TN 14 (02-10)

DI 40515.020 Due Process Notification in Title II and Title XVI Cases

A. Due process notices in Title II and Title XVI cases

1. Title II due process predetermination notice

In Title II cases, a due process predetermination notice is required in those cessations and adverse reopenings that do not require statutory benefit continuation language per DI 28080.005. The following are examples:

  • Whereabouts unknown cessations.

  • Fraud cases.

  • Substantial gainful activity (SGA) cessations.

  • Failure to follow prescribed treatment.

See also GN 03001.005, Notice Requirements for Title II Due Process Actions.

2. Title XVI notice of planned action

In Title XVI cases, a notice of planned action containing Goldberg/Kelly (see SI 02301.300) appeal rights (payment continuation) is required when SSA proposes an adverse action, except in the following cases:

  • Medical cessations and medical adverse reopenings, since these cases require a statutory benefit continuation due process notice per DI 28080.025.

  • Whereabouts unknown Title XVI payment suspension (S06) per SI 02301.240. Also see SM 01305.001O.23.

For certain other exceptions to Goldberg/Kelly procedures, see SI 02301.300E.

B. Providing due process notice in Title II, Title XVI, and concurrent cases

1. Providing due process in Title II cases

  • For information on Title II cases when due process is required, see DI 28080.001 and GN 03001.005.

  • For information about when statutory benefit continuation applies, see DI 40515.100.

  • For information on continuing disability review (CDR) cases in which the PC DE prepares the cessation determination, see DI 28080.001.

  • For information about giving due process notice in adverse reopenings that result from a Quality Assurance (QA) rebuttal, see DI 27525.001.

  • Provide due process notice before processing a work and earnings cessation or adverse reopening involving work issues when Central Office (CO)/Office of Quality Performance (OQP) has sufficient information/evidence to prepare a determination.

  • For the format and content of the due process notice (including auxiliary notices) in work and earnings cessations, see DI 13010.185H.

  • For adverse reopening notice instructions, see DI 27540.001.

2. Providing due process in Title XVI and concurrent cases

In Title XVI and concurrent cases:

  • For due process notice requirements and for determining concurrency, see DI 28080.030 and DI 28080.035

  • For guidance on determining concurrency, see DI 28030.005 and DI 28030.010.

  • For notice requirements in adverse reopening cases, see DI 27540.001.

  • Update the Disability Control File (DCF) in remarks.

  • Process the Title II case using Title II due process procedures in concurrent work and earnings adverse action cases, and process the Title XVI case using Title XVI procedures. See DI 13010.185 - DI 13010.197 for additional information on due process work issue cases.

  • For information about when statutory benefit continuation applies, see DI 40515.100.

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