Identification Number:
EM-20050 REV
Intended Audience:RCs/ARCs/ADs/FOs/TSCs/OCO-CSTs
Originating Office:ORDP OISP
Title:The Goldberg Kelly (GK) Notice, Request for Reconsideration, and GK Payment Continuation during the COVID-19 Pandemic
Type:EM - Emergency Messages
Program:Title XVI (SSI)
Link To Reference:See References at the end of this EM
 
Retention Date: 11/30/2022

Summary of Change

A.


    · Updated the language to reflect that the additional good cause circumstances apply to reconsideration requests filed after the 65-day (60 days plus five mail days) appeal period

    · Added a note that explains that recipients who file a reconsideration request more than 15 days after, but within 65 days of the GK notice may also receive GK payment continuation


B.

    · Paragraph 1 – deleted language that refers to the 15-day GK payment continuation period

    · Paragraph 1 – added language that explains that recipients who file a reconsideration request more than 15 days after, but within 65 days of the GK notice may also receive GK payment continuation

    · Paragraph 2 – deleted language that refers to the 15-day GK payment continuation period


C.

    · Title – updated the title to account for the policy change implemented by EM-21064

    · Paragraphs 1 and 2 - Updated the language to reflect that the additional good cause circumstances apply to reconsideration requests filed after the 65-day (60 days plus five mail days) appeal period

    · C.1.b-c added examples for mail delivery and transportation issues


D.

    · Section D was not in the original EM. The information in section D was under section E

    · D.1, sentence 4 – deleted E and added D

    · D.3 – Added sentence 3 which provides more detailed instructions


E.

    · The information previously in section E was moved to section D. Section E now includes the information that was in section F

    · Paragraph 1 - deleted language that refers to the 15-day GK payment continuation period and added language to refer readers to EM-21064 and updated language to reflect that good cause development is needed for reconsideration request filed more than 65 days after the date on the GK notice only

    · E.2.a, Title – deleted 15-day GK payment continuation period and added 65-day appeal period, and added note below a

    · E.2.b, Title – deleted 15-day GK payment continuation period and added 65-day appeal period

    · E.2.b, paragraph, sentence 2 - deleted “15-day GK payment continuation period” and added “more than 65 days after the date on the GK notice”


F.

    · The information in section F was moved to section E and section F was deleted

Reference

    · Updated EM-20010 SEN – added “Rev 8”

    · Added – EM 21064 Goldberg Kelly Payment Continuation Period
    · Added – OB-21-038 Handling Reconsideration Requests Involving Goldberg-Kelly Payment Continuation


    A. Purpose

      This EM provides Field Offices (FOs) and TeleService Centers (TSCs) with supplemental guidance for the GK notice (Notice of Planned Action), non-medical request for reconsideration, and GK payment continuation business process. These instructions also explain the additional circumstances in which good cause may exist when we receive a request for reconsideration filed more than 65 days (60 days of presumed receipt plus 5 mail days) after the date on the GK notice. We presume that a recipient receives the GK notice five days after the date on it unless the recipient can show that it was not received within the five days. See SI 04005.012.

      Note: Effective October 29, 2021 recipients who file a request for reconsideration more than 15 days after the date, but within 65 days of the date on the GK notice qualify for GK payment continuation unless they waive it. See EM-21064 for instructions on processing reconsideration requests filed more than 15 days after the date, but within 65 days of the date on the GK notice.


    B. Background

      As of March 17, 2020, the Social Security Administration (SSA) temporarily suspended most reductions, suspensions, and termination of title XVI payments (i.e. adverse actions) during a critical time in the COVID-19 pandemic. As we resume processing adverse actions, there may be unusual or unavoidable circumstances due to the COVID-19 pandemic that may prevent recipients from filing a request for reconsideration in time to receive GK payment continuation automatically.

