Effective Dates: 08/17/2016 - Present Previous | Next

TN 4 (02-20)

DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination

A. FO actions when an individual wants to request an explanation or a reconsideration of an unfavorable medical CDR determination

During the interview, the FO will take the following actions when an individual wants to request an explanation or a reconsideration of an unfavorable medical CDR:

  • •

    Explain the disability hearing process to the individual,

  • •

    Explain the individual’s rights pertaining to the reconsideration process,

  • •

    Explain the individual’s responsibilities pertaining to the reconsideration process,

  • •

    Provide the required appeal forms, and

  • •

    Follow the instructions in DI 12026.025 Field Office (FO) Processing Guidelines in Requesting a Reconsideration for a Medical Continuing Disability Review (CDR) Determination.

1. Explain the disability hearing process to the individual

When discussing the disability hearing process:

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    Explain what a reconsideration CDR is by referring to the information in DI 12026.001B Reconsideration of a Continuing Disability Review (CDR) Based on Medical Cessation or Adverse Medical Reopening.

  • •

    Explain the time limits for filing a request for reconsideration. For more information on time limits for filing an appeal, refer to GN 03101.010 Time Limit for Filing Administrative Appeals.

NOTE: When a foreign case is involved, see

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    DI 12026.020B.5., in this section, and

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    DI 12026.025 Field Office (FO) Processing Guidelines in Requesting a Reconsideration for a Medical Continuing Disability Review (CDR) Determination

2. Explain the individual’s rights pertaining to the reconsideration process

Advise the individual of his or her right to:

  1. a. 

    Request an appeal.

  2. b. 

    Elect or decline statutory benefit continuation (SBC).

    If the individual requests reconsideration, within 10 business days of receipt of the notice, the individual must sign a statement indicating whether he or she elects or declines SBC. This statement is acceptable on an SSA-795 (Statement of Claimant or Other Person), using the language from the Election Statement Exhibit found in DI 12095.171 SSA-795 Election Statement — Exhibits. If the individual makes a late election of SBC, he or she must establish ‘good cause.’ For more information on SBC, see

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      DI 12026.025 Field Office (FO) Processing Guidelines in Requesting a Reconsideration for a Medical Continuing Disability Review (CDR) Determination

    • •

      DI 12027.007 Who May Elect Statutory Benefit Continuation (SBC),

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      DI 12027.008 Evaluating the Time Limits for Statutory Benefit Continuation (SBC), and

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      DI 12027.015 Cases Excluded from Statutory Benefit Continuation (SBC)

    • •

      SI 02260.007 Waiver Procedures for Disability Cessation Cases

  3. c. 

    Appoint a representative. Explain to the individual the importance of informing the Social Security Administration (SSA) at the earliest possible time if he or she obtains representation.

  4. d. 

    Present additional evidence to support the appeal. Explain to the individual the importance and advantage of providing additional evidence and medical sources at the earliest possible time.

    NOTE: Although individuals may submit evidence at the disability hearing, explain to the individual that it is preferable that any new evidence is provided before completion of the case development of his or her appeal.

  5. e. 

    Request SSA assistance in obtaining evidence and, if necessary, request that SSA issue an SSA-1272-U4 (Subpoena-Disability Hearing), to compel the production of certain evidence or testimony. For more information on subpoenas, see DI 33010.050 Subpoenas and Other Requests for Testimony and Documents.

  6. f. 

    Receive notice of the time of the disability hearing at least 20 calendar days before the disability hearing, and the right to waive the 20-day advance notice. If the individual wants to waive this right, see DI 12026.020C.3 in this section.

  7. g. 

    Receive reimbursement for expenses to travel to the disability hearing location, under certain circumstances. For more information on reimbursement of travel expenses, refer to DI 33010.045 Reimbursement for Travel Expenses to Disability Hearing Site.

  8. h. 

    Present and question witnesses. Contact the Disability Hearing Unit (DHU) if the individual needs assistance in getting a witness to appear.

  9. i. 

    Waive a personal appearance at the disability hearing by indicating this option on the SSA-789 (Request for Reconsideration - Disability Cessation Right to Appear), and completing the SSA-773-U4 (Waiver of Right to Appear – Disability Hearing). Inform the individual of the consequences of not appearing at the disability hearing, as stated on the SSA-789.

    NOTE: The individual can later waive his or her right to appear by submitting an SSA-773-U4 Waiver of Right to Appear - Disability Hearing form or by submitting a written statement. For more information on the use of this form, see DI 12026.022.

  10. j. 

    Review the evidence in the individual's official case folder. Inform the individual that a review of the official case folder generally takes place the day of the disability hearing. However, it can occur at the FO prior to the Disability Determination Services (DDS) development or at other times, by arranging with the DHU. For more information on providing access to medical records, refer to GN 03340.035 Access to Medical Records. If the case folder contains information related to the Office of the Inspector General (OIG) Cooperative Disability Investigation Unit (CDIU) evidence, refer to DI 33025.036 Disability Hearing Officer's Use of Cooperative Disability Investigation Unit (CDIU) Report of Investigation (ROI) Evidence.

