Identification Number:
DI 12026 TN 4
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 120 – Appeals Processing
Subchapter 26 – Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI
Transmittal No. 4, 02/25/2020

Audience

FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
PSC: CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
ODD-DDS: REF;
OCO-OEIO: BET, CR, ERE, FCR, FDE, RECONE, RECONR, RECOVR;
OCO-ODO: BET, CR, CST, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RCOVTA, RECONE, RECOVR;
OHO/OAO: OHAAC, OHACO (SAWDY), OHAHOs, OHAROs;

Originating Component

ODP

Effective Date

Upon Receipt

Background

With this request we are archiving sections DI 12095.040, DI 12095.050, DI 12095.055 and DI 12095.065. The content previously located in DI 12095.040 has been moved to new section DI 12026.021, the content previously located in DI 12095.050 has been moved to new section DI 12026.022, the content previously located in DI 12095.055 has been moved to new section DI 12026.026, and the content previously located in DI 12095.065 has been moved to the new section DI 12026.027. These sections contain information involving the forms we use in requests for reconsideration of disability cessation cases. The updated sections include revisions to the content and cross-references.

Summary of Changes

DI 12026.001 Reconsideration of a Continuing Disability Review (CDR) Based on Medical Cessation or Adverse Medical Reopening

We made the following changes to this section:

  • We made minor revisions to this section.

  • Policy information contained in this section remains unchanged.

DI 12026.015 Field Office (FO) Actions when an Individual Disagrees with the Medical Cessation or Adverse Medical Reopening Determination

We made the following changes to this section:

  • We made minor revisions to this section.

  • Policy information contained in this section remains unchanged.

DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination

We made the following changes to this section:

  • We revised the title to reflect the actual content of this section,

  • We revised the subtitle of subsection A to reflect the content of this section, and

  • Made revisions throughout the section to reflect the intended content

  • We added procedures on FO actions when some or all of the required forms are not returned

DI 12026.021 Completion of the SSA-789 Request for Reconsideration - Disability Cessation Right to Appear

We made the following changes to this section:

  • The content previously located in DI 12095.040 has been moved to this new section

DI 12026.022 Completion of the SSA-773-U4 Waiver of Right to Appear - Disability Hearing

  • The content previously located in DI 12095.050 has been moved to this new section

DI 12026.026 Completion of the SSA-769-U4 Request for Change in Time/Place of Disability Hearing

  • The content previously located in DI 12095.055 has been moved to this new section

DI 12026.027 Completion of the SSA-770-U4 Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation

  • The content previously located in DI 12095.065 has been moved to this new section

DI 12026.030 Field Office (FO) Actions after the Reconsideration Continuing Disability Review (CDR) Determination

We made the following changes to this section:

  • We removed two sentences from the first paragraph of this section.

  • We eliminated Section B due to recent system changes involving UMC payments rendering these instructions irrelevant.

DI 12026.001 Reconsideration of a Continuing Disability Review (CDR) Based on Medical Cessation or Adverse Medical Reopening

A. Levels of the appeal process

Claimants have the right to appeal an unfavorable medical CDR determination. This subchapter focuses on the reconsideration level of appeal.

There are four levels of medical CDR appeals:

  1. 1. 

    Reconsideration, which includes:

    • Pre-hearing review by an adjudicative team or designated person that was not involved in the initial unfavorable determination; and

    • Disability Determination Services (DDS) Disability hearing review by a Disability Hearing Officer (DHO), in person, by video teleconferencing (VTC), or by way of telephone (in some circumstances) with the claimant, his or her appointed representative (if applicable), and any witnesses. A Disability Hearing Unit (DHU) handles all disability hearings within the DDS.

  2. 2. 

    Hearing by an administrative law judge (ALJ)

  3. 3. 

    Appeals Council (AC) review

  4. 4. 

    Federal Court review

B. The DDS disability hearing at the reconsideration level

A DDS disability hearing is an evidentiary meeting that provides the claimant an opportunity to review the evidence, introduce new evidence, and present his or her objections to an unfavorable medical determination before a DHO.

NOTE: The DDS disability hearing at the reconsideration level applies to CDR determinations only, and does not apply to initial disability determinations claims.

For information on initial disability claims, see DI 12005.001 Documenting a Request for Reconsideration of an Initial Disability Claim.

C. Basics of the DDS disability hearing at the reconsideration level

The Social Security Act affords the claimant the right to a disability hearing at the reconsideration level of appeal in certain Title II and Title XVI cases.

1. Types of DDS disability hearing cases with appeal rights

An individual has a right to a DDS disability hearing at the reconsideration level if the initial medical determinations resulted in a:

  • Medical cessation,

  • Adverse medical reopening, or

  • Reopening that changes only the basis of the cessation.

2. Issues that may be involved in unfavorable medical determinations with appeal rights

The DDS disability hearing process applies to unfavorable medical determinations involving:

  • Medicare for Qualified Government Employees (MQGE) cases,

  • Extended Period of Eligibility (EPE) cases,

  • Prisoner cases,

  • Foreign cases,

  • Railroad cases,

  • Whereabouts Unknown (WU) cases; if the claimant files an appeal on an initial cessation determination DDS has already made and,

  • Fraud and Similar Fault (FSF) cases.

3. When a DDS reconsideration disability hearing applies

A DDS reconsideration disability hearing of a medical CDR applies when:

  • An initial CDR determination finds that a claimant's impairment ceased, did not exist or is no longer disabling, or

  • The Social Security Administration (SSA) proposes to adversely reopen and revise a favorable determination based on medical or medical-vocational factors. For more information on reopenings, see DI 33020.025 Reopenings by the Disability Hearing Officer (DHO).

