TN 4 (02-95)
Generally, the SSA-L8165-U2 explains actions that are not initial determinations subject
to appeal. For this reason, appeal rights are not preprinted on the SSA-L8165-U2.
The system will generate an SSA-L8165 when there is a change in direct deposit. Paragraphs
covering direct deposit are listed under the caption “About Your Request For Direct Deposit” in the chart in NL 00803.025.
Issue a manual SSA-L8165-U2 to:
Notify recipients about a fee agreement with their attorney/ representative.
Notify a representative payee applicant or former payee who does not have the right
to appeal our payee selection that he/she was not chosen to be payee;
Notify a legally incompetent adult recipient or a child recipient receiving direct
payment about selection of a representative payee.
Dismiss a request for reconsideration not timely filed.
Notify a recipient that request to withdraw his/her SSI application has been approved.
Notify a recipient about a waiver decision when you waive part but not all of the
CAUTION: Do not use an SSA-L8166-U2 in this situation because the appeal rights on the SSA-L8166-U2
do not include the right to a formal conference. Instead, you must use an SSA-L8165-U2
and copy appeal rights from the SSA-L8173-U3 or SSA-L8174-U3 .
Explain administrative actions which do not have appeal rights per SI 04010.010C.1.
Restore benefits to the protected payment level.
Stop multiple payments and pay the correct amount.
Correct erroneous payments over the payment ceiling.
Notify a recipient that no penalty applies.
Use an SSA-L8165-U2 with paragraph RECM50 (NL 00804.224) followed by paragraph 2508 (NL 00804.240) to dismiss a request for reconsideration that was not filed timely.
Notice language for representative payee applicants per C. above - NL 00703.821.
Notice language for legally incompetent adult claimant or child claimant in direct
payment - NL 00703.823.
Notice language approving request to withdraw SSI application - NL 00804.215 - paragraph 2482.
Notices for partial waiver of overpayment - NL 00803.230.
Instructions and notice language to stop multiple payments and pay the correct amount
- (See SI 02301.315D and NL 00804.225, GBKM06. Appeal rights are at GBKM08.)
Instructions and notice language to correct erroneous payments over the payment ceiling.
(See SI 02301.315E and NL 00804.225, GBKM07. Appeal rights are at GBKM08.)
Instructions and notice language that no penalty applies. (See SI 02301.110 and NL 00804.240, PENM51 and PENM52.)