Deemed initial determinations are based on the assumption that the recipient's circumstances remain the same as in the prior month. An initial determination is deemed to occur (i.e., no notice is sent) on the first of each month that a recipient is shown on the record as eligible and payment amount remains unchanged. A deemed determination cannot occur in any month that is an effective month of a notice of an initial determination. See SI 04070.030B. and SI 04070.040F. for an explanation of effective months of initial determinations with notices.

Based on this definition of deemed initial determinations, there are no deemed determinations for any months in which payments are not received; e.g., a period of suspension. (See SI 02301.201B.1. – Description of Posteligibility Events and SI 02301.205 – Suspension and Reestablishing Eligibility, for a definition of “suspension.”

Deemed initial determinations are important in that they allow the Agency to effect change for past months that are not governed by written notices of initial determinations. Therefore, it is important to identify months for which there is a deemed initial determination and months for which there is an actual written initial determination.

REMINDER: The concepts of deemed initial determinations and effective months of notices of initial determinations apply only for purposes of administrative finality with respect to nondisability issues. They do not apply to disability determinations.

An award notice dated February 15, 2003 which explains ongoing payments beginning March 1, 2003 has an effective month of March. The first deemed determination is April 1, 2003.

An award notice dated June 16, 2003, which explains that payments are effective with January 1, 2003 and continuing, has effective months of January 1, 2003 through July 2003. The first deemed determination is August 1, 2003.

An individual reports on February 5, 2003 that they began receiving an extra $30 a month in their pension check beginning with the current month. The individual receives a Notice of Planned Action dated February 12, 2003 that says their SSI check will be reduced by $30 as of April 2003. This notice is a revised initial determination with an effective month of April 2003. Deemed initial determinations begin once more with May 1, 2003.

The date of an initial determination is important because in most instances reopening is possible only within one or two years of this date. This is true even if the initial determination has been appealed.

When a notice of an initial determination is sent, the date of the notice is the date the initial determination was made.

Careful interviewing regarding the issues being questioned permits identification of the appropriate notice. Also consider the following in determining the date of the notice:

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  When the notice was issued by the system, determine the date of the initial determination from the Online Retrieval System (ORS). Automated notices are dated seven calendar days after the corresponding systems run date in the NOTC field of the SSR. (See NL 00801.005 – Systems Generated Notices. See MSOM ORS 003.001 – TNA Online Notice Retrieval System for an explanation of ORS.

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  When there is a manual or automated overpayment notice, the date can be obtained from the Overpayment Sequence Data Segment (OPSQ) (See SM 01601.880 – Overpayment Sequence Data – OPSQ).

When there was no notice of the initial determination, determine the date of the determination as follows:

A denial notice is issued June 18, 1999. This determination cannot be reopened after June 18, 2001 (24 months later) for good cause.

On February 2, 1999 an FO learns that an SSI recipient was residing in an institution where N02 should have applied for November 1996 through July 1997. The FO must determine the earliest deemed initial determination it can reopen and revise. The FO counts back 24 months to February 2, 1997. The first deemed initial determination coincident to or after February 2, 1997 is March 1, 1997.

On May 12, 2003, SSA discovered that a SSI recipient had changed their living arrangement on February 22, 2000 causing an overpayment. Because the Agency did not find fraud or similar fault, the overpayment assessment is limited to 24 months from June 2001 to May 2003. The first deemed initial determination that can be made based on the discovery date of May 12, 2003 under the 2 year good cause rule is June 1, 2001.

On January 5, 2002, SSA discovered, through a computer match, that a recipient began receiving an annuity in September 1999. SSA did not find fraud or similar fault. The first deemed initial determination based on the discovery date of January 5, 2002 is February 1, 2000. The period that can be reopened and revised according to administrative finality is February 2000 through January 2002.

If budget month income will create an overpayment in the budget months barred to correction, input the excess income, suppress automated notices, and wait for the record to compute the overpayment. Then use the PS M02, force due procedure, to change the due amount on the SSR to the original amount so that the overpayment is zero. Once the record has been placed in PS M02, terminate that record and establish a start date record. Issue manual notices as appropriate.