4. When a DDS reconsideration disability hearing of a medical CDR does not apply

A DDS reconsideration disability hearing of a medical CDR is NOT applicable for:

  • Initial determinations made on a new application, (including closed period cases), unless the new application is forwarded for association with a pending case that is subject to the reconsideration CDR process.

  • Reconsideration of initial determinations made on new applications, including partially favorable determinations (for example, closed periods and later onsets).

  • Cases involving nonmedical issues, for example, substantial gainful activity (SGA), overpayment of benefits, amount of income and resources (Title XVI), or reconsideration of cessations based on, 'whereabouts unknown.'

D. References

  • DI 12005.001 Documenting a Request for Reconsideration of an Initial Disability Claim

  • DI 29001.001 The Right to a Disability Hearing at the Medical Continuing Disability Review (CDR) Reconsideration Level

  • DI 29001.005 The Scope of the Disability Hearing

  • DI 29001.010 Overview of Component Responsibilities Related to Medical Continuing Disability (CDR) Disability Hearings

  • DI 29005.022 New Application and Request for Reconsideration

  • DI 33020.025 Reopenings by the Disability Hearing Officer (DHO)

DI 12026.015 Field Office (FO) Actions when an Individual Disagrees with the Medical Cessation or Adverse Medical Reopening Determination

An individual who disagrees with the medical cessation or adverse medical reopening determination may want an explanation of the determination or wish to file an appeal and call, write, or visit the FO.

IMPORTANT: When the individual calls the Social Security Administration (SSA) for an explanation, advise him or her that a telephone conversation does not establish a request for appeal and does not protect the appeal filing date . All appeal requests must be submitted in writing.

A. Review the individual’s SSA case folder

Before interviewing the individual, review his or her case folder. Establish the type of determination the individual would be appealing (for example, medical, nonmedical or a combination of determinations).

B. If the individual writes to the FO

After receiving a notice of the initial determination, any writing submitted by the individual or his or her appointed representative, which clearly states a disagreement with the medical cessation or adverse medical reopening determination, establishes a request for reconsideration. For more information on what constitutes a request for reconsideration, refer to GN 03102.100 The Reconsideration Process.

For all written requests for an explanation, call the individual or use the document processing system (DPS) to send an SSA-2708 (Field Office Call/Come In Request),to arrange a personal interview. Make sure to save a copy of the SSA-2708 in the online retrieval system (ORS). For telephone conversations with the individual, follow the instructions in DI 12026.015C in this section.

When sending an SSA-2708:

  • Ask the individual to call or come into the office for an interview,

  • Explain that the SSA-2708 sent to the individual, does not establish a new or reconsidered determination,

  • Explain the right to appeal, the time limit for filing an appeal, and, if appropriate, good cause for late filing of an appeal, and

  • Do not attempt to explain the medical basis for the determination.

C. If the individual telephones the FO

Review the individual’s SSA case folder. If the individual wants to conduct the interview during the call, follow the instructions in DI 12026.015D in this section and proceed to conduct the interview by telephone. If the individual does not want to have the interview conducted during the call, ask the individual to come into the office for an interview and take the following actions:

  • Explain that we do not consider the telephone conversation a request for an appeal and the call does not protect the appeal filing date. Explain that all appeal requests must be submitted to SSA in writing;

  • Explain the right to appeal, the time limit for filing an appeal, and if appropriate, good cause for late filing of an appeal;

  • Document or update any new contact information for the individual (for example, address, telephone number(s) or third-party information, if applicable);

  • Determine when the individual wishes to come into the FO to file an appeal, and

  • Document the telephone conversation on an SSA-5002 (Report of Contact), and add this form to the Disability Related Development (blue) section of the electronic or paper folder.

D. Conducting the interview with the individual

When you conduct the interview with the individual:

  • Discuss the reasons for the determination (for example, “you missed a scheduled exam,” “the Disability Determination Services (DDS) determined you are no longer disabled,” “the DDS was unable to contact you,” etc.), the individual’s disagreement with the determination, and his or her appeal rights.

  • If the individual wants to file an appeal, explain the DDS disability hearing process, and his or her rights and responsibilities with respect to the hearing process following the procedures in DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination.

  • Make sure the individual understands that he or she has not filed the appeal until the appeal forms are completed and submitted in writing;

  • Document the interview conversation on an SSA-5002 and add this form to the Disability Related Development (blue) section of the electronic or paper folder.

E. References

  • DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination

  • DI 81010.135 Storing Non-Medical Evidence in the Electronic Folder (EF)

  • GN 03102.100 The Reconsideration Process

DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination

A.  FO actions when an individual wants to request an explanation or a reconsideration of an unfavorable medical CDR determination

During the interview, the FO will take the following actions when an individual wants to request an explanation or a reconsideration of an unfavorable medical CDR:

  • Explain the disability hearing process to the individual,

  • Explain the individual’s rights pertaining to the reconsideration process,

  • Explain the individual’s responsibilities pertaining to the reconsideration process,

  • Provide the required appeal forms, and

  • Follow the instructions in DI 12026.025 Field Office (FO) Processing Guidelines in Requesting a Reconsideration for a Medical Continuing Disability Review (CDR) Determination.

1. Explain the disability hearing process to the individual

When discussing the disability hearing process:

  • Explain what a reconsideration CDR is by referring to the information in DI 12026.001B Reconsideration of a Continuing Disability Review (CDR) Based on Medical Cessation or Adverse Medical Reopening.

  • Explain the time limits for filing a request for reconsideration. For more information on time limits for filing an appeal, refer to GN 03101.010 Time Limit for Filing Administrative Appeals.

