generated by the match:
A. That the Source Jurisdiction file and the records created
by the match will be used and accessed only for the
purposes stated in this agreement .
B. That the Source Jurisdiction file and the records created
by the match will not be duplicated or disseminated within
or outside SSA other than redisclosures under conditions
set forth in item F of this article to other Federal
agencies which are required by law to have this same
information.
C. That. the Source Jurisdiction file and the records created
by the match will be provided adequate security as agreed
upon.
D. Not to create a separate file or system which consists of
information concerning only those individuals who are
involved in the specific matching program.
8
E. Not to use the Source Jurisdiction file to extract
information about nonmatched individuals for any purpose .
F. To the extent that SSA wishes to redisclose any information
provided by the Source Jurisdiction or generated by this
match to other Federal agencies which are required by law to
have this same information, such redisclosure shall be
subject to the requirements of the Privacy Act, as amended,
wherever applicable . Records generated by this matching
agreement shall be redisclosed to the Health Care Financing
Administration, Railroad Retirement Board, Department of
Labor, the Department of Veterans Affairs and the Office of
Child Support Enforcement . No other such redisclosure
arrangements shall be implemented without prior notice to
the Source Jurisdiction and written permission of the Source
Jurisdiction. Such permission shall not be given unless the
redisclosure is required by law or essential to the conduct
of this matching program.
G. The Source Jurisdiction matching files remain the property
of the Source Jurisdiction and will be returned or destroyed
when the necessary matching activity under the agreement has
been completed as provided in article VIII below.
Article VIII , Procedures for Retention and Timely
Destruction of Identifiable Records
SSA agrees to follow these procedures for the retention and timely
destruction of identifiable records :
A. With regard to records which the source jurisdiction does not
wish returned, SSA will retain all identifiable records
received or generated for the period of time required for any
processing related to the matching program and will then
destroy the records by heat and/or demagnetization within 12
months, unless the information has to be retained in
individual claims files in order to meet evidentiary
requirements . In the latter instance, SSA will retire
identifiable records in accordance with the Federal Records
Retention Schedule (44 U.S .C. 3303a) .
B. When data are received on electronic files, SSA will return
the files to the source within 12 months . If the Source
Jurisdiction does not wish the files returned, SSA will
destroy such electronic files by demagnetization and heat, as
indicated above, within the same 12 month period. These same
procedures pertain to disk records .
9
Article IX, Notice, Verification, and Opportunity
to Contest Match Data
SSA agrees :
A. To notify all individuals who apply for benefits that
information obtained through matching programs may be used by
SSA in determining eligibility for benefits .
B. To provide notices to all beneficiaries describing SSA' s
matching activities following Office of Management and Budget
guidelines . In addition to the specific notice of this
matching program, to be published in the Federal Register by
SSA, SSA' s notice consists of a general notice in the Federal
Register and periodic mailing to all beneficiaries/
recipients describing SSA' s matching activities .
C. To verify information obtained under this agreement prior to
initiating any adverse action against an affected beneficiary.
D. That before taking any adverse actions based on the information
received from a match obtained under this agreement, SSA will
confirm, through its standard verification procedures (e .g. ,
examining SSA claims folder (s) and making personal contacts) in
accordance with its Program Operations Manual System, that the
SSN belongs to the individual and that the individual is
confined. In addition, SSA will provide all individuals for
whom SSA decides such adverse action is necessary with the
following information:
1 . That SSA has received information which indicates that the
individual is confined under the jurisdiction of a named
prison system or is an inmate of a public institution
beginning (month/year) .
2 . For actions under section 202 (x) (1) , that the confinement
resulted from conviction for the commission of an offense
punishable by confinement of more than one year, regardless
of the actual sentence imposed, and for actions under
section 1611 (e) (1) (A) , that the individual is an inmate of a
public institution, and that benefits/payments must
therefore be suspended or stopped pursuant to applicable
statutory requirements .
3 . For actions under title II, that if the individual fails to
contest the validity of the adverse information within
30 days, SSA will assume that the data is correct and will
make the necessary adjustment to the individual' s payment .
