Exhibit 4 - Stieberger Potential Class Member Notice
SOCIAL SECURITY ADMINISTRATION
Important Information
Name |
ST |
Date: |
Address |
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Claim Number: |
City, State, Zip |
DOC: |
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We have good news for you about your past claim for disability benefits. We are writing
to you about a court case that may affect you. Because of this court case you may
be entitled to money from Social Security. Please read this letter carefully.
INFORMATION ABOUT THE COURT CASE
You may be entitled to Social Security or Supplemental Security Income disability
payments based on a past claim you filed. In a recent court case called Stieberger
v. Sullivan, we agreed to look again at certain claims that were denied or where payments
were stopped. We believe that your claim may be one of those that we agreed to look
at again.
HOW TO ASK FOR A REVIEW
We will not look at your claim again unless you ask us to do so. If you want us to
do this, fill out the enclosed reply form that came with this letter and mail it right
away in the enclosed envelope. You have 180 days from the day you received this letter
to ask us to look at your claim again, but don't wait. If you don't send the form
back, we will not look at your claim again. We will write to you when we receive your
reply form.
IF YOU NOW GET MONEY FROM SOCIAL SECURITY
Even if you get money from Social Security, we may still owe you more money. Return
the reply form in this letter within 180 days to ask us to look at your past claim
again.
PROTECTING YOUR RIGHTS
Sending in the enclosed reply form does not protect your rights on any other claim
for benefits. If you have a claim for benefits that we are still considering or that
we recently denied and you disagree with our decision, you must follow the guidelines
that we tell you about in the notice on that claim.
IF YOU HAVE ANY QUESTIONS
If you have any questions, you may contact any Social Security office. The address
and phone number of your local Social Security office are printed at the top of this
letter. If you call or visit an office, please take this letter with you. It will
help us answer your questions.
FOR HELP
Additionally, if you have someone helping you with your claim, you should contact
him/her. You also may contact one of the following offices to obtain a legal representative,
or you may contact the lawyers in this case. These offices are listed below.
OFFICES THAT WILL REFER YOU TO ORGANIZATIONS THAT PROVIDE FREE LEGAL REPRESENTATION
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New York City Area:
Legal Services for New York City, (212) 431-7200 or
The Legal Aid Society, (718) 722-3100.
The Rest of New York State:
Greater Upstate Law Project, (800) 724-0490, or
(800) 635-0355.
OFFICE THAT WILL REFER YOU TO AN ATTORNEY WHO WILL CHARGE A FEE FOR REPRESENTATION
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Throughout New York State:
National Organization of Social Security Claimants'
Representatives, (800) 431-2804, or (914) 735-8812.
OFFICES OF THE LAWYERS THAT REPRESENTED CLAIMANTS IN THIS LAWSUIT
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The Legal Aid Society of New York
Civil Division, Civil Appeals & Law Reform Unit
11 Park Place, Room 1805
New York, New York 10007
(212) 406-0745
Legal Services for the Elderly
130 W. 42nd Street, 17th Floor
New York, New York 10036-7803
(212) 391-0120
MFY Legal Services
35 Avenue A
New York, New York 10009
(212) 475-8000
Enclosure:
Reply form and envelope
Exhibit 5 - Stieberger Reply Form
Exhibit 6 - Request For Court Case Review/Change of Address Worksheet
REQUEST FOR COURT CASE REVIEW/CHANGE OF ADDRESS WORKSHEET
1. |
COURT CASE NAME |
: |
2. |
COURT CASE IDENTIFIER |
: |
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3. CHECK ONE: [ ] REQUEST FOR REVIEW [ ] CHANGE OF ADDRESS
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4. |
DATE OF CONTACT |
: - - |
5. |
CLAIMANT'S OWN SSN |
: - - |
6. |
CLAIMANT'S DATE OF BIRTH |
: - - |
7. |
CLAIMANT'S FIRST NAME |
: |
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CLAIMANT'S MIDDLE INITIAL
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CLAIMANT'S LAST NAME |
: |
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8. |
STREET ADDRESS |
: |
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CITY |
:
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STATE |
: |
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ZIP |
:
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9.PHONE # |
:( ) -
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10. |
NAME OF PAYEE |
:
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11. |
NAME OF ATTY/REP |
: |
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12.
CLAIM/SSN NUMBERS (LIST ALL KNOWN CLAIM/SSN NUMBERS)
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TII (CLAIM NO. & BIC) |
VERIFY |
TXVI (SSN. & ID)VERIFY |
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- - -
- - -
- - -
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- - -
- - -
- - -
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13.
SIGNATURE (If claimant/payee appears in person, please obtain signature).
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PREPARED BY: OFFICE CODE
PREPARERS TELEPHONE NO: (INCLUDE AREA CODE)
Instructions For Completion of the Request For Court Case Review/Change of Address
Worksheet
Item 1.
Print the name of the court case claimant/payee/representative is inquiring about
(i.e., “Stieberger”).
Item 2.
This worksheet can be used to implement all class action court cases. The court case
identifier for “Stieberger” is ST.
Item 3.
If a claimant/payee/representative is requesting review (e.g., walk-in) under the
“Stieberger” Court Order, check the first block. If the claimant/payee/representative has previously
requested review under “Stieberger” and is informing SSA of a new address, check the second block. If the claimant/payee/representative
is requesting review and notifying SSA of a new address simultaneously, check both
blocks.
Item 4.
Provide date of contact (mm/dd/yyyy).
Item 5.
Provide claimant's own social security number.
Item 6.
Provide claimant's date of birth (mm/dd/yyyy).
Item 7.
Print claimant's complete first name, middle initial, if appropriate, and complete
last name, allowing one letter for each underscore provided on the worksheet.
Item 8.
Print the street address, city, state abbreviation, and zip code of the claimant or
claimant's payee/representative, as appropriate, allowing one letter for each underscore
provided on the worksheet.
Item 9.
Provide the telephone number, including area code, of the claimant/payee/representative,
as appropriate.
Item 10.
Print the complete first name, middle initial, and last name of the payee, not to
exceed 19 characters, if appropriate. If the complete name exceeds 19 characters,
shorten the first name to ensure that the complete last name is provided. Leave a
space after the first name and after the middle initial.
Item 11.
Print the complete first name, middle initial, if appropriate, and complete last name
of the attorney/representative, if claimant has representation.
