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

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  within 60 days after receiving the advance notice

- Recipients who appeal within 10 days of receiving the advance notice should receive continued or reinstated payment at the protected payment level (PPL)

- Recipients who appeal 11 or more days after, but within 60 days of receiving the advance notice may experience a reduction in payment but will be reinstated to payment at the PPL.

OR

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  after the 60 day period and good cause exist for extending the time limit.

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

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  certain erroneous payment cases (see SI 02301.315),

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

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

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.

See SI 02301.310C.6 - Appeal and the Right to Goldberg Kelly (GK) Payment Continuation and SI 02301.415 - SSA-263-U2, Waiver of Supplemental Security Income Payment Continuation .

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

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

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  the individual has 60 days to appeal and continue to receive unreduced benefits after receiving the notice, but only 10 days to appeal to continue receiving unreduced benefits without interruption,

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

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  unreduced benefits may be waived,

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  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,

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  the recipient might have to pay back incorrect payments if they lose the appeal, and

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  reporting responsibilities.

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

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  suggest waiving payment continuation to avoid an overpayment, or

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

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

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

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:

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  input the change,

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

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  take the reconsideration request.

Determine the presumed notice receipt date:

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  Count 5 calendar days after the date on the notice.

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  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.

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  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 notice processing.

Determine the 60-day time limit to file the reconsideration request and qualify for payment continuation:

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  Count 60 days after the notice receipt date as determined above.

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  If the 60th day is a non-work day for SSA, extend the time limit to the next work day.

If the recipient does not file the reconsideration request within the 60-day time limit, advise the recipient that they must explain in writing the reason for missing the time limit. For instructions on developing good cause, see SI 04020.020B.2. through SI 04020.020B.3.

Give the recipient a completed Form SSA-94 (Receipt of SSI Appeal Request) only when they qualify for GK payment continuation at the PPL and do not waive it, or when they request it later after waiving it.

See SI 02301.410 for an exhibit of the SSA-94.

If the recipient qualifies for GK payment continuation at the PPL and on their own initiative chooses against it:

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  obtain a signed Form SSA-263-U2 (Waiver of Supplemental Security Income Payment Continuation),

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  retain the original copy in the recipient's file, and

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  give the duplicate copy to the recipient.

See SI 02301.415 for an exhibit of the SSA-263-U2.

If you cannot issue an appeal decision the same day as the appeal is received, follow instructions in SI 02301.315 - Erroneous Payments and GK Payment Continuation to continue (or restore) benefits at the PPL. If you can issue an appeal decision the same day the appeal is received, input a due process data (DPD) entry following SM 01305.570A2 - Processing of Initial Appeal Decision.

To input appeals data, refer to MS 04420.001 - Appeals-Overview and MS 00302.007 - Appeal Process.