Basic (01-01)

VB 02504.020 Initiating SVB AC Review

A. Policy

1. Individual Requests AC Review

a. Time and Manner of Requesting Review

An individual who is dissatisfied with the ALJ's action on his/her claim may ask the AC to review that action. The request must be filed in writing within 60 days after the date of receipt of the notice of hearing decision or notice of dismissal.

NOTE: The request may be made on a Form HA-520 (Request for Review of Hearing Decision/Order), by letter, or by any other writing that shows the individual disagrees with the ALJ's action and is over the signature of the individual or his/her representative. Ensure that the request for review shows “title VIII” or “SVB”. If there is a concurrent claim, annotate the HA-520 to show the other title(s) involved.

b. Extension of Time to Request Review

An individual may request an extension of time to request review. The request must:

  • Be in writing;

  • Be filed with the AC; and

  • Give the reasons why the request for review cannot be (or was not) filed timely.

To determine whether good cause exists, the AC will use the standards in GN 03101.020.

2. Own Motion Review and Notice

The AC may review on its own motion the ALJ's action at any time within 60 days after the date of the decision or dismissal. If the AC decides to review a decision or dismissal on its own motion, it will mail a notice of review to the individual and representative, if any, at his/her last known address.

NOTE: The AC may review a case on its own motion and dismiss the request for hearing for any reason the ALJ could have dismissed the request for hearing.

3. Dismissal by AC

The AC will dismiss a request for review if the request was not filed within the time period and the AC did not find good cause to extend the time to request review.

The AC may also dismiss any proceedings before it if:

  • The individual files a written request for dismissal; or

  • The individual dies unless the issue before the AC is an overpayment for which the individual's estate may be responsible; or

  • The individual who filed is not a proper party; or

  • An ALJ has not issued a decision or dismissal; or

  • The issue upon which the request is based is not subject to review (i.e., there was no initial determination as described in VB 02501.040); or

  • For any reason the ALJ could have dismissed the request for hearing.

Dismissal of a request for review is binding and not subject to further review. (NOTE: In the 4th circuit, an individual has the right to seek judicial review of an AC dismissal of an ALJ's decision (see AR 99-4(11), Bloodsworth v. Heckler).)

B. Policy — Notice of Review

The AC will send prior notice of review when it plans to:

  • Issue a partially favorable decision; or

  • Issue an unfavorable decision; or

  • Review a case on its own motion and remand the case to an ALJ.

The AC does not send prior notice of review when it:

  • Issues a fully favorable decision; or

  • Grants review to remand to an ALJ.

C. Procedure

1. Action on ALJ Decisions/Dismissals That the AC Has Vacated

When an AC remand is received, check the SVB Intranet site to ensure that the record shows the AC transferred the claim to the hearing office as of the date of the AC order. If the AC (or hearing office) has not updated the SVB Intranet site, make the appropriate entries.

2. Individual Expresses Dissatisfaction With ALJ Decision Late

See VB 02501.005B. for procedures when a request for AC review is filed more than 60 days after receipt of the notice of the ALJ's decision/dismissal. See VB 02504.020A.1.b. regarding extension of time to request review.

3. Untimely Request for AC Review

If the individual has not requested an extension of the time to file a request for review:

  • Obtain from the individual a signed statement explaining why he/she could not file the request within the prescribed time frame; and

  • Attach the statement to the AC copy of the HA-520.

If you have any information that might explain the delay, attach an RC documenting the information.

IMPORTANT: Only the AC can make a finding as to whether “good cause” exists to extend the time for filing a request for AC review.

4. Processing the Request for AC Review

a. Request for Review

If a letter or other correspondence requests AC review of the ALJ's action, e.g., the individual indicates disagreement or dissatisfaction with the decision or dismissal, or otherwise indicates intent to pursue his/her appeal rights:

  • Complete Form HA-520 as outlined in VB 02504.020C.6., ensuring that the form shows the issue(s) being appealed.

  • Type the name of the individual making the request in the space for his/her signature.

    NOTE: The letter is a request for review and an HA-520 should not be sent to the individual merely to obtain his/her signature.

  • Annotate the HA-520 under “Remarks” that the request for review was made by letter, who submitted the letter, when the letter was received, and the date of the letter.

  • Attach the letter to the “claims folder” copy of the HA-520 and a legible copy of the letter to each copy of the HA-520.

    CAUTION: If the letter is of a confidential nature, attach the original letter securely to the “claims folder” copy of the HA-520. Prepare no copies of the letter. The AC can then determine if the confidential material can be properly included in the official record.

  • See VB 02504.020C.6.h. for the date to be used for the request for review.

