TN 1 (11-00)
An SSA-831-U3 must be completed for every case, with certain special entries. See
DI 32548.045 for notice instructions.
Enter in remarks section “Hyatt III Review - Unfavorable. This determination affirms the determination of (date of prior
denial)”. On pending cases returned from OHA for consolidation with readjudication claims, add “class member is automatically entitled to an ALJ hearing.” Also add this remark
in cases where there is consolidation of a non-Hyatt III claim with multiple Hyatt III claims if any of the Hyatt III claims previously were appealed to the ALJ hearing level. See DI 32548.015B.3.b.
For reversals of denials, enter in remarks section “Hyatt III Review - Favorable (or “Partially Favorable” if a later onset date or closed period
is established.) This determination revises the determination of (date of prior denial)”.
If work activity is involved (see DI 32548.020C.2.b.) enter “File contains work activity that needs to be adjudicated by the FO.”
If more than one prior denial is being reopened, enter in remarks section “Hyatt III Review - (favorable, partially favorable, or unfavorable). This determination revises
the determinations of (dates of all prior denials covered under Hyatt III ).”
If reopening and there is a subsequent allowance, annotate:
Subsequent allowances in SSA-831 remarks section “Superseded by Hyatt III reopening decision of (date of Hyatt III SSA-831-U3). This determination remains the CPD for future CDRs.”
The Hyatt III reopening SSA-831-U3 “Allowance of (date of subsequent allowance) superseded by this
Hyatt III reopening determination but remains the CPD for future CDRs.”
NOTE: See DI 32548.020C. for exceptions to the SSA-831 remarks if the subsequent allowance involves a current
Follow DI 27021.005 to determine if a brief supplemental rationale is necessary.
Refer to DI 27021.020 for specific instructions outlining these situations.