Before completing the form, the field office (FO) should ensure that the issue being protested is an initial determination.

If an initial determination was made, check the appropriate box and complete the form.

If an initial determination has not been made, the SSA-561 should not be completed. However, if the claimant or representative insists on completing the SSA-561 even though an initial determination has not been made, explain that we have not made a decision and the claimant can file an appeal after we make a decision, see GN 03102.100C.9.; check "No" on the box for "Has initial determination been made?" and complete the form.

For dismissal of a request for reconsideration information, see GN 03102.200B.3.

Enter the SSN of the claimant who is filing the appeal.

If the claim number is different from the claimant’s SSN, enter the claim number, number holder’s (NH) SSN, or beneficiary identification code (BNC) as it appears on the notice from the Social Security Administration.

Specify type of claim, e.g., Retirement Survivors Insurance (RSI) benefits, Disability Insurance (DI) benefits, Supplemental Security Income (SSI) payments, Special Veterans Benefits (SVB), Health Insurance/Supplementary Medical Insurance (HI/SMI) entitlement, lump-sum death payment, disability freeze, deductions, earnings record revision.

State why claimant believes determination is incorrect. In an overpayment case, clarify whether claimant is questioning the determination of overpayment or the waiver determination or both. Describe any additional evidence submitted. Document on Report of Contact if claimant refuses to give any information requested on the form.

If the claimant needs additional space, they may use a separate sheet of paper and attach a copy to the Form SSA-561.

Either the claimant or the representative may sign. A signature is not, however, required to process the reconsideration. If we have a written request that clearly shows dissatisfaction with an initial determination and it clearly originated with the claimant, process the reconsideration without the signature. For the reconsideration process information, see GN 03102.100C.

Check appropriate box. If request was not timely filed, attach claimant's written explanation to the claims folder copy. For more information on good cause for extending the time to file an appeal, see GN 03101.020.

Check the appropriate box to show the status and type of action taken. For FO reconsideration development of request for reconsideration information, see GN 03102.300.

Show the Social Security Office address that the employee who prepares or receives the form.

Date appeal received for the request for reconsideration is the walk-in date, email date, fax date, date-stamp, or postmark date on the Form SSA-561, letter, envelop, or any other written documents. Record date appeal request received on the Modernized Claim System (MCS) appeal screens or Modernized SSI Claim System (MSSICS) appeal screens, if appropriate.

Check the appropriate box to show the status and type of action taken that the recipient appealed an adverse action. For GK payment continuation information, see SI 02301.310.

Forward the request for reconsideration and related materials to the appropriate component, e.g., cases involving medical and vocational issues to the Disability Determination Services (DDS), Title II non-medical issues to Processing Center (PC). For component responsibility in the reconsideration process information, see GN 03102.175.

Reconsideration requests for non-medical SSI-only cases remain in the FO.