TN 1 (01-08)

DI 12026.025 Processing the Request for Reconsideration–Disability Hearing

A. Review the Forms

Ensure that the appeal forms are appropriate, complete, and filed timely (or timely filing has been established by a “good cause” determination).

1. SSA-789-U4 (Request for Reconsideration – Disability Cessation)

In processing the form:

  • Check that the form is complete; that the claimant has indicated whether or not they wish to appear at the disability hearing, and has completed the block for interpreter and language needs. There is no longer a requirement that the claimant or their representative payee, if applicable, sign the form.”

  • If the SSA-789-U4 is incomplete, the FO will attempt to call the claimant for the necessary information to indicate whether the claimant wants a face-to-face hearing or needs an interpreter. If the claimant has no phone or the attempt is not successful, the FO will send a call in/come in letter and set a diary for 15 days. Attempts to contact the claimant are documented on an SSA-5002. If the claimant has not responded whether they want a hearing or need an interpreter within that 15 days, the case is forwarded to the DDS for resolution.

  • Provide the claimant with their copy of the SSA-789-U4.

  • Provide the claimant with the information sheet, SSA-888 (Reconsideration/Disability Hearing Process) (DI 33095.025) or its Spanish version, SSA-888-SP (Reconsideration/Disability Hearing Process) (DI 33095.030).

  • Provide the claimant with the telephone numbers for their service area field office (FO) and Disability Hearing Unit (DHU). Explain to the claimant that it is preferable for them to call the DHU on substantive questions or if they need to report a change relating to the disability hearing.

    NOTE: SSA cannot expect the claimants to make long distance phone calls and the claimants may call either the FO or DHU.

2. SSA-3441-BK or i3441 (Disability Report – Appeal or Internet Disability Report – Appeal)

Verify the completeness of the form. Obtain as much information as available, provided it is likely to be reliable and is relevant. If the form is incomplete:

  • Re-contact the claimant if the SSA-3441/i3441 received was not fully completed or any information seems to be incorrect or incomplete.

  • Note auditory observations made during any telephone conversation with the beneficiary.

  • Document the information on the EDCS 3367 or electronic SSA-5002 (Report of Contact) in the electronic folder; or paper SSA-5002 in the paper folder.

Title II

See MSOM Report of Contact (RPOC) (MSOM MCS 008.007).

Title XVI

When documenting the report of contact in:

  • MSSICS

    See MSOM Report of Contact (DROC) (MSOM MSSICS 022.010).

  • Non-MSSICS

    Prepare a paper SSA-5002, RC to document this information. Forward the RC for folder association.

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

Ensure that the SSA-827 forms have the appropriate signature and are dated.

4. SSA-795 (Statement of Claimant or Other Person)

Provide the claimant with a copy of their election statement. See Processing Statutory Benefit Continuation (DI 12027.010B.4.) for information about the SBC election statement.

5. SSA-3881 (Questionnaire for Children Claiming SSI)

Review SSA-3881 for completeness in Title XVI childhood disability claims.

B. Complete System Inputs to Document Appeal Information

Record essential control information in the system to document the appeal and any SBC information. See Processing Statutory Benefit Continuation (SBC) (DI 12027.010C) about SBC system inputs.

Title II

Input appeal information in the Postentitlement Online System (POS). See POS Selection List (PESL) (MSOM T2PE 002.003) and Disability Cessation (PEC1) (MSOM T2PE 003.024).

Title XVI

When recording the appeal information for Title XVI:

  • Input appeal information in Modernized Supplemental Security Income Claims Systems (MSSICS). See MSOMS Appeals - Overview, MSOMS (MSOM MSSICS 020.001).

  • Non-MSSICS Cases - Use MSSICS Direct Update SSR (DUSSR).

    Non-MSSICS cases are those cases never processed in MSSICS or where there is no active claim iteration on the MSSICS pending file. See MSOM Appeals Process (MSOM BUSSR 002.007).

C. Folder Preparation

1. Disability Folder(s) Available in the FO

Place the request for reconsideration, any supporting forms, and any evidence provided by the claimant in the claimant’s official folder.