NOTE: When a foreign case is involved, see

  • DI 12026.020B.5., in this section, and

  • DI 12026.025 Field Office (FO) Processing Guidelines in Requesting a Reconsideration for a Medical Continuing Disability Review (CDR) Determination

2. Explain the individual’s rights pertaining to the reconsideration process

Advise the individual of his or her right to:

  1. a. 

    Request an appeal.

  2. b. 

    Elect or decline statutory benefit continuation (SBC).

    If the individual requests reconsideration, within 10 business days of receipt of the notice, the individual must sign a statement indicating whether he or she elects or declines SBC. This statement is acceptable on an SSA-795 (Statement of Claimant or Other Person), using the language from the Election Statement Exhibit found in DI 12095.171 SSA-795 Election Statement — Exhibits. If the individual makes a late election of SBC, he or she must establish ‘good cause.’ For more information on SBC, see

    • DI 12026.025 Field Office (FO) Processing Guidelines in Requesting a Reconsideration for a Medical Continuing Disability Review (CDR) Determination

    • DI 12027.007 Who May Elect Statutory Benefit Continuation (SBC),

    • DI 12027.008 Evaluating the Time Limits for Statutory Benefit Continuation (SBC), and

    • DI 12027.015 Cases Excluded from Statutory Benefit Continuation (SBC)

    • SI 02260.007 Waiver Procedures for Disability Cessation Cases

  3. c. 

    Appoint a representative. Explain to the individual the importance of informing the Social Security Administration (SSA) at the earliest possible time if he or she obtains representation.

  4. d. 

    Present additional evidence to support the appeal. Explain to the individual the importance and advantage of providing additional evidence and medical sources at the earliest possible time.

    NOTE: Although individuals may submit evidence at the disability hearing, explain to the individual that it is preferable that any new evidence is provided before completion of the case development of his or her appeal.

  5. e. 

    Request SSA assistance in obtaining evidence and, if necessary, request that SSA issue an SSA-1272-U4 (Subpoena-Disability Hearing), to compel the production of certain evidence or testimony. For more information on subpoenas, see DI 33010.050 Subpoenas and Other Requests for Testimony and Documents.

  6. f. 

    Receive notice of the time of the disability hearing at least 20 calendar days before the disability hearing, and the right to waive the 20-day advance notice. If the individual wants to waive this right, see DI 12026.020C.3 in this section.

  7. g. 

    Receive reimbursement for expenses to travel to the disability hearing location, under certain circumstances. For more information on reimbursement of travel expenses, refer to DI 33010.045 Reimbursement for Travel Expenses to Disability Hearing Site.

  8. h. 

    Present and question witnesses. Contact the Disability Hearing Unit (DHU) if the individual needs assistance in getting a witness to appear.

  9. i. 

    Waive a personal appearance at the disability hearing by indicating this option on the SSA-789 (Request for Reconsideration - Disability Cessation Right to Appear), and completing the SSA-773-U4 (Waiver of Right to Appear – Disability Hearing). Inform the individual of the consequences of not appearing at the disability hearing, as stated on the SSA-789.

    NOTE: The individual can later waive his or her right to appear by submitting an SSA-773-U4 Waiver of Right to Appear - Disability Hearing form or by submitting a written statement. For more information on the use of this form, see DI 12026.022.

  10. j. 

    Review the evidence in the individual's official case folder. Inform the individual that a review of the official case folder generally takes place the day of the disability hearing. However, it can occur at the FO prior to the Disability Determination Services (DDS) development or at other times, by arranging with the DHU. For more information on providing access to medical records, refer to GN 03340.035 Access to Medical Records. If the case folder contains information related to the Office of the Inspector General (OIG) Cooperative Disability Investigation Unit (CDIU) evidence, refer to DI 33025.036 Disability Hearing Officer's Use of Cooperative Disability Investigation Unit (CDIU) Report of Investigation (ROI) Evidence.

    NOTE: When an authorized person requests a copy of an electronic case folder, include all documents (paper and electronic) that comprises the official disability case folder in the copy provided. Offer the authorized person a compact disc (CD) copy of the case folder. For more information on providing a copy of the case folder see, DI 81001.030 Claimant or Representative Requests a Copy of the Claims Folder.

  11. k. 

    Request a hearing before an administrative law judge (ALJ), if the individual disagrees with the disposition of his or her reconsideration appeal.

3. Explain the individual's responsibilities pertaining to the medical CDR reconsideration process

Advise the individual of his or her responsibility to:

  1. a. 

    Request an appeal and sign the SBC election statement within 10 days of receiving the notice to receive SBC (or establish good cause for late filing of the SBC election statement).

    NOTE: Clearly explain to the individual that, if the appeal is unsuccessful, SBC payments will result in an overpayment, and the individual is responsible to repay the overpayment amount.

  2. b. 

    Attend all consultative examinations (CE), if requested to do so by the DDS. Inform the individual that the CE is administered at no cost to the individual. Explain the importance of attending the CE and cooperating in all requests because failure to cooperate may affect the reconsideration determination.

  3. c. 

    Immediately inform the DHU of any event that affects scheduling of the disability hearing, (for example, the appointment of a representative, a change of address or any hospitalization).

4. Provide the required appeals forms

Provide the following forms.

a. SSA-789 Request for Reconsideration – Disability Cessation Right to Appear

Use form SSA-789 when an individual requests reconsideration on medical continuing disability issues and when selecting whether someone will appear on the individual’s behalf. Assist the individual with completing this document, if requested. If the individual completes any writing that specifically addresses his or her disagreement with the initial determination, the request for reconsideration is considered to be filed, and the pursuit of an SSA-789 should be initiated. See DI 12026.021 Completion of the SSA-789 Request for Reconsideration – Disability Cessation Right to Appear.