Further, that the individual has 60 days after the date he or
she receives the notice to reauest reconsideration of the
agency' s determination.
10
For actions under title XVI, that if the individual fails to
contest the validity of the adverse information within
10 days, SSA will assume that the data is correct and will
make the necessary adjustment to the individual' s payment.
Further, that the individual has 60 days after the date he or
she receives the notice to request reconsideration of the
agency' s determination.
4 . SSA is responsible for determining the most suitable
representative payee to receive title II and title XVI
payments . For title II and title XVI actions under the
representative payee provisions cited in Article I of this
agreement, in addition to notices provided to any affected
Social Security beneficiary or SSI recipient, that the
representative payee receiving notice has 30 days to contest
the Agency' s decision to change representative payee for the
affected beneficiary or recipient based in part on the
current payee' s incarceration or confinement under applicable
provisions of the Act and regulations requiring revocation of
certification of payment to certain representative payees and
monitoring of representative payee performance by SSA.
NOTE : SSA' s final decision on the representative payee
issue does not affect the eligibility or entitlement
of the individual to the continued receipt of Social
Security benefits or supplemental security income
payments . In the event that there is any adverse
effect on the monthly benefit payments to the
beneficiary or recipient as a result of this match,
if a decision is made to change the representative
payee, the beneficiary or recipient will receive
notice of the change as provided in sections
205 (j ) (2) (E) (ii) and 1631 (a) (2) (B) (xi) of the Act .
Article X, Comptroller General Access
SSA and the Source Jurisdiction agree that the General Accounting
Office (Comptroller General) may have access to all SSA and Source
Jurisdiction records as necessary in order to verify compliance with
this agreement .
Article XI , Security Procedures
The following minimum safeguards will be afforded to the data
provided by the Source Jurisdiction and the records created by the
match.
A. Access to the data will be restricted to only those authorized
employees and officials who need it to perform their official
duties in connection with the intended use of the data;
11
B. The data will be stored 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;
C. The data will be transported under appropriate safeguards
consistent with the manner in which it is stored and processed;
D. The data will be processed 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 other means;
E. All personnel who will have access to the data will be advised
of the confidential nature of the information, the safeguards
required to protect the information, and the sanctions for
noncompliance contained in section 1106 (a) of the Act and/or
other appropriate Federal statutes;
F. SSA and the Source Jurisdiction reserve the right to make onsite
inspections or other provisions for auditing compliance with
this agreement; and
G. The Source Jurisdiction and the SSA Data Integrity Board reserve
the right to monitor compliance of systems security requirements
during the lifetime of this agreement and of any
12-month extension of this agreement .
Article XII, Remote Terminal Access
SSA will not allow remote terminal access to any electronic files
provided under the terms of this agreement .
Article XIII , Reimbursement
The Source Jurisdiction agrees to provide the prisoner information
at no cost to SSA.
Article XIV, Term of the Agreement
This agreement and related matching activity will be effective
30 days after notice of the matching program has been published in
the Federal Register or 40 days after submission of the model
agreement upon which this 'agreement is based to Congress and the
Office of Management and Budget, or after both parties to the
agreement have signed the agreement, whichever is later, and will
continue for a period of 18 months from the effective date . Within
3 months prior to expiration of this agreement (i .e . , 15 to 18
months after the effective date) , the respective Source Jurisdiction
and the SSA Data Integrity Board (DIB) may approve an extension of
1 year pursuant to 5 U. S . C. § 552a (o) (2) (D) .
12
In order to renew the Agreement, both SSA and
(insert Source Jurisdiction name) must certify in writing that :
A. The matching program will be conducted without change; and
B. The matching program has been conducted in compliance with this
original. agreement .
If either party does not want to renew this agreement, it should
notify the other of its intention not to renew at least 90 days
before the end of the then-current period. This agreement may only
be changed by a written modification to this agreement which is
signed by both parties and is approved by the SSA DIB.
This agreement may be terminated at any time with the consent of
both parties . Either party may singly terminate the agreement
upon written notice to the other party; in which case, the
termination shall be effective 90 days after the date of the
notice or at a later date specified in the notice .
