TN 55 (08-96)

DI 12586.093 Effectuating Payment -- Title XVI Procedures -- Stieberger

A. Policy

Payment is made for the PAYMENT PERIOD according to DI 12586.050. The class member will continue to be paid for months after the end of the PAYMENT PERIOD, provided the regular factors of entitlement are met.

B. Procedure

1. Compute Payment

In computing payments consider the following:

2. Initial Denial Posted (e.g., N-30)

  1. If an initial denial is posted, T-30 prior record (if needed - see SM 01801.001 ff.). Process a start date record with an SSA-450-SI.

  2. No Record Online--Follow routine procedures for establishing a record. Process an SSA-450-SI per SM 01005.002 ff. Show “ STIEBERGER Class Member” in the Remarks segment (RMKS).

  3. IAR Involved - see 3.b. below.

3. T-50 or T-51 Status

  1. Prepare an SSA-450-SI per SM 01005.001 ff to establish a new record. Show the first day of the first month of the PAYMENT PERIOD as the start date.

  2. IAR may be an issue. Payment of SSI benefits under Stieberger is a reopening of an eligibility determination. A class member may have more than one supplemental security record, each representing a distinct period in which the person claimed eligibility (for which a new application had to be submitted). The decision to pay IAR or not to pay IAR must be made for the record being reopened. The decision must be made on a “record-by-record” rather than on a "person-by-person" basis. The steps in making the decision are:

    • identify the record being reopened--the record for which benefits are due as a result of the Stieberger determination;

    • if any payment has already been made on that record--to the person or to the State--no IAR can be paid. The additional benefits due go to the individual; and,

    • if no payment has been made on that record, then look for “GR” (grant reimbursement) code on the record.

    If there is a GR code on the prior record, carry over the GR code to the new record. The SSI payment goes to the State for IAR.

    If there is not a GR code on the prior record, but there is an IAR authorization in a prior or current file, input a GR code to the new record, The SSI payment goes to the State for IAR. Complete a manual SSA-8125 and mail it to the appropriate State agency. (See SI 02003.040 for completion of the SSA-8125).

    If there is no GR code, and no authorization, assume that no authorization exists. Release the entire retroactive initial payment to the individual.

4. T-30 or T-31 Status

Refer to SM 01005.020 D.

5. Record in Pay Based on Subsequent Claim

  1. Process A-OTP to pay retroactive amount back to Stieberger DOE in accordance with SM 01901.150. If claimant is DAA, payment rules for DAA cases apply.

  2. IAR involved - reimburse the State even if the IAR was paid on a later application if:

    • there is a GR code on the prior record; or

    • there is an IAR authorization in file from a prior claim;

  3. Designate the State Agency as payee to send the retroactive check to the state via A-OTP.

  4. Complete and mail an SSA-8125 to the appropriate State Agency.

  5. Process a start date record to reflect original Stieberger application date.

6. Current Pay Case Earlier DOE On Same Application

  1. Process an A-OTP to pay retroactive amount to the date of eligibility in accordance with SM 01901.150.

  2. IAR involved - Do not reimburse the State if only DOE is being redetermined.

  3. Issue any retroactive payment due the individual.

  4. Apply title II and title XVI offset per GN 02610.005D.

  5. See 5.e., above, for notices.

7. Current Initial Denial Posted - Earlier DOE On Earlier Applications

  1. Prepare SSA-450-SI start date per 2.a., above. The input will create a new record unless there are exceptions. (Refer to SM 01001.000ff for exceptions.)

  2. If an exception exists, T-30 or T-50 record, then establish new record reflecting earlier DOE. (Do not duplicate any PD/PB payments made on the prior record.)

  3. IAR involved - refer to 3.b., above.

8. Systems Annotation

Annotate the RMKS segment of the SSR in all Stieberger cases. Show " Stieberger Class Member" in RMKS.

C. Procedure -- Notices

The following subsection gives notice preparation instructions, references, paragraphs, and sample notices.

1. Notice -- Preparation

Prepare the appropriate Notice of Reconsideration for all decisions.