If budget month income creates an underpayment for the budget months barred to correction, enter the excess income and post a “U” TAC. Wait for the transaction to process in order to determine the amount of the underpayment. Delete the “U” TAC and use the PS M02, force due process. Change the due amount so that the underpayment for the record is correct. Once the record has been placed in PS M02, terminate that record and establish a start date record. Issue manual notices as appropriate.

On June 15, 2003, the FO learns that a SSI recipient had $30 more income than shown on their record beginning with January, 2001 and continuing, but they remain eligible throughout. The earliest determination the FO can reopen and revise is the July 1, 2001 deemed initial determination. To change the payment amount for July 2001 and August 2001, the FO must input the correct amount of income received in May 2001 and June 2001. The input in this case is straightforward; the eligibility and payment determinations for months before July 2001 are not affected by the changes to the budget months.

Bobby K. is a disabled child who lives with their parent. At a redetermination conducted in the office on June 15, 2003, the FO learns that Bobby's parent has been working since May 2001, making enough in some months to make Bobby ineligible. (The earliest month the FO can revise the determination for is July 2001.) In May 2001, Bobby's parent worked a lot of overtime and their deemed income caused Bobby to exceed the income limit. In June and July, they didn't earn that much and Bobby is eligible for these months. The wages fluctuate each month, but Bobby isn't ineligible again until December 2001. Although the wages for May and June must be input to correct the payment determination for July and August, this creates an erroneous overpayment for May and June, which are barred from correction. Therefore, the FO suppresses the automated notices and after the system computes the overpayment, the FO places the record in force due (PS M02) to change the due amount. The FO then terminates this record and starts a new one. The FO also prepares an SSA-L8155-U2 (Notice of Planned Action) and an overpayment notice because the automated notices were suppressed.

On April 13, 1999, SSA staff initiated a redetermination. At that time, the Agency discovered that the individual was receiving more income than was previously reported but did not find fraud or similar fault. Consequently, SSA staff reviewed the period from March 1997 to March 1999, which was within 26 months. Under administrative finality, May 1997 is the earliest month that can be revised. Since budget month income will create an overpayment in this case, SSA should input the excess income, suppress automated notices, and wait for the record to compute the overpayment. Then, SSA should use the force due procedure (PS M02) to change the due amount on the SSR to the original amount so that the overpayment is zero for the 2 months (March & April) which are barred to correction. Once the record has been placed in PS M02, the record should be terminated and a start date record should be established. (See SI 04070.030F., MSOM BUSSR 002.001 E, and SM 02101.250.)

Based on a Federal benefit rate of $500 and countable income of $480, a SSI recipient was receiving $20 in SSI each month. At a redetermination interview on June 15, 2003, they reported that in May 2001 a friend gave them $1,000, making them ineligible in that month. At the same time, they stopped taking meals at their parents' house (May 2001 was the last month they received this income). This in-kind support and maintenance was valued at $50 on the SSR. The FO determines that the earliest month for which the determination can be revised is July 2001 and so inputs the receipt of the $1,000 income in May 2001 and removes the $50 income for June 2001 on so that payments for July 2001 and continuing will be computed correctly. However, these inputs will create an overpayment for May 2001 and an underpayment for June 2001 with a net underpayment for these two months. Because the underpayment for these two months is incorrect, the FO places a “U” TAC on the record when it inputs the income changes. Once the system has computed the underpayment, the FO deletes the “U” TAC and places the record in PS M02, force due, to change the due amount so that the total underpayment on the record does not include the amount for May and June of 2001. The FO issues an SSA-L8151-U2 (Notice of Change in Payment).

If any new evidence and a review of the systems record are sufficient to determine whether a revised determination is appropriate, do not request the folder to conduct a folder review. If these are not sufficient to determine whether a revised determination is appropriate, and a review of evidence in file is required, request the folder and determine whether evidence permits current eligibility or an increase in payment amount. If so, do whatever is appropriate to begin payments or increase the current payment amount until the folder is received. This could mean taking a new application if current eligibility exists and determining whether reopening is correct later when the folder is received.

If the appropriate level for reopening is the ALJ or AC, the ALJ or AC may require the folder before deciding whether to reopen and revise the prior decision. Obtain the folder, incorporate in the folder any new evidence, and forward the folder to the ALJ or AC, as appropriate. The ALJ or AC will notify the claimant if the decision is reopened or if reopening is denied.