Article XV, Persons to Contact
A. The SSA contact for policy questions concerning the matching
operation is William Browne, Office of Program Benefits
Policy, 3-A-25 Operations Building, 6401 Security Boulevard,
Baltimore, Maryland 21235 , (410) 965-7685 .
B. The SSA contact for questions concerning the matching
agreement is Tim DeHoff, Office of Program and Integrity
Reviews, 3-J-3 Annex Building, 6401 Security Boulevard,
Baltimore, Maryland 21235 , (410) 965-3891 . The FAX number is
(410) 966-4337
C. For technical questions concerning the computer operation
itself, the system contact is Paul Swanenburg, Chief Data
Exchange Branch, 3-L-16 Operations Building, 6401 Security
Boulevard, Baltimore, Maryland 21235, (410) 965-5454 .
D. The Source Jurisdiction contact for the matching operation is
1. /k1 A ( IJIThr,
coo CrA/k.. CPO ,off 141/e (7realzyy du 970-351d-40C
(insert name, address and telephone number) .
Signature
In witness whereof, the parties hereby execute this agreement .
FOR T:HE G ISSIO R OF SOCIAL SECURITY �� l
BY _t-s%� ,,,r DATE >//3/ G
/
(TITLE) )
13
FOR THE SOURCE JURISDICTION
Cnmmissinnarc DATE n6/9R/99
BY
Dale K. Hall. Chair
(TITLE)
TAB A
ADDENDUM (Type I)
TO THE AGREEMENT Bp.TWEEN THE SOCIAL SECURITY ADMINISTRATION
AND THE t l'.vS Qb
This addendum to the basic agreement expands the universe of
individuals about whom the source jurisdiction is capable of
providing and willing to provide information to the Social
Security Administration (SSA) . The Source Jurisdiction agrees to
provide to SSA, in addition to information outlined in the basic
agreement, information concerning other confined individuals,
pursuant to section 1611 (e) (1) (A) of the Act, 42 U.S . C. §
1382 (e) (1) (A) . As outlined in the basic agreement, this
statutory provision requires non-payment of benefits to an
individual for any month throughout which the individual is an
inmate of a public institution (title XVI program).
Elements regarding the relevant matching program as a whole in
the basic agreement remain in force for the expanded definition
and data records as well as for those definitions and data
records outlined in the basic agreement .
Expanded Definition
The definition of individuals to be added to the basic agreement
follows :
"Other Confined Individuals" , for purposes of this agreement,
includes individuals who are confined to a jail or similar
facility throughout any month during the period covered by this
agreement . Such an individual remains confined if transferred
from one such public institution to another or if temporarily
absent from such an institution or if he or she is born in the
institution during the month and resides in the institution the
rest of the month, or resides in the institution as of the
beginning of a month and dies in the institution during the
month.
Data Elements for Other Confined Individuals
1. Name (provide all names the individual has been known to use)
2 . Social Security Number (provide all numbers the individual
has been known to use)
3 . Date of Birth (known or alleged)
4 . Gender
5 . Dates of Confinement
6 . Place of Confinement (i .e . , provide SSA with the address (es)
of institution (s) where the individual (s) can be located; or,
in the case of individuals who are inmates of correctional
facilities, use SSA' s four-digit, alphanumeric correctional
facility address codes as the prisoner location code; or use
any code agreed upon by SSA and the source jurisdiction)
7. Status - incarcerated individual, certain other individual
confined in an institution at public expense, or other
confined individual . (NOTE : This element is requested for all
individuals described in the basic agreement and any addenda
required. )
8 . Any and all other data elements or combinations thereof as
specified by SSA and found in the most current EVS package.
NOTE: Before the matching program is conducted in SSA' s
central office, the incoming SSNs will be verified,
and only SSNs considered verified will be used in the
matching program.
Signature
In witness whereof, the parties hereby execute this addendum to
the basic agreement .
