Effectuate payment prior to completing development when capability development is the only issue pending. (See GN 00502.020A.1. for a further discussion of this policy.)

Effectuate payment priorto completing development when the claimant has been determined incapable and you are still developing for a representative payee when all other development is complete. Follow instructions in GN 00504.105 to pay current benefits while withholding retroactive benefits if permitted by GN 00504.105.

If 60 days have passed since issuance of an ALJ decision and development is not complete, effectuate payment based on documentation in file and continue to develop.

You may limit development in certain windfall offset claims following the instructions in SI 02006.005.

When effectuating a favorable hearing decision on the issue of disability:

• •

  suppress the systems generated notice per SM 01301.675 and issue a manually prepared SSA-L8165 (Important Information) or the ALJ reversal notice on the Field Office Notice System (FONS);

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  use the format and appeals language as explained in b. - d. below; and

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  send a copy to the ALJ and, if applicable, to the claimant's representative payee, legal guardian, and/or authorized representative under cover of an SSA-L4031.

Begin the notice with:

“The administrative law judge decided on ( month/day/year ) that you meet the medical requirements to receive Supplemental Security Income (SSI). Because of this, you are now eligible for SSI checks as a ( type of payment ). The rest of this letter explains what this means to you.”

Follow the format for an SSA-L8025-U2 (see NL 00802.015 for format) and include the appeals language used for an SSA-L8025-U2 (NL 00804.224).

Begin the notice with the language shown in b. above.

Follow the format for an SSA-L8025-U2. Explain the periods of ineligibility. Include the appeals language used for an SSA-L8025-U2 (NL 00804.224).

If the claimant is being denied because of an issue that was not decided on appeal, follow the format for an SSA-L8030-U2 (SSI Notice of Disapproved Claim). (See NL 00802.025 for format.)

Begin the notice with the following language:

“The administrative law judge decided on ( month/day/year ) that you meet the medical requirements to receive Supplemental Security Income (SSI). However, on reviewing your case, we found that you do not meet all of the other requirements. Therefore, we cannot pay you. The rest of this letter explains what this means to you.”

Give a detailed explanation of ineligibility.

Use the appeals language for the SSA-L8030-U2 (NL 00804.224).

For ALJ and AC decisions, use the diagnosis codes found on the Office of Disability Adjudication and Review (ODAR) Case Processing Management System (CPMS) or the diagnosis found in the medical findings of the ALJ or AC decision.

Follow the instructions below to make an interim entry when making the payment effectuating input for US District court cases only. For non-MSSICS claims, complete the medical data (MD) field of the 1719B (SSI Posteligibility Input) per SM 01305.900 ff. with an interim entry of N00103.

For claims in MSSICS, enter a non-permanent disability, a diary reason of 3 and a medical diagnosis code of 0010.

It is not necessary to forward the claim folder(s) to the Disability Review Section for the diagnosis coding and medical diary information.

If an MBR has been established for the title II claim and a new record is being established to pay the claim, input this medical data postadjudicatively per SM 01005.140.

If the MBR has not yet been established for the title II claim when you are about to adjudicate the title XVI claim, complete the MD field of the 1719B (SM 01305.900 ff.) with an interim entry of N00013.

CAUTION: Do not leave the interim data on the system as the Social Security Administration relies on the diagnosis code for statistical purposes. In addition, an incorrect medical review period may generate unnecessary alerts to the DRS.