Items 12.
Complete only if claimant/payee/representative is requesting court case review. It
is not necessary to complete the claims information when only reporting a change of
address. This information is required to establish a “walk-in” record on the Civil Action Tracking System (CATS). If not complete, the form will
be returned for completion.
Provide all claim numbers, including BIC and/or ID, under which the claimant filed
for benefits. Use the back of the sheet, if necessary. This is needed to ensure that
all appropriate claims are reviewed under the class action. Attempt to verify the
claim numbers via MBR and/or SSR. If there is no record on the MBR/SSR, verify the
SSN on the Numident. Be sure to write “YES” in the space provided in the “VERIFY” column on the worksheet indicating that the account numbers were verified.
Item 13.
Obtain the signature of the claimant/payee/representative only if he/she appears in
person.
Item 14.
Print the name, office code, and telephone number, including area code, of the SSA
employee completing this form.
MAIL THE COMPLETED WORKSHEET TO THE FOLLOWING ADDRESS:
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SSA, Office of Disability and International Operations
Class Action Section
Attn: STIEBERGER Coordinator
P. O. Box 17369
Baltimore, MD 21298-0050
Exhibit 7 - Stieberger Screening Sheet
STIEBERGER
SCREENING SHEET
IMPORTANT: A separate screening sheet must be prepared for each claim number and the
applications screened must be identified. See IV below.
CLASS ACTION CODE: S T
1. CLAIMANT'S SSN: - -
2. CLAIMANT'S NAME:
(Please Print) (Last) (First)
3. DATE OF BIRTH: / /
(MM/DD/YYYY)
4. CLAIM #: - - -
(BIC/ID)
5. DATE OF SCREENING: / /
(MM/DD/YYYY)
6. SCREENING RESULT:
MEMBER: REQUIRES
REVIEW (J)
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NON-MEMBER: DOES NOT REQUIRE
REVIEW (F)
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SCREENOUT CODE
(see II. for codes)
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I. CLASS MEMBERSHIP REOPENING ENTITLEMENT DETERMINATION
7.
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Does the Stieberger alert package indicate that no claim for disability benefits was ever filed on the
SSN provided?
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Yes No (If yes: Stop here! Check block 7 follow II below.) (If no : Go to 8.)
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8.
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Does the Stieberger alert package indicate that the claimant was not a New York state resident at the
time all claim(s) were finally decided?
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NOTE: If the final decision on the claim(s) was based upon the res judicata effect being
given to an earlier New York decision, do not screen out the Stieberger claim(s). The individual may still be eligible for Stieberger reopening.
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Yes No (If yes: Stop here! Check block 8 and follow II below.) (If no: Go to 9.)
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9.
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Were all claims for disability benefits finally denied or ceased for some reason(s)
other than medical or vocational reasons? The reason(s) was
.
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Yes No (If yes: Stop here! Check block 9 and follow II below.) (If no: Go to 10.)
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10.
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Were the remaining claims for disability benefits finally denied/ceased, at any level,
between October 1, 1981 and October 17, 1985, inclusive; or, between October 18, 1985
and July 2, 1992, inclusive, at the hearings or Appeals Council levels of review.
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Yes No (If yes: Go to 11.) (If no: Stop here! Check block 10 and follow II below.)
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11.
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Did the claimant receive a subsequent decision review after October 17, 1985 under
P.L. 98-460 that covered a prior cessation within the Stieberger period and was that decision review appealed to an ALJ?
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Yes No (If yes: Stop here! Check block 11 and follow II below.) (If no: Go to 12.)
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12.
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Did the remaining claim(s) receive a non-New York final decision(s), at any time,
that covered the entire time period covered by the Stieberger claim(s).
NOTE: If a subsequent non-New York claim that encompassed the Stieberger timeframe was denied based upon the res judicata effect being given to an earlier
New York decision, do not screen out the Stieberger claim(s). The individual may still be eligible for Stieberger reopening.
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Yes No (If yes: Stop here! Check block 12 and follow II below.) (If no: Go to 13.)
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13.
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Was the remaining claim(s) decided under any other New York class action order, e.g.,
State of New York, Dixon, or Hill; and, if so, did the decision cover the same period as the Stieberger claim(s)?
NOTE: The criteria for readjudications may be different for each class action. Therefore,
if you screen out the Stieberger claim because the individual received a decision based upon a readjudication under
another class action, you must be sure that the period of time covered by the readjudication
in the other class action, both with respect to development and payment, is at least
as broad as the development and payment periods in the potential Stieberger readjudication.
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Yes No (If yes: Stop here! Check block 14 and follow II below.) (If no: Go to 15.)
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14.
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Did the remaining claim(s) receive a Federal court decision on the merits or did the
claimant choose Federal court review instead of Stieberger review on the remaining claim(s) within the Stieberger period?
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Yes No (If yes: Stop here! Check block 15 and follow II below.) (If no: Go to 16.)
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15.
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Did the remaining claim(s) receive a determination/decision, after July 2, 1992 that
covered the same timeframe and issues covered in the Stieberger claim(s)?
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Yes No (If yes: Stop here! Check block 16 and follow II below.) (If no: Follow III below.
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II.
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Individuals Not Entitled To Reopening
If you checked block 07, 08, 09, 10, 11, 12, 13, 14, or 15, and if all claims within
the Stieberger period have been screened out, the claimant is not entitled to reopening. Check “NON-MEMBER” (F) in item 6 on page 1, fill in the screen-out code (07, 08, 09, 10, 11, 12, 13,
14, 15 or 16). NOTE: In multiple claims situtations, fill in, at item 6, page 1, the screen-out code of
the last claim screened.
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III.
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Class Members Entitled to Reopening
If you have no blocks checked, the claimant is a class member entitled to reopening.
Check “MEMBER” (J) in item 6 on page 1.
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IV.
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On the lines below, please enter the date of the application(s) and final decision(s)
considered in the screening process. Also indicate the administrative level at which
the final decision was made (i.e., initial, recon, ALJ, AC). If claims are screened
out when proceeding through the screening sheet, indicate the screenout code at which
each claim is eliminated from Stieberger reopening.
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Date of Application(s)
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Date of Decision(s) |
Level of Final Decision
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Screenout Code |
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BEFORE SIGNING, PLEASE BE SURE TO COMPLETE ITEM 4 on PAGE 1.