    NOTE: When an authorized person requests a copy of an electronic case folder, include all documents (paper and electronic) that comprises the official disability case folder in the copy provided. Offer the authorized person a compact disc (CD) copy of the case folder. For more information on providing a copy of the case folder see, DI 81001.030 Claimant or Representative Requests a Copy of the Claims Folder.

  11. k. 

    Request a hearing before an administrative law judge (ALJ), if the individual disagrees with the disposition of his or her reconsideration appeal.

3. Explain the individual's responsibilities pertaining to the medical CDR reconsideration process

Advise the individual of his or her responsibility to:

  1. a. 

    Request an appeal and sign the SBC election statement within 10 days of receiving the notice to receive SBC (or establish good cause for late filing of the SBC election statement).

    NOTE: Clearly explain to the individual that, if the appeal is unsuccessful, SBC payments will result in an overpayment, and the individual is responsible to repay the overpayment amount.

  2. b. 

    Attend all consultative examinations (CE), if requested to do so by the DDS. Inform the individual that the CE is administered at no cost to the individual. Explain the importance of attending the CE and cooperating in all requests because failure to cooperate may affect the reconsideration determination.

  3. c. 

    Immediately inform the DHU of any event that affects scheduling of the disability hearing, (for example, the appointment of a representative, a change of address or any hospitalization).

4. Provide the required appeals forms

Provide the following forms.

a. SSA-789 Request for Reconsideration – Disability Cessation Right to Appear

Use form SSA-789 when an individual requests reconsideration on medical continuing disability issues and when selecting whether someone will appear on the individual’s behalf. Assist the individual with completing this document, if requested. If the individual completes any writing that specifically addresses his or her disagreement with the initial determination, the request for reconsideration is considered to be filed, and the pursuit of an SSA-789 should be initiated. See DI 12026.021 Completion of the SSA-789 Request for Reconsideration – Disability Cessation Right to Appear.

IMPORTANT: Upon receipt in the FO, the SSA-789 must be date-stamped at the top of the form. Record the receipt date of the SSA-789 at the top of the form as follows: “Received MM/DD/YYYY in FO XXX.”

A completed Modernized SSI Claims System (MSSICS) appeals output can be substituted for the SSA-789 in Title XVI and concurrent cases if the individual also provides a clear written indication of disagreement with the initial CDR determination.

NOTE: Do not use an SSA-561-U2 (Request for Reconsideration) form for CDR reconsideration because the SSA-789 contains information and questions not covered by the SSA-561-U2. Sometimes the claimant submits the wrong form, including the SSA-561-U2. If this occurs, proceed as follows:

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    Contact the claimant to confirm whether the form submitted was intended (or not) by the claimant. If not, transfer the information from the incorrect form to form SSA-789

  • •

    Request the information missing from the SSA-789 – specifically whether or not the claimant wants to appear at a disability hearing, and if not, that we explained their rights with respect to a disability hearing.

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    Notate the discussion on an SSA-5002 (Report of Contact)

b. SSA-795 Statement of Claimant or Other Person for request to continue SBC

An individual can request to continue SBC on the SSA-795 within 10 days of receiving the determination notice. If the individual requests SBC more than 10 days after receiving the determination notice, obtain an SSA-795 with his or her 'good cause' statement for late filing. Refer to DI 12027.008B Evaluating the Time Limits for Statutory Benefit Continuation (SBC).

Election or declination of SBC payments are described in:

  • •

    DI 12027.010B Processing Statutory Benefit Continuation (SBC), and

  • •

    DI 12095.171 SSA-795 Election Statement — Exhibits

Note: The individual must complete an SSA-795 whether he or she accepts or declines SBC. In concurrent cases, the individual must submit two SSA-795s; see examples 1 and 3 in DI 12095.171 Election Statement — Exhibits.

Also, see:

  • •

    'Good cause' statement with late filing of an appeal referred to in GN 03101.020, and

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    'Good cause' statement with late filing of request for SBC referred to in DI 12027.008B

c. SSA-795 Statement of Claimant or Other Person of good cause for late filing

If the individual requests reconsideration more than 60 days after receiving the determination notice, obtain an SSA-795 with his or her 'good cause' statement for late filing. Refer to GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal.

d. SSA-827 Authorization to Disclose Information to the Social Security Administration (SSA)

Form SSA-827 serves as the individual's written request and authorization for a medical or other source to release information to SSA. Obtain one completed original SSA-827 per case. For instructions on completing the SSA-827, see DI 11005.055 Completing Form SSA-827 Authorization to Disclose Information to the Social Security Administration (SSA) and DI 11005.056 Signature Requirements for Form SSA-827.