IMPORTANT: Upon receipt in the FO, the SSA-789 must be date-stamped at the top of the form. Record the receipt date of the SSA-789 at the top of the form as follows: “Received MM/DD/YYYY in FO XXX.”

A completed Modernized SSI Claims System (MSSICS) appeals output can be substituted for the SSA-789 in Title XVI and concurrent cases if the individual also provides a clear written indication of disagreement with the initial CDR determination.

NOTE: Do not use an SSA-561-U2 (Request for Reconsideration) form for CDR reconsideration because the SSA-789 contains information and questions not covered by the SSA-561-U2. Sometimes the claimant submits the wrong form, including the SSA-561-U2. If this occurs, proceed as follows:

  • Contact the claimant to confirm whether the form submitted was intended (or not) by the claimant. If not, transfer the information from the incorrect form to form SSA-789

  • Request the information missing from the SSA-789 – specifically whether or not the claimant wants to appear at a disability hearing, and if not, that we explained their rights with respect to a disability hearing.

  • Notate the discussion on an SSA-5002 (Report of Contact)

b. SSA-795 Statement of Claimant or Other Person for request to continue SBC

An individual can request to continue SBC on the SSA-795 within 10 days of receiving the determination notice. If the individual requests SBC more than 10 days after receiving the determination notice, obtain an SSA-795 with his or her 'good cause' statement for late filing. Refer to DI 12027.008B Evaluating the Time Limits for Statutory Benefit Continuation (SBC).

Election or declination of SBC payments are described in:

  • DI 12027.010B Processing Statutory Benefit Continuation (SBC), and

  • DI 12095.171 SSA-795 Election Statement — Exhibits

Note: The individual must complete an SSA-795 whether he or she accepts or declines SBC. In concurrent cases, the individual must submit two SSA-795s; see examples 1 and 3 in DI 12095.171 Election Statement — Exhibits.

Also, see:

  • 'Good cause' statement with late filing of an appeal referred to in GN 03101.020, and

  • 'Good cause' statement with late filing of request for SBC referred to in DI 12027.008B

c.  SSA-795 Statement of Claimant or Other Person of good cause for late filing

If the individual requests reconsideration more than 60 days after receiving the determination notice, obtain an SSA-795 with his or her 'good cause' statement for late filing. Refer to GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal.

d. SSA-827 Authorization to Disclose Information to the Social Security Administration (SSA)

Form SSA-827 serves as the individual's written request and authorization for a medical or other source to release information to SSA. Obtain one completed original SSA-827 per case. For instructions on completing the SSA-827, see DI 11005.055 Completing Form SSA-827 Authorization to Disclose Information to the Social Security Administration (SSA) and DI 11005.056 Signature Requirements for Form SSA-827.

e. SSA-3441-BK Disability Report – Appeal

Use form SSA-3441-BK to collect updated information about the individual's impairment(s). Use the SSA-3441-BK for all requests for CDR reconsideration. For instructions on completing the form in the Electronic Disability Collect System (EDCS), see DI 81010.150D Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (ECDS).

f. SSA-3881-BK Questionnaire for Children Claiming SSI Benefits

Use form SSA-3881-BK to record information from nonmedical sources about evidence of the individual's functioning capabilities. If the appeal is for a child claiming Supplemental Security Income (SSI) benefits, use form SSA-3881-BK to record information from nonmedical sources about evidence of the individual's functioning capabilities.

B. FO actions when some or all of required forms mailed to claimant are missing information or not returned

When the FO receives a request for reconsideration in writing, and the required forms sent to the claimant are not returned or returned missing information, take the following actions:

  1. 1. 

    Contact the individual by telephone to obtain the necessary information

  2. 2. 

    Send a call-in/come-in letter and set a 15-day diary, if the individual has no phone or the attempt is not successful.

  3. 3. 

    Document attempts to contact the individual on an SSA-5002 (Report of Contact) and place a copy of the SSA-5002 in the folder.

  4. 4. 

    Forward the case to the DDS for resolution, if the individual does not respond within 15 days.

  5. 5. 

    Provide the individual with a copy of the SSA-789, if applicable.

  6. 6. 

    Provide the individual with the English or Spanish version of form SSA-888 (Reconsideration/Disability Hearing Procedures). Versions of these documents are located in DI 33095.025 or DI 33095.030.

  7. 7. 

    Provide the individual with the telephone numbers for the FO and DDS in his or her service area. Explain to the individual that we prefer that he or she call the DDS with any questions or if he or she needs to report a change relating to the disability hearing.

NOTE: SSA does not expect individuals to make long distance phone calls and individuals may call either the FO or DDS.

C. Other medical CDR reconsideration issues

1. Medical issue exists for both Title II and Title XVI

Have the individual complete only one SSA-789, if he or she wishes to file a request for reconsideration under both titles in a concurrent case.

  • Check the appropriate blocks in the, “Type of Benefit” section of the SSA-789.

  • File or upload the SSA-789 in Jurisdictional Documents/Notices (the red tab) of the official folder.

  • Document the reason(s) the individual is not appealing all cases, if the individual is restricting the appeal to one case only.

NOTE: Do not require a claimant to pursue other benefits through the appeals process. For example, in a concurrent claim, if the SSI denial is appealed, the individual does not need to pursue a Title II appeal for SSI eligibility. For more information, see SI 00510.001 Overview of the Filing for Other Program Benefits Requirements.

