Identification Number:
GN 03102 TN 8
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Reconsideration (Title II and Entitlement Under Title XVIII)
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 031 – Appeals
Subchapter 02 – Reconsideration (Title II and Entitlement Under Title XVIII)
Transmittal No. 8, 07/26/2021

Audience

PSC: BA, CA, CS, DE, DS, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BIES, CR, CTE, FCR, FDE, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BTE, CR, CST, CTE, CTE TE, DE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: REF;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DT, 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.

Summary of Changes

GN 03102.100 The Reconsideration Process

We capitalized “title” when referring to Title II or Title XVI or Title XVIII.

In GN 03102.100C.7, we deleted parenthesis and added comma.

In GN 03102.100C.10, we deleted “or submits additional evidence”.

In GN 03102.100D, we added “(PE)”.

GN 03102.175 Component Responsibility in the Reconsideration Process

In GN 03102.175B.1.c, we deleted parenthesis and added comma. We also corrected the query name to “MS 03504.002”.

In GN 03102.175B.2, we deleted period and changed “field office” to “FO”.

In GN 03102.175B.3, we deleted parenthesis and added comma.

In GN 031020.175B.6, we deleted parenthesis and added comma. We also deleted “with the exception of Prototype States, where the first level of appeal is the hearing and not the reconsideration see DI 12015.100B and DI 12015.100D.”

In GN 031020.175B.7, we changed “field offices” to “FO”. We also changed the period to comma and changed “See” to “see”.

GN 03102.200 Claimant Requests Reconsideration

We capitalized “title” when referring to Title II.

In GN 03102.200A.1, we spelled out acronym DDS.

In GN 03102.200A.3, we added eCDR.

In GN 03102.200B.2, we added SP and added “or to the appropriate DDS.”

In GN 03102.200B.5, we deleted “Disability Determination Services” and parenthesis.

In GN 03102.200C, we corrected the query name to “MS 03504.002”.

GN 03102.300 FO Reconsideration Development of Request for Reconsideration

We spelled out acronym “FO”.

We capitalized “title” when referring to Title II.

In GN 03102.300B.1, we spelled out acronym “RPOC”

In GN 03102.300B.3, we spelled out acronym “PC” and “DDS”.

In GN 03102.300B.5.a, we added a period and deleted extra space.

In GN 03102.300B.5.c, we spelled out acronym “GLPSC”.

In GN 03102.300B.5.e, we changed the period to comma and changed “See” to “see”.

GN 03102.325 PC Reconsideration Processing Procedures

We spelled out acronym “PC”.

In GN 03102.325B.4, we changed “authorizer (CA)” to “specialist (CS)”.

In GN 03102.325B.5, we spelled out acronym “OGC”.

In GN 03102.325B.6 and GN 03102.325B.7, we changed the period to comma and changed “See” to “see”.

GN 03102.350 Claimant Sends Reconsideration Request to PC — Procedure

We spelled out acronym “PC” and “FO”.

We changed the period to comma and changed “See” to “see”.

GN 03102.400 Reconsideration of Claims Involving Railroad Compensation — Procedure

In GN 03102.400A, we spelled out acronym “RRB” and changed the font “she”.

In GN 03102.400C, we spelled out acronym “PC”.

In GN 03102.400D, we spelled out acronym “GLPSC” and capitalized “title” when referring to Title II.

GN 03102.425 Reconsideration Notices of Determination

In GN 03102.425A.1, we changed “Disability Adjudication and Review (ODAR)” to “Hearings Operations (OHO)”. We spelled out acronym “ALJ” and “AC”.

In GN 03102.425A.2, we spelled out “RECON SGA”.

In GN 03102.425B.1, we changed the period to comma and changed “See” to “see”. We also changed “-General” to “for Claims”.

In GN 03102.425D, we corrected the query name to “MS 03510.001”.

GN 03102.450 Form SSA-662, Reconsideration Determination

We spelled out acronym “RECON SGA”.

