TN 2 (02-04)

SI 04020.060 Effectuating SSI Reconsidered Determinations

A. Policy — Notice of Reconsidered Determination

The notice must be mailed to the claimant's last known address, and it must include specific reasons for the determination and ALJ hearing rights. If appropriate, it must also include an explanation of how to use Expedited Appeals Process (EAP). (See SI 04060.000)

B. Procedure — General

1. Effectuating Reconsidered Determinations

For MSSICS cases, update the applicable appeal screens including AJAS and ADIS with the determination (see MSOM MSSICS 020.023, MSOM MSSICS 020.025); for non-MSSICS screens, update the UAPD screens using direct SSR update (see MSOM BUSSR 002.010). An automated SSI appeal effectuation notice for reversals of initial disability determinations will be generated when the appropriate systems input is made. If a manual effectuation notice is required, use Form SSA-L8455-U2 for IC reconsideration reversals and Form SSA-L8456-U2 for affirmations of IC decisions (see NL00802.050). Use Form SSA-L8457-U2 for post-eligibility (PE) cases (see NL 00803.095).

If the reconsideration reverses a prior medical denial but the claim now is being denied for nonmedical reasons, include stock paragraph 1407 (NL 00804.200) in the notice.

NOTE: Validate direct deposit, address, and phone number information prior to effectuating appeal decisions.

(See DI 12005.000 for the reconsideration procedure for initial claims involving medical issues.)

2. Evidence Received After Reconsidered Determination Has Been Rendered

Review the case in light of any evidence which has been received directly from the claimant or from anyone who might write on behalf of the claimant.

a. Evidence Does Not Justify Reopening/Revision

If the evidence does not meet the criteria for reopening, handle as follows:

  • If the appeal period has not expired and the claimant or representative writes and/or submits additional evidence which clearly indicates disagreement with the reconsideration determination, treat the submission as a request for hearing and process in accordance with SI 04030.020. Give the submission of the new evidence as the reason for disagreement with the prior determination.

  • If the appeal period has expired, develop for good cause. Send the good cause development along with the hearing request to the HO. The ALJ will determine whether there is good cause for late filing of the request for a hearing.

b. Revised Reconsidered Determination is Appropriate

If, based on the additional evidence, the reconsidered determination should be revised to make a fully favorable determination and the rules of administrative finality permit reopening (see SI 04030.020B.6, SI 04030.020B.7, and SI 04070.000), then appropriately reopen and revise it. Advise the claimant by the notice of the revised reconsidered determination (SSA-L8100-U2) that he/she has the right to a hearing, (see NL 00803.025 and NL 00803.030 for information on the SSA-L8100-U2).

3. Claimant Wants to File New Claim -- Adverse Reconsiderations

Explain that he/she might lose benefits by filing a new application instead of requesting appeal. Stress the importance of requesting appeal within 60 days. If the claimant persists, take a new application.

NOTE: The res judicata language appears on the revised Form SSA-L8030-U2 (Notice of Disapproved Claim) under the caption “New Application.” See NL 00802.020 to NL 00802.025 for a description of Form SSA- L8030-U2 and instructions on its completion. See GN 03101.160A for a definition of “res judicata.”

C. Procedure — Completion of Forms

1. SSA-8450 (FO Record of SSI Reconsideration)

a. Purpose

Use this form to make a complete record of a reconsideration in non-MSSICS cases. Complete the record-of-conference portion for formal conferences.

b. Name of Spouse and SSN

Fill in the name and SSN of claimant's spouse, if any, whether spouse is eligible or not.

c. Date of Initial Determination

Fill in the date of notice of the initial determination.

d. Issue

Check one or more of these blocks to indicate the issue in dispute. Use the space provided to explain the basis for the disagreement; i.e., why the claimant believes the determination on the issue was incorrect. Also, use this space to indicate if the appeal involves a concurrent title II/title XVI common issue.

REMINDER: If more space is needed, use a separate sheet of paper.

e. Was New Evidence Obtained?