e. SSA-3441-BK Disability Report – Appeal

Use form SSA-3441-BK to collect updated information about the individual's impairment(s). Use the SSA-3441-BK for all requests for CDR reconsideration. For instructions on completing the form in the Electronic Disability Collect System (EDCS), see DI 81010.150D Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (ECDS).

f. SSA-3881-BK Questionnaire for Children Claiming SSI Benefits

Use form SSA-3881-BK to record information from nonmedical sources about evidence of the individual's functioning capabilities. If the appeal is for a child claiming Supplemental Security Income (SSI) benefits, use form SSA-3881-BK to record information from nonmedical sources about evidence of the individual's functioning capabilities.

B. FO actions when some or all of required forms mailed to claimant are missing information or not returned

When the FO receives a request for reconsideration in writing, and the required forms sent to the claimant are not returned or returned missing information, take the following actions:

  1. 1. 

    Contact the individual by telephone to obtain the necessary information

  2. 2. 

    Send a call-in/come-in letter and set a 15-day diary, if the individual has no phone or the attempt is not successful.

  3. 3. 

    Document attempts to contact the individual on an SSA-5002 (Report of Contact) and place a copy of the SSA-5002 in the folder.

  4. 4. 

    Forward the case to the DDS for resolution, if the individual does not respond within 15 days.

  5. 5. 

    Provide the individual with a copy of the SSA-789, if applicable.

  6. 6. 

    Provide the individual with the English or Spanish version of form SSA-888 (Reconsideration/Disability Hearing Procedures). Versions of these documents are located in DI 33095.025 or DI 33095.030.

  7. 7. 

    Provide the individual with the telephone numbers for the FO and DDS in his or her service area. Explain to the individual that we prefer that he or she call the DDS with any questions or if he or she needs to report a change relating to the disability hearing.

NOTE: SSA does not expect individuals to make long distance phone calls and individuals may call either the FO or DDS.

C. Other medical CDR reconsideration issues

1. Medical issue exists for both Title II and Title XVI

Have the individual complete only one SSA-789, if he or she wishes to file a request for reconsideration under both titles in a concurrent case.

  • •

    Check the appropriate blocks in the, “Type of Benefit” section of the SSA-789.

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    File or upload the SSA-789 in Jurisdictional Documents/Notices (the red tab) of the official folder.

  • •

    Document the reason(s) the individual is not appealing all cases, if the individual is restricting the appeal to one case only.

NOTE: Do not require a claimant to pursue other benefits through the appeals process. For example, in a concurrent claim, if the SSI denial is appealed, the individual does not need to pursue a Title II appeal for SSI eligibility. For more information, see SI 00510.001 Overview of the Filing for Other Program Benefits Requirements.

2. Both medical and nonmedical issues exist

If the individual wishes to file an appeal on each issue:

  • •

    Obtain a completed SSA-789 and the other necessary forms required for appeal of the medical issue.

  • •

    Obtain a completed SSA-561-U2 for the nonmedical issue.

a. Title II

For Title II cases: If the nonmedical issue is critical to eligibility, complete the nonmedical appeal before completing the medical issue appeal. Otherwise, complete the medical issue appeal first.

b. Title XVI and concurrent Title II and Title XVI

Process the nonmedical reconsideration first when the nonmedical issue is critical to eligibility, (for example, income and resources). If the nonmedical issue is not critical to eligibility, do not load into MSSICS until after the medical determination has been made, and only if medically allowed. Otherwise, the presence of the nonmedical appeal will block the medical appeal.

  • •

    For information about a nonmedical reconsideration, see SI 04020.010C.1 What Is SSI Reconsideration.

  • •

    For information about due process protections and Goldberg/Kelly procedures, see SI 02301.300 Due Process Protections - General.

3. Waiver of 20-day advance notice for disability hearing date

When processing a waiver of the 20-day advance notice for a disability hearing:

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    Ensure the individual understands that he or she should not waive the right to receive a 20-day advance notice of the disability hearing if additional time is needed to prepare for the hearing.

  • •

    Obtain a signed SSA-795 from the individual or his or her representative, containing the following language:

    “I have been advised of my right to be sent a notice of the time and place of my disability hearing at least 20 days before the date of my hearing. Additionally, I have been advised that I should not give up this right if I need additional time to prepare for the hearing. However, I am prepared to have my hearing on or after [insert date], and hereby knowingly and willingly give up my right to be sent the 20-day advance notice as cited in 20 CFR, sections 404.914(c)(1), and 416.1414(c)(1).”

  • •

    NOTE: If the reconsideration request involves only Title XVI, revise the above language to delete 404.914(c) (1). If it involves only Title II, delete 416.1414(c) (1).

  • •

    Send the individual's statement to the DHU along with the SSA-789.