FOR THE COMMISSIONER OF SOCIAL SECURITY
B - l�wC, !T ,.z_-- DATE t )//s/ C//
- / r1�//, e 244 ii z-r
(TITLE) J
R THE SOURCE JURISDICTION
Weld County Board f Commissioners
DATE 04/28/99
ah,p3t
• ale K. Hall (Title)
(prsns)
INSTRUCTIONS FOR REPORTING BY DISKETTE
15
Q 7
(prsns)
TRANSMITTAL OF PRISONER DATA--DISKETTE/PAPER
SOCIAL SECURITY ADMINISTRATION
49.g5II: PeggNcY DISKE'1'1'n/PAP MED
A. ORGANIZATION (AGENCY/OFFICE) : DATE OF REQUEST:
NTACT'S
2. ADDRESS:
3 . TE O : t hav TREET address not PO
BOX) B. UR TO C. REQUESTOR
IDENTIFICATION NUMBER: TYPE:
(As was assigned by SSA) (Prigns} G
D.TYPE OF MEDIA:
DISKETTE 3 1/2" : DISKETTE 5 1/4" : PAPER:
E
TOTAL NUMBER OF F. BLOCK SIZE = 6500 G. RECORD COUNT:
DISKETTES: RECORD LENGTH = 130
RCOORD FORMAT = (n3{mber of records on tile.)
H. SENDER'S VOLUME SERIAL NUMBER(S) : I. LABEL TYPE:
(if diskettes) STANDARD (SL) NO
LABEL(NL)
( (qA].y if disk?tte)
J. YOUR INCOMING DATA SET NAME: EVSPRSN
S PRSN
K. REPORTING PERIOD: START--
_ ENDING--
for ex le:admissi or 0I/0I/I 999-03i3 I/1999) rL L. RESUBMISSION If applicable,check one
below if this is a resubmittai of a diskette or paper listi (
ng returned to you because of errors—see page
24 for diskette instructions,or page 36 for paper instructions.) -- '
( ? 1ST RESUBM S IN (. S RESUBMISSION ( ) 3RD REST, MI $ION
FOR SA US ONLY:
TRACING NUMBER RECORD COUNT
SLOT ASSIGNMENT
i I j
•
•
MAIL MEDIA TO: SOCIAL SECURITY ADMINISTRATION
DES TELEPHONE: 410-966-2907
METRO WEST BUILDING
P.O. BOX 1600
BALTIMORE, MARYLAND 21201 ----for diskettes and paper only
(NOTE: This transmittal MUST be completed and accompany the input file II
that
you send to SSA. You should photocopy blank copies of this form for use in
future submittals. If you have a change in address/phone/etc. for
receiving files, you MUST also notify SSA in a separate letter at the
address above.
16 & 26
(prsns)
INPUT DISKETTE SPECIFICATIONS FOR FILE YOU SEND TO SSA •
For the diskettes you send to SSA, use the following
specifications:
o Use 3 . 5 inch microdisks (double sided/high density) , •
or 5 .25 inch mini-floppy diskettes (double sided/high
density or double sided/double density) .
o Use MS-DOS compatible diskette files. If you do not
have an MS-DOS operating system, you may still be able to
create an MOS-DOS compatible diskette file. Some operating
systems, e.g. UNIX,XENIX and APPLE may have a DOS shell
that can be used to create these files. (Please check your
operating systems manual when creating the DOS file to
transmit to SSA. )
Format for Submitting Diskettes:
o Use ASCII-I Character Set
o Use the same file name on each diskette
o Use a separate record count for each diskette
o Fixed length record- 130 characters
o Use record layout indicated in Format for File
Correctional Facility sends to SSA
o Diskette rmis- DLL contain any other files or datasets
(e.g. , library files, proprietary software, etc. ) other
than the EVSPRSN that will be sent to SSA.
o All records should begin with the first character
position 01 (no blanks at the beginning of the diskette) .
o SSA will n.ot accept backup, compressed, or zipped •
fields.
o The file must be named EVSPRSN and be in the root
directory. Dc not use file extensions (i.e. , txt.wpd) . A
diskette must not contain more than one file.
o Each diskette must be mailed in a separate envelope.