GN 03102.475 New Claim, Evidence or Correspondence Involving Identical Issue Received After Reconsideration

In GN 03102.475A, we spelled out acronym “FO” and “PC”.

In GN 03102.475C.1, we deleted parenthesis and added comma.

In GN 03102.475C.2, added a multilevel list “a” and “b”.

GN 03102.500 MCS (Modernized Claims System) Claims - Reconsiderations

We corrected the query name to “MS 03504.002”.

We changed “Refer to MSOM MCS 010.001 for an overview of MCS reconsiderations.” To “MSOM MS 03510.001 Title II Appeals Screens – Overview”.

 

GN 03102.100 The Reconsideration Process

A. Introduction to the reconsideration process

This subchapter contains general policies and procedures for developing and processing reconsideration requests under Title II and reconsideration requests on Medicare entitlement under Title XVIII. For appeal policies and procedures for other issues, see the following instructions:

  • for Title XVI reconsiderations, see SI 04020.000,

  • for reconsiderations of medical denials, see DI 81010.150,

  • for reconsideration of benefits for special veterans, see VB 02502.001,

  • for the Centers for Medicare and Medicaid Services (CMS) processing of appeals of the amount paid or covered services for Medicare Parts A and B, see HI 00208.070 and HI 01205.005,

  • for appeals of Medicare Income Related Monthly Adjustment Amounts (IRMAA), see HI 01140.000, and for the appeal process for Medicare Part D subsidy determination, see HI 03040.001.

B. Definitions for the reconsideration process

1. Reconsideration

Reconsideration is the mandatory first step in the administrative review process that the Social Security Administration (SSA) provides to a claimant dissatisfied with an initial determination. Exceptions to the mandatory reconsideration step and in which a hearing is the first level of review are listed in 20 CFR 404.930(a) (2), (6), and (7).

Reconsideration involves a thorough reexamination of all evidence on record. The person reviewing the case will make the reconsideration determination based on all evidence used in the initial determination and any additional evidence or information submitted with the appeal. The reviewer must not have been involved in the initial determination.

2. Processing Centers (PC)

PC refers to all program service centers (PSC), the Office of Disability Operations (ODO), and the Office of Central Operations (OCO). For a list of Title II non-medical reconsideration requests that are the jurisdiction of the PCs, refer to GN 03102.175B.

C. Policy for reconsideration requests

1. Who has the right to a reconsideration

Any party to the initial determination or any party who shows in writing that his or her rights may be adversely affected by the initial determination has the right to a reconsideration. For more information about the appeal of an initial determination, see GN 03101.040.

2. Who may request a reconsideration

The claimant, his or her appointed representative, representative payee, or other third party on behalf of the claimant can file a request for reconsideration. The SSA employee must provide to the claimant a copy of the request for reconsideration as notification that SSA received the appeal.

NOTE: Effective March 16, 2012, appointed representatives have the affirmative duty to use the iAppeals (i561 (Internet Request for Reconsideration), i501 (Internet Request for Hearing by Administrative Law Judge), and i3441 (Internet Disability Report-Appeal)) application to file a request for reconsideration or a request for hearing on a medically denied claim if they request direct fee payment on that matter. For more information on the policy on affirmative duties for representatives, see GN 03970.010B.

3. What constitutes a writing for a reconsideration request

Any writing (SSA-561-U2, letter, facsimile, or email) or timely submission of additional evidence after receiving a notice of initial determination by the claimant, his or her representative payee, or his or her appointed representative which clearly implies disagreement with the initial determination constitutes a request for reconsideration. A signature is not required on a written request for reconsideration.

A claimant may submit the iAppeals i561 to request a reconsideration for a medical or non-medical issue. For information on the iAppeals process for Title II claims, see GN 03101.125 and GN 03101.127.

A request for reconsideration must be in writing. An oral inquiry such as a phone call to the national 800 number network or to a field office (FO) to request forms is not a valid request for reconsideration and does not protect the date of an appeal.

4. What is not a request for reconsideration

A mere request for information or an explanation of SSA’s determination does not constitute a request for reconsideration.

