SI 04060.030 Processing EAP Requests and Agreements - Title XVI
A. Procedure — individual elects eap
1. Individual Elects EAP in Lieu of Appeal
Explain the requirements in SI 04060.020. If the appellant still wishes to use EAP, secure a signed statement on an SSA-795 (Statement of Claimant or Other Person) and forward the statement together with the case folder to the RO, ATTN: ARC, Programs.
Although the statement need not include each point separately, ensure that the following is included:
he/she has received an explanation of and agrees to all the conditions in SI 04060.020, and
wishes to enter into an EAP agreement.
Ensure that the statement also includes an indication that the appellant understands the next level of appeal is to file in U.S. District Court. Keep a copy of the statement in the FO until the final agreement is signed or a decision is made that EAP does not apply.
IMPORTANT: Be sure that the individual understands that this is an alternative to the appeals process and that the right to pursue the issue through the normal administrative appeals process will be curtailed once a formal agreement is signed by both parties.
Inform the claimant that once an agreement is signed by both parties, there is no provision for withdrawal from the agreement and the only way to proceed is through the U.S. District Court.
2. Individual Elects EAP While Hearing or AC Review Is Pending
a. Hearing Request Pending
Follow the instructions in A.1. above, except that you must send the statement and the file to the appropriate HO. Retain a copy of the statement until the final agreement is signed.
b. AC Review Pending
If an individual elects to use EAP while the request for AC review is pending, follow the same procedure as above but forward the statement to ODAR, Office of Executive Director, Suite 1400, 5107 Leesburg Pike, Falls Church, VA 22041-3255.
NOTE: The claims folder should already have been forwarded to ODAR Headquarters in Falls Church, Virginia by the ALJ.
1. Preparing the Agreement
The RO prepares the agreement and sends it to the FO.
2. Obtaining the Claimant's Signature
The FO contacts the claimant and obtains his/her signature within 30 days of receipt of the agreement. If the claimant has a representative, the claimant is to be contacted through the representative, if possible. However, the claimant signs the agreement, not the representative, even though the representative may request initially that EAP be used.
3. If the Claimant Cannot be Contacted
If, after 30 days, the claimant's signature has not been obtained, the FO documents the reason and returns it, along with the unsigned EAP agreement, to the RO. The 30 days can be extended if there is, in the judgment of the FO staff, a chance that the claimant will sign the agreement. The RO must be advised of the delay.
4. The Claimant Signs the Agreement
When the claimant has signed the agreement, the FO returns it to the RO for the signature of the RC and distribution.
5. Signature by the RC
The RC signs the agreement on behalf of the Commissioner and applies the SSA seal. A cover letter is prepared to transmit the agreement to the appellant, leaving the date blank on both the agreement and the letter. The office secretary will date stamp the agreement the same date as the letter and release them the same day to the claimant and/or representative.
C. Procedure — FO and RO processing
1. Claimant Fails to Respond or Refuses to Sign
a. FO Action
Return the agreement to the RO.
b. RO Action
Notify the claimant (and representative) directly by letter (with a copy to the FO) that he/she has 30 days from its receipt to request either an ALJ hearing or AC review (depending on the level of review just completed), or, by signing the agreement, to continue the appeal through EAP. If at the end of the 30-day period you have not heard from the claimant, cancel the request for EAP.
NOTE: The effect of this cancellation is that the reconsidered determination or ALJ decision is the final determination or decision in the case. There is no right to appeal from this action. The request for EAP will be treated as a request to proceed to the next step of administrative review (i.e., ALJ hearing or AC review).
2. Claimant Objects to the Wording of the Agreement
a. FO Action
Submit any language the claimant suggested to the RO.
b. RO Action
Consider whether to adopt it. If not, contact the individual (by phone if possible) to explain the reason that the suggested language cannot be used and offer another opportunity to sign. If the individual still objects, deny the EAP request, forward the case to ODAR.
3. Claimant Decides Not to Pursue EAP Request
If the claimant indicates a desire not to pursue the EAP request before it becomes final (signed by both the claimant and SSA official on behalf of the Commissioner), obtain a signed statement to that effect and forward it to the office responsible for preparing the agreement.
4. Sample Language
a. Denied Request
Use the language in NL 00703.471.
b. Cancelled Request
Use the language in NL 00703.472.
5. FO Action Upon Receipt from the RO
a. Review Eligibility Factors
When you receive the file from the RO, review it to determine that all other pertinent eligibility factors are met.
b. Other Eligibility Factors Not Met
If any other pertinent eligibility factor is not met, advise the appellant (and representative) by letter that EAP does not apply. Also, advise the claimant that a denied EAP request is considered a request for a hearing and that the folder is being forwarded to the appropriate ODAR office for further action.
Advise the appellant that he/she will be contacted by the ODAR office. Put the address of the ODAR office to which the file is sent in the letter. Do not add an appeal paragraph because denying the use of EAP is not an initial determination. Forward the file to the appropriate ODAR office. (See C.4.a above for sample language).
6. All Other Eligibility Factors Established — RO Action
If all other pertinent eligibility factors are established, prepare an agreement and forward it to the appropriate FO for the individual's signature.
When the agreement is signed by both the claimant and the SSA official on behalf of the Commissioner, forward the claim folder marked EAP to Office of Civil Actions, ODAR, Office of Executive Director, Suite 1400, 5107 Leesburg Pike, Falls Church, VA 22041-3255.
Title II EAP, GN 03107.000