TN 3 (02-97)

NL 00802.030 SSA-L8165, SSI Important Information

A. Description

Generally, the SSA-L8165 is used to explain actions that are not initial determinations and, therefore, not subject to appeal. For this reason, there are no preprinted appeal rights on the SSA-L8165. The manual version of this form is blank except for the letterhead.

EXCEPTION: Use certain appeal language on the manual SSA-L8165-U2 for: ALJ reversals as discussed in the second bullet below; and certain representative payee issues (see sixth bullet).

B. When to use — Manual Notice

Send a manual SSA-L8165-U2 to:

  • Notify a claimant that presumptive disability/blindness (PD/PB) payments will begin or end;

  • Notify a claimant (representative payee, authorized representative and /or legal guardian) about effectuation of an administrative law judge (ALJ) decision when the ALJ decision does not address all factors of eligibility.

  • Deny a duplicate application;

  • Dismiss a request for reconsideration not filed timely;

  • Notify an individual that we are not going to reopen or revise a prior determination.

  • Notify individuals about representative payee issues not requiring appeal rights.

  • Notify a claimant when his/her recurring SSI check precedes the retroactive check, that we are sending the retroactive check to the State to repay it for furnishing interim assistance;

  • Abate a claim due to an improper applicant;

  • Explain administrative actions that do not have appeal rights per SI 04010.010C; and

  • Notify the claimant (representative payee, authorized representative and/or legal guardian) about an attorney fee under the attorney fee agreement process.

C. Process

The system automatically generates an SSA-L8165 when:

1. PD/PB Cases

  • The FO or DDS transmits a determination to pay PD/PB payments (the system sends an SSA-L8165 with paragraphs 1420, 1431, 1418 and 1419 (NL 00804.205) telling the claimant we will send checks for 6 months); and

  • Six months have elapsed and the DDS has not made a final decision (the system sends a second SSA-L8165 with paragraph 1432 explaining that the checks will stop).

    NOTE: The initial claims notices system generates appropriate paragraphs on automated award and denial notices when a claimant is receiving or has received PD/PB payments pending a final determination.

2. IAR Cases

For situations described in SI 02003.040, the system generates an SSA-L8165 to the State agency using paragraphs 1070, 1071 or 1072 (See NL 00804.125 for the language).

D. Procedure

1. ALJ Reversals

  1. a. 

    Always suppress the system-generated posteligibility notice and issue an SSA-L8165-U2 manually when effectuating an ALJ reversal per B. above.

  2. b. 

    When completing the SSA-L8165-U2 for an ALJ effectuation, follow instructions for completing the SSA-L8025 in NL 00802.010. If the FO determines that the claimant is ineligible for some reason(s) not addressed by the ALJ decision, follow the instructions for completing the SSA-L8030 in NL 00802.020 to complete the SSA-L8165-U2.

    NOTE: System-generated posteligibility notices (i.e., the SSA-L8100 and SSA-L8151) are not acceptable substitutes for the SSA-L8165 since these posteligibility notices are not for initial claims situations. Also, do not use an SSA-L8025 or SSA-L8030 since these notices are only for the initial determination on the claim.

2. Duplicate Claim

  1. a. 

    If the claimant files a duplicate claim, issue a manual SSA-L8165-U2 with paragraph MISM50 (NL 00804.240).

  2. b. 

    If someone else files a duplicate claim on behalf of the claimant, issue a manual SSA-L8165-U2 with paragraph MISM51 (NL 00804.240) to the applicant.

3. Dismissal of Reconsideration Request

To dismiss a request for a reconsideration that was not filed timely, issue a manual SSA-L8165-U2 with paragraph RECM50 (NL 00804.224) followed by paragraph 1481 (NL 00804.240).

4. Representative Payee Cases

Issue an SSA-L8165-U2 using the appropriate notice language in NL 00703.000 for representative payee issues not requiring appeal rights.

5. IAR Check to the State

To notify a claimant that we are sending a retroactive check to the State to repay interim assistance when the recurring SSI check to the claimant precedes the retroactive check, issue a manual SSA-L8165-U2. (See SI 02003.030B and SI 02003.035C.2.)

6. Abatement Cases

To abate a claim due to an improper applicant. (See SI 00601.012B);

7. Cases With Attorney Fees

The Fee Agreement Notice will contain only information pertinent to representative fees, e.g., determinations on the fee agreement and fee amount.

E. References


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900802030
NL 00802.030 - SSA-L8165, SSI Important Information - 02/18/1997
Batch run: 10/01/2012
Rev:02/18/1997