If new evidence was obtained in the course of the reconsideration, indicate details of the evidence in the space provided; i.e., the nature (documentary, oral), the source (claimant, third party), witnesses, etc.

REMINDER: If more space is needed, use a separate sheet of paper.

f. Was New Evidence Presented During or After Conference?

Check “yes” if any new evidence was presented for the first time during or after the conference.

g. Pertinent Details

Use this space to give any pertinent information about the conference not covered by the various check blocks. Note such facts as whether the claimant appeared at the conference alone or was accompanied by a relative or friend, whether claimant was advised of the reconsideration determination at the conference, whether the claimant requested a hearing during the conference. Also record any particular difficulty arranging or conducting the conference, whether an interpreter was needed, setting of the conference (e.g., district manager's office), length of conference, and any unusual claimant reaction (favorable or unfavorable) to notice of initial determination received or the reconsideration procedure.

h. Reconsideration Determination

Check the appropriate block to indicate whether the initial determination was affirmed, reversed, or modified upon reconsideration.

i. Rationale Supporting Determination

Use this space to explain the reasoning applied in arriving at the reconsideration determination.

Give a concise and orderly statement of the pertinent facts. Describe the evidence from which the facts were taken, if not described in the “new evidence” section. Summarize letters, RC's, etc., if pertinent, rather than quoting them at length.

If there is claimant disagreement with the facts and this disagreement is not resolved to the claimant's satisfaction, show why it cannot be resolved and include all versions, showing who gave which.

Show the conclusions reached and the reasons for them. Do not merely repeat the facts.

Show how conflicting allegations have been resolved, and why the allegations or evidence accepted were given greater weight.

Cite the authority for the findings; e.g., the applicable sections of the Act, the regulations, etc.

j. Signature and Effectuation

Give the date the determination was made and the date effectuated if different from date of determination, sign, and show title in the block provided.

2. Exhibit - SSA-8450 (District Office Record of SSI Reconsideration) -- (Front)

G-SSA-8450-1

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Exhibit - SSA-8450 (District Office Record of SSI Reconsideration) -- (Back)

G-SSA-8450-2

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3. SSA-L8455-U2 (SSI Notice of Reconsideration) -- Initial Claims

a. Purpose

Use this form to notify the claimant of the results of a favorable reconsideration in initial claims cases.

File the SSA-561-U2 and the SSA-8450 in the folder (non-MSSICS cases).

b. General

If the claimant has a representative, send a copy to the representative, also.

c. FO

Type the FO address and phone number in the upper right hand corner.

d. Date

Show the date the notice will be mailed.

e. Claim Number

Show the claimant's SSN.

f. Reconsideration Filed

Show the date the reconsideration request was received.

g. Name and Address

Show the name and mailing address of the claimant in the upper left hand corner of the notice.

h. Body of the Notice

Cover the following points:

  • A summary of the issue(s) involved in the reconsideration;

  • The effect, if any, of the reconsideration results on eligibility and payment; and

  • The time period(s) affected by the reconsideration results.

NOTE: This form is available on the Distributed Online Correspondence System (DOCS).

4. Exhibit -- SSA-L8455 -U2 (Supplemental Security Income Notice of Reconsideration)-- (Front)

Social Security Administration

Supplemental Security Income

Notice of Reconsideration

Office Address:

Office Hours:

Telephone:

Social Security Number:

Date:

Reconsideration Filed:

Form SSA-L8455-U2

5. Exhibit - SSA-L8455-U2 (Supplemental Security Income Notice of Reconsideration) - (Back)

Do You Disagree With The Decision?

If you disagree with the decision, you have the right to ask for a hearing before an Administrative Law Judge (ALJ). The ALJ will review your entire case, even the parts you agree with. The ALJ also will consider any new facts you have and then will make a new decision. The new decision could be more favorable to you than the one you already have. But, keep in mind that the new decision also could be the same as or less favorable than the decision you already have.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for a hearing

  • You have to ask for a hearing in writing. We'll ask you to sign a Form SSA-501, called “Request for Hearing.” Contact one of our offices if you want help.