Modular disability folder (MDF) - Refer to General Overview of the MDF (DI 70005.005).

Certified electronic folder (CEF) - Refer to DI 12026.025C.3.

2. Disability Folder Unavailable in the FO

MDF - Request the folder and annotate the request to indicate there is a disability hearing pending. The following references provide information about requesting an MDF:

  • Title II - Follow Processing Center Action Control System (PCACS) Coordination (DI 40525.100).

  • Title XVI - Follow Case Control Data – CCTL (SM 01601.415) and Alert Response (AR) Codes on the SSA-8028 (SM 01201.035) to request folder (except in foreign claims).

  • Foreign Claim - See DI 12026.020B.5.

  • Obtain any prior folder needed – Refer to Unable to Locate Medical Folder after Initial FO Search - Detective Work (DI 13015.080) and Exhibit of SSA-5002 Folder Documentation (DI 13015.250) for guidance.

  • Unable to locate the prior folder - Follow FO Procedures for Reconstructing Lost/Missing Claims Folders (GN 03105.030).

CEF - See DI 12026.025C.3.

3. Electronic Continuing Disability Review (eCDR) Appeals

eCDR currently includes electronic folder case processing for initial Continuing Disability Reviews (CDRs) and Age 18 Redeterminations. See eCDR Short Term Process Overview (DI 81010.200). CDR reconsiderations are no longer excluded from electronic folder case processing. If the CDR being appealed was processed in EDCS, the reconsideration can be processed electronically.

  • DI 81010.255 for FOs processing appeals using eCDR in electronic folder cases.

  • DI 81020.255 for DDSs processing appeals using eCDR in electronic folder cases.

D. Route the Folder

Determine the type of claim to determine where to route the folder.

1. Claims Other Than Career Railroad or Foreign Claims

Route the folder to the FO’s service area DHU.

2. Career Railroad (RR) Claim

Route the official folder to the Great Lakes Payment Service Center (GLPSC):

  • Follow the procedures for processing railroad cases. See GLPSC - Career Railroad and Railroad Annuitant Cases, (DI 29005.020).

  • Include the copy in the disability folder and route the folder to:

    GLPSC, Disability Processing Branch
    P.O. Box 87755
    Chicago, IL 60680-0955

Do not forward a copy of the SSA-789-U4 to the DHU.

3. Foreign Claim

Do not forward any documents or information to the DDS associated with the servicing FO. Instead:

  • Route to the Office of International Operations (OIO)

  • Include the copy in the disability folder and route the folder to OIO. Do not forward a copy of the SSA-789-U4 to the DHU.

  • Forward all materials to:

    Social Security Administration
    Office of International Operations
    P.O. Box 17775
    Baltimore, Maryland 21235-7775

For CEF cases, refer to:

  • DI 81010.255 for FOs processing appeals using eCDR in electronic folder cases.

  • DI 81020.255 for DDSs processing appeals using eCDR in electronic folder cases.

E. Processing Other Issues When a Reconsideration – Disability Hearing is Pending

1. Request for Change in Time/Place of Disability Hearing

If the claimant contacts the FO, rather than the DHU or the Disability Hearing Officer (DHO):

  1. When claimant comes into the FO

    Ensure the claimant completes and signs an SSA-769-U4 form. See SSA-769-U4 (Request for Change in Time/Place of Disability Hearing) (DI 12095.055) for an exhibit of the form and instructions for its completion.

  2. When claimant telephones the FO

    Obtain information needed to complete the SSA-769-U4. Have the claimant (or their representative payee) come in to sign the SSA-769-U4.

    Document the information on a report of contact (RC); either electronically (RPOC/DROC) or paper SSA-5002 (Report of Contact).

    Title II

    See MSOM Report of Contact (RPOC), MSOM MCS 008.007.

    Title XV

    • When documenting the report of contact in: MSSICS

      See MSOM Report of Contact (DROC) (MSOM MSSICS 022.010).

    • Non-MSSICS

      Prepare a paper SSA-5002, RC to document this information. Forward the RC for folder association.

