TN 5 (10-23)

SI 04020.010 What Is Supplemental Security Income (SSI) Reconsideration

A. Introduction -- Role in the appeals process

Reconsideration is the mandatory first step in the administrative review process that is provided to a claimant who is dissatisfied with an initial determination unless a hearing is the first level of appeal (e.g., a revised initial determination that results in suspension, reduction, or termination of only past benefits.)

B. Policy

1. Description of reconsideration

Reconsideration involves a thorough reexamination of all evidence on record including evidence produced at an informal or formal conference. Field office (FO) personnel at the claims representative level or higher conduct the reconsideration. The person conducting the case review, informal conference, or formal conference will make the reconsideration determination. They must have had no involvement in the initial determination.

2. Effect of reconsideration determination

A reconsideration determination is final and binding at the time it is made, unless the:

  • Claimant or any other party to the determination requests a hearing before an Administrative Law Judge (ALJ) within the time period and a decision is made; or

  • Expedited Appeals Process (EAP) is used, see SI 04060.000; or

  • Reconsideration determination is revised.

3. Scope of reconsideration

The scope of reconsideration is not confined to the issues in dispute. It consists of reexamination of all evidence of record. In addition, we undertake development if there is a reasonable basis to do so. Explore all leads for obtaining evidence. If any presumption or tolerance was applied to the issue at dispute in the reconsideration request, the FO must fully develop the issue. For example, the claims representative used a match with Veterans Affairs (VA) records to determine VA income. The claimant alleges the VA computer match is incorrect. The FO must fully develop the VA income in making the reconsideration determination.

4. Independent decision maker

The decision maker must not have made or previously reviewed the initial determination being reconsidered. For purposes of this subchapter, the decision maker is the claims representative or higher level employee.

5. Types of reconsideration

The three types of reconsideration are:

  • Case review;

  • Informal conference; or

  • Formal conference.

For instructions regarding reconsideration - disability hearing for a medical cessation/adverse medical reopening determination - Title II and Title XVI, see DI 12026.000.

6. Sources of information

In addition to the Program Operations Manual System (POMS), sources of information used to reconsider initial determinations include:

  • The Social Security Act (the Act);

  • Social Security Administration (SSA) Regulations;

  • Social Security Rulings;

  • Operating instructions;

  • Commissioner's Decisions;

  • Acquiescence Rulings;

  • General Counsel Opinions; and

  • Other pertinent laws and rulings, such as State laws on supplementary payments, State plans on resource limits and exclusions, etc.

C. Process

1. FO

The FO reconsiders non-medical issues arising from initial determinations of SSI and certain concurrent SSI or Retirement, Survivor, Disability, Health Insurance (RSDHI) claims. These include substantial gainful activity (SGA), income and resources, and SSA's calculation of the amount of change in the federally administered State supplementary payment amount which results from a mass change.

Specifically, the FO:

  • Gives the claimant a full explanation of the issues involved;

  • Gives the claimant a full explanation of their right to reconsideration and, if appropriate, continuation of payments;

  • Explains the nature of reconsideration to the claimant including alternatives (case review, informal conference, formal conference);

  • Assists the claimant in executing a request for reconsideration;

  • Accepts any evidence offered;

  • Undertakes requested development, including development requested by other components;

  • Forwards requests for reconsideration and related materials on cases involving medical issues to the Disability Determination Services (DDS) and non-medical issues to the Processing Center (PC) as appropriate;

  • Renders non-medical reconsideration determinations;

  • Determines good cause for late filing of reconsideration requests and good cause for failure to file within the 10-day Goldberg Kelly payment continuation period; and

  • Makes the appropriate Modernized SSI Claims System (MSSICS) input to process appeal requests. For MSSICS appeal information, see MS 04420.001 and MS 00302.007.

2. DDS

The DDS reconsiders all medical and vocational issues in SSI and concurrent SSI/RSDHI claims.

3. Program Service Center (PSC)

The PSC reconsiders Title II non-medical claims and any other matter forwarded from the FO requiring a reconsideration determination.

To Link to this section - Use this URL:
SI 04020.010 - What Is Supplemental Security Income (SSI) Reconsideration - 10/05/2023
Batch run: 10/05/2023