BASIC (01-12)

DI 27530.010 Notices and Other Actions In Common Reopening and Related Situations

A. Revision or change is less favorable

1. Title II only

If the personalized notice was not released for the original determination (e.g., allowance reviewed during preefectuation), correct the determination and follow current notification instructions.

If the personalized notice was released for the original allowance determination, prepare a revised SSA-831 Disability Determination and Transmittal. Do not delete or remove the previous SSA-831.

  • Enter the following remark in item 34, “This revises the previous determination of (DD/MM/YYYY).”

  • Prepare and release a notice of revised determination in accordance with DI 27540.000 Reopening Notice Instructions.

  • Process electronic reopenings per DI 81020.115C.

  • For paper cases, do not input the revised determination. For paper case processing instructions, see DI 27530.005

2. Title XVI only

If the personalized notice was not released for the original determination, correct the determination and forward any revised instructions to the field office (FO). Follow current notification procedures.

If the personalized notice was released for the original determination follow the procedures below.

  • Prepare a revised SSA-831. Do not delete or remove the previous SSA-831.

  • Enter the following remark in Item 34, “This revises the previous determination of (DD/MM/YYYY).”

  • Prepare and release a notice of revised title XVI determination in accordance with DI 27540.000 (if necessary modify the suggested format and wording to fit the situation).

  • Forward any revised instructions to the FO.

3. Concurrent cases

a. Title II

If the personalized notice was not released for the original determination, correct the determination and follow current notification instructions.

If the personalized notice was released for the original determination, follow the procedures below.

  • Prepare a revised SSA-831. Do not delete or remove the previous SSA-831.

  • Prepare and release a notice of revised determination in accordance with DI 27540.000. Modify the language so that it refers to Social Security benefits. Do not use the Medicaid paragraph, but include the disclaimer paragraph 842 and the appeals paragraph 305. Include paragraph 901 if the claimant has been receiving benefits for 24 months or more.

b. Title XVI

Follow the title XVI only instructions (DI 27530.010A.2. in this section) but add disclaimer paragraph 841.

B. Revision or change is more favorable

1. Title II only

If the personalized notice was not released for the original determination, correct the determination and follow current notification instructions.

If the personalized notice was released for the original determination, follow the procedures below.

  • Prepare a revised SSA-831. Do not delete or remove the previous SSA-831.

  • If the revision is only partially favorable, follow DI 27540.000.

2. Title XVI only

If the personalized notice was not released for the original determination, correct the determination and the SSA-4648 Title XVI Disability Claims Control, and follow current notification procedures.

If the personalized notice was released for the original determination, follow the procedures below:

  • Prepare a revised SSA-831.

  • Prepare a SSA-4648 or forward revised instructions to the FO.

  • Prepare notification instructions in accordance with DI 27540.000.

  • Include paragraphs appropriate to the determination, e.g., 1029, 1391, 1373. The appeals paragraph is preprinted.

  • If a reopening of an initial allowance results in a partially favorable earlier onset date or a denial is reopened to a partially favorable allowance, follow DI 27540.020B.

3. Concurrent cases

a. Title II

Same as title II only instructions (see DI 27530.010B.1. in this section) but add disclaimer paragraph 842.

b. Title XVI

Same as title XVI only instructions (see DI 27530.010B.2. in this section) but add paragraph 841.

C. Basis change only

1. Title II only

If the personalized notice was not released for the original determination, correct the determination and follow current notification instructions.

If the personalized notice was released for the original determination, follow the procedures below:

  • Prepare a revised SSA-831.

  • Prepare and release a notice affirming the original determination (e.g., see DI 27540.025). Include the personalized rationale.

  • Send case to the FO, unless the referring office (e.g., Office of Disability Operations (ODO)) requests return of the folder.

2. Title XVI only

If the personalized notice was not released for the original determination, correct the determination and follow current notification instructions.

If the personalized notice was released for the original determination, follow the procedures below.

  • Prepare a revised SSA-831.

  • Prepare and release a notice on the appropriate blank letterhead affirming the original determination with language from NL 00705.266 Reopening 14 - Change in Basis – Blind to Disabled – Title XVI.

  • Include personalized disability language if the revision is less favorable (e.g., if revising from blind to disabled).

  • Return the folder to the FO.

See Details

3. Concurrent cases

a. Title II

Same as title II only instructions (DI 27530.010C.1. in this section), but add disclaimer paragraph 842.

b. Title XVI

Same as title XVI only instructions (DI 27530.010C.2. in this section), but add disclaimer paragraph 841.

D. No change in basis or end result – claimant aware of potential reopening and revision

If we notified the claimant that we were considering reopening and revision or the claimant or his or her representative requested reopening and revision, follow the instructions below.

1. Title II only

  • Document the file regarding any additional evidence.

  • Prepare and release a notice on the appropriate blank letterhead with language from NL 00705.256 Reopening 12 – No Change in Basis or End Result - Claimant Aware or Denial of Request to Reopen and Revise – Title II or Title XVI.

  • Return case to referring office (e.g., FO, ODO).

2. Title XVI only

  • Document the file regarding any additional evidence.

  • Prepare and release a notice on the appropriate blank letterhead using language from NL 00705.256.

  • Return case to referring office (e.g., FO, ODO).

3. Concurrent cases

a. Title II

Same as title II only instructions (see DI 27530.010D.1. in this section), but add disclaimer paragraph 842 to the notice.

b. Title XVI

Same as title XVI only instructions (DI 27530.010D.2. in this section), but add disclaimer paragraph 841 to the notice.

E. No change in basis or end result – claimant unaware of potential reopening and revision

If we did not notify the claimant that we were considering reopening and revision, and the claimant or his or her representative did not request reopening and revision, he or she is unaware of the potential action. We do not need to notify an “unaware” claimant if there is no change to the basis or end result. That is because the claimant is not waiting to hear from us and we have no changes to report. Follow the instructions below for title II only, title XVI only, and concurrent cases.

  • Document the file regarding any additional evidence.

  • No notice is required.

  • Return case to referring office (e.g., FO, ODO).


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http://policy.ssa.gov/poms.nsf/lnx/0427530010
DI 27530.010 - Notices and Other Actions In Common Reopening and Related Situations - 07/24/2012
Batch run: 07/24/2012
Rev:07/24/2012