TN 5 (12-92)

RS 02201.004 Claim for Benefits or Request for Revision is Withdrawn or Not Pursued

A. Policy

SSA makes every reasonable effort to obtain the evidence needed to make a determination so that the period in question does not become barred to correction.

B. Procedure

Assist the NH if he/she is unable to secure the evidence.

1. NH is Cooperative

  1. a. 

    If the evidence is inconclusive but it appears the NH has or can obtain the evidence, follow GN 01010.410.

  2. b. 

    If the NH does not have or cannot obtain the evidence, make a determination based on available evidence.

  3. c. 

    Do not credit unposted wages or SEI unless satisfactory proof is obtained.

  4. d. 

    Prepare Forms SSA-7000-U5, SSA–7010-U5 or SSA-4500-U6 (for State and local wages paid before 1/1/87) as appropriate.

2. NH is Uncooperative

  1. a. 

    If the NH is uncooperative or cannot be located, make a determination based on the evidence of record.

  2. b. 

    If available evidence indicates the posted wages or SEI are incorrect and the NH has been uncooperative, send a 30-day notice to the NH advising that the posted wages or SE will be deleted unless evidence is received within the period.

3. FO Unsure of Proper Decision

  1. a. 

    If unsure of the proper decision, submit claims cases to PC. If the PC cannot resolve the issue, submit the material to the Regional Commissioner.

  2. b. 

    Submit nonclaim cases to OCRO and disability cases to ODO.

4. Revision Results In Uninsured Status

If the revision results in uninsured status, disallow the claim or request instead of approving the withdrawal.

5. SSA Makes An Initial Determination

  1. a. 

    Always send a notice of initial determination which includes appeal rights (RS 02201.032, GN 03101.050) whenever SSA makes an initial determination.

  2. b. 

    Consider an initial determination (See GN 03101.040) to be any determination which affects:

    • Entitlement to monthly benefits (including dates and amounts), lump sum death payments, Part A hospital insurance benefits, or enrollment Part B supplementary medical insurance benefits.

    • Termination of a period of disability.

    • Revision of an earnings record.

    • Paying benefits through a representative payee when the beneficiary is age 18 or older and has not been adjudged legally incompetent.

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RS 02201.004 - Claim for Benefits or Request for Revision is Withdrawn or Not Pursued - 12/14/1992
Batch run: 07/03/2014