Print name and phone number Signature
Stieberger Screening Sheet Instructions
General Instructions: It is expected that most screening will be completed based on related queries (FACT,
SSIRD, STALE, earnings query extract, OHO query extract, etc.) which are part of the
alert package. If the folder is available, use the folder to complete the screening
sheet. Since the answer to some of these questions is not readily apparent from queries
only, if the claim file is not available, assume the claim is not screened out and
go on to the next question. If a conclusive class membership determination cannot
be made from the information available, the claimant should be screened in.
A SEPARATE screening sheet must be prepared for each claim number. Make sure the claim number,
BIC/ID and SSN, are the same as on the STIEBERGER Case Flag Alert to ensure proper case clearance. Consider all Title II and Title XVI claims (denials/cessations) decided at any level of administrative
review (initial, reconsideration or OHO) during the period of October 1, 1981 and
October 17, 1985, inclusive; or, at the ALJ or Appeals Council level between October
18, 1985 and July 2, 1992, inclusive.
Question 1:
Please fill in the claimant's SSN from BOAN/PAN field on alert.
Question 2:
Print the claimant's name (last name, and first name).
Question 3:
Fill in the claimant's date of birth (2-digit month, 2- digit day, 4-digit year).
Question 4:
Fill in the claim number(s) (social security number) under which this claim is being
processed. Include the BIC (Title II)/ID (Title XVI).
Question 5:
Complete the screening date using 2-digit month, 2-digit day, and 4-digit year.
Question 6:
Complete this information last. Do not fill in until the screening process has been
completed.
Question 7:
If the Stieberger alert package indicates that no claim for disability benefits was filed under the
claim number given, obtain an MBR or SSR under the beneficiary's own social security
number if it is different from the claim number given. If there is still no evidence
that a disability claim was filed, check block 7 and follow II.
Question 8:
Screen for residency as of the date of the final determination(s)/ decision(s), not
date of application. If there is a SSIRD in file check for claimant's past address(es).
If there is an OHO query extract in file check for hearing office code as follows:
5024, 5200, 5308, 5023, 5310, 5102, 5020, 5021, 5110, 5135. If there is only an MBR
in package, check claimant's address. If the claimant was not a resident of New York
at the time any claims were finally decided within the Stieberger period, those claims are not entitled to Stieberger reopening. Continue to screen any remaining claims in which the claimant was a resident
of New York and go to question 9. NOTE: If a non-New York denial decision within the Stieberger timeframe was due to the res judicata effect being given to a New York decision,
move on to question 9. If not check block 8 and follow II.
Question 9:
Review the query package and/or folder to determine if the claimant was denied for
medical or vocational reasons as opposed to technical reasons (insured status, engaging
in SGA, excess income and resources) on any claim. Look for basis denial codes for
title II of: E1, E2, E3, E4, F1, F2, G1, G2, H1, H2, J1, J2, K1, K2, L1, L2, M5, M6.
For Title XVI look for: N30, N31, N32, N34, N35, N36, N37, N39, N40, N41, N42, N43,
N45, N46, N47, N48, N51. If claimant was denied for other than medical reasons, state
the reason on the line provided. If any claims were finally denied for non-medical/vocational
reasons within the Stieberger period, those claims are not entitled to Stieberger reopening. Check block 9 and follow II. Continue to screen any remaining claims in
which there are medical/vocational determinations and go to question 10.
Question 10:
Review queries to determine dates of all disability applications denied/ ceased. If
claimant's application(s) for disability benefits were not denied/ ceased between
October 1, 1981 and October 17, 1985, inclusive, at any level of administrative review,
or, between October 18, 1985 and July 2, 1992, inclusive, at the ALJ or Appeals Council
levels of review, those claims are not entitled to Stieberger reopening. Check block 10 and follow II. Continue to screen any remaining claims
which meet the date criteria and go to question 11.
Question 11:
If the post-October 17, 1985 determination by the NYDDS was a decision review under
P.L. 98-460 of a prior cessation, the claimant is not entitled to Stieberger reopening on either the prior cessation determination or the decision review completed
under P.L. 98-460. Check block 11 and follow II. Continue to screen any remaining
claims in which the claimant did not receive a decision review or in which the claimant
did receive a decision review and appealed it to an ALJ and go to question 12.
Question 12:
If the claimant received a final decision which was rendered by a non-New York jurisdiction
on a claim(s) which covered the entire Stieberger period, claimant is not entitled to Stieberger reopening on this claim. Check block 12 and follow II. Continue to screen any remaining
claims within the Stieberger period. NOTE: If the non-New York denial decision was due to the res judicata effect being given
to a New York decision, move on to question 13.
Question 13:
If the claimant received a decision on a claim(s) under any other New York class action
order which covered the entire Stieberger period, e.g., State of New York, Dixon or Hill, that reopened the claim, the claimant is not entitled to Stieberger reopening of this claim. Check block 13 and follow II. Obtain a DDSQ to determine
if the claimant received a favorable decision under the above-referenced court cases.
If claim was last decided at the OHO level, you will have to contact the DPB of your
Regional Office. They will obtain a CATS query to determine if the claimant has received
a court decision. Continue to screen any remaining claims within the Stieberger period which were not covered by any other New York class action. NOTE: The criteria for readjudications may be different for each class action. For example,
if the claimant received a decision under State of New York, but that decision provided only a limited redetermination of the claim, the claimant
is eligible for review under Stieberger on that claim. However, if the relief under the other class action is as broad as
what the claimant would receive under Stieberger, that claim is not eligible for Stieberger review.
Question 14:
Check the OHO query to determine court activity. If the claimant received a court
decision on the merits that covered the entire period of the Stieberger claim, the claimant is not entitled Stieberger reopening of this claim. If the claim was last decided at OHO level, you will have
to contact the DPB of your Regional Office. They will obtain a CATS query to determine
if claimant has received a court decision. In addition, any claim in which the claimant
opted for court review instead of Stieberger reopening is not entitled further review on that claim. If either condition is satisfied,
check block 14 and follow II. Continue to screen any remaining claims within the Stieberger period which were not covered by a court decision or option for court review.
NOTE: If the claimant's case was dismissed in court for a technical reason e.g., untimeliness,
the claimant is eligible for Stieberger reopening on that claim.
