BASIC (04-00)

VB 02501.035 Administrative Actions That Are Initial Determinations

A. Policy

Initial determinations are those determinations that are subject to administrative and judicial review.

B. Examples

Initial determinations include, but are not limited to, determinations about:

1. Qualification, Entitlement, Suspension and Termination

The following are initial determinations:

  • Meeting or failure to meet the qualifying events for SVB payments (see VB 00101.005 and VB 00102.001);

  • Applicability of a disqualifying event prior to SVB entitlement (see VB 00102.005);

  • Entitlement to SVB payments after beneficiaries move abroad;

  • Disallowance of SVB payments for failure to reside outside the United States;

  • Suspension of SVB payments on the basis of a disqualifying event or other event (e.g., return to the United States) occurring after SVB entitlement (see VB 00102.005);

  • Termination of SVB payments;

  • Reinstatement of payments, as well as denial of reinstatement, when the beneficiary has requested reinstatement in writing.

2. Amount of Benefit

The following are initial determinations:

  • Amount of the SVB payment;

  • Recomputation/revision in SVB payment amount on the basis of a change in "other benefit" income (see VB 00701.000 ff.);

  • Determination that a deduction is not to be imposed or that a benefit is not to be withheld;

3. Overpayment and Underpayment

The following are initial determinations:

  • The fact, amount and cause of an overpayment or underpayment and whether action to adjust or refund will be taken;

  • Waiver of recovery of an overpayment.

4. Representative Payee

The following are initial determinations:

  • Determinations as to the need to pay benefits through a representative payee because of a beneficiary's incapability to manage his/her own benefits are initial determinations;

  • Determinations about who is selected or continued as a representative payee;

  • Representative payee misuse cases regarding the negligence (or good acquittance) determination (see GN 00604.055);

5. Other

The following are initial determinations:

  • Denial of request for withdrawal of a claim or for cancellation of a request for withdrawal of a claim;

  • A claim for benefits based on alleged misinformation (see GN 00204.008 for more information on what is appealable).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1402501035
VB 02501.035 - Administrative Actions That Are Initial Determinations - 08/30/2012
Batch run: 08/30/2012
Rev:08/30/2012