2. Both medical and nonmedical issues exist

If the individual wishes to file an appeal on each issue:

  • Obtain a completed SSA-789 and the other necessary forms required for appeal of the medical issue.

  • Obtain a completed SSA-561-U2 for the nonmedical issue.

a. Title II

For Title II cases: If the nonmedical issue is critical to eligibility, complete the nonmedical appeal before completing the medical issue appeal. Otherwise, complete the medical issue appeal first.

b. Title XVI and concurrent Title II and Title XVI

Process the nonmedical reconsideration first when the nonmedical issue is critical to eligibility, (for example, income and resources). If the nonmedical issue is not critical to eligibility, do not load into MSSICS until after the medical determination has been made, and only if medically allowed. Otherwise, the presence of the nonmedical appeal will block the medical appeal.

  • For information about a nonmedical reconsideration, see SI 04020.010C.1 What Is SSI Reconsideration.

  • For information about due process protections and Goldberg/Kelly procedures, see SI 02301.300 Due Process Protections - General.

3. Waiver of 20-day advance notice for disability hearing date

When processing a waiver of the 20-day advance notice for a disability hearing:

  • Ensure the individual understands that he or she should not waive the right to receive a 20-day advance notice of the disability hearing if additional time is needed to prepare for the hearing.

  • Obtain a signed SSA-795 from the individual or his or her representative, containing the following language:

    I have been advised of my right to be sent a notice of the time and place of my disability hearing at least 20 days before the date of my hearing. Additionally, I have been advised that I should not give up this right if I need additional time to prepare for the hearing. However, I am prepared to have my hearing on or after [insert date], and hereby knowingly and willingly give up my right to be sent the 20-day advance notice as cited in 20 CFR, sections 404.914(c)(1), and 416.1414(c)(1).

  • NOTE: If the reconsideration request involves only Title XVI, revise the above language to delete 404.914(c) (1). If it involves only Title II, delete 416.1414(c) (1).

  • Send the individual's statement to the DHU along with the SSA-789.

    If the DHU already has the SSA-789, notify the DHU of the individual’s statement by telephone or e-mail. Upload the individual's statement to the electronic folder or mail it to the DHU if the folder is paper.

4. Selection of an appointed representative

  • If the individual wants to appoint an attorney or other qualified person to represent him or her, refer to GN 03910.001 Representation of Claimants - Overview.

  • If the folder is located in the FO, see GN 03910.040H Appointment and Revocation of Appointment of Representative.

  • If the folder is not located in the FO, see GN 03910.040I Appointment and Revocation of Appointment of Representative.

  • Inform the DHU by the Electronic Disability Collect System (EDCS) of an update after transfer (UAT) if an appointed representative has been confirmed. Refer to DI 81010.095 Using the Update After Transfer (UAT) Utility

  • If the folder is paper, submit a SSA-5002 when an appointed representative has been confirmed.

5. Responsibility for processing foreign cases

a. Office of Central Operations (OCO)

Foreign cases are the jurisdiction of OCO and its components. Within the Office of Earnings and International Operations (OEIO), the International Benefits Office (IBO) functions as the “field office” for foreign cases. However, the Disability Hearing Officer (DHO) handling foreign cases is a member of the International Disability Unit (IDU) operating within the Office of Disability Operations (ODO).

b. FO

Regional and FOs do not process hearings for foreign cases except when the DHO has prior involvement in a particular case. In those instances, the IDU requests assistance from the regional office via the Office of Disability Determinations (ODD). The IDU's DHO continues to process all other foreign reconsideration cases.

If the individual resides in a foreign country or uses a foreign mailing address and contacts the FO (rather than the IBO) for assistance in filing a request for reconsideration of a CDR, follow current procedures, with the following exceptions:

  • Do not request the case folder.

  • Do not take any action regarding SBC, other than obtaining an SSA-795 regarding the SBC election choice and auxiliaries’ payments.

Inform the individual that he or she can come to the United States (U.S.) for a hearing; or he or she can have OEIO review his or her case and issue a decision based on the evidence of record, which would include any additional evidence submitted in connection with the reconsideration request. If an individual or representative wishes to appear at a hearing:

  • Find out where in the U.S. the individual wishes to have the hearing held (the individual’s point-of-entry into the U.S. or his or her temporary U.S. residence determines the region where we will schedule the hearing). Since there are no provisions provided for a DHO to travel, the hearing must be conducted by the regional IDU's DHO.

  • Find out when he or she will be in that area; and

  • Include the location and time the individual is available in the material forwarded to OEIO.

Ensure that the individual understands there are no provisions for reimbursing expenses for travel outside of the U.S.

NOTE: If after entering the U.S., the individual has to travel more than 75 miles (one way) to attend a hearing, he or she may request reimbursement for travel expenses incurred within the U.S. For information about reimbursement of travel expenses to the disability hearing site, refer to DI 33010.045 Reimbursement for Expenses to Travel to Disability Hearing Site.

6. Individual also files a new disability application

When an individual files a new application at the same time as a request for reconsideration or before issuance of a reconsidered determination:

  • Forward both cases to the DDS or to the office where the prior case is located.

  • Refer to DI 12045.010 Processing Disability Claims at Different Levels of Appeal, title II and title XVI - Common Issue Cases.