Question 15:
Review the queries to determine if a subsequent claim was decided based on the earliest
remaining claim(s) in the Stieberger period. An individual who has received a decision after July 2, 1992 on a later claim,
which covered the entire timeframe and issues as in the Stieberger claim, has obtained all available relief under the Stieberger settlement.
If the claimant did not receive entitlement to all disability benefits that he/she
would be entitled to under the Stieberger settlement, prepare an SSA-831-U3 annotated with “STIEBERGER reopening. This adopts the SSA-831 dated.” If necessary, forward to the FO for development of non-medical factors of entitlement.
If full payment has not been made on the post-July 2, 1992 claim, send the claim to
a claims authorizer to pay any additional payment/benefit due.
If full payment has been made on the post-July 2, 1992 claim, check block 15 and follow
II.
Return to screening sheet, sections II and III for screen in and screen out instructions.
Be sure to complete item IV. In multiple claims situations, when no claims remain
that are eligible for Stieberger reopening, enter the screenout code in number 6 on page 1 of the final claim screened.
Exhibit 8 - Screen-out Notice
SOCIAL SECURITY ADMINISTRATION
Important Information
Name |
ST |
Date: |
Address |
|
Claim Number: |
City, State, Zip |
DOC: |
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THIS NOTICE IS ABOUT YOUR SOCIAL SECURITY/SUPPLEMENTAL SECURITY INCOME BENEFITS.
PLEASE READ IT CAREFULLY!
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A.
WE HAVE FOUND THAT YOU ARE NOT ENTITLED TO REOPENING UNDER STIEBERGER v. SULLIVAN.
You asked us to review your case under the terms of the Stieberger court decision. We have looked at your case and decided that you are not a Stieberger class member entitled to reopening. This means that we will not review under the Stieberger class action our earlier decision to deny or cease your benefits. The reason you are
not a class member entitled to reopening under the Stieberger court decision is checked below.
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B.
WHY YOU ARE NOT A CLASS MEMBER ENTITLED TO REOPENING
YOU ARE NOT A STIEBERGER CLASS MEMBER ENTITLED TO REOPENING BECAUSE:
1.
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[ ]
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You did not file a claim for disability benefits under the social security number
provided.
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2.
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[ ]
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You were not a New York state resident at the time your disability benefits were finally
denied or ceased.
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3.
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[ ]
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Your benefits were denied or ceased for some reason other than your medical condition.
That reason was
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4.
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[ ]
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Your benefits were not denied or ceased between October 1, 1981 and October 17, 1985,
inclusive, at any administrative level; or, between October 18, 1985 and July 2, 1992,
inclusive at the Administrative Law Judge or Appeals Council levels of review.
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5.
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[ ]
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You received a decision review after October 17, 1985 under P.L. 98-460 that covered
the same period as your Stieberger claim(s) and you did not appeal that decision to the hearing level.
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6.
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[ ]
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You were found not disabled in a final decision by a non-New York adjudicator that
covered the same period as your Stieberger claim(s).
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7.
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[ ]
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You received a decision under another New York Court order such as the State of New York, Hill, or Dixon that covered the same period as your Stieberger claim(s).
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8.
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[ ]
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You have received a Federal court decision(s) on the merits of your Stieberger claim or you opted for Federal district court review instead of Stieberger reopening.
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9.
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[ ]
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You received a subsequent determination/decision after July 2, 1992 that covered the
same timeframe and issues as your Stieberger claim.
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10.
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[ ]
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Other
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C.
WE ARE NOT DECIDING WHETHER YOU ARE DISABLED
It is important for you to know that this notice is not a decision about whether you
are or were disabled. We are deciding only that you are not a Stieberger class member entitled to reopening.
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D.
WHAT YOU MAY DO IF YOU DISAGREE WITH THIS DETERMINATION
You have 60 days from the date you receive this notice to send your written disagreement
directly to:
The Office of the General Counsel
Social Security Administration
Rm. 617 Altmeyer Bldg.
6401 Security Blvd.
Baltimore, MD 21235
Attn: The Stieberger Case Coordinator
We will assume that you received this notice 5 days after the date of the notice unless
you show us otherwise.
You may ask to see the record on which we decided you were not a class member entitled
to reopening. If you do ask to see it, you will have 45 days after we tell you that
it is available for inspection at a mutually agreed upon Social Security office. You
may also ask for your attorney or other representative to look at the record.
When your written disagreement is received, the Office of the General Counsel will
look at your case again, notify you of the final determination and advise you of any
further appeal rights you may have.
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E.
IF YOU HAVE A LEGAL REPRESENTATIVE OR WOULD LIKE TO OBTAIN ONE
If you have a legal representative, you should show this notice to that person.
If you would like to obtain a legal representative, you may contact one of the attorneys
representing the Stieberger class at the following address:
The Legal Aid Society of New York
Stieberger Implementation Project
841 Broadway, 3rd Floor
New York, NY 10003
(212) 477-5010
If you would like a referral to an attorney who will charge a fee for representation,
you may contact the National Organization of Social Security Claimants' Representatives
by calling (800) 431-2804.
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F.
YOU CONTINUE TO HAVE THE RIGHT TO FILE A NEW APPLICATION FOR BENEFITS. FILING A NEW
APPLICATION IS NOT THE SAME AS CHALLENGING OUR CLASS MEMBERSHIP DECISION, AND OBTAINING
A NEW DECISION ON A PAST APPLICATION.
Si usted habla espanol y no entiende esta carta, favor de llevarla a la oficina de
Seguro Social arriba mencionada para que se la expliquen.
Exhibit 9 - Stieberger Alert
999889 00000
CTWALT01 STIEBERGER COURT CASE FLAG/ALERT
REVIEW PSC DOC TOE ALERT DATE RESPONSE DATE OLD BOAN/PAN
OFFICE
SSN (BOAN OR PAN) NAME BIRTH DATE REFERENCE #
FOLDER LOCATION INFORMATION
CAN/HUN BIC/MFT CATG TITLE CFL CFL DATE ACN
PAYEE ADDRESS
SHIP TO ADDRESS
SERVICING FO
SPECIAL INSTRUCTIONS:
IF A CURRENT CLAIM IS PENDING AT TIME OF FO INTERVIEW, THIS CLAIM MAY BE CONSOLIDATED WITH THE CURRENT CLAIM. SEE DI 12586.025B. FOR ADDITIONAL INSTRUCTIONS
Exhibit 10 - Development/Payment Period Worksheet
STIEBERGER DEVELOPMENT/PAYMENT PERIOD WORKSHEET SUMMARY SHEET --- KEEP ON TOP!
