If an individual disagrees with the initial determination, reconsideration is the first step in the administrative review process.

The method of reconsideration for Title XVI consists of a case review, informal conference, or formal conference. The method used depends on the issue involved. In Supplemental Security Income (SSI) disability or blindness claims, medical issues can only be reconsidered through case review. Nonmedical issues can be reconsidered through either case review or informal conference. Generally, if we are taking an adverse action, the recipient can request case review, informal conference, or a formal conference. See SI 04020.000 for a full explanation of the reconsideration review.

In general, a hearing before an ALJ, is the next level of appeal after we have made a reconsideration determination. There are exceptions to this general rule. For more information, see SI 04030.010A.2, SI 04070.050A.4, and SI 04070.050A.5.

If the individual disagrees with either the ALJ decision or the dismissal of a hearing request, they may ask the AC to review the action. The AC may dismiss or deny the request for review, or it may grant the request and either issue a decision or remand the case to an ALJ. The AC may also review an ALJ decision (within 60 days of the hearing decision or dismissal) on its own motion. The AC has final review authority for Social Security Administration (SSA).

An individual may request EAP but only after appealing at least through the reconsideration step. See SI 04060.000 for more details on the EAP process. EAP may be used in those cases in which the individual does not dispute SSAs version of the facts in their claim. Rather, the individual challenges the constitutionality of the law underlying the determination. SSA, and all parties to the determination, must agree to using EAP.

The AC review completes the administrative review process. If an individual is still dissatisfied, they may request judicial review which is done by filing a civil action in a Federal district court.

It is possible for a case to have different issues at different levels of appeal. Once the ALJ issues a decision and notifies the individual, the case goes to the field office (FO) for effectuation of the ALJ decision. The FO then sends a notice on those issues that were not addressed by the ALJ. This notice will provide the claimant with a reconsideration as the next level of appeal. The ALJ's notice will provide the claimant with AC review as the next level of appeal.

The ALJ may consider a new issue at the hearing even though it arose after the hearing request and even though it has not been considered in an initial or reconsidered determination. The ALJ will notify all parties to the hearing about the new issue.

Administrative finality is the concept that a determination or decision becomes final and binding when rendered, unless it is timely appealed or later reopened and revised. This term is used throughout the appeals subchapters.

A decision is a written notice of a formal action at or above the ALJ level.

When used in the context of appeals, a merits determination or decision merely refers to a determination or decision that has further administrative and judicial review. For more information on new application in lieu of appeal, see SI 04005.020C.

To vacate means to set aside the previous action. For example, an ALJ or the AC may vacate a dismissal of a request for review. The AC may also vacate a dismissal on its own motion. For more information on new application in lieu of appeal, see SI 04005.020C.