BASIC (06-11)

DI 57601.005 Request for Hearing Filed in Region I

Citations:

20 CFR 405.20

20 CFR 405.301

A. Background

Special hearing rules apply to disability claims filed by residents in Region I (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont) and those Canadian residents whose servicing field office (FO) is in the Region I.

The first level of appeal for claims is a reconsideration by the State Disability Determination Services (DDS) except in New Hampshire, which is a prototype state. In New Hampshire, the first level of appeal is a hearing before an administrative law judge (ALJ).

Rules at the hearing level for disability claims filed by residents in Region I and those Canadian residents, whose servicing field office (FO) is in Region I, are still in effect.

B. Requests for a hearing in Region I

A hearing before an ALJ is the next level of appeal for the following determinations:

  • a Disability Determination Services (DDS) reconsideration determination; or

  • an initial determination from a prototype state. (In Region I, New Hampshire is the only prototype State.)

C. Time limits for appeal

The claimant must file a written request for a hearing no later than 60 days after the date of receipt of the notice of the determination or decision (60 days plus 5 days mail time).

If the claimant does not timely file a hearing request, the FO:

  • obtains a good cause statement from the claimant explaining the reason for the late filing. See Request for Administrative Law Judge (ALJ) Hearing Filed Late DI 12010.002.

  • advises the claimant that the ALJ will determine if good cause exists to grant an extension for filing the hearing request.

NOTE: If the claimant does not file a hearing request timely and the claimant does not establish good cause for late filing, the ALJ may dismiss the appeal.

D. FO actions for processing a request for hearing

1. Interviewing the claimant

The FO should follow the interview procedures in Request for Administrative Law Judge (ALJ) Hearing, DI 12010.001 and The Hearing Process, GN 03103.010.

2. Processing a hearing request

  1. Establish the appeal in the Modernized Claims System (MCS) , the Modernized Supplemental Security Income Claims System (MSSICS), or both, per Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS), DI 81010.150.

  2. If the Certified Electronic Folder (CEF) was previously the official folder but there is now an EDCS exclusion at the hearing level, prepare a paper folder per CEF Exclusions and Limitations, DI 81010.030. The paper folder is the official folder for cases that include both an EDCS claim and a non-EDCS claim.

  3. For appeals that are not processed through the MCS or MSSICS appeal screens, fax the appeal request into EDCS if one of the claims is established in EDCS and file the appeal request in the paper folder.

    References

    • DI 81010.030C - Processing Multiple Claims When At Least One of the Claims Is an EDCS Exclusion

    • DI 12010.005 - Development of Administrative Law Judge (ALJ) Hearing Cases – Reconsideration Denial - Medical/Vocational Basis

3. Transferring hearing requests

Transfer all hearing requests to the hearing office (HO) within five business days per FO Procedures for Forwarding HA-501-U5 (Request for Hearing by Administrative Law Judge) and Folder to HO, GN 03103.080.

Do not hold the claim pending receipt of the SSA-3441 (Disability Report – Appeal). See Development of Administrative Law Judge (ALJ) Hearing Cases – Reconsideration Denial - Medical/Vocational Basis, DI 12010.005 and Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS), DI 81010.150.

Do not hold the claim pending receipt of the SSA-827 (Authorization to Disclosure Information to the Social Security Administration) per DI 11005.057 Field Office Instructions for Obtaining Form SSA-827.