. . .See page 21 for Label/Mailing instructions and
page 24 for Resubmission instructions.
17
•
•
•
•
•
•
•
(prsns)
TNPUT DISKETTE FORMAT FOR FTT,F REPORTER SENDS TO SSA
Dataset: EVSPRSN
Field Field Field
Tnc'stion Fuld Name Size Type
1-9 SOCIAL SECURITY NUMBER 21 9 N
10-12 ENTRY CODE "TPV" 3 A
13-15 PROCESSING CODE "317" 3 N
16-28 LAST NAME 2/ 13
A/N
29-38 FIRST NAME 10
P./N
39-45 MIDDLF NAME OR INITIAL 7
A/N
46-53 DALE. OF BIRTH (MMDDYYYY) 8 N
54 SEX CODE (M=Male F=Female U=Unknown) 1 A
55 BLANK 1
56-63 REPORT DATE (MMDDYYYY) 2/ 8 N
64-79 REPORTING PERIOD (MMDDYYYYMMDDYYYY) 4/ 16 N
80-87 DATE OF CONVICTION (MMDDYYYY) _5/ 8 N
88-95 DATA OF CONFINEMENT (MMDDYYYY) €/ 8 N
96-103 RELEASED DATE (MMDDYYYY) 2/ 8 N
104 INMAn, STATUS CODE a/ 1 A
105-110 FACILITY IDENTIFICATION CODE 2/ 6 A/N
111 BLANKS 1
112-115 REPORTER IDENTIFICATION CODE 1D/ 6 A/N
116-125 INTERNAL INMATE IDENTIFICATION CODE 22/ 10 A/N
126-130 BLANKS S
(prsns)
1 / Social Security Number--This field may not be left blank.
If the SSN is missing or incomplete, input all zeroes.
2/ Last Name--Required field and may ncat, be left blank. Do
not use any hyphens, apostrophes, or spaces
3/ Report Date--Date reporter prepared report
4/ Reporting Period--Period of time or which report is being
prepared. For example: Reporting period 03/01/1997 through
05/31/1997 should be shown as 0301199705311997
5/ Date of Conviction--Date inmate was convicted of an offense
6/ Date of Confinement--The date that confinement began
7/ Released Date--Date inmate was released from custody
8/ Inmate Status Code--Type of sentence
Y = Convicted--Sentence of more than one year or crime
carries possible sentence of more than one year
N = --
Convicted--Sentence of 12 months or less reporter
unable to verify if crime carries possible sentence of more
than one year
S = Convicted--Reporter confirms crime does not carry
possible sentence of more than one year
C = Confined but not convicted--Crime does not carry
possible sentence of more than one year
D = Confined but not convicted-- Crime carries possible
sentence of more than one year or reporter is unable to
determine possible sentence length
= Not guilty by reason of insanity or found incompetent
to stand trial
P = Parole violator
9/ Facility Identification Number--A six position
alpha/numeric code assigned by SSA to the correctional or mental
health facility. This code identifies the facility where the
inmate is confined.
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EXAMPLE:
Code Source Supplying Inmate Data to i.
SSA
CA 8099 North Pole City Jail
AL 7500 South Pole City Jail
10/ Reporter Identification Code--A four position alpha/numeric III
code assigned by SSA for reporting inmate data to SSA.
EXAMPLE:
Code Source Supplying Inmate Data to
SSA
3CAP State of California Dept. of Corr.
3ALF State of Alabama Dept. of Corr.
2300 Cook County Jail
11/ Internal Inmate identification Code--Identification code
used by correctional or mental health facility.
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LABELING/MAILING:
Diskette External Label Instructions
Prepare an external label for the outside of your diskette
showing the following data:
o File Name: The file should be EVSxxxxPRS (the x' s represent
the month and year of the first date of the reporting period) .
EXAMPLE: Reporting period is 03/01/1997 through 05/31/1997 .