CLAIMANT'S SSN: - -
PERSON WHO COMPLETED THIS WORKSHEET:
, ; ; ( ) -
Surname and initial Office code Telephone
============================================================== = =====
FIRST MONTH OF DEVELOPMENT PERIOD: /
============================================================== = =====
TITLE II PAYMENT: BIC:
POTENTIAL ADMINISTRATIVE ONSET: /0 1/ [ ] Cessation Case
See DI 32586.020
POTENTIAL MOET: /
[ ]
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DDS could establish onset as early as / / if 10(e)(5) exception is met.
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[ ]
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If disability is established, benefits terminate / ; if claimant is found currently disabled, re-entitle to benefits effective / 0 1 / .
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[ ]
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Prisoner suspension period (s): / - /
/ - /
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Payment is intermittent - see worksheet.
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Consider TWP provisions if there was work after 11/91.
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DDS Established actual onset / / -LATER than administrative onset.
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DDS Established actual onset / / -EARLIER than administrative onset. Pay benefits only from the “Potential MOET”, and only if insured status is met at the established onset date.
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TITLE XVI PAYMENT:
POTENTIAL ONSET AND ENTITLEMENT: / 0 1 / (“administrative
onset”)
DDS could establish onset as early as / / if 10(e)(5) exception is met.
[ ]
|
Payment is intermittent - see worksheet.
|
[ ]
|
DDS Established actual onset / / -LATER than administrative onset.
|
[ ]
|
DDS Established actual onset / / -EARLIER than administrative onset. Pay benefits only from the “Potential MOET”.
|
STIEBERGER DEVELOPMENT/PAYMENT PERIOD WORKSHEET
PART I. GATHER INFORMATION - DEVELOPMENT PERIOD
A.
|
1. Month request for review rec'd (from alert): 2. Month of class member's death: 3. Enter the earlier of A.1 and A.2
|
/
/
/
|
B.
|
1. Filing date of the earliest Title II denial covered by Stieberger:
|
/
|
|
2. Alleged onset date in that denial:
|
/ /
|
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3. If a DWB or surviving child claim, NH's date of death:
|
/
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4. If a CDB claim, month CDB attains age 22:
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/
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5. If a DWB claim, month DWB attains age 50:
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/
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6. If a DWB claim, last month of prescribed period; if a CDB reentitlement claim,
last month of the reentitlement period:
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/
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C.
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Filing date of the earliest Title XVI denial covered by Stieberger:
|
/
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D.
|
If Stieberger determination was a cessation, month of Title II or XVI termination:
|
/
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E.
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Periods of entitlement to unreduced “A” , “HA”, DWB or CDB benefits before the month shown in A.3
|
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began: /
|
ended: /
|
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began: /
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ended: /
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F.
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Periods of entitlement to Title XVI benefits before the month shown in A.3
|
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began: /
|
ended: /
|
|
began: /
|
ended: /
|
G.
|
Is there a current claim pending which, if approved, would be retroactive to a month
before the month shown in A.1?
|
Y / N
|
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If so, period of potential entitlement based on the current claim:
|
begins: /
ends: /
|
H.
|
Was there ever a final medical denial issued when (s)he did not reside in NY State?
|
Y / N
|
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Period covered by denial:
|
AOD: /
Date of decision: /
|
J.
|
Using SEQY postings show: Yrs pre-1990 with earnings over $3600/stat. blind (do not use year of onset - B2)
|
1 9 1 9 1 9 1 9
|
|
Yrs after 1989 with earnings over $6000/stat blind (do not use year of onset - B2)
|
1 9 1 9 1 9 1 9
|
PART II. DETERMINE THE DEVELOPMENT PERIOD
USE THE CHART ON THE NEXT PAGE TO COMPUTE THE DEVELOPMENT PERIOD
For the following calculations, use the results of Part I.
-
1.
“X” out any month later than the month shown in A.3.
-
2.
Find the earlier of the months shown in B.2., C OR D. “X” out any months before this month.
-
3.
“X” out any months in the periods shown in E, F, G, or H
-
4.
“X” out ALL months in any year shown in J.
-
5.
Find the most recent 48 months that were not been “X'ed” out. If there are fewer than 48 such months, use all the boxes that were not “X'ed”. Counting back with the month shown in A.3, place a “D” in the 48th month not “X'ed” out. Enter that month here:
/
-
6.
If the month in 5. above is later than the month shown in B.4 or B.6, enter the month
shown in B.4 or B.6.
/
-
7.
The first month of the DEVELOPMENT PERIOD is the earlier of the month in 5. or 6.
above. Show that month at the top of the Summary Sheet.
/
Stieberger DEVELOPMENT PERIOD Chart:
|
J a n
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F e b
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M a r
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A p r
|
M a y
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J u n
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J u l
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A u g
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S e p
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O c t
|
N o v
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D e c
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1996 |
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1995 |
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1994 |
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1993 |
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1992 |
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1991 |
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1990 |
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1989 |
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1988 |
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1987 |
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1986 |
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1985 |
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1984 |
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1983 |
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1982 |
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1981 |
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1980 |
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1979 |
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PART III: GATHER INFORMATION - PAYMENT PERIOD(S)
Before you compute PAYMENT PERIODS, you will have to show additional information (from
your interview with the class member, if necessary):
-
K.
Periods of entitlement to “A” (reduced or unreduced), “HA” , DWB or CDB benefits:
began: / ended: /
began: / ended: /
-
L.
Periods the class member was confined due to felony-related conviction:
began: / ended: /
began: / ended: /
-
M.
Periods the class member absent from the U.S., or institutionalized (N02) (SI 00501.400):
began: / ended: /
began: / ended: /
PART IV: COMPUTE THE TITLE II PAYMENT PERIOD
USE THE CHART ON THE NEXT PAGE TO COMPUTE THE TITLE II PAYMENT PERIOD
/
-
1.
Determine the MOET based on the earliest Stieberger claim. If the claimant had no previous Title II entitlement, you can use the following
procedure; otherwise, use regular Title II rules for the result of this step.