Actions that are not initial determinations are not subject to reconsideration. For examples of actions that are not initial determinations, see GN 03101.080.

5. Dismissal of a request for reconsideration

Dismissal of a request for reconsideration is the rejection of or refusal to accept the request. The action makes the prior determination the final determination of the Commissioner. A dismissal is not subject to appeal. For more information on grounds for dismissal of an appeal, see GN 03102.200B.

6. Time period to request reconsideration

The appeal period is generally 60 days. The 60 days start the day after the individual receives the notice of the determination or decision. SSA presumes the date that the individual receives the notice is 5 days after the date on the notice, unless the individual can show us that he or she did not receive the notice within the 5 days.

Exceptions:

  • Do not add 5 days for mailing when you hand the notice to the claimant.

  • Extend the time to include the next full workday when the period for requesting the appeal ends on a Saturday, Sunday, legal holiday or any other day, all or part of, which is a non-workday for Federal employees.

  • Use the stamp cancellation or “postmark” date on the envelope for a mailed appeal if the receipt date would result in the loss or lessening of the claimant’s rights or benefits. If the postmark is unreadable or there is no postmark, we consider the appeal timely filed if we receive it by the 70th day after the date on the notice of the determination or decision. For instructions on good cause for extending the appeal period, see GN 03101.020.

7. Where to submit a request for reconsideration

A claimant can submit a request for reconsideration to any SSA office, Veterans Administration Regional Office in the Philippines, or any Railroad Retirement Board Office if the claimant has at least 10 or more years or after December 31, 1995 has at least 5 years of railroad service, see RS 01601.110A.1.

8. SSA cannot reconsider an initial determination on its own motion

SSA may not reconsider a determination on its own motion. However, without a request from the claimant, SSA may correct an error in an initial determination under the rules of administrative finality. For more information on administrative finality, see GN 04001.000.

9. Reconsideration filed early

a. Initial determination not made

Send the claimant a letter that explains that we have not made a decision and that he or she can file an appeal after we make a decision. See the exhibit letter for an appeal requested before a decision is made on a case in NL 00703.470.

b. Notice pending release or in transit

If a notice is pending release or is in transit, e.g., SSA made the initial determination and the notice appears on Online Retrieval System (ORS), but the claimant has not received it, accept the appeal.

10. Reconsideration filed late

a. Claimant submits request for reconsideration after the 60–day period for requesting reconsideration

Accept the request for reconsideration. SSA may extend the time limit for requesting a reconsideration if the request for an extension is in writing and the claimant shows good cause for missing the time limit. In most cases, the component responsible for making the reconsideration determination will make the good cause determination. The claimant cannot appeal a determination where SSA did not find good cause. For instructions on obtaining and processing a good cause statement, see GN 03101.020.

b. Claimant submits additional evidence after the 60–day period for requesting reconsideration

Accept the evidence and develop for good cause. See GN 03101.020 for instructions on obtaining and processing a good cause statement.

11. Notice of reconsidered determination

The notice advises the claimant of the determination and its basis, and informs him or her of the right to a hearing. If appropriate, an explanation of the Expedited Appeals Process is included. For instructions on reconsideration notices of determination, see GN 03102.425. For instructions on the expedited appeals process, see GN 03107.100.

D. References

GN 03102.175 Component Responsibility in the Reconsideration Process

A. Background

This section defines component responsibility for processing requests for non-medical reconsiderations under Title II and reconsiderations under Title XVIII of the Social Security Act.

See Also

Appeal policies and procedures specific to a particular benefit are in the following references:

B. Policy for jurisdiction and component responsibility

1. Field Office (FO)

The FO is responsible for:

  1. a) 

    Explaining the reconsideration process.

  2. b) 

    Interviewing and assisting the claimant in filing the request for reconsideration.

  3. c) 

    Establishing the reconsideration on MCS for claims that are not MCS exclusions, see GN 03102.500 and MSOM MS 03504.002. The writing and document may be