  • Distribute the copies of the HA-520 and forward statement or new evidence as outlined in VB 02504.020C.7.

b. Individual's Letter Asks for Review Form, HA-520

  • Send the form HA-520 to the individual with instructions for completing. If this kind of request is received in the reviewing office, forward the request to the FO.

  • Inform the individual in the transmittal letter of the time by which the request for review must be filed. (See VB 02504.020A.1.a. for the time limit for requesting AC review.)

  • Explain that the letter does not protect the individual's filing date for an appeal.

  • If an HA-520 is received, attach the letter requesting the form to the “claims folder” copy of the HA-520.

NOTE: The completed HA-520 must be received within 60 days after the individual's receipt of notice of the hearing decision to meet the time limit for filing a timely request for AC review.

5. Completing the HA-520

a. Type of Action

Ensure that the HA-520 shows that the request for review is on a title VIII issue. Check whether the request for review of the hearing decision or dismissal is based on an initial entitlement or a postentitlement action.

b. Type of Claim

Until the HA-520 is revised to include title VIII, annotate “SVB” or “title VIII” in the remark's section.

If the claim involves a concurrent title VIII and/or Title II/title XVI issue(s), indicate that issues other than those related to title VIII are being appealed by checking the appropriate block.

If the request for review involves an issue not relating to payment entitlement (i.e., waiver of overpayment, timely filing, etc.), specify the reason next to “Other.”

c. Reason for Appeal

In “My reasons for disagreement are,” give specific reasons why the individual is dissatisfied with the action on his/her hearing request. If additional space is needed, use a separate sheet of paper and attach a copy to each copy of the HA-520.

d. Additional Evidence

  • If the individual has brought additional evidence to submit, attach it to the “claims folder” copy of the HA-520. Show “evidence attached” on all copies of the form.

  • If the individual does not have the evidence present, ask him/her to forward it to the AC within 5 days. Describe briefly on the HA-520 the type of evidence to be submitted.

Distribute copies of HA-520 immediately. Do not delay forwarding the HA-520 to the AC pending receipt of the evidence. If the evidence is later received by the FO, forward it directly to the AC via route slip, annotated with the individual's name, SSN (or “alpha claim” if the individual does not have an SSN), and “SVB claim, Attn: RSI Branch.”

e. Signature

The individual, his/her representative, or the individual's legal guardian may sign the form. If the representative signs, the individual's signature is unnecessary. If the individual signs and he/she has a representative, insert the name and address of the representative. If the representative has not filed an SSA-1696, Appointment of Representative, ask him/her to do so. (See GN 03920.010.)

6. Timeliness of the Request for Appeals Council Review

  • Check the appropriate block to indicate whether the review request is being filed within 60 days after the date of receipt of notice of the ALJ's action.

  • If filed more than 60 days after the date of receipt of notice, attach to the claims folder copy a statement from the individual explaining the delay.

  • Attach any pertinent letter, material, or information in the FO on the timeliness of the request for review.

  • If the request was not timely filed, send a letter asking the individual to forward a statement to the AC giving an explanation for the delay and attach a copy of the letter to the “claims folder” copy of the HA-520.

  • If the explanation is sent to the FO, forward it immediately to the AC, showing that the issue is SVB and the file should be sent to the RSI Branch.

7. Acknowledging Request for Review

Complete the acknowledgment block. Show as date filed the earliest of the following:

  • Date of in-office filing;

  • Postmark or date stamp showing receipt in the FO when HA-520 was received by mail; or

  • Postmark or date stamp showing receipt in the FO of any other writing which contained a definite request for review.

Attach to the “claims folder” copy of the HA-520 any writing which could be construed as a request for review or that expresses dissatisfaction with the ALJ action.

Any writing or report of contact with the individual after his/her receipt of the ALJ's decision/dismissal indicating dissatisfaction with the ALJ's action.

8. Distributing Copies of the Completed HA-520

If a different FO is the servicing FO, attach an RC with the servicing FO address and code number.

In all cases, distribute copies of the completed HA-520 as follows:

a. Claims Folder Copy

Send to the Appeals Council, Office of Disability Adjudication and Review, 5107 Leesburg Pike, Falls Church, VA 22041, Attn: RSI Branch – SVB Claim.

b. Individual Copy

Give or mail to the individual.

c. Representative Copy

Give or mail to the individual's representative. If the individual is not represented, destroy this copy.

d. Field Office Copy

If filed in the servicing FO, retain. If filed in other than the servicing FO, send the FO copy to the servicing office (FO or CPS).

e. Hearing Office File

Send the hearing office copy the:

Office of the Regional Chief Administrative Law Judge
555 Battery St., 5th Floor
San Francisco, CA
Attn: Judge Cahn

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VB 02504.020 - Initiating SVB AC Review - 08/20/2012
Batch run: 09/07/2012