Basic (05-03)

GN 03001.025 Processing Third Party Reports in Title II Adverse Action Situations

A. Policy

An advance notice is required for all third party reports except in the following cases:

  • Death of the beneficiary (see GN 02602.050).

  • Undeliverable check (see SM 00624.001).

  • Death of a representative payee.

  • Representative payee refuses to serve.

  • Beneficiary is legally incompetent and representative payee is unavailable.

  • Evidence of misuse of funds by representative payee and substitute payee is unavailable.

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

B. Procedure

1. Advance Notice

  1. a. 

    Send the advance notice. See GN 03001.015A. for notice content.

    NOTE: Manual notices should be completed using DPS (Distributed Online Correspondence 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. b. 

    Diary the case to allow sufficient time for a protest to be filed.

2. No Protest Is Received

Take the adverse action.

3. Beneficiary Protests Before An Adverse Action Is Taken

  • Consider rebuttal.

  • Make a determination.

  • Take the adverse action, if appropriate.

  • Send the final notice with appeal rights.

4. Beneficiary Disagrees After Adverse Action Has Been Taken

If the beneficiary/claimant disagrees after the final determination has been made, take the following action:

  • Reopen the final determination, or

  • Take an appeal if the beneficiary wants to appeal the final determination.

NOTE: Follow GN 03102.000 for procedures on processing a reconsideration determination and GN 03103.000 for procedures on processing ALJ hearing requests.

5. Beneficiary Disagrees With Equity of the Law

If the beneficiary/claimant disagrees with the equity of the law, take the adverse action and send the initial determination with appeal rights. The beneficiary may use the expedited appeal process once a reconsidered determination is made. See GN 03107.000 for the expedited appeal process.

C. Procedure

If an adverse action is taken inadvertently without advance notice, reinstate benefits and follow GN 03001.025B.4.

D. References

See SI 02301.010 and SI 02301.300 for title XVI procedures on handling reports and Goldberg/Kelly instructions.

See GN 04001.000, GN 04010.000 and GN 04020.000 for information and procedures on Reopenings.


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GN 03001.025 - Processing Third Party Reports in Title II Adverse Action Situations - 11/15/2011
Batch run: 04/27/2016