BASIC (05-03)

GN 03001.020 Processing First Party Reports in Title II Adverse Action Situations

A. Policy

Immediate action to suspend, adjust, or terminate benefits may be taken based on a first party report if there is no indication the report is inaccurate and the action is taken no later than 6 months after the month of the report. If a beneficiary/claimant has a representative payee and the beneficiary is reporting an event, the report should be confirmed with the representative payee.

NOTE: For title XVI policy on first/third party reports, follow SI 02301.010 and SI 02301.300.

B. Procedure

1. Notice Requirements

Send a written final notice after the adverse action is taken. See GN 03001.015B.

NOTE: Manual notices should be completed using DPS (Document Processing System) and sent to ORS (Online Retrieval System) to ensure that a record of the notice is available and that due process requirements have been met.

2. Report By a Child Under Age 15

Verify the report with the representative payee if the child is not his/her own payee, and if the report affects other benefits on the record.

3. Beneficiary Questions Effect And/Or Validity Of Report

• Explain the basis for and effect of the adverse action.

• If the report is correct, take the appropriate adverse action and issue a written final notice.

• Advise the beneficiary that he/she may formally appeal the action after the final notice is received.