In 10. below are paragraphs for use in “ Stieberger notices.” In 11. below are sample Notices Of Reconsideration which show how to use the Stieberger paragraphs and which appeals language to use. However, all other language is used for sample purposes only. Any of the stock paragraphs that are appropriate for a case situation may be used in the actual Notice of Reconsideration.

2. Notice References

NL 00801.010--manual notice preparation, notice suppression.

NL 00801.015--notice suppression on start date records.

NL 00802.050--preparing Notice of Reconsideration for initial claims.

NL 00803.095--preparing Notice of Reconsideration for post-eligibility cases.

NL 00804.100ff.--stock paragraphs used to cover situations not involving Stieberger issues.

3. Notice Language

The following are paragraphs developed the “Stieberger notices.”

Paragraph #1: Introductory Paragraph

We looked at (1) Supplemental Security Income (SSI) case again to see if we owed (2) money because of the Stieberger court case. This case is about how we decided whether a person was disabled.

 

Fill-ins:

1 -Choice 1:your
 Choice 2:her
 Choice 3:his
2 -Choice 1:you
 Choice 2:her
 Choice 3:him

Paragraph #2: Onset date established based on a Stieberger review. (Always precedes paragraph  3.)

We used special rules to decide the date (1) became disabled under the Stieberger criteria. This may not be the same date we would have found (2) disabled if we had not applied the special Stieberger rules.

 

Fill-ins:

1 -Choice 1:you
 Choice 2:she
 Choice 3:he
2 -Choice 1:you
 Choice 2:her
 Choice 3:him

Paragraph #3: Disability approved for all or some months and recipient meets nondisability requirements.

Based on the Stieberger court case, we looked at the facts in (1) case (2) to see if (3) disabled (4) . (5) .

 

Fill-ins:

1 -Choice 1:your
 Choice 2:her
 Choice 3:his
2 -Choice 1:from MM/YY to MM/YY
 Choice 2:for MM/YY
3 -Choice 1:you were
 Choice 2:she was
 Choice 3:he was
4 -Choice 1:beginning MM/YY through MM/YY
 Choice 2:for MM/YY
5 -Choice 1:We decided you were/she was/he was not disabled for MM/ YY or MM/YY through MM/YY because (reason for denial for those months). (Use this choice when person is disabled for part of the period.)
 Choice 2:Null

Paragraph #4: Individual Not Eligible for SSI For Nonmedical Reasons.

We have decided (1) not eligible to receive Supplemental Security Income (SSI) payments.

 

Fill-ins:

1 -Choice 1:you are
 Choice 2:she is
 Choice 3:he is

Paragraph #5: Individual Disabled But Ineligible For Nondisability Reasons.

Based on the Stieberger court case, we looked at the facts in (1) case (2) to see if (3) disabled. Even though we decided (4) disabled (5) , we cannot pay (6) any (7) SSI money because (8) .

 

Fill-ins:

1 -Choice 1:your
 Choice 2:her
 Choice 3:his
2 -Choice 1:beginning MM/YY through MM/YY
 Choice 2:for MM/YY
3 -Choice 1:you were
 Choice 2:she was
 Choice 3:he was
4 -Choice 1:you were
 Choice 2:she was
 Choice 3:he was
5 -Choice 1:for these months
 Choice 2:for this month
6 -Choice 1:you
 Choice 2:her
 Choice 3:him
7 -Choice 1:more (use when individual is or was receiving SSI based on another period of eligibility)
 Choice 2:null
8 - Reason for nonmedical denial.

Paragraph #6: Individual currently receiving payments outside the " Stieberger period" and payments not affected by Stieberger .

(1) This decision does not affect the payments (2) now getting.

 

Fill-ins:

1 -Choice 1:We decided (you are/she is/he is) due more SSI payments. (Use when disability is approved for all months.)
 Choice 2:Null
2 -Choice 1:you are
 Choice 2:she is
 Choice 3:he is

Paragraph #7: Medicaid Referral Paragraph for Individual Living in a State Where SSA Makes Medicaid Determination (Modified Version of Paragraph 1152)

For information about any change for (1) in (2) Medicaid eligibility caused by this action, you should get in touch with (3) .