      When the system identifies a change on a recipient’s record as an adverse action (i.e. when the new monthly benefit amount due is less than the amount due in the last regular first of the month payment), it automatically generates a GK notice to the recipient, or it can be issued online. See SI 02301.301B. The GK notice explains the adverse action, the right to appeal the adverse action, and the right to GK payment continuation at the protected payment level (PPL) if the adverse action is appealed within 10 days of receipt of the GK notice. Effective October 29, 2021, the GK notice also explains that recipients who file a request for reconsideration more than 10 days after the date, but within 60 days of the date on the GK notice may also receive GK payment continuation unless they waive it. Because we presume that a recipient receives the GK notice five days after the date on the notice, effective October 29, 2021, we provide GK payment continuation when recipients file a request for reconsideration within 65 days of the date of the GK notice, unless the recipient waives it. See EM-21064 and OB-21-038.

      This EM provides additional guidance to determine whether to request and issue an online or automatic GK notice, whether good cause exists when a recipient files a request for reconsideration more than 65 days after the date on the GK notice due to unusual or unavoidable circumstances caused by or resulting from the COVID-19 pandemic.


    C. Good Cause for Filing a Request for Reconsideration and Receipt of GK Payment Continuation after the 65-day Appeal Period During the COVID-19 Pandemic

      Our current policy provides sufficient flexibility to allow the FO to find good cause for a late filing of a request for reconsideration and to provide GK payment continuation when the request for reconsideration is filed more than 65 days after the date on the GK notice during the COVID-19 pandemic. See SI 04020.020.

      When a request for reconsideration filed more than 65 days after the date on the GK notice, apply existing policy to make a good cause finding based on the circumstances of the recipient’s case. When the circumstance meets our current policy, the FO should find good cause and pay the recipient at the PPL.

      Use the following provisions to determine if good cause exists. Listed under each provision are examples of when good cause can be found because of COVID-19 related circumstances. Although these examples are the more common circumstances, this is not an exhaustive list.


        1. Circumstances impeded the recipient’s or representative payee’s efforts to file the request for reconsideration:

          a. Recipient or representative payee attempts to visit the FO to submit the request for reconsideration within the appeal period, but the office is closed to the public due to unforeseen circumstances (e.g., COVID-19 pandemic).

          b. Interruptions to mail delivery or inability to access mailbox. For example, post office or private mailbox service is limited or delayed due to postal service’s resource or logistic issues.

          c. Transportation services are interrupted or there is limited access to transportation. For example, public transportation is interrupted because there is limited public transportation staff to operate transport vehicles, limited occupancy of public transportation, limited hours, limited routes due to the COVID-19 pandemic. For example, private transportation is limited due to a personal or representative payee’s illness, curfews, or travel restriction due to the COVID-19 pandemic.

          d. Recipient or representative payee moved from the address of record and did not receive the GK notice or did not receive the GK notice in sufficient time.

          e. Recipient or representative payee could not complete the request for reconsideration in time because of child or family care changes due to stay at home orders or school at home requirements.


        2. The recipient’s physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) prevented him or her from timely filing the request for reconsideration:

          a. Recipient, representative payee, or recipient’s primary caretaker is seriously ill or hospitalized, preventing him or her from contacting us.

          b. Death or serious illness in the recipient’s or representative payee’s immediate family, including being seriously ill due to COVID-19.

          c. Non-English-speaking recipient received an English language notice, did not understand the instructions in the notice to call for assistance, and due to stay-at- home orders could not obtain assistance from a friend or relative.


        3. SSA or the Centers for Medicare and Medicaid Services (CMS) actions were confusing or misleading.

          a. Recipient or representative payee received multiple GK notices within a short period of time and was confused about the number of days that he or she had to file the request for reconsideration in order to receive GK payment continuation.

          b. Recipient or representative payee contacted us by telephone, and we gave incorrect or incomplete information.


        4. The recipient or representative payee did not understand the requirements of the Social Security Act (Act), resulting from amendments to the Act, other legislation, or court decisions.


    D. GK Notice Procedure


        1. GK notice: printing the GK notice during the GK temporary period

      When an adverse action is processed during the GK temporary period, FOs can select an online GK notice with options to print locally and either hand deliver or mail to the recipient. Printing the GK notice locally allows us to reduce the next month’s payment in a timely manner. During the COVID-19 pandemic, FOs should select an online GK notice only when they are able to hand deliver or mail the GK notice to the recipient the same day that they produce it. Otherwise, FOs must select the overnight automated notice to automatically generate and send the GK notice to the recipient per D.2 below.