If the Stieberger determination is a cessation, show the month of termination, as shown in D above:
/
If it was an initial claim for HA, HC, or DWB benefits, subtract 12 months from the
month shown in B.1. If it was a claim for C benefits (RSI), subtract 6 months from
the month shown in B.1:
/
If it was a claim for HA or DWB benefits, add 5 full calendar months to the date shown
in B.2. If it was a claim for C or HC benefits, show the month shown in B.2 (or the
following month, if the AOD in B.2 is not the first day of the month):
/
If it was a claim for DWB or surviving child benefits, show the date of death of the
number holder as shown in B.3:
/
If it was a claim for DWB benefits, show the date the DWB attained age 50 as shown
in B.3:
Circle the latest date.
-
2.
Using the chart on THIS page, “X” out any month before the month you circled in step 1 above.
-
3.
Put a “T” in the box for any month in the period shown in H.
-
4.
“X” out any months in periods shown in G, K or L.
-
5.
Count the LATEST 48 months that have not been marked. Mark these boxes with an “E”.
The FIRST “E” month is the potential month of entitlement (MOET):
/
-
6.
The Potential MOET is also the potential administrative onset for cessations, all
SSI claims , and CDB claims. For initial claims for HA or DWB benefits, subtract 5
months from the MOET. This will be the potential established onset date:
/0 1/ .
(note: The DDS may make the onset as early as the AOD [or termination date in cessations],
if the 10(e)(5) conditions are met).
-
7.
If any “T” months are shown, benefits AND THE PERIOD OF DISABILITY will TERMINATE with the first
“T” month. Benefits and the period of disability will resume with the first non-“T” month if the claimant is found to be currently disabled.
Potential benefits would terminate:
/
Potential resumption of benefits:
/
Stieberger PAYMENT PERIOD CHART Title II
|
J a n
|
F e b
|
M a r
|
A p r
|
M a y
|
J u n
|
J u l
|
A u g
|
S e p
|
O c t
|
N o v
|
D e c
|
1991 |
|
|
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|
|
|
|
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|
|
|
/// |
1990 |
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1989 |
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1988 |
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1987 |
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1986 |
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1985 |
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1984 |
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1983 |
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1982 |
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1981 |
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1980 |
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1979 |
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|
|
|
PART V: COMPUTE THE TITLE XVI PAYMENT PERIOD
USE THE CHART ON THIS PAGE TO COMPUTE THE TITLE XVI PAYMENT PERIOD
Stieberger PAYMENT PERIOD CHART Title XVI
|
J a n
|
F e b
|
M a r
|
A p r
|
M a y
|
J u n
|
J u l
|
A u g
|
S e p
|
O c t
|
N o v
|
D e c
|
1991 |
|
|
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|
|
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|
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|
/// |
1990 |
|
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1989 |
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1988 |
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1987 |
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1986 |
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1985 |
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1984 |
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1983 |
|
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1982 |
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1981 |
|
|
|
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|
|
1980 |
|
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1979 |
|
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|
-
1.
“X” out any month before the month shown in C.
-
2.
“X” out any month in the periods shown in F, G, H, K, or M.
-
3.
Count the LATEST 48 months that have not been marked. Mark these boxes with an “E”.
The FIRST “E” month is the potential established onset date:
/0 1/
(note: The DDS may make the onset as early as the AOD, if the 10(e)(5) conditions are met).
-
4.
Payment may be made for all “E” months, subject to the regular rules of eligibility and applying the Stieberger tolerances in DI 12586.080. As of Jan. 1st of the year prior to the year in which the favorable SSA-831 was
signed, regular development rules apply.
Exhibit 11 - Stieberger Folder Request Memo
STIEBERGER Folder Request Memo
STIEBERGER FOLDER REQUEST MEMO Date
TO:
|
ODIO Stieberger Folder Retrieval Unit P.O. Box 17369 Baltimore, MD. 21298-0050
|
FROM:
|
DDS
|
Code
|
|
FO
|
Code
|
SUBJECT:
|
Responder Name
Responder SSN
Title II Claim No.(s)
|
Please obtain the Title II and XVI claim file/medical evidence for the following Stieberger application(s) and forward to this office.
Date of Application |