 

Fill-ins:

1 -Choice 1:MM/YY
 Choice 2:MM/YY through MM/YY
2 -Choice 1:your
 Choice 2:her
 Choice 3:his
3 - Name of State Agency

4. Sample Notices

The following are sample Notices Of Reconsideration. The shaded paragraphs indicate paragraphs or revisions of existing paragraphs that can be used in " Stieberger notices."

Situation 1: Disability Approved For All Months (IC)--Not Currently Getting SSI Based on Another Application

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

NOTICE OF RECONSIDERATION

 Office Address:
 Office Hours:
 Telephone Number:
 Social Security Number:
 Date:

Name

Street Address

City/State/Zip Code

 

We looked at your Supplemental Security Income (SSI) case again to see if we owed you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.

We decided you are eligible to receive SSI payments. The following chart shows the amount of SSI money due you and for what months the money is due. This letter will also tell you more about our decision.

How Much We'll Pay You

FromThroughAmount Due Each Month
MM/DD/YYMM/DD/YY$xxx.xx
MM/DD/YYMM/DD/YY$xxx.xx

Information About Your Disability

We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.

Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you were disabled. We decided you were disabled beginning MM/YY through MM/YY.

 

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Your Payment Is Based On These Facts

  • You first met all requirements for eligibility on MM/DD/YY. The law prohibits payment of benefits for any days in a month before you meet all eligibility requirements.

  • You were living in the State of XXX for MM/YY on.

  • The amount of money we pay you from the State where you live depends on its rules.

    --You are living with others in the County of YYY in the State of XXX for MM/YY on.

  • You have monthly income which must be considered in figuring your payment as follows:

    --Your assistance payments based on need of $xxx.xx for MM/YY through MM/YY.

Information About Your Back Payment

We are sending you a Supplemental Security Income check for $xxx.xx in MM/ YY. We will not count the part of this money which was due for back payments as your resource for 6 months. If the money is not spent before MM/DD/YY, we will count any money left over as part of your resources. But things bought with this money may count as resources the month after they are bought. Your Social Security office can tell you which things count as resources. You cannot get SSI if the resources we count have a value of more than $2000.00.

Information About Medicaid

An agency of your State will advise you about the Medicaid program. If you have questions about your eligibility for Medicaid or need immediate medical assistance, you should get in touch with (name of State agency).

Things To Remember

  • Payments may change if your circumstances change. Therefore, you are required to report any change in your situation that may affect your Supplemental Security Income payment. For example, you should tell us if you move, if anyone else moves from or into your household, if your marital status changes, if income or resources for you or members of your household change, if you stop or start attending school regularly, if your medical condition improves or if you go to work.


    Page 3

    Read the booklet “When You Get SSI-What You Need to Know” carefully for additional information about this requirement.

  • The doctors and other trained personnel who decided that you are disabled believe that your health may improve. Therefore, we will review your case in about 3 years. We will send you a letter before we start the review. Based on that review, your SSI will continue if you are still disabled. But it will end if you are no longer disabled.

If You Disagree With The Decision

If you disagree with the decision, you have the right to ask for a hearing before an Administrative Law Judge (ALJ). The ALJ will review your entire case, even the parts you agree with. The ALJ also will consider any new facts you have and then will make a new decision. The new decision could be more favorable to you than the one you already have. But, keep in mind that the new decision also could be the same as or less favorable than the decision you already have.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called “Request for Hearing.” Contact one of our offices if you want help.

How The Hearing Process Works

The ALJ will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it is important that you give us any new facts as soon as you can.

The hearing is your chance to tell the ALJ why you disagree with the decision in your case. You can give the ALJ new evidence and bring people to testify for you. The ALJ also can require people to bring important papers to your hearing and give facts about your case. You can question these people at your hearing.


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Please read the enclosed pamphlet "Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case." It has more information about the hearing.

It Is Important To Go To The Hearing

It is very important that you go to the hearing. If for any reason you can't go, contact the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule the hearing if you have a good reason.

If you don't go to the hearing and don't have a good reason for not going, the ALJ may dismiss your request for a hearing.

If You Want Help With Your Hearing

You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your hearing.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

If You Have Any Questions

If you have any questions, you may call, write or visit any Social Security Office. If you call or visit our office, please have this letter with you and ask for (name of field office contact). The telephone number is shown at the top of page 1.

Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

 Manager's Name
 Title

 

Enclosures (2)

Situation 2: Disability Denied For Some Months (IC)--Not Currently Getting SSI Based on Another Application

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

NOTICE OF RECONSIDERATION

 Office Address:
 Office Hours:
 Telephone Number:
 Social Security Number:
 Date:

Name

Street Address

City/State/Zip Code

We looked at your Supplemental Security Income (SSI) case again to see if we owed you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.

We decided you are eligible to receive SSI payments. The following chart shows the amount of SSI money due you and for what months the money is due. This letter will also tell you more about our decision.

How Much We'll Pay You

FromThroughAmount Due Each Month
MM/DD/YYMM/DD/YY$xxx.xx
MM/DD/YYMM/DD/YY$xxx.xx

Information About Your Disability

We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.

Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you were disabled. We decided you were disabled beginning MM/YY through MM/YY. We decided you were not disabled for MM/YY because (reason for denial for those months).

 

SSA-L8455-U2


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Your Payment Is Based On These Facts

  • You first met all requirements for eligibility on MM/DD/YY. The law prohibits payment of benefits for any days in a month before you meet all eligibility requirements.

  • You were living in the State of XXX for MM/YY on.

  • The amount of money we pay you from the State where you live depends on its rules.

    --You are living with others in the County of YYY in the State of XXX for MM/YY on.

  • You have monthly income which must be considered in figuring your payment as follows:

    --Your assistance payments based on need of $xxx.xx for MM/YY through MM/YY.

Information About Your Back Payment

We are sending you a Supplemental Security Income check for $xxx.xx in MM/ YY. We will not count the part of this money which was due for back payments as your resource for 6 months. If the money is not spent before MM/DD/YY, we will count any money left over as part f your resources. But things bought with this money may count as resources the month after they are bought. Your Social Security office can tell you which things count as resources. You cannot get SSI if the resources we count have a value of more than $2000.00.

Information About Medicaid

An agency of your State will advise you about the Medicaid program. If you have questions about your eligibility for Medicaid or need immediate medical assistance, you should get in touch with (name of State agency).

Things To Remember

  • Payments may change if your circumstances change. Therefore, you are required to report any change in your situation that may affect your Supplemental Security Income payment. For example, you should tell us if you move, if anyone else moves from or into your household, if your marital status changes, if income or resources for you or members of your household change, if you stop or start attending school regularly, if your medical condition improves or if you go to work.


    Page 3

    Read the booklet "When You Get SSI-What You Need to Know" carefully for additional information about this requirement.

  • The doctors and other trained personnel who decided that you are disabled believe that your health may improve. Therefore, we will review your case in about 3 years. We will send you a letter before we start the review. Based on that review, your SSI will continue if you are still disabled. But it will end if you are no longer disabled.

If You Disagree With The Decision

If you disagree with the decision, you have the right to ask for a hearing before an Administrative Law Judge (ALJ). The ALJ will review your entire case, even the parts you agree with. The ALJ also will consider any new facts you have and then will make a new decision. The new decision could be more favorable to you than the one you already have. But, keep in mind that the new decision also could be the same as or less favorable than the decision you already have.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called “Request for Hearing.” Contact one of our offices if you want help.

How The Hearing Process Works

The ALJ will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it is important that you give us any new facts as soon as you can.

The hearing is your chance to tell the ALJ why you disagree with the decision in your case. You can give the ALJ new evidence and bring people to testify for you. The ALJ also can require people to bring important papers to your hearing and give facts about your case. You can question these people at your hearing.


Page 4

Please read the enclosed pamphlet “Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case.” It has more information about the hearing.

It Is Important To Go To The Hearing

It is very important that you go to the hearing. If for any reason you can't go, contact the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule the hearing if you have a good reason.

If you don't go to the hearing and don't have a good reason for not going, the ALJ may dismiss your request for a hearing.

If You Want Help With Your Hearing

You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your hearing.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

If You Have Any Questions

If you have any questions, you may call, write or visit any Social Security Office. If you call or visit our office, please have this letter with you and ask for (name of field office contact). The telephone number is shown at the top of page 1.

Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

 Manager's Name
 Title

 

Enclosures (2)

Situation 3: Disability Approved But No Money Due Because Individual Ineligible for Nonmedical Reasons--Individual Not Currently Getting SSI Based on Another Application

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

NOTICE OF RECONSIDERATION

 Office Address:
 Office Hours:
 Telephone Number:
 Social Security Number:
 Date:

We have decided you are not eligible to receive Supplemental Security Income (SSI) payments.

Why We Can't Pay You

We looked at your SSI case again to see if we owed you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.

We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.

Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you were disabled. Even though we decided you were disabled for these months, we cannot pay you any SSI money because you had too much income for those months.

Our Decision Is Based On These Facts

  • You are living in the State of XXX for MM/YY on.

  • Whether we can pay you money from the State where you live depends on its rules.

    --You are living with others in the County of YYY in the State of XXX for MM/YY on.

     

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  • You have monthly income which must be considered in figuring your eligibility as follows:

    --Your Social Security benefits--before deductions for Medicare premiums, if any--of $xxx.xx for MM/YY on.

Information About Medicaid

Since you are not receiving SSI payments, you are not automatically eligible for medical assistance under the Medicaid program. However, if you need help with medical bills, you still may be eligible for medical assistance. Contact (name of State agency) which handles eligibility for medical assistance about the eligibility requirements of the State's medical assistance programs.

Things To Remember

  • Although you are not eligible for the reasons given above, we have determined that you are disabled.

  • This decision refers only to your claim for SSI payments.

  • If at any time in the future you think you qualify for payment, please contact us immediately about filing a new application. We cannot make payment for any month before the month in which you apply.

If You Disagree With The Decision

If you disagree with the decision, you have the right to ask for a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge (ALJ). The ALJ will review your case and consider any new facts you have.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called "Request for Hearing." Contact one of our offices if you want help.


Page 3

How The Hearing Process Works

The ALJ will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it important that you give us any new facts as soon as you can.

The hearing is your chance to tell the ALJ why you disagree with the decision in your case. You can give the ALJ new evidence and bring people to testify for you. The ALJ also can require people to bring important papers to your hearing and give facts about your case. You can question these people at your hearing.

Please read the enclosed pamphlet "Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case." It has more information about the hearing.

It Is Important To Go To The Hearing

It is very important that you go to the hearing. If for any reason you can't go, contact the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule the hearing if you have a good reason.

If you don't go to the hearing and don't have a good reason for not going, the ALJ may dismiss your request for a hearing.

If You Want Help With Your Hearing

You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your hearing. If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

New Application

You have the right to file a new application at any time, but filing a new application is not the same as appealing this decision. If you disagree with this decision and you file a new application instead of appealing, you might lose some benefits, or not qualify for any benefits. So, if you disagree with this decision, you should file an appeal within 60 days.


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If You Have Any Questions

If you have any questions, you may call, write or visit any Social Security Office. If you call or visit our office, please have this letter with you and ask for (name of field office contact). The telephone number is shown above.

Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

 Manager's Name
 Title

 

Enclosure

Situation 4: Disability Approved For All Months (PE) (Stieberger Months Outside Current Eligibility Period)

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

NOTICE OF RECONSIDERATION

 Office Address:
 Office Hours:
 Telephone Number:
 Social Security Number:
 Date:

Name

Street Address

City/State/Zip Code

We looked at your Supplemental Security Income (SSI) case again to see if we owed you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.

We decided you are due more SSI payments. This decision does not affect the payments you are now getting. The following chart shows the amount of SSI money due you and for what months the money is due. This letter will also tell you more about our decision.

How Much We'll Pay You

FromThroughAmount Due Each Month
MM/DD/YYMM/DD/YY$xxx.xx
MM/DD/YYMM/DD/YY$xxx.xx

Information About Your Disability

We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.

Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you were disabled. We decided you were disabled beginning MM/YY through MM/YY.

 

SSA-L8457-U2


Page 2

Your Payment Is Based On These Facts

  • You were living in the State of XXX for MM/YY on.

  • The amount of money we pay you from the State where you live depends on its rules.

    --You are living with others in the County of YYY in the State of XXX for MM/YY on.