How The Hearing Process Works

The ALJ will mail you a letter at least 20 days before the hearing to tell you its date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it is important that you give us any new facts as soon as you can.

The hearing is your chance to tell the ALJ why you disagree with the decision in your case. You can give the ALJ new evidence and bring people to testify for you. The ALJ also can require people to bring important papers to your hearing and give facts about your case. You can question these people at your hearing.

Please read the enclosed pamphlet “Your Right To An Administrative Law Judge Hearing and Appeals Council Review of Your Social Security Case.” It has more information bout the hearing.

It Is Important To Go To The Hearing

It is very important that you go to the hearing. If for any reason you can't go, contact the ALJ as soon as possible before the hearing to explain why. The ALJ will reschedule the hearing if you have a good reason.

If you don't go to the hearing and don't have a good reason for not going, the ALJ may dismiss your request for a hearing.

IF You Want Help With Your Hearing

You can have a friend, lawyer or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your hearing.

If you get someone to help you, you should let us know. If you hire someone, we must approve of the fee before he or she can collect it.

6. Exhibit SSA-L8456-U2 - SSI Notice of Reconsideration - (Front)

Use this form to notify the claimant of an adverse reconsidered determination.

Social Security Administration

Supplemental Security Income

Notice of Reconsideration

Office Address:

                   Telephone:

Social Security Number:

Date:

Reconsideration Filed:

TURN THIS OVER IF YOU THINK WE ARE WRONG. Form SSA-L8456-U2

Exhibit - SSA-L8456-U2 (SSI Notice of Reconsideration -(Back)

Do You Think We're Wrong?

If you think we're wrong, you have the right to appeal. A person who hasn't seen your case will look at it. That person will be an Administrative Law Judge. In the rest of our letter we'll call this person an ALJ. The ALJ will correct mistakes and look at any new facts you have before deciding your case. We call this a hearing.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you receive this letter.

  • You'll have to have a good reason for waiting more than 60 days to ask for a hearing.

  • You have to ask for a hearing in writing. We'll ask you to sign an SSA form HA-501, called “Request for Hearing.” Contact one of our offices if you want help.

How The Hearing Works

A hearing works like this.

The ALJ will tell you the time and place for the hearing.

The ALJ will explain the law in your case. The ALJ will state the known facts and tell you what has to be decided.

You can tell the ALJ why you think we're wrong. You can give the ALJ more facts. And you can bring people to say why you're right. The ALJ can make people come to your hearing and bring important papers. You can question these people at your hearing.

We'll ask if you want to go to the hearing in person. If you say you want to go, you should attend if at all possible. If you change your mind or if you can't get to the hearing, you should tell us. You should know that your being there may help the ALJ decide your case.

New Application

You have the right to file a new application at any time, but filing a new application is not the same as appealing this decision. You might lose benefits if you file a new application instead of filing an appeal.

Therefore, if you think this decision is wrong, you should ask for an appeal within 60 days.

If You Want Help With Your Hearing

You may want help from a friend, lawyer or someone else. There are groups that can find you a lawyer. Some can give you a free lawyer. We can give you the names of these groups.

7. Exhibit - SSA-L8456-U2-SP (SSI Notice of Reconsideration) - Spanish Version - (Front)

Administracion del Seguro Social

Seguridad de Ingreso Suplemental

Aviso de Reconsideracion

Supplemental Security Income Notice of Reconsideration)

                   Fecha:

Numero de Reclamacion:

Reconsideracion Registrada:

IMPORTANTE

AVISO DE RECONSIDERACION LEA CUIDADOSAMENTE

Su reclamacion para pagos de seguridad de ingreso suplemnetal (SSI) fue revisada segun usted lo solicito. Lamentamos que aun no pueda ser aprobada. Personas diferentes a las que revisaron anteriormente su reclamacion han examinado cuidadosamente toda la evidencia e informacion para llegar a esta decision.

