BASIC (04-00)

VB 02502.025 Effectuating the Reconsideration Determination

A. POLICY -- NOTICE OF RECONSIDERED DETERMINATION

The notice must be mailed to the claimant's last known address, and it must include specific reasons for the determination and hearing rights. If appropriate, it must also include an explanation of how to use the EAP (see VB 02506.000 ff.).

B. PROCEDURE -- NOTICES

Notices of reconsideration decisions specifically tailored for SVB cases are being prepared and will be available on FONS in the future. Until that time, SSI notices of reconsideration decisions will be used as a pattern for notices of reconsideration in SVB notices. Major changes will be necessary when the SVB claimant or recipient is outside the United States.

1. Notices in Favorable Reconsidered Initial Claims Determinations

Manually prepare and release a notice similar to SSA-L8455-U2 in favorable determinations involving initial SVB claims. This includes initial qualification and entitlement determinations. Follow instructions in SI 04020.060C.3. and SI 04020.060C.4. in preparing this notice. However, where appropriate, refer to "Special Veterans Benefits" or "SVB" instead of "Supplemental Security Income" or "SSI."

If the claimant is outside the United States when the notice is issued, delete headings and paragraphs about attending a hearing, including those under "How The Hearing Process Works" and "It is Important To Go To the Hearing" and "If You Want Help With Your Hearing." Replace the text under "Do You Disagree With The Decision?" with the following:

"If you disagree with the decision, you have the right to ask for a hearing before an Administrative Law Judge (ALJ). The ALJ will review your entire case, even parts you agree with. The ALJ will also consider any new facts you have and then will make a new decision. The new decision could be more favorable to you than the one you already have. But, keep in mind that the new decision also could be the same or less favorable than the decision you already have.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you get this letter.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • The ALJ conducts hearings only in the United States.

  • You have to ask for a hearing in writing.

Also, in foreign cases, add the following heading and text:

  • "If You Have Any Questions"

  • "If you have any questions, you can contact the United States Embassy or consulate nearest to your home. If you are in Canada or Mexico, you can contact any U.S. Social Security Office. If you are in the Philippines, you can contact the U.S. Claimants Affairs Regional Office at 1131 Roxas Boulevard, Manila, Philippines. Take this letter with you if you visit any of these offices."

2. Notices in Unfavorable Reconsidered Initial Claims Determinations

Manually prepare and release a notice similar to SSA-L8456-U2 in unfavorable determinations involving initial SVB claims. This includes initial qualification and entitlement determinations. Follow instructions in SI 04020.060C.5. in preparing this notice. However, where appropriate, refer to "Special Veterans Benefits" or "SVB" instead of "Supplemental Security Income" or "SSI."

If the claimant is outside the United States when the notice is issued, delete headings and information about attending a hearing, including "How the Hearing Works" and "If You Want Help with Your Hearing." Under "Do You Think We're Wrong?" show the following text:

"If you disagree with the decision, you have the right to appeal. A person who has not seen your case will look at it. That person will be an Administrative Law Judge. In the rest of our letter, we'll call this person an ALJ. The ALJ will review those parts of the decision you disagree with and consider any new facts you have before deciding your case. We call this a hearing.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you get this letter.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • The ALJ conducts hearings only in the United States.

  • You have to ask for a hearing in writing."

Also, in foreign cases, add the following heading and text:

  • "If You Have Any Questions"

  • "If you have any questions, you can contact the United States Embassy or consulate nearest to your home. If you are in Canada or Mexico, you can contact any U.S. Social Security Office. If you are in the Philippines, you can contact the U.S. Claimants Affairs Regional Office at 1131 Roxas Boulevard, Manila, Philippines. Take this letter with you if you visit any of these offices."

3. Notices in Posteligibility Reconsidered Determinations

Manually prepare and release a notice similar to Form SSA-L8457-U2 in posteligibility reconsideration cases. Follow instructions in SI 04020.060C.7. in preparing this notice. Where appropriate, refer to "Special Veterans Benefits" or "SVB" instead of "Supplemental Security Income" or "SSI."

If the beneficiary is outside the United States when the notice is issued, delete headings and information about attending a hearing, including "How A Hearing Works" and "If You Want Help With Your Hearing." Under "Do You Disagree With The Decision?" show the following text:

"If you disagree with the decision, you have the right to appeal. A person who hasn't seen your case before will look at it. That person will be an Administrative Law Judge. In the rest of our letter we'll call this person an ALJ. The ALJ will review those parts of the decision you disagree with and consider any new facts you have before deciding your case. We call this a hearing.

  • You have 60 days to ask for a hearing.

  • The 60 days start the day after you get this letter.

  • You must have a good reason if you wait more than 60 days to ask for a hearing.

  • The ALJ conducts hearings only in the United States.

  • You have to ask for a hearing in writing.

Also, in foreign cases, add the following heading and text:

  • "If You Have Any Questions"

  • "If you have any questions, you can contact the United States Embassy or consulate nearest to your home. If you are in Canada or Mexico, you can contact any U.S. Social Security Office. If you are in the Philippines, you can contact the U.S. Claimants Affairs Regional Office at 1131 Roxas Boulevard, Manila, Philippines. Take this letter with you if you visit any of these offices."

C. PROCEDURE -- OTHER EFFECTUATION ISSUES

1. Systems

Notify the system of the results of a reconsidered determination and any necessary adjustment action. (See VB 04000.000 ff.)

2. Evidence Received After Reconsidered Determination Has Been Rendered

Review the case in light of any evidence which has been received directly from the claimant or from anyone who might write on his/her behalf.

a. Evidence Does Not Justify Reopening/Revision

Proceed as follows:

  • If the appeal period has not expired, provide a full explanation of the reconsidered determination by letter to the claimant (or correspondent, if disclosure is permitted; see GN 03301.020 ff.).

  • Treat the submission as a request for hearing and process accordingly. Give the submission of the new evidence as the reason for disagreement with the prior determination.

  • If the period for requesting a hearing expired before the new evidence was received, advise the claimant that the reconsidered determination remains the final decision of the Social Security Commissioner.

  • Include the letter of inquiry and a copy of the response in the file along with an RC briefly explaining the situation and the sequence of events. If a hearing is later requested, these documents, in additional to those required by GN 03103.220, should provide the individual conducting the hearing with sufficient information to determine whether there is good cause for late filing of the request for a hearing.

b. Revised Reconsidered Determination is Appropriate

If, based on the additional evidence, the reconsidered determination should be revised and the rules of administrative finality permit reopening, then appropriately reopen and revise it. Advise the claimant by the notice of the revised reconsidered determination that he/she has the right to a hearing. (See VB 02501.001D.1.)

3. Claimant Wants to File New Claim -- Adverse Reconsiderations

Explain that he/she might lose benefits by filing a new application instead of requesting appeal. Stress the importance of requesting appeal within 60 days.

4. Completion of SSA-8450 (FO Record of SSI Reconsideration)

The following considerations apply:

  • Use this form to make a complete record of each reconsideration.

  • Complete the record-of-conference portion whenever a formal conference is held.

  • Follow instructions in SI 04020.060C. for completion of the individual items.

  • Amend the title of the SSA-8450 to show "RECORD OF SVB RECONSIDERATION";

  • If necessary, check the "OTHER" block when describing the SVB issue involved in the reconsideration action.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1402502025
VB 02502.025 - Effectuating the Reconsideration Determination - 04/04/2000
Batch run: 01/27/2009
Rev:04/04/2000