File name is EVS0397PRS .
o Reporting Period: Show the reporting period as MM/DD/YYYY-
MM/DD/YYYY. EXAMPLE: 03/01/1997-05/31/'_997 .
o Reporter ID : This is the code that is located in fields
112-115 of ycur record layout format, e. g. , 3CAP, the 4-
digit code that is assigned by SSA.
For the above the external diskette label should be shown:
EVS0397PRS
03/01/1997-05/31/1997
3CA2
Diskette Mailing Instructions
Prepare a mailing label for the outside of your shipping
envelope showing the following address :
SSA
Div. of Employer Services
Metro West Building
P.O. Box 1600
Baltimore, Maryland 21201
A COPY OF YOUR DISKETTE TRANSMITTAL FORM MUST ACCOMPANY YOUR
DISKETTE IN THE SHIPPING ENVELOPE.
IF YOU WANT A VERIFICATION DISKETTE RETURNED, PROVIDE YOUR
CORRECT STREET ADDRESS ON THE OUTSIDE OF THE DISKETTE. DO NOT
USE A POST OFFICE BOX NUMBER.
^rsrs
OUTPUT DISKETTE FORMAT FOR FEEDBACK FILE SSA SENDS TO REPORTER
Dataset Name: PUR.VATPV tapes; ; PUR3480/3490 .VATPV (-_-art ridges)
Field Field Field
Location Field Name Size Type
1-9 SOCIAL SECURITY NUMBER 9 N
10-22 LAST NAME 13 A/N
23-32 FIRST NAME 10 A/N
33-39 MIDDLE NAME OR INITIAL 7 A/N
40-47 DATE .OF BIRTH (MMDDYYYY) 8 N
48 BLANK 1
49 SEX CODE (M=Male F=Female 1 A
U=Unknown)
50-57 DATE OF CONVICTION (MMDDYYYY) 8 N
58-65 DATE OF CONFINEMENT (MMDDYYYY) 9 N ;.
66 BLANK 1
67-76 INTERNAL INMATE IDENTIFICATION CODE 10 A/N
77 BLANKS 1 •
78 VERIFICATION CODE 1/ 1 A/N
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79-81 PROCESSING CODE "317" 3 N
82-85 REPORTER IDENTIFICATION CODE 4 A/N
86-87 BLANKS 2
88-96 VERIFIED SSN LOCATED BY SSA 2/ 9 •
N
• 97 BLANK 1 •
• 98-103 FACILITY IDENTIFICATION CODE 6 A/N
104 INMATE STATUS CODE 1 A
105-112 RECEIPT DATE (MMDDYYYY) 8 N
113-120 REPORT DATE (MMDDYYYY) 8 NLI
121-136 REPORTING PERIOD (MMDDYYYYMMDDYYYY) 16 N
137-144 RELEASED DATE (MMDDYYYY) 8 N
145-150 BLANKS 6 (pg22)
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1/ Verification Codes :
Blank = Input SSN verified on name, DOB, and sex code.
= SSN not in file (impossibie SSN/never issued to
anyone, OR NO SSN found if all 000 ' s submitted) .
2 = Name and DOB match, sex code does not
3 = Name and sex code match, DOB does not
4 = Name matches, DOB and sex codes do not
5 = Name does not match, DOB and sex code not checked
= Input SSN did not verify; SSA located and verified a
different SSW shown in positions 88-96
A = Input SSN did not verify. SSA found an SSN which
matched exactly on name and DOB using alpha search
routines .
B = Input SSN did not verify. SSA found an SSN which
matched exactly on name but not DOB, using alpha search
routines .
2/ This is the SSN located and verified by SSA.
NOTE: . The output file will contain verification data for
each input record submitted.
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INSTRUCTIONS FOR RESUBMISSION OF DISKETTE '..
When your diskette is ready for resubmission, do the following:
o Replace the previous externa label with a new external
label. Annotate with the remark "Resubmission" under your
Reporter ID Code.
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o Fill out another transmittal form for the diskette .
o Circle the appropriate choice in number 10 of the
transmittal sheet if the diskette is a resubmission of a
diskette returned to you because of errors.
A TRANSMITTAL SHEET MUST ACCOMPANY ALL RESUBMISSIONS.
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