Last Update: 9/2/2005 (Transmittal I-2-63)
HA 01280.099 Exhibit - SSI Payment
Status Request
Renumbered from HALLEX section I-2-8-99
SSI Payment Status Request
- Please Expedite
Part I. (To be completed
by AC)
The case of the individual named below has been remanded to
an Administrative Law Judge for further proceedings. A copy of the
remand order is attached.
a. _____________________ b. _______________________ SSN
Individual's Name
c. _____________________
Date of Remand Order
d. _____________________________
Date of Prior Request for Hearing
e. ______________________________
Date of Prior Decision or Dismissal Order
f. This case was remanded to:
___________________________________________ HO
___________________________________________ Address
___________________________________________
___________________________________________
___________________________________________Telephone (with
area code)
___________________________________________
Name of Hearing Office Manager or other contact person
Part 2. (To be completed
by FO)
So that the individual may be promptly notified of his or
her rights to continued payments, please
perform SSI queries, check off the appropriate category and refer
to POMS DI 12027.065 for further instructions.
(Check one)
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a.
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Individual
received continued payments before at the ALJ hearing level, but
is not receiving payments now. HO will send notice in Exhibit.
FO will take necessary actions regarding redetermination of nondisability
factors and reinstatement of continued payments. Retroactive payments
may begin for the first month of nonpayment following the date of
the prior decision or dismissal order shown in Part 1.e. If the individual
wants to waive continued payments, the FO will have the individual
complete a written waiver, which will be sent to the HO for association
with the CF.
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b.
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Individual
received continued payments before at the ALJ hearing level, and
is receiving payments now. HO will send notice in Exhibit.
No FO action necessary to reinstate payments, which should continue
uninterrupted as long as the individual continues to meet the nondisability
requirements of eligibility. If the individual wants to waive continued
payments, the FO will have the individual complete a written waiver,
which will be sent to the HO for association with the CF, and the
FO will stop the payments.
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c.
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Individual
did not receive continued payments before at the ALJ hearing level.
HO will send notice in Exhibit. If the individual
contacts the FO to request continued payments, the FO will have the
individual complete a written request, which will be sent to the
HO for association with the CF. FO will take necessary actions regarding redetermination
of nondisability factors and starting continued payments, which
may begin for the month of the remand order shown in Part 1.c.
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Please telephone the HO shown
in Part 1.f. above and send them a copy of this form as followup.
For the telephone contact give the following information:
Name of individual (Part 1.a.)
SSN (Part 1.b.)
Date of Remand Order (Part 1.c.)
Which category checked off in Part 2. above (a. or b. or c.)
Name and telephone number of FO staff person making the call.