Identification Number:
SI 04070 TN 7
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Administrative Finality - SSI
Type:POMS Transmittals
Program:Title XVI (SSI)
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 040 – Administrative Review, Appeals and Finality - SSI
Subchapter 70 – Administrative Finality - SSI
Transmittal No. 7, 02/06/2019

Audience

OCO-OEIO: FDE, RECONE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure. We are updating the POMS section to complete the last sentence in SI 04070.050A.4. In 2005, SI 04070.050A.4 was revised to remove a reference to, the now deleted DI 12025.070, however, it was not replaced with an appropriate policy reference and the sentence was left incomplete.

Summary of Changes

SI 04070.050 Notice of Revised SSI Determination or Decision

We revised subsection A.4 to include the appropriate policy referral.

Subsection A Added a reference to DI 28095.040 Continuing Disability Review (CDR) Notices for Cessations to the end of A.4.

A.4 "the DDS will manually prepare and release the cessation notice. (See DI 28095.040 - Continuing Disability Review (CDR) Notices for Cessations)."

 

SI 04070.050 Notice of Revised SSI Determination or Decision

A. Policy – Notice of Revised SSI Determination or Decision

1. When Notice is Sent

A notice is required whenever a revision is made.

2. Where Notice is Sent

SSA mails the notice to the recipient's last known address and to the last known addresses of the representative payee and representative, if any on record.

See NL 00801.001B.3. – Notices General, for description of who must receive notices.

3. Contents of Notice

The notice must state the basis for the revision and the effect(s) of the revision and inform the parties of the right to further review (i.e., appeal).

4. Suspension, Termination, or Reduction

If the revision results in suspension, termination or reduction of current benefits, the SSA-L8155 must inform the recipient of his/her rights to continued benefits and to reconsideration. (see SI 02301.301 – Overview of Goldberg/Kelly (GK) Processing). If the revised determination involves disability or blindness cessation because of medical reasons, the DDS will manually prepare and release the cessation notice. (See DI 28095.040 Continuing Disability Review (CDR) Notices for Cessations).

5. No Suspension, Termination, or Reduction

If the revision does not affect current benefits, the SSA-L8100 will inform the recipient of his or her right to a hearing if the revision affects a retroactive closed time period.

6. Evidence Not in the Record

If the AC or an ALJ proposes a revision based on evidence not in the record or which prior determination was used, the ODAR notice will inform the recipient of the proposed action and the right to a hearing before any further action is taken.

7. Evidence on Record

If the AC or an ALJ proposes a revision based only on evidence of record or which the prior determination or decision was based, the ODAR notice will advise the recipient of the proposed action, and will notify the claimant of all appeal rights.

B. Procedure - Notice Forms

1. Prepare Notice to Claimant

If you reopen and revise the prior determination, the system will normally notify the recipient automatically by issuing a Notice of Revised Determination (SSA-L8100). If a manual notice is required, send an SSA-L8100-U2. If the claimant has requested that the decision be reopened and there is no basis to reopen and revise, use form SSA-L8165-U2 (Notice of Decision) to inform the claimant of your denial of his/her request.

2. Contents of Form SSA-L8165-U2 - Prior Determination Not Reopened

Include the following in the Form SSA-L8165-U2 when a prior determination will not be reopened:

a. Reason for Not Reopening

Explain why you are not reopening and revising.

b. No Appeals Paragraph

Since the denial of a request to reopen is a matter of administrative discretion and not an initial determination, do not include an appeals paragraph.

3. Advance Notice of Action to Be Taken Not Required

The system will normally issue an SSA-L8100 (Notice of Revised Determination). Ensure that the notice advises the recipient/ claimant of the right to hearing by an ALJ as well as the basis for the revised determination.

Prepare an SSA-L8100 for a revised determination pertaining to a closed retroactive period (i.e., preceding and not involving a current, prospective, or ongoing period). This also includes suspensions, terminations, and reductions as long as these adverse actions pertain to a retroactive period and do not involve a change in an individual's current eligibility or payment status.

4. Advance Notice of Action to Be Taken is Required

a. Medical Issues Not Involved

Use SSA-L8155 (SSI Notice of Planned Action). Usually, this notice is automated or online. The recipient/claimant must be advised of the basis for the planned action and the right to reconsideration and payment continuation (Goldberg/Kelly).

b. Medical Issue Involved

DDS's issue the appropriate cessation notice per DI 28095.040B Continuing Disability Notices – Cessation Notice Instructions and DI 28095.110 Title XVI Medical Cessation Notices Chart.

5. Required Language

When you must send a manual notice, regardless of which notice (SSA-L8155 or SSA-L8100) is used, insert the notice paragraph 2750 from NL 00804.240 Miscellaneous, in notices which are prepared by the FO to refer to the fact that this is a revised determination.

C. Examples - Notices

1. Advance Notice Not Required Prior to the Revision Action

On March 2, 2001, we render an initial determination which establishes that the applicant is eligible for $400 per month beginning on February 1, 2001 (the month after the January 15, 2001 date of application). On September 1, 2002, the claimant presents evidence which establishes that he/she was actually eligible for $314 per month from February 1, 2001 to May 2001 and was eligible for $400 per month from June 1, 2001 and continuing.

A computer-generated SSA-L8100 is sent reflecting the revised determination with opportunity to request a hearing on the revised determination.

2. Advance Notice Required Prior to the Revision Action

On March 2, 2001, an initial determination establishes that the claimant is eligible for $314 per month, beginning February 1, 2001. On July 1, 2002, the claimant presents evidence which establishes that he was living in the household of another and receiving support and maintenance beginning February 1, 2001 and continuing, and therefore, was only eligible for $209.34.

Since the change is a proposed as well as a retroactive reduction, a computer-generated SSA-L8155 is sent reflecting the above revised determination of $209.34 per month beginning February 1, 2001, with opportunity to request reconsideration of the revised determination and the right to benefit continuation.

D. References – Notices

1. SSI Posteligibility Notices

See NL 00803.000 Supplemental Security Income (SSI) Posteligibility Notices

2. Manually Prepared Notices

See NL 00801.010 Manually Prepared Notices

3. Goldberg/Kelly Notices

See SI 02301.305 Online Goldberg Kelly (GK) Notices, SI 02301.307 Manual Goldberg Kelly (GK) Notice Procedures and SM 01305.530 Initial Adverse Action Events Requiring an Online or Manual Notice


SI 04070 TN 7 - Administrative Finality - SSI - 2/06/2019