PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 265 – Initial Case ProcessingSubchapter 35 – Notice InstructionsTransmittal No. 9, 03/21/2024
Audience
Originating Component
ODP
Effective Date
Upon Receipt
Background
This transmittal revisions apply to claimant correspondence and notices for initial level claims at the initial and reconsideration level. We provide definitions, roles and responsibilities for individuals we may correspond with during the initial and reconsideration claims process.
Summary of Changes
DI 26535.042 Recipients of Correspondence and Notices-Initial claims
Updated the section title to specify "initial claims".
The revised claimant definition removes additional terms as "interchangeable".
The revised representative payee definition clarifies the rep payee roles and responsibilities.
Added an "important" reminder regarding ARs after each table.
The revised table column headings specify the guidance is for initial and subsequent claims.
The revised table includes a "notice" column that clarifies when other individuals receive notices in initial and subsequent claims.
The table guidance is revised for payees.
CITATIONS:
Instructions in this section apply to claimant correspondence and notices for initial level claims at the initial and reconsideration level. As indicated in DI 26535.042C, in this section, we communicate with claimants, and other individuals, as defined in DI 26535.042B, in this section, who may have a duty or responsibility to act on behalf of or help the claimant or beneficiary in the disability claims process.
An individual claiming a right under the Title II or Title XVI benefits program.
NOTE: In some instances, the claimant may also be the proper applicant, a beneficiary, or a recipient.
An individual who has the right to sign a valid application on behalf of themselves or on behalf the claimant.
For more information on proper applicants, see GN 00204.003.
An individual the claimant appoints to represent them in their business before the Social Security Administration (SSA) (i.e., to act on the claimant's behalf and pursue the claimant's interests).
For more information on representation of claimants, see DI 31001.001.
An incompetent adult is an individual who has been the subject of a judicial finding of incompetency.
For more information on a legally incompetent adult, see GN 00204.003.
For more information on legal guardians, see DI 26535.042A.6, in this section.
An individual or entity responsible for managing Social Security benefits or payments of a beneficiary or recipient who is determined incapable of managing or directing the management of their own benefits.
IMPORTANT:
We may only disclose information to payees that the individual needs to perform the duties of a payee (e.g., to receive and disburse or conserve the beneficiary’s Social Security benefits). A representative payee does not have the same rights as a legal guardian unless they are also the legal guardian.
For additional information about disclosure and modified notices to payees, see GN 03316.120 and NL 00603.025A.2.
For more information on payee responsibilities and duties, see GN 00502.114.
An individual appointed by a state court to manage the affairs of an individual who is not able to do so. However, the appointment of a legal guardian or conservator does not necessarily mean the person is legally incompetent. Rather, as noted in DI 26535.042B.4, in this section, we consider a person to be legally incompetent when a state court has issued an order stating that the individual is legally incompetent.
For more information on the role of the legal guardian or conservator, see GN 00502.139A.1.
In some instances, other individuals or entities who have a duty or responsibility to act on behalf of or to assist a claimant or beneficiary must receive correspondence or notices that the claimant also receives to fulfill the duty they have to the claimant.
An adult claimant, including individuals who have attained age 18 in an age-18 redetermination case, is the primary recipient of correspondence and notices.
Adult claimants
If the initial or subsequent claim involves
Correspondence Copy
Notice
Proper Applicant who is NOT a claimant, Payee, or AR
No
Payee
see NOTE
AR
Yes
NOTE:
The Payee receives a modified copy of the notice. For more information, see NL 00603.025A.2.
IMPORTANT: ARs must be currently appointed to receive correspondence and notices; for more information, see DI 31001.001 or GN 03305.025.
For claimants under age 18, the primary recipient of correspondence and notices is the parent or legal guardian. For adult claimants with a legal guardian, the primary recipient of correspondence and notices is the legal guardian.
Child claimants and adult claimants with a legal guardian