  • You have monthly income which must be considered in figuring your payment as follows:

    --Your assistance payments based on need of $xxx.xx for MM/YY through MM /YY.

Information About Your Back Payment

We are sending you a Supplemental Security Income check for $xxx.xx in MM/ YY. We will not count the part of this money which was due for back payments as your resource for 6 months. If the money is not spent before MM/DD/YY, we will count any money left over as part of your resources. But things bought with this money may count as resources the month after they are bought. Your Social Security office can tell you which things count as resources. You cannot get SSI if the resources we count have a value of more than $2000.00.

Information About Medicaid

For information about any change for MM/YY to MM/YY in your Medicaid eligibility caused by this action, you should get in touch with (Name of State Agency).

Things To Remember

This determination replaces all previous determinations for the above periods.

If You Disagree With The Decision

If you disagree with the decision, you have the right to ask for a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge (ALJ). The ALJ will review your case and consider any new facts you have.


Page 3

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called "Request for Hearing." Contact one of our offices if you want help.

How The Hearing Process Works

The ALJ will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it is important that you give us any new facts a soon as you can.

The hearing is your chance to tell the ALJ why you disagree with the decision in your case. You can give the ALJ new evidence and bring people to testify for you. The ALJ also can require people to bring important papers to your hearing and give facts about your case. You can question these people at your hearing.

Please read the enclosed pamphlet "Your Right To An Administrative Law Judge Hearing And Appeals Council Review Of Your Social Security Case." It has more information about the hearing.

It Is Important To Go To The Hearing

It is very important that you go to the hearing. If for any reason you can't go, contact the ALJ as soon as possible before the hearing and explain why. The ALJ will reschedule the hearing if you have a good reason.

If you don't go to the hearing and don't have a good reason or not going, the ALJ may dismiss your request for a hearing.

If You Want Help With Your Hearing

You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your hearing.


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If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

If You Have Any Questions

If you have any questions, you may call, write or visit any Social Security Office. If you call or visit our office, please have this letter with you and ask for (name of field office contact). The telephone number is shown at the top of page 1.

Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

 Manager's Name
 Title

 

Enclosure

Situation 5: Disability Approved But No Money Due Because Individual Ineligible for Nonmedical Reasons (IC) (Individual Currently Getting SSI Based on Another Application)

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

NOTICE OF RECONSIDERATION

 Office Address:
 Office Hours:
 Telephone Number:
 Social Security Number:
 Date:

We looked at your SSI case again to see if we owed you money because of the Stieberger court case. This case is about how we decided whether a person was disabled.

Why We Can't Pay You

We used special rules to decide the date you became disabled under the Stieberger criteria. This may not be the same date we would have found you disabled if we had not applied the special Stieberger rules.

Based on the Stieberger court case, we looked at the facts in your case from MM/YY to MM/YY to see if you were disabled. Even though we decided you were disabled for these months, we cannot pay you any more SSI money because you had too much income for those months.

This decision does not affect the payments you are now getting.

Our Decision Is Based On These Facts

  • You are living in the State of XXX for MM/YY on.

  • Whether we can pay you money from the State where you live depends on its rules.

    --You are living with others in the County of YYY in the State of XXX for MM/YY on.

  • You have monthly income which must be considered in figuring your eligibility as follows:

     

SSA-L8456-U2


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  • --Your Social Security benefits--before deductions for Medicare premiums, if any--of $xxx.xx for MM/YY on.

Information About Medicaid

For information about any change for MM/YY to MM/YY in your Medicaid eligibility caused by this action, you should get in touch with (Name of State Agency).

Things To Remember

  • Although you are not eligible for the reasons given above, we have determined that you are disabled.

  • This decision refers only to your claim for SSI payments.

If You Disagree With The Decision

If you disagree with the decision, you have the right to ask for a hearing. At the hearing, a person who has not seen your case before will look at it. That person is an Administrative Law Judge (ALJ). The ALJ will review your case and consider any new facts you have.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called “Request for Hearing.” Contact one of our offices if you want help.

How The Hearing Process Works

The ALJ will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it important that you give us any new facts as soon as you can.


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The hearing is your chance to tell the ALJ why