Effective Dates: 08/20/2018 - Present Previous | Next

Basic (04-01)

VB 01501.011 Processing First-Party Reports

A. Policy

The processing of a first-party report is permitted if the report meets all of the requirements in VB 01501.010D.3. and the event reported does not result in an adverse action. (EXCEPTION: First-party reports of death; see VB 01505.015.)

NOTE: First-party reports received in a Federal Benefits Unit will be faxed and then mailed to the servicing CPS or FO for input.

First-party reports having an adverse effect on SVB qualification, entitlement or payment(s) cannot be processed until the beneficiary (unless legally incompetent) and representative payee are given the opportunity to appeal the adverse action.

B. Procedures — First-Party Reports Having Adverse Effect

1. Report Filed/Received in Office Not Having Jurisdiction of SVB Claim

Fax and then mail the first-party report (and information obtained per (VB 01501.010D.3.) to the CPS or FO having jurisdiction of the SVB claim.

2. Report Filed/Received in Office With Jurisdiction of SVB Claim

Do not process the report. Prepare and send a Notice of Planned Action (REMINDER: Currently all SVB notices are manual; see VB 05001.000) to the beneficiary (unless legally incompetent) and payee explaining the following:

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    the basis for the adverse action;

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    how the report adversely affects SVB payments and/or entitlement;

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    the individual has 60 days to appeal the action taken,

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    how to file an appeal;

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    SVB will continue (uninterrupted and unchanged based on the event reported) until a decision is made at the first appeal level if the individual files an appeal within 10 days after receiving the Notice of Planned Action (Goldberg/Kelly due process protection); and

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    the adverse report will be processed if no response to the Notice of Planned Action is received by the close of the 10-day Goldberg/Kelly due process period.

NOTE: Due to the variations in foreign mail delivery, presumption of an individual's receipt of the Notice of Planned Action within 5 days of the date on the notice per SI 02301.300E.5. will NOT always apply in SVB adverse actions. Allow 2 weeks mail time for the delivery of SVB advance notices PLUS the 10-day Goldberg/Kelly due process period before processing the adverse action unless the notice is handed directly to the individual or the Notice of Planned Action is mailed to a United States address. If the notice is handed to the individual or mailed to a United States address, use the timeframes in SI 02301.310C.2. and SI 02301.310C.3. for determining when the due process period ends.

Update the Intranet site “Special Veterans Benefits” with the following: (Entries will be needed in both the SUSPENSION and REMARKS fields):

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    the effective date of the adverse SVB event;

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    the reason for the event;

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    the date the Notice of Planned Action is mailed or given to the beneficiary (unless legally incompetent) and payee; and

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    the Goldberg/Kelly due process expiration date. (See NOTE: above for determining this date.)

If an appeal is not filed by the Goldberg/Kelly due process expiration date, process the adverse first-party report.

C. Procedure — Timely Appeal to Formal Notice Filed

If the beneficiary/payee disagrees with the adverse action and his/her written appeal request is filed with SSA before the advance notification due process expiration date reflected on the SVB intranet site, do not process the adverse action. Process the appeal per VB 02502.010.

NOTE: If the appeal is filed in an SSA office not having SVB jurisdiction, fax and then mail the appeal request to the office having jurisdiction of the SVB claim. In addition, annotate the date the appeal was received in the REMARKS field on the SVB Intranet site.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1401501011
VB 01501.011 - Processing First-Party Reports - 08/20/2018
Batch run: 12/10/2024
Rev:08/20/2018