An initial determination:
Is SSA's formal, written disposition of any legal or factual issue affecting an individual's
right to or the amount of benefit payments or any other right provided by the Social
Security Act. Claimants only have a right to appeal actions taken by SSA that are
Can be made by any employee in the FO who is delegated authority to approve or disapprove
applications for Social Security benefits, specifically the claims representative
and higher level personnel with delegated authority. (Initial determinations in SVB
cases are generally made by FO personnel.)
Is subject to administrative and judicial review and is final and binding unless the
claimant requests an appeal within 60 days or SSA finds good cause for extending the
time period to file an appeal or SSA revises the initial determination.
Generally, when a claimant files for SVB, he/she receives both a notice of qualification
and a notice of entitlement. Both claims notices constitute initial determinations
and provide appeal rights as show above. (See VB 00101.005A.)
SSA may always make a new initial determination whenever a change occurs in the factual
situation despite how much time elapses from the date of that change. The fact that
SSA determines that a claimant meets the requirements for entitlement does not preclude
SSA from making another determination that the claimant no longer meets those requirements
at some subsequent date. The new determination is effective with the date of the change
in the factual situation.
Because failure to make a determination with respect to any claim or PE issue is not
an initial determination, when such failure comes to SSA's attention, the claim or
PE issue must be adjudicated.