Date of Denial/Termination |
|
|
|
|
|
|
|
|
|
|
|
|
Requestor's Name Requestor's Telephone No.
Attachment: Copy of Stieberger Alert-Query Package
Exhibit 12 - Stieberger 48-Month Chart
48 MONTH TABLE
12/93 - 01/90 |
12/91 - 01/88 |
11/93 - 12/89 |
11/91 - 12/87 |
10/93 - 11/89 |
10/91 - 11/87 |
09/93 - 10/89 |
09/91 - 10/87 |
08/93 - 09/89 |
08/91 - 09/87 |
07/93 - 08/89 |
07/91 - 08/87 |
06/93 - 07/89 |
06/91 - 07/87 |
05/93 - 06/89 |
05/91 - 06/87 |
04/93 - 05/89 |
04/91 - 05/87 |
03/93 - 04/89 |
03/91 - 04/87 |
02/93 - 03/89 |
02/91 - 03/87 |
01/93 - 02/89 |
01/91 - 02/87 |
12/92 - 01/89 |
12/90 - 01/87 |
11/92 - 12/88 |
11/90 - 12/86 |
10/92 - 11/88 |
10/90 - 11/86 |
09/92 - 10/88 |
09/90 - 10/86 |
08/92 - 09/88 |
08/90 - 09/86 |
07/92 - 08/88 |
07/90 - 08/86 |
06/92 - 07/88 |
06/90 - 07/86 |
05/92 - 06/88 |
05/90 - 06/86 |
04/92 - 05/88 |
04/90 - 05/86 |
03/92 - 04/88 |
03/90 - 04/86 |
02/92 - 03/88 |
02/90 - 03/86 |
01/92 - 02/88 |
01/90 - 02/86 |
12/89 - 01/86 |
12/87 - 01/84 |
11/89 - 12/85 |
11/87 - 12/83 |
10/89 - 11/85 |
10/87 - 11/83 |
09/89 - 10/85 |
09/87 - 10/83 |
08/89 - 09/85 |
08/87 - 09/83 |
07/89 - 08/85 |
07/87 - 08/83 |
06/89 - 07/85 |
06/87 - 07/83 |
05/89 - 06/85 |
05/87 - 06/83 |
04/89 - 05/85 |
04/87 - 05/83 |
03/89 - 04/85 |
03/87 - 04/83 |
02/89 - 03/85 |
02/87 - 03/83 |
01/89 - 02/85 |
01/87 - 02/83 |
12/88 - 01/85 |
12/86 - 01/82 |
11/88 - 12/84 |
11/86 - 12/82 |
10/88 - 11/84 |
10/86 - 11/82 |
09/88 - 10/84 |
09/86 - 10/82 |
08/88 - 09/84 |
08/86 - 09/82 |
07/88 - 08/84 |
07/86 - 08/82 |
06/88 - 07/84 |
06/86 - 07/82 |
05/88 - 06/84 |
05/86 - 06/82 |
04/88 - 05/84 |
04/86 - 05/82 |
03/88 - 04/84 |
03/86 - 04/82 |
02/88 - 03/84 |
02/86 - 03/82 |
01/88 - 02/84 |
01/86 - 02/82 |
12/89 - 01/86 |
12/87 - 01/84 |
11/89 - 12/85 |
11/87 - 12/83 |
10/89 - 11/85 |
10/87 - 11/83 |
09/89 - 10/85 |
09/87 - 10/83 |
08/89 - 09/85 |
08/87 - 09/83 |
07/89 - 08/85 |
07/87 - 08/83 |
06/89 - 07/85 |
06/87 - 07/83 |
05/89 - 06/85 |
05/87 - 06/83 |
04/89 - 05/85 |
04/87 - 05/83 |
03/89 - 04/85 |
03/87 - 04/83 |
02/89 - 03/85 |
02/87 - 03/83 |
01/89 - 02/85 |
01/87 - 02/83 |
12/88 - 01/85 |
12/86 - 01/83 |
11/88 - 12/84 |
11/86 - 12/82 |
10/88 - 11/84 |
10/86 - 11/82 |
09/88 - 10/84 |
09/86 - 10/82 |
08/88 - 09/84 |
08/86 - 09/82 |
07/88 - 08/84 |
07/86 - 08/82 |
06/88 - 07/84 |
06/86 - 07/82 |
05/88 - 06/84 |
05/86 - 06/82 |
04/88 - 05/84 |
04/86 - 05/82 |
03/88 - 04/84 |
03/86 - 04/82 |
02/88 - 03/84 |
02/86 - 03/82 |
01/88 - 02/84 |
01/86 - 02/82 |
12/85 - 01/82 |
12/83 - 01/80 |
11/85 - 12/81 |
11/83 - 12/79 |
10/85 - 11/81 |
10/83 - 11/79 |
09/85 - 10/81 |
08/83 - 09/79 |
08/85 - 09/81 |
08/83 - 09/79 |
07/85 - 08/81 |
07/83 - 08/79 |
06/85 - 07/81 |
06/83 - 07/79 |
05/85 - 06/81 |
05/83 - 06/79 |
04/85 - 05/81 |
04/83 - 05/79 |
03/85 - 04/81 |
03/83 - 04/79 |
02/85 - 03/81 |
02/83 - 03/79 |
01/85 - 02/81 |
01/83 - 02/79 |
12/84 - 01/81 |
12/82 - 01/79 |
11/84 - 12/80 |
11/82 - 12/78 |
10/84 - 11/80 |
10/82 - 11/78 |
09/84 - 10/80 |
09/82 - 10/78 |
08/84 - 09/80 |
08/82 - 09/78 |
07/84 - 08/80 |
07/82 - 08/78 |
06/84 - 07/80 |
06/82 - 07/78 |
05/84 - 06/80 |
05/82 - 06/78 |
04/84 - 05/80 |
04/82 - 05/78 |
03/84 - 04/80 |
03/82 - 04/78 |
02/84 - 03/80 |
02/82 - 03/78 |
01/84 - 02/80 |
01/82 - 02/78 |
12/81 - 01/78 |
12/79 - 01/77 |
11/81 - 12/78 |
11/79 - 12/76 |
10/81 - 11/78 |
10/79 - 11/76 |
09/81 - 10/78 |
09/79 - 08/76 |
08/81 - 09/78 |
08/79 - 09/76 |
07/81 - 08/78 |
08/79 - 09/76 |
06/81 - 07/78 |
06/79 - 07/76 |
05/81 - 06/78 |
05/79 - 06/76 |
04/81 - 05/78 |
04/79 - 05/76 |
03/81 - 04/78 |
03/79 - 04/76 |
02/81 - 03/78 |
02/79 - 03/76 |
01/81 - 02/78 |
01/79 - 02/76 |
12/80 - 01/78 |
12/78 - 01/76 |
11/80 - 12/77 |
11/78 - 12/75 |
10/80 - 11/77 |
10/78 - 11/75 |
09/80 - 10/77 |
09/78 - 10/75 |
08/80 - 09/77 |
08/78 - 09/75 |
07/80 - 08/77 |
07/78 - 08/75 |
06/80 - 07/77 |
06/78 - 07/75 |
05/80 - 06/77 |
05/78 - 06/75 |
04/80 - 05/77 |
04/78 - 05/75 |
03/80 - 04/77 |
03/78 - 04/75 |
02/80 - 03/77 |
02/78 - 03/75 |
01/80 - 02/77 |
01/78 - 02/75 |
Exhibit 13 - Stieberger Title II SGA Denial Letter
(Title II SGA Denial Notice)
SOCIAL SECURITY ADMINISTRATION
Important Information
Name |
ST |
Date: |
Address |
|
Claim Number: |
City, State, Zip |
DOC: |
|
IMPORTANT INFORMATION
A settlement agreement in the Stieberger v. Sullivan class action lawsuit requires the Social Security Administration to look at your
case again to determine if our earlier decision that you were not or were no longer
disabled was correct.
Because you worked continuously during the period we reviewed, we have looked only
at your work and earnings, not your health problems. We have completed this review
and we still find that the determination in your case is proper and in accordance
with the law. Therefore, the denial of your application remains unchanged.
Include the paragraph below only if the claimant is in current pay:
This notice does not affect the checks that you are getting now based on your later
application.
THE DISABILITY RULES
To be considered disabled, your health problems must meet all of the following rules.
