TN 10 (08-23)

GN 03102.225 Preparation of Form SSA-561-U2 (Request for Reconsideration)

A. When to use

For reconsideration under Title II, Title XVI, and reconsideration for entitlement under Title XVIII, use the SSA-561-U2 in GN 03102.250.

B. Procedure - How to complete SSA-561-U2

1. Initial determination

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-U2 should not be completed. However, if the claimant or representative insists on completing the SSA-561-U2 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.

2. Claimant Social Security Number (SSN)

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

3. Claim number

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.

4. Issue being appealed

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.

NOTE: When reconsideration is requested on non-medical concurrent Title II and Title XVI common issues, the request is deemed to apply to both claims, if the time limit for appealing either claim has not expired.

5. Reason for appeal

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-U2.

6. Signature

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.

7. Timeliness of request

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.

8. FO development

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.

9. Social Security Office address and date appeal received

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-U2, 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.

10. SSI cases only - Goldberg Kelly (GK)

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.

11. Routing instructions

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.

C. References

  • GN 03102.250 Form SSA-561-U2 (Request for Reconsideration)

  • GN 03101.040 Appeals of the Initial Determination

  • GN 03102.100 The Reconsideration Process

  • GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal

  • GN 03102.300 Field Office (FO) Reconsideration Development of Request for Reconsideration

  • GN 03102.175 Component Responsibility in the Reconsideration Process

  • SI 02301.310 Appeal and the Right to Goldberg Kelly (GK) Payment Continuation

To Link to this section - Use this URL:
GN 03102.225 - Preparation of Form SSA-561-U2 (Request for Reconsideration) - 08/30/2023
Batch run: 08/30/2023