BASIC (04-00)

VB 02501.040 Appeals - Administrative Actions Which Are Not Initial Determinations

A. Policy

Administrative actions that are not initial determinations may be reviewed by us, but they are not subject to administrative or judicial review.

B. Examples

Actions that are not initial determinations include, but are not limited to:

1. Nonpayment

The following are not initial determinations:

  • The rate of withholding to recover an overpayment;

  • Continuation of benefits to a beneficiary who has failed to report a termination or suspension event does not constitute a determination. SSA may consider the correctness of such payments whenever it becomes aware of the event. The determination then made as to termination or suspension is an initial determination which is subject to administrative review and to reopening under the rules of administrative finality.

2. Appeals and Reopening

The following are not initial determinations:

  • Denial of request to extend the time period for requesting review of determination or decision;

  • Denial of request to use the EAP

  • Denial of request to reopen a determination or decision;

  • Denial on the basis of res judicata. (SSA will review cases denied on the basis of res judicata, but only to see if we correctly applied res judicata.);

  • Denial of request to readjudicate claim and apply an Acquiescence Ruling;

  • Denial of request to be included as a class member eligible for relief in a court case;

3. Representative Payee

The following are not initial determinations:

  • A finding that a representative payee misused benefits paid on behalf of a beneficiary;

  • Representative payee's determination on how to spend accrued or conserved funds.

4. Attorneys and Representatives

The following are not initial determinations:

  • A finding as to the amount an attorney or other representative may charge for representing a claimant or beneficiary before SSA;

  • Disqualifying or suspending a person from acting as a representative in a proceeding before SSA.

5. Other

The following are not initial determinations:

  • Informal denial notices and notices closing out protective writings for SVB;

  • Declining to make a determination on a claim for benefits based on alleged misinformation.

  • Compromising, suspending or terminating collection of an overpayment under the Federal Claims Collection Act.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1402501040
VB 02501.040 - Appeals - Administrative Actions Which