TN 24 (10-04)

SI 02301.310 Appeal and the Right to Goldberg Kelly (GK) Payment Continuation

A. Policy

1. Qualifying for Goldberg Kelly (GK) Payment Continuation

Recipients qualify for GK payment continuation at the Protected Payment Level (PPL) when they appeal an adverse action:

  • within 10 days after receiving the advance notice, or

  • after the 10-day period and good cause exists for extending the time limit.

EXCEPTIONS: GK payment continuation at the PPL does not apply to:

  • certain erroneous payment cases (see SI 02301.315),

  • collection of a penalty unless the recipient also appeals the overpayment determination (see SI 02301.100 SI 02301.110), and

  • medical cessation cases. When appealing these cases, individuals must elect Statutory Benefit Continuation (not GK) and can elect it at the reconsideration and/or hearing levels of appeal (see DI 12027.000).

NOTE: In concurrent medical cessation cases, electing not to receive title II benefit continuation is NOT failure to apply for and pursue other benefits for SSI (N06).

2. Waiving Payment Continuation

Recipients who qualify for payment continuation may choose to waive it. After waiving it, they may reconsider and receive it (including retroactive benefits) at any time before the first appeal decision.

B. Procedure - Explanations

When a recipient or payee reports in person a change that results in an adverse action or appeals an adverse action:

1. Explain

  • the change fully so that the individual understands the effect on benefits,

  • the right to receive written notice of the change before it occurs (if a GK notice has not been issued),

  • the individual has 60 days to appeal after receiving the notice, but only 10 days to appeal and continue receiving unreduced benefits,

  • unreduced benefits continue only until there is a decision at the first appeal level,

  • unreduced benefits may be waived,

  • even after waiving unreduced benefits, the individual may request them any time before the appeal decision on the reconsideration occurs and have them restored back to the first month they were reduced or stopped,

  • the recipient might have to pay back incorrect payments if he/she loses the appeal, and

  • reporting responsibilities.

CAUTION: When payment continuation results in overpayment, a recipient may still meet the requirements for waiver of recovery in SI 02260.001.

2. Do Not

Do not

  • suggest waiving payment continuation to avoid an overpayment, or

  • take a signed statement about the possibility of an overpayment, or

  • encourage or try to influence an individual to make a decision regarding payment continuation, or

  • suggest accepting a reduction in the PPL based on changes that are not being appealed. An individual must on his/her own initiative request a reduced benefit.

C. Procedure - Recipient Appeals

Follow these procedures to protect a recipient's right to payment continuation when he/she files a reconsideration request.

1. Advance Notice Issued and Appeal Filed Same Day

When a recipient or payee reports a change to the field office (FO) in person that results in an adverse action and wishes to appeal at the same time:

  • input the change,

  • immediately prepare an online or manual GK notice and hand it to the recipient, and

  • take the reconsideration request.

NOTE: A recipient cannot appeal an adverse action until there is a written notice of the determination.

2. Advance Notice Mailed - Determine Receipt Date

Determine the presumed notice receipt date:

  • Count 5 calendar days after the date on the notice.

  • If the notice is not available on the online retrieval system (ORS), count 12 calendar days after the notice run date in the NOTC segment on the SSR (7 days notice processing and 5 days mailing) or use the notice date in the DUPR segment on the SSR.

  • If the receipt date is a non-delivery day for the Post Office, extend the receipt date to the next delivery day.

IMPORTANT: If the notice cannot be found on the ORS, consider accepting a reasonable allegation of the receipt date since notice run dates on the Supplemental Security Record (SSR) are not always accurate and mailing of notices may not occur on time. See SI 02301.301B.3. and SI 02301.301B.4. about noti