TN 3 (02-97)
NL 00802.030 SSA-L8165, SSI Important Information
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.
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).
1. ALJ Reversals
Always suppress the system-generated posteligibility notice and issue an SSA-L8165-U2 manually when effectuating an ALJ reversal per B. above.
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
If the claimant files a duplicate claim, issue a manual SSA-L8165-U2 with paragraph MISM50 (NL 00804.240).
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.