A request for SBC establishes the claimant’s intent to appeal; see DI 12026.015B.

The individual must request SBC for cash benefits or Medicare, if applicable, within 15 business days (10 business days plus 5 business days for mailing) from the date of the medical cessation or medical adverse reopening/revision determination notice. See considerations for specified time limits:

• •

  Separate SBC elections are required at both the reconsideration and administrative law judge (ALJ) hearing levels.

• •

  Individual may change election options only within the 15-day time frame but may request to stop receiving SBC at any time.

• •

  If the individual declines SBC during the 15-day period after the initial cessation, the individual will not have the opportunity to elect SBC again until the individual receives the notice of reconsideration determination.

• •

  An election remains effective until a new determination or decision on the current appeal is issued, or the individual requests to stop receiving SBC

• •

  The 60-day appeal period for requesting reconsideration or an ALJ hearing is not affected.

See GN 03101.010 about time limits for filing an appeal.

A request for SBC is late if it is received more than 15 business days (10 business days plus 5 business days for mailing) from the date of the medical cessation or medical adverse reopening/revision determination notice. Accept a late election only if good cause for late election is established. Take the following actions when good cause is involved:

1. 1. 

   Good cause determination at the reconsideration appeal level

   1. a. 

      If the FO receives the SBC election request after the 15-day period at the reconsideration level, develop good cause for extending the SBC time limit and prepare a good cause determination. Document the good cause determination using form SSA-553 – Special Determination. Record the reason for late filing, an evaluation of the facts, and the determination. Fax completed SSA-553 into section B of the electronic folder or place it in the Red-Jurisdictional Documents/Notices section of the Modular Disability Folder (MDF).

   2. b. 

      Consider the reason for the delay using the following criteria:

      • •

        Circumstances impeded the individual’s efforts to pursue their request or appeal.

      • •

        The individual’s physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) prevented the individual from timely filing the request or from understanding or knowing about the need to file a timely request.

      • •

        The actions of SSA or the Centers for Medicare and Medicaid Services (CMS) misled the individual.

      • •

        The individual or representative payee did not understand the requirements of the Social Security Act (Act), resulting from amendments to the Act, other legislation, or court decisions.

   3. c. 

      If you are unable to find good cause for late filing, release notice titled "Good Cause Denial for SBC" which is in the continuing disability review (CDR) folder in the Document Processing System (DPS), see NL 00703.480. NOTE: denying an SBC good cause request is not appealable.

2. 2. 

   Good cause determination at the hearing appeal level

   1. a. 

      If the request for a hearing is filed within the 60-day appeal period, and the SBC election is received after the 15-day period, the FO will determine good cause for late filing of the SBC election. See DI 12027.008B1.

   2. b. 

      If both the requests for hearing and SBC election are filed more than 60 days after the date of receipt of the notice of the reconsidered determination, the ALJ will determine good cause for late filing of the election of SBC. Route the appeal and SBC election request to the hearing office and request they make a good cause determination. The hearing office will notify the FO about the ALJ’s good cause determination via memorandum or e-mail.