TN 16 (11-92)
RS 01702.556 Preparation of the SSA-3428-U2, Determination of Disallowance
The determination of disallowance will inform VA of the reason the listed survivor(s) is ineligible for the VA payment.
In these cases omit the DO code, and print in red ink in the top right portion of the form “FOR VA PURPOSES ONLY.”
Also, if RRB has jurisdiction, print in red ink in the top right portion of the form, “NO ELIGIBILITY TO RSI BENEFITS OR SPECIAL VA PAYMENT BECAUSE OF RRB JURISDICTION.”
Attach to VA Form 21-4180 and forward to VA or RRB (as appropriate). If no claim has been filed, or if RRB does not have jurisdiction, prepare a disallowance for VA only.
Do not apply our overpayment or offset procedures - VA will apply its own procedures.
Do not notify the beneficiary - VA will send the appropriate notice.