INFORMATION ABOUT SUBSTANTIAL GAINFUL WORK
-
•
Keep you from doing any kind of substantial gainful work. This kind of work is described
below.
-
•
Exist at the same time you have the required number of work credits.
-
•
Last, or be expected to last, for at least 12 months in a row, or result in death.
Generally, substantial gainful work is physical or mental work you are paid to do.
Work can be substantial even if it is part- time. To decide if your work is substantial,
we consider the nature of your job duties, the skills and experience you need to do
the job, and how much you actually earn.
Usually, we consider work to be substantial and gainful if monthly earnings, after
allowable deductions, average over $500 per month ($300 before January 1, 1990). The
law provides for a higher earnings test for substantial gainful activity if you are
blind. That amount in 1995 was $940.00. If you are self- employed, we may give more
consideration to the kind and value of your work, including your part in the management
of the business, than to your income alone.
Your work may now be different than before your disability began. It may not be as
hard to do and your pay may be less. However, we may still consider your work to be
substantial and gainful under our rules.
THE BASIS FOR OUR DECISION
(Include personalized explanation according to NL 00603.100)
IF YOU DISAGREE WITH THE DECISION
If you disagree with this decision, you have the right to appeal. We will review your
case and look at any new facts you have. Then, a person who did not make the first
decision will decide your case.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
-
•
You must have a good reason if you wait more than 60 days to ask for an appeal.
-
•
You have to ask for an appeal in writing. We will ask you to sign a form SSA-501-U2,
called “Request for Hearing”. Contact one of our offices if you want help.
Please read the enclosed pamphlet, “Your Right to Question the Decision Made on Your Social Security Claim”. It contains more information about the appeal.
NEW APPLICATION
You have the right to file a new application at any time, but filing a new application
is not the same as appealing this decision. If you disagree with this decision and
you file a new application instead of appealing:
-
•
you might lose benefits, or not qualify for any benefits, and
-
•
we could deny the new application using this decision, if the facts and issues are
the same.
So, if you disagree with this decision, you should file an appeal within 60 days.
IF YOU WANT HELP WITH YOUR APPEAL
You can have a friend, a lawyer, or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. We have a list of groups that
can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And, if you hire a lawyer, we will
withhold up to 25 percent of any past due benefits to pay toward the fee.
IF YOU HAVE ANY QUESTIONS
If you have any questions, you may call, write, or visit any Social Security office.
If you call or visit our office, please bring this letter with you. It will help us
answer your questions.
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly when you arrive at the office.
Enclosure:
Pamphlet entitled, “Your Right to Question the Decision Made on Your Social Security Claim”
Exhibit 14 - Stieberger Title XVI SGA Denial Letter
(Title XVI SGA Denial Notice)
SOCIAL SECURITY ADMINISTRATION
Important Information
Name |
ST |
Date: |
Address |
|
Claim Number: |
City, State, Zip |
DOC: |
|
IMPORTANT INFORMATION
A settlement agreement in the Stieberger v. Sullivan class action lawsuit requires the Social Security Administration to look at your
case again to determine if our earlier decision that you were not or were no longer
disabled was correct.
Because you worked continuously during the period we reviewed, we have looked only
at your work and earnings, not your health problems. We have completed this review
and we still find that the determination in your case is proper and in accordance
with the law. Therefore, the denial of your application remains unchanged.
Include the paragraph below only if the claimant is in current pay:
This notice does not affect the checks that you are getting now based on your later
application.
ADDITIONAL INFORMATION ABOUT SSI DISABILITY
For you to be considered disabled for SSI payments, your health problems must meet
the following rule:
Your health problems must last, or be expected to last at least 12 months in a row,
or result in death. And, your health problems must keep you from doing any kind of
substantial gainful work. This kind of work is described below.
INFORMATION ABOUT SUBSTANTIAL GAINFUL WORK
Generally, substantial gainful work is physical or mental work you are paid to do.
Work can be substantial even if it is part- time. To decide if your work is substantial,
we consider the nature of your job duties, the skills and experience you need to do
the job, and how much you actually earn.
Usually, we consider work to be substantial and gainful if monthly earnings, after
allowable deductions, average over $500 per month ($300 before January 1, 1990). The
law provides for a higher earnings test for substantial gainful activity if you are
blind. That amount in 1995 was $940.00. If you are self- employed, we may give more
consideration to the kind and value of your work, including your part in the management
of the business, than to your income alone.
Your work may now be different than before your disability began. It may not be as
hard to do and your pay may be less. However, we may still consider your work to be
substantial and gainful under our rules.
THE BASIS FOR OUR DECISION
(Include personalized explanation according to NL 00603.100)
IF YOU DISAGREE WITH THE DECISION
If you disagree with this decision, you have the right to appeal. We will review your
case and look at any new facts you have. Then, a person who did not make the first
decision will decide your case.
-
•
You have 60 days to ask for an appeal.
-
•
The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show us that you did not get it within the
5-day period.
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•
You must have a good reason if you wait more than 60 days to ask for an appeal.
-
•
You have to ask for an appeal in writing. We will ask you to sign a form SSA-501-U2,
called “Request for Hearing”. Contact one of our offices if you want help.
Please read the enclosed pamphlet, “Your Right to Question the Decision Made on Your Social Security Claim”. It contains more information about the appeal.
NEW APPLICATION
You have the right to file a new application at any time, but filing a new application
is not the same as appealing this decision. If you disagree with this decision and
you file a new application instead of appealing you might lose benefits, or not qualify
for any benefits. So, if you disagree with this decision, you should file an appeal
within 60 days.
IF YOU WANT HELP WITH YOUR APPEAL
You can have a friend, a lawyer, or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. We have a list of groups that
can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it.
IF YOU HAVE ANY QUESTIONS
If you have any questions, you may call, write, or visit any Social Security office.
If you call or visit our office, please bring this letter with you. It will help us
answer your questions.
Also, if you plan to visit an office, you may call ahead to make an appointment. This
will help us serve you more quickly when you arrive at the office.
Enclosure:
Pamphlet entitled, “Your Right to Question the Decision Made on Your Social Security Claim”
NOTE: Please do not forward completed folders to The Class Action Section (CAS) located
in Baltimore, Maryland. Upon completion of a case, the folder should be forwarded
to the appropriate storage facility (PSC, WBDOC, ODO). CAS does not house completed
folders.