D. References

  • DI 10105.904 General - Auxiliary(s)

  • DI 11005.056 Signature Requirements for Form SSA-827

  • DI 12027.008 Evaluating the Time Limits for Statutory Benefit Continuation (SBC)

  • DI 12027.010 Processing Statutory Benefit Continuation (SBC)

  • DI 12095.000 Appeals Processing Exhibits - Table of Contents

  • DI 29001.001 The Right to a Disability Hearing at the Medical Continuing Disability Review (CDR) Reconsideration Level

  • DI 33010.050 Subpoenas for Testimony and Other Documents

  • DI 81001.035 Copying a Certified Electronic Folder (CEF) to CD

  • DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)

  • DI 81010.255 Electronic Continuing Disability Review (eCDR) Cessation Reconsideration

  • DI 81010.257 Electronic Continuing Disability Review (eCDR) Cessation Hearing Appeal

  • DI 81020.025 Processing Electronic Reconsideration Cases

  • GN 00203.011 Special Interviewing Situations: Limited English Proficiency (LEP) or Language Assistance Required

  • GN 03101.010 Time Limit for Filing Administrative Appeals

  • GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal

  • GN 03910.040 Appointment and Revocation of Appointment of Representative

DI 12026.021 Completion of the SSA-789 Request for Reconsideration - Disability Cessation Right to Appear

A. Overview of the SSA-789

The claimant, an appointed representative, a representative payee or other third party filing on the claimant's behalf can use the SSA-789 Request for Reconsideration to request reconsideration on an initial disability cessation determination. It is essential to complete the SSA-789 correctly because the disability hearing unit (DHU) will rely on the information on this form in order to schedule hearings.

Complete only one SSA-789 on all claims for entitlement where the individual has received a cessation notice(s). Upon receipt in the field office (FO), the SSA-789 must be date-stamped at the top of the form. For additional information about requests for reconsideration, see DI 12026.001 Reconsideration of a Continuing Disability Review (CDR) Based on Medical Cessation or Adverse Medical Reopening.

NOTE: Do not use the SSA-561-U2 to file a request for reconsideration of a disability cessation. For additional information on the SSA-561-U2 see,

  • DI 12005.001 Documenting a Request for Reconsideration of an Initial Disability Claim and,

  • GN 03102.225 Preparation of Form SSA-561-U2 (Request for Reconsideration)

B. Procedures for completing the SSA-789

Enter the information as follows:

1. Identifying information

  • Enter the claimant's full name as shown on the cessation notice and, if different, the name of the number holder (NH).

  • Enter the claimant's Social Security number (SSN) next to his or her name regardless of whether it is the claim number on which the claimant files the SSA-789.

  • Enter the Wage Earner’s SSN only if the claimant's SSN is different from the wage earner.

  • Complete the spouse’s name and SSN only if the reconsideration request involves a Title XVI case and the spouse is not the NH.

When the Request for Reconsideration-Disability Cessation involves more than one SSN, enter all SSNs on the form. For example, when the individual receives a cessation notice(s) on more than one benefit, he or she would generally file the request for reconsideration on all entitlement claims.

NOTE: In Title XVI and concurrent cases, it is permissible to input the reconsideration request directly in the claim path of the Modernized Supplemental Security Income Claims System (MSSICS) and fax a copy of the printed appeal summary into eView under an SSA-789 coversheet. See DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination.

2.  Selecting type of benefit

  • Check the appropriate box to indicate which type(s) of benefit the individual is appealing - title II Social Security Disability Insurance (DI) or Title XVI Supplemental Security Income (SSI).

  • Check both boxes (under each benefit) if the reconsideration request involves a concurrent claim.

3. Reason for filing a request for reconsideration

Enter the reason for the reconsideration request. Be as specific as possible.

  • Briefly describe why the individual believes he or she is still disabled, or what part of the notice he or she thinks is inaccurate.

  • Avoid writing, “I am still disabled and cannot work.” This statement does not provide specific information about the individual’s reason for requesting reconsideration.

  • The individual must provide a reason for filing late if the date of the cessation notice exceeds 65 days.

  • For additional information, see

    • DI 12026.015 Field Office (FO) Actions when an Individual Disagrees with the Medical Cessation or Adverse Medical Reopening Determination

    • GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal

4. Additional information submitted by claimant

Enter any additional information the individual wishes to submit as follows:

  • List any information the individual or someone on his or her behalf, submits or plans to submit.

  • Enter any documentation that will be provided with form SSA-789, and attach additional pages if needed.

  • Instruct the individual to submit any new information as early as possible in the disability hearing process.

NOTE: Explain that waiting until the hearing to submit additional information may delay the determination because the disability hearing officer (DHO) may need to return the case to the disability determination services (DDS) to develop the new evidence.

5. Appearance at the hearing and the need for an interpreter

The SSA-789 has two boxes to indicate whether the individual wishes to appear at the hearing.

  1. a. 

    Check the first box if the individual, and/or his or her representative, wishes to appear at the hearing. When an interpreter is required:

    1. 1. 

      Check the box indicating the need for an interpreter and specify the language. For more information on interpreters for individuals, see GN 00203.011H Special Interviewing Situations: Limited English Proficiency (LEP) or Language Assistance Required.

    2. 2. 

      If the individual provides his or her own interpreter, explain that the interpreter must be able to translate technical medical terminology and concepts.

    3. 3. 

      If the individual provides an interpreter and the interpreter appears to be unqualified (for example, a young child), prepare an electronic or paper version of the report of contact, form SSA-5002 (Report of Contact) for the case folder explaining the situation.

  2. b. 

    Check the second box if the individual or appointed representative does not wish to appear at the hearing. In addition, ask the individual or appointed representative to sign the SSA-773-U4 (Waiver of Right to Appear - Disability Hearing). For more information regarding completion of the SSA-773-U4, see DI 12026.022 SSA-773-U4 Waiver of Right to Appear – Disability Hearing.