  3. In all requests for change in time/place of disability hearing

    Notify DHU of the request. When the claimant requests to change the disability hearing and it is less than 10 days before the scheduled hearing date, notify the DHU by telephone or e-mail.

    Document the forms and information about the request for change in time/place of disability hearing in the claimant’s official folder. For CEF cases, refer to:

    • DI 81010.255 for FOs processing appeals using eCDR in electronic folder cases.

    • DI 81020.255 for DDSs processing appeals using eCDR in electronic folder cases.

2. Title II - SGA Issues

In processing Title II cases with SGA issues:

  • Develop and resolve work issues discovered during DDS or DHU review.

    See Responsibilities and Procedures - Work Issue Cases, DI 10501.025.

  • Prepare an initial substantial gainful activity (SGA) determination if the work is SGA; the conditions for FO processing are met; and extended period of eligibility (EPE) does not apply.

  • Advise claimant in the SGA determination notice that no disability hearing will be held on the medical cessation issue because they have been found “not disabled” due to work.

  • Send a copy of the SSA-833-U5, Cessation or Continuance Disability Determination or Transmittal, to the DHU to cancel the hearing process.

  • Complete FO actions using existing SGA and EPE procedures. Return case to DDS or DHU for action on medical issue(s) if work is not SGA or work is SGA but EPE applies.

3. Subsequent Material or Information Received

a. New Evidence

When receiving new evidence, including sources, after the release of the folder to the DHU:

  • Check case control system to determine location of folder.

  • Use Route Slip, SSA-408, to forward the material to the component indicated by the case control system.

  • Forward the material to the DHU if a reconsideration determination has been issued and the case has left the DHU. The DHO will determine the relevance of the material and the action to take.

NOTE: An exception to this routing applies if the case is at an Administrative Law Judge (ALJ) or Appeals Council (AC) location. In these instances, forward the material for folder association and review to the ALJ or AC office where the folder is located.

b. Change of Address

When a claimant reports a change of address and they have a disability hearing pending, the FO will:

  • Send written confirmation of the change to the DHU. Include the office code for the FO servicing the claimant's current address.

  • Telephone the DHU and report the change if a disability hearing is scheduled and the change of address will involve a change in the DDS or DHU site. Send an e-mail confirmation of the phone call to the DHU.

    NOTE: The DHU forwards the confirmation for folder association.

  • Update the Title II and/or Title XVI records with the new address.

4. When Claimant Wishes to Withdraw Request for Reconsideration of a Disability Cessation/Adverse Medical Reopening

a. Contact the Office Where the Claim Folder is Located

E-mail or telephone the appropriate office (the DDS or DHU) and request that they return the claims folder to the FO.

Request that the DHU postpone the hearing process pending disposition of the withdrawal.

NOTE: The DDS or the DHU forwards any request for withdrawal sent directly to them to the FO.

b. Title II

Follow the general withdrawal instructions for Title II claims, see Claimant Requests Reconsideration (GN 03102.200B.6.). Career Railroad Cases - GLPSC will handle requests for withdrawals.

Foreign Claim Cases - OIO will handle requests for withdrawals.

c. Request for Withdrawal Approved

Ensure benefits terminated and SBC are repaid before approving the withdrawal. Refer to Conditions for Withdrawal (WD) (GN 00206.005).

Send a copy of the claimant’s notice approving the withdrawal to the DHU so the hearing process can be cancelled.

d. Request for Withdrawal Not Approved

When processing a request for withdrawal:

  • Return case to the DDS or the DHU.

  • Send a copy of the notice informing the claimant that the Field Office (FO) did not approve their request.

e. Request for Withdrawal Cancelled

When a claimant wants to cancel their request for withdrawal:

  • If the withdrawal cancellation is filed within 60 days from the date the notice of approval of withdrawal was received by the claimant, process the claim as though no withdrawal had taken place.

  • Reinstate any previously approved SBC benefits retroactive to the month they stopped unless the claimant indicates otherwise.

  • Send a copy of the claimant's request for cancellation of the withdrawal to the DHU. Provide the claimant's name, address, and telephone number, and the name, address, and telephone number of any representative on the request for cancellation.