La "Determinacion de Reconsideracion" adjunta explica en ingles por que su reclamacion no puede ser aprobada. Si usted necesita ayuda con la traduccion, pida a alguien familiarizado con ambos idiomas que le ayude. O comuniquese con cualquier oficina de Seguro Social.

Si usted no esta de acuerdo con la ultima decision, puede pedir una

audiencia ante un juez de ley administrativa (ALJ) de la Oficina de

Audiencias y Apelaciones. Pero tiene que solicitar esta audiencia a la

oficina de Seguro Social dentro de 60 dias de la fecha en que reciba este aviso. Al dorso de este aviso y en el folleto adjunto encontrara ma s infomracion respecto a como solicitar una audiencia.

Lea al dorso si cree que estamos equivocados.

SSA-L8456-U2

Si Usted Cree Que Estamos Equivocados

Si cree que estamos equivocados, usted tiene derecho a apelar. Examinara su caso una persona que no lo haya visto antes. Esa persona sera un juez de ley administrativa. A continuacion, llamaremos a esta persona un ALJ. El ALJ enmedara errores y vera cualquier hecho nuevo que usted presente antes de decidir su caso. Llamamos esto una audiencia.

Usted tiene 60 dias para pedir una audiencia.

Los 60 dias empiezan el dia siguiente al dia en que usted reciba esta carta.

Necesitara tener una buena razon si espera mas de 60 dias para pedir una audiencia.

Tiene que apelar por escrito. Le pediremos que firme un formulario del Seguro Social, HA-501, que se llama, "Solicitud Para Audiencia."

Comuniquese con una de nuestras oficinas oficinas si quiere ayuda.

Como Se Lleve a Cabo Una Audiencia

La audiencia se lleva a cabo como sigue:

El ALJ le notificara a usted la fecha, hora y lugar donde se llevara a cabo la audiencia.

El ALJ explicara la ley en su caso. El ALJ expondra los hechos conocidos, y le dira a usted lo que tiene que ser decidido.

Usted podra decirle al ALJ por que cree que nosotros estamos equivocados. Podra darnos mas pruebas, y podra traer personas que digan porque usted tiene razon.

El ALJ puede pedir que se presenten personas y que traigan documentos importantes. Usted puede hacerles preguntas a estas personas durante su audiencia.

Le preguntaremos si usted quiere asistir a la audiencia en persona. Si usted se compromete a venir, debs asistir si es posible. Si usted cambia de opinion o si no puede llegar a la audiencia, debs notificarnos. Usted debs saber que asistir a la audiencia puede ayudar al ALJ a decidir su caso.

Nueva Solicitud

Usted tiene el derecho a radicar una nueva solictud en cualquier momento, pero radicar una nueva solicitud no es lo mismo que apelar esta decision. Podra perder beneficios si usted radica una nueva solicitud en vez de radicar una apelacion. Porlo tanto, si usted cree que esta decision es incorrecta, debe pedir una apelacion dentro de 60 dias.

Si Quiere Ayuda Con Su Apelacion

Quizas quiera que le ayude un amigo, un abogado u otra persona. Hay

organizaciones que le pueden consequir a un abogado. Algunas le pueden dar un abogado gratis. Nosotros le podemos dar los nombres de estas organizaciones.

Form SSA-L8436-U2-SP(Back)

8. SSA-L8457-U2 - SSI Notice of Reconsideration - PE - Front

Use this form to notify the claimant of the results of a reconsideration in PE situations.

Social Security Administration

Supplemental Security Income

Notice of Reconsideration (PE)

Office Address:

                    Telephone:

Date:

Social Security Number:

Reconsideration Filed:

Form SSA-L8457-U2

9. Exhibit - SSA-L8457-U2 - SSI Notice of Reconsideration -PE - (Back)

Do You Disagree With The Decision?

If you disagree with the decision, you have th