    If the DHU already has the SSA-789, notify the DHU of the individual’s statement by telephone or e-mail. Upload the individual's statement to the electronic folder or mail it to the DHU if the folder is paper.

4. Selection of an appointed representative

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    If the individual wants to appoint an attorney or other qualified person to represent him or her, refer to GN 03910.001 Representation of Claimants - Overview.

  • •

    If the folder is located in the FO, see GN 03910.040H Appointment and Revocation of Appointment of Representative.

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    If the folder is not located in the FO, see GN 03910.040I Appointment and Revocation of Appointment of Representative.

  • •

    Inform the DHU by the Electronic Disability Collect System (EDCS) of an update after transfer (UAT) if an appointed representative has been confirmed. Refer to DI 81010.095 Using the Update After Transfer (UAT) Utility

  • •

    If the folder is paper, submit a SSA-5002 when an appointed representative has been confirmed.

5. Responsibility for processing foreign cases

a. Office of Central Operations (OCO)

Foreign cases are the jurisdiction of OCO and its components. Within the Office of Earnings and International Operations (OEIO), the International Benefits Office (IBO) functions as the “field office” for foreign cases. However, the Disability Hearing Officer (DHO) handling foreign cases is a member of the International Disability Unit (IDU) operating within the Office of Disability Operations (ODO).

b. FO

Regional and FOs do not process hearings for foreign cases except when the DHO has prior involvement in a particular case. In those instances, the IDU requests assistance from the regional office via the Office of Disability Determinations (ODD). The IDU's DHO continues to process all other foreign reconsideration cases.

If the individual resides in a foreign country or uses a foreign mailing address and contacts the FO (rather than the IBO) for assistance in filing a request for reconsideration of a CDR, follow current procedures, with the following exceptions:

  • •

    Do not request the case folder.

  • •

    Do not take any action regarding SBC, other than obtaining an SSA-795 regarding the SBC election choice and auxiliaries’ payments.

Inform the individual that he or she can come to the United States (U.S.) for a hearing; or he or she can have OEIO review his or her case and issue a decision based on the evidence of record, which would include any additional evidence submitted in connection with the reconsideration request. If an individual or representative wishes to appear at a hearing:

  • •

    Find out where in the U.S. the individual wishes to have the hearing held (the individual’s point-of-entry into the U.S. or his or her temporary U.S. residence determines the region where we will schedule the hearing). Since there are no provisions provided for a DHO to travel, the hearing must be conducted by the regional IDU's DHO.

  • •

    Find out when he or she will be in that area; and

  • •

    Include the location and time the individual is available in the material forwarded to OEIO.

Ensure that the individual understands there are no provisions for reimbursing expenses for travel outside of the U.S.

NOTE: If after entering the U.S., the individual has to travel more than 75 miles (one way) to attend a hearing, he or she may request reimbursement for travel expenses incurred within the U.S. For information about reimbursement of travel expenses to the disability hearing site, refer to DI 33010.045 Reimbursement for Expenses to Travel to Disability Hearing Site.

6. Individual also files a new disability application

When an individual files a new application at the same time as a request for reconsideration or before issuance of a reconsidered determination:

  • •

    Forward both cases to the DDS or to the office where the prior case is located.

  • •

    Refer to DI 12045.010 Processing Disability Claims at Different Levels of Appeal, title II and title XVI - Common Issue Cases.

D. References

  • •

    DI 10105.904 General - Auxiliary(s)

  • •

    DI 11005.056 Signature Requirements for Form SSA-827

  • •

    DI 12027.008 Evaluating the Time Limits for Statutory Benefit Continuation (SBC)

  • •

    DI 12027.010 Processing Statutory Benefit Continuation (SBC)

  • •

    DI 12095.000 Appeals Processing Exhibits - Table of Contents

  • •

    DI 29001.001 The Right to a Disability Hearing at the Medical Continuing Disability Review (CDR) Reconsideration Level

  • •

    DI 33010.050 Subpoenas for Testimony and Other Documents

  • •

    DI 81001.035 Copying a Certified Electronic Folder (CEF) to CD

  • •

    DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)

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    DI 81010.255 Electronic Continuing Disability Review (eCDR) Cessation Reconsideration

  • •

    DI 81010.257 Electronic Continuing Disability Review (eCDR) Cessation Hearing Appeal

  • •

    DI 81020.025 Processing Electronic Reconsideration Cases

  • •

    GN 00203.011 Special Interviewing Situations: Limited English Proficiency (LEP) or Language Assistance Required

  • •

    GN 03101.010 Time Limit for Filing Administrative Appeals

  • •

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

  • •

    GN 03910.040 Appointment and Revocation of Appointment of Representative

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412026020
DI 12026.020 - Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination - 08/17/2016
Batch run: 02/25/2020
Rev:08/17/2016