Field office (FO) and processing center (PC) technicians will use the instructions
in this section to send a Title II non-medical hearing request to the hearings level
using the ENM application.
FO technicians will also use these instructions to forward the hearing request to
the jurisdictional PC when the case involves a Title II only non-medical issue, per
GN 03103.080C.2 in this section. The FO is responsible for processing Title II exceptions as described
in GN 03103.080A.1 below.
FO/PC technicians will create, upload documents, edit, and change the case jurisdiction
in the ENM application, and route all Title II non-medical appeals cases to the Special
Review Cadre (SRC), office code 5ZU, with the exception of class action cases. Class
action cases will continue to be routed to the local jurisdictional hearing office.
For instructions on ENM case creation, upload instructions, and troubleshooting, see
GN 03103.080B in this section.
Once created, ENM is the official folder of record for non-medical cases.
The terms "hearing request" and "HA-501" are used interchangeably throughout these
instructions. These instructions presume:
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•
The beneficiary received a reconsideration determination, if procedurally applicable.
For more information on the hearing process, see GN 03103.010;
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•
There is a completed HA-501 (Request for Hearing by Administrative Law Judge) or i501,
or a written document that disagrees with the prior determination. For more information
on completing the HA-501, see GN 03103.020. For more information on iAppeals non-medical, see GN 03101.127; and
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•
When applicable, the technician has completed the Electronic Non-disability Summary
Sheet (eNDSS). For instructions on completing the eNDSS, see GN 03103.130B.
Other Program Operations Manual System (POMS) sections include instructions for processing
hearing requests on the following situation:
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1.
Title II exceptions
The FO does not send hearing requests involving Title II exceptions to the PC. For
Title II exceptions, the FO is responsible for processing the hearing request by following
the instructions in GN 03103.080C.1 in this section. Title II exceptions include:
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•
Substantial gainful activity (SGA);
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•
Res judicata (previously determined claim for disability benefits);
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•
Work issue continuing disability review (CDR) (dispute of earnings and work activity
- does not include appeals on overpayments if beneficiary agrees with the work CDR
determination);
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•
Benefit Offset National Demonstration (BOND) overpayments;
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•
Administrative sanctions; and
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•
The need for representative payment and the payee selected.
For Title II exceptions, the FO technician is not required to complete an eNDSS report;
however, the FO technician must create the ENM case and include the required documents
in GN 03103.080B.4 below into ENM.
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2.
Title XVI only or concurrent (Title II/Title XVI) common non-medical issue
Process non-medical hearing requests for Title XVI only or concurrent (Title II/Title
XVI) common issues per SI 04030.030.
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4.
Medicare Part A (Hospital Insurance (HI)), Part B (Supplementary Medical Insurance
(SMI)), and Income-Related Monthly Adjustment Amount (IRMAA)
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•
Process hearing requests for Medicare Part A and Part B per GN 03108.210.
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5.
Representative payee misuse
Process hearing requests for payee misuse per the instructions in GN 00604.064G.
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6.
No reconsideration determination
If the claimant insists on filing a hearing request before receipt of a reconsideration
determination, process the hearing request per GN 03103.120.
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7.
Late hearing request
When a claimant submits a hearing request late, see GN 03101.020D. Do not delay forwarding a late hearing request to the hearings level while awaiting
receipt of a good cause statement.