NOTE: There is no need to complete all of the identifying information on the SSA-773-U4 if filed together with the SSA-789. Complete only the name, claim number(s), and obtain the signature. If the individual decides, subsequent to filing, to waive the appearance, complete the entire SSA-773-U4.

6. Witness' signature(s)

The individual, his or her appointed representative, representative payee, or other third party on behalf of the individual may sign the form. However, a signature is not required to process the reconsideration request under certain conditions. See DI 12026.021B.6.c in this section below for an explanation.

  1. a. 

    When the individual has an appointed representative, enter the appointed representative's name and address in the designated spaces on the SSA-789.

  2. b. 

    If the individual lists an appointed representative on the SSA-789, ensure an SSA-1696-U4 (Claimant's Appointment of Representative), is in the case folder. For information regarding the appointment of a representative, see GN 03910.040 Appointment and Revocation of Appointment of Representative.

  3. c. 

    No signature is required on the SSA-789 to process a reconsideration request if we have a statement that clearly shows dissatisfaction with an initial determination and it clearly originated with the individual. For additional information regarding the informal request for a hearing, see GN 03103.010 The Hearing Process.

  4. d. 

    If applicable, have witnesses sign the form, and complete the address information in the designated spaces. Check the first box if the individual, and/or his or her representative, wishes to appear at the hearing.

7. Items on the SSA-789 for the Social Security office use only

Complete only the items that apply. For items that do not apply, enter N/A (not applicable); do not leave these spaces blank.

a. FO code

Check the box next to the FO code and enter the code as follows:

  • Enter the servicing FO code.

  • If the individual files a request for reconsideration at a location that is not the individual's servicing FO, look up the servicing FO code using the Detailed Office/Organization Resource System (DOORS), and enter it on the SSA-789. For additional information on DOORS, see MS 01301.002 Detailed Office/Organization Resource System (DOORSMAINMENU)

  • Enter the International Program Service Center (INTPSC) code as the FO code for foreign claims.

b. Benefit continuation

Check the box next to, ‘Benefit Continuation,’ if the individual's benefit payments will continue.

c. Foreign language notices

Check the box next to, ‘Foreign Language Notice,’ if the individual or applicant meets the criteria for receiving this notice (for example, only speaks Spanish). Notate the desired language in the designated space.

C.  Additional references:

DI 12026.022 Completion of the SSA-773-U4 Waiver of Right to Appear - Disability Hearing

A. Overview of the SSA-773-U4

The SSA-773-U4 allows the individual or an appointed representative to waive the right to appear at the disability hearing. As described on the form, explain to the individual the consequences of not appearing.

IMPORTANT: The individual must understand that filing the waiver does not waive the disability hearing process, only the right to a personal appearance at the hearing. If the individual waives his or her right to appear at the hearing, the disability hearing officer (DHO) will base his or her reconsidered determination solely on the evidence in the case folder. The individual can reverse the waiver anytime prior to the DHO's written reconsidered determination.

B. Completion of the SSA-773-U4

Complete the SSA-773-U4 as follows:

  1. 1. 

    Complete the name and Social Security Number (SSN) of the claimant following the same format used to complete the SSA-789 (Request for Reconsideration-Disability Cessation Right to Appear). For additional information on completing the SSA-789, see DI 12026.021 Completion of the SSA-789 Request for Reconsideration - Disability Cessation Right to Appear.

  2. 2. 

    Complete the type of benefit - Title II Social Security Disability Insurance (Disability) and/or Title XVI Supplemental Security Income (SSI).

  3. 3. 

    Complete the spouse information including SSN, only if SSI is involved.

  4. 4. 

    Ask the individual or his or her representative to sign the form, complete the address, telephone, and date boxes.

  5. 5. 

    Have the witnesses sign the form and complete the appropriate address information, if applicable.

NOTE: If the SSA-773-U4 is completed at the same time as either the SSA-789 or the SSA-770-U4, Notice Regarding Substitution of Party upon Death of Claimant - Reconsideration of Disability Cessation, complete only the name of claimant, the SSN, the signature, and the date on the SSA-773-U4, and attach it to the accompanying form(s).

 

DI 12026.026 Completion of the SSA-769-U4 Request for Change in Time/Place of Disability Hearing

A. Overview of the SSA-769-U4

The individual has the right to request a change in the time or place of a scheduled disability hearing; however, the disability hearing unit (DHU) decides whether to reschedule the hearing. The SSA-769-U4 allows the individual or an appointed representative to request a change in the time or place of a scheduled disability hearing or both.

B. Completing a request for changing a currently scheduled hearing

Complete the SSA-769-U4 as follows:

  1. 1. 

    Complete the identifying information following the same format used to complete the SSA-789 (Request for Reconsideration-Disability Cessation Right to Appear). For additional information on completing form SSA-789, see, DI 12026.021B.

  2. 2. 

    Complete the type of benefit - Title II Social Security Disability Insurance (Disability) and/or Title XVI Supplemental Security Income (SSI).

  3. 3. 

    Complete the identifying information of the appointed representative, if applicable.

  4. 4. 

    Complete the information regarding the scheduled hearing including the date, time, and location.

    • If a postponement is requested, the individual must indicate the number of days needed for the postponement.

    • If the request is for a change in location, specifically indicate the proposed new location and reason for the requested change.

  5. 5. 

    Enter the reason for the request. The DHU will not grant a postponement if the individual cannot show good cause. For additional information on reasons for requesting a change in time or place, see paragraph C, below.

  6. 6. 

    Ensure the individual or appointed representative completes the identifying information in the designated space and signs the form.

  7. 7. 

    Witnesses’ signature are only required if the individual signs his or her name with the mark ‘X.’ If this occurs, the witness(es) must sign in the designated spaces, providing his or her name, address, area code and telephone number.