        2. GK notice: local printing not available or after the mail deadline

      When local printing is not available, or after the deadline to mail a notice, FOs must select an overnight automated GK notice, even if this results in a later adverse action month. This option may result in an overpayment, but is required by due process.


        3. GK notice – adverse action requires manual GK notice

      When an adverse action requires a manual GK notice, use the instructions in SI 02301.307 to generate it. Suppress the automated notice so that the DBGK screen becomes available. On the DBGK screen, record that the GK notice was mailed and the SSR can be updated with the due process data (DPD).

    E. Appeal Procedure


      A recipient, representative payee, or appointed representative may contact SSA by telephone either through the National 800-number# or directly to the FO indicating disagreement with the GK notice and that the recipient intends to file a request for reconsideration that qualifies him or her for GK payment continuation at the PPL. If a recipient, representative payee, or appointed representative contacts SSA within 65 days from the date on the GK notice, consider that the recipient may qualify for GK payment continuation. See EM-21064 for instructions on processing reconsideration requests received within 65 days from the date on the GK notice. For reconsideration requests received more than 65 days after the date on the GK notice, develop for good cause for extending the time limit to file a request for reconsideration and receive GK payment continuation.


        1. National 800 Number Network (N8NN)

          When a recipient (including a representative payee, or appointed representative) contacts the TSC to file a request for reconsideration in order to receive GK payment continuation, follow the current procedures in TC 03001.020. When establishing the lead referral (step 2), select “Requests Payment Continuation” and any other options that apply; and send SSA 561-U2 Request for Reconsideration to the recipient.


        2. FO

          a. Contact with a recipient within the 65-day (60 days plus 5 mail days) appeal period

              When a recipient, representative payee, or appointed representative contacts the FO directly within 65 days of the date on the GK notice stating or indicating that he or she wishes to file a request for reconsideration in order to receive GK payment continuation, follow current procedures in SI 04020.020C.1. In addition, take the following actions.


              · Explain that the quickest way to file the request for reconsideration is by completing and submitting the i561 available on the iAppeals Non-Medical application at ssa.gov/iApplNMD.

              · Explain the option to print, complete, and mail the printable version of the SSA-561-U2 available at https://www.ssa.gov/forms/ssa-561-u2.pdf.

              · If a recipient does not have Internet access or is uncomfortable with using electronic devices, explain that he or she can send us any writing by mail that states he or she disagrees with our determination and includes information that will enable us to identify him or her.

              · Document the call on the DROC

              Note: Effective October 29, 2021 recipients who file a request for reconsideration more than 15 days after the date, but within 65 days of the date on the GK notice qualify to receive GK payment continuation unless they waive it. See EM-21064 for instructions on processing reconsideration requests filed more than 15 days after the date, but within 65 days of the date on the GK notice.


            b. Receipt of a request for reconsideration after the 65-day (60 days plus 5 mail days) appeal period z

              If a good cause statement is not included with or written on the request for reconsideration, develop for good cause per GN 03101.020D.1 and SI 04020.020C.1. FOs should find good cause when the reason for filing the request for reconsideration more than 65 days after the date on the GK notice is due to a personal circumstance caused or impacted by the COVID-19 pandemic. Refer to section C above for examples.
    Direct all program–related and technical questions to your RO support staff. RO support staff may refer questions or problems to their Central Office contacts.

      References

      EM-20010 SEN Rev 8 Disaster Procedures – Coronavirus Disease 2019 (COVID-19) Pandemic – One Time Instruction


    SI 2301.301 Overview of Goldberg/Kelly Processing

    SI 02301.305 Online Goldberg Kelly (GK) Notices

    SI 02301.307 Goldberg Kelly Notice Procedures

    SI 02301.310 Appeal and the Right to Goldberg Kelly (GK) Payment Continuation

    SI 04020.020 Request for SSI Reconsideration

    SI 04005.015 Good Cause for Extending the Time Limit to File an Appeal


      TC 03001.020 Handling Appeal Requests

      EM-21064 Goldberg Kelly Payment Continuation Period

      OB-21- 038 Handling Reconsideration Requests Involving Goldberg Kelly Payment Continuation


    EM-20050 REV - The Goldberg Kelly (GK) Notice, Request for Reconsideration, and GK Payment Continuation during the COVID-19 Pandemic - 01/18/2022