  • Return the case to the DDS or the DHU, i.e., whichever component had it on the date the request for withdrawal was received.

NOTE: If additional evidence is received, return the case to the DDS.

5. When Claimant Dies Before the Determination Made on Request for Reconsideration - Disability Cessation

a. Input the death information to the claimant’s record(s)

Contact the office having the claims folder, if necessary, for leads to any party who may be entitled or adversely affected by the determination.

Title II

These cases could include a surviving spouse, auxiliary beneficiaries, or a representative of the estate.

Title XVI

Refer to SSI Underpayment Due - Claimant Deceased – General (SI 02101.003).

b. Substitute Party Involved

When there is a substitute party involved:

  • Secure a SSA-770-U4 (Notice Regarding Substitution of Party Upon Death of Claimant – Reconsideration of Disability Cessation) form if it is determined there is substitute party involvement. Use this form when allowing a substitute party to pursue the appeal of a deceased claimant. For an exhibit and instructions, see SSA-770-U4 (Notice Regarding Substitution of Party Upon Death of Claimant – Reconsideration of Disability Cessation) (DI 12095.065).

  • Inform the substitute party that a hearing may not be necessary if a favorable determination can be issued based on available evidence.

  • Telephone the DHU and report the claimant's death. If the substitute party has informed the FO that they wish to appear at the disability hearing scheduled for the claimant, inform the DHU not to postpone the hearing. Also, provide the DHU with the substitute party's name, address, and telephone number. Otherwise, any hearing scheduled will be postponed pending receipt of the SSA-770-U4.

  • Route the completed SSA-770-U4.

    Prepare a SSA-408 (Route Slip) and forward the copies of the SSA-770-U4 to the component with the claims folder and to the appropriate DHU.

    NOTE: When forwarding the folder copy to a DHU different from the one previously having the folder, annotate the SSA-408 to show, “Substitute party requested disability hearing in your area - Attached forwarded for folder association.”

    Include any additional medical information (e.g., recent hospitalizations, physician's report, death certificate).

c. Substitute Party Wishes to Withdraw Request for Reconsideration - Disability Cessation

When a substitute party wishes to withdraw the Request for Reconsideration:

  • Route the completed SSA-770-U4 (Notice Regarding Substitution of Party Upon Death of Claimant – Reconsideration of Disability Cessation); follow routing instructions in DI 12026.025E.5.b., fourth bullet

  • If the office with the case returns the case to the FO for action on the withdrawal, the FO will refer to Conditions for Withdrawal (WD) (GN 00206.005) and follow the general withdrawal instructions in GN 03102.200B.6.

d. Substitute Party Not Located

Document the information that the substitute party was not located on a paper or electronic report of contact (RC). Include in the documentation the name and address of any known next of kin of the claimant.

Title II

See MSOM Report of Contact (RPOC) (MSOM MCS 008.007).

Title XVI

  • MSSICS

    See MSOM Report of Contact (DROC) (MSOM MSSICS 022.010).

  • Non-MSSICS

    Prepare a paper SSA-5002, RC to document this information. Forward the RC for folder association.

e. References for CEF Cases

For Certified Electronic Folder (CEF) cases, refer to:

  • DI 81010.255 for FOs processing appeals using eCDR in electronic folder cases.

  • DI 81020.255 for DDSs processing appeals using eCDR in electronic folder cases.

f. Remand Cases, Common Issue Cases, and Escalated Claims

For information about remands, common issue cases, or escalated claims, refer to:

  • Remand Cases

    See Reviewing Informal Remand Cases (GN 04440.247C.1.).

  • Common Issue Cases

    See Claims Under Different Titles - Common Issue – General (DI 12045.005).

  • Escalated Claim Cases

    Send any case escalated or any material for forwarding to the DHU rather than the DDS when the case is currently at the DHU or when the DHU made the reconsidered determination.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0412026025
DI 12026.025 - Processing the Request for Reconsideration-Disability Hearing - 12/09/2013
Batch run: 12/09/2013
Rev:12/09/2013