  8. 8. 

    Notify the DHU by telephone if the individual requests to reschedule a hearing fewer than 10 days before the scheduled hearing date. For additional information, see, DI 33010.005E Scheduling, Postponing, Changing Place of Disability Hearing.

C. Reason for the request

  1. 1. 

    Good cause

    The DHU will not grant a request to postpone or change the time of a hearing unless the individual can show good cause. The individual should state specifically his or her reason for requesting a change in the time or location of a hearing. For example, “I am scheduled to go into the hospital that week, and the facility is outside of my town,” or “I have a new doctor giving me extra tests that will not be completed until ____.”

  2. 2. 

    Change in a specific date or time

    Inform the individual that the DHU may not be able to accommodate requests for changes in specific dates or times. For additional information regarding ‘good cause’ reasons to postpone or change the date or time of a disability hearing, see:

  • DI 33010.040 Transfer of Case to a Different DHU and,

  • DI 33010.005E Scheduling, Postponing, Canceling or Changing Place of Disability Hearing

    Note: To the extent possible, the DHU will make every attempt to grant requests for changes in a hearing location. However, no reimbursement is available for additional travel due to changes in the hearing location.

DI 12026.027 Completion of the SSA-770-U4 Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation

A. Overview of the SSA-770-U4

The SSA-770-U4 allows a substitute party to pursue the appeal of a deceased individual. For more information on the substitution of party, see DI 29005.025 Individual Dies before a Determination is made on a Request for Reconsideration Continuing Disability Review (CDR).

Complete the SSA-770-U4 as follows:

  1. 1. 

    Complete the identifying information about the deceased and check the appropriate box to indicate the substitute party’s relationship to the deceased.

  2. 2. 

    Check the appropriate box if the substitute party has in his or her care the deceased’s child(ren) under age18, (or an eligible student) or disabled child.

  3. 3. 

    Check the appropriate box whether the substitute party wishes to proceed or does not wish to proceed with a reconsideration requested by the deceased. For additional instructions on completing this response, see paragraphs C and D below.

  4. 4. 

    Have the substitute party sign the form, print his or her full name, complete the mailing address, telephone number, and date, where designated.

  5. 5. 

    If the substitute party signs by a mark ‘X,’ two witnesses must sign the form and complete the address information where designated.

B. Substitute party wishes to proceed with the reconsideration of the disability cessation

The individual recognized as a substitute party to the reconsideration must choose at least one of the three selections and submit the SSA-770-U4. Check box 1 on the form. In addition, check box 'a,' 'b,' or 'c,' as indicated on the form.

  1. 1. 

    The substitute party indicates he or she will attend the disability hearing already scheduled. If the substitute party would like to attend the hearing already scheduled, he or she will select, ‘a’ on the SSA-770-U4.

  2. 2. 

    The substitute party requests a change in the scheduled hearing . If the substitute party requests a change in the time or place of the scheduled hearing, he or she will select, ‘b’ on the SSA-770-U4. Handle a request to change a scheduled hearing by a substitute party as follows

    • Attach form SSA-769-U4 (Request For Change In Time/Place of Disability Hearing)

    • Complete the appropriate information on behalf of the deceased claimant and the substitute party in the designated spaces.

    • Inform the substitute party that he or she will receive notification of the change in time or place of the disability hearing if approved by a representative of the Disability Hearing Unit (DHU).

  3. 3. 

    The substitute party indicates he or she does not wish to attend the disability hearing . If the substitute party does not wish to attend the disability hearing, he or she will select 'c' on the SSA-770-U4. Take the following actions:

    • Inform the substitute party of the consequences concerning the request to not attend the hearing and have him or her sign form SSA-773-U4 (Waiver of Right to Appear-Disability Hearing).

    • Attach the SSA-773-U4 with only the deceased claimant's name and social security number (SSN).

    • Inform the substitute party that he or she will receive notification of the reconsideration determination.

C. Substitute party states that he or she wants to withdraw the reconsideration request

If the individual does not wish to proceed with the reconsideration of a disability cessation requested by the deceased, check box 2. Take the following actions:

  1. 1. 

    Inform the substitute party of his or her potential liability for an overpayment as well as his or her eligibility for a potential underpayment that may result from the reconsideration decision.

  2. 2. 

    Attach the SSA-773-U4 with only the deceased claimant's name and SSN.

  3. 3. 

    Inform the substitute party that unless the overpayment is $200 or more, recovery of an overpayment from a deceased claimant's estate is not considered. If, after the explanation, the substitute party is not interested in pursuing the reconsideration, have him or her complete the appropriate box on the SSA-770-U4 . For additional information regarding a claimant’s potential liability of overpayment and eligibility for an underpayment, see:

  • DI 11055.050 Claimant Dies after Filing and Prior to a Disability Determination and,

  • DI 23020.010 Potential or Actual Overpayment Cases

DI 12026.030 Field Office (FO) Actions after the Reconsideration Continuing Disability Review (CDR) Determination

A. FO receives folder

After completing the reconsideration determination, the disability hearing officer (DHO) returns the case folder to the servicing FO. FOs responsible for processing appeals using electronic continuing disability review (eCDR) should refer to DI 81010.255 Electronic Continuing Disability Review (eCDR) Cessation Reconsiderations.

B. References

  • DI 81010.255 Electronic Continuing Disability Review (eCDR) Cessation Reconsiderations

  • DI 81020.255 Processing a Reconsideration Appeal of an Electronic Continuing Disability (eCDR) Cessation


DI 12026 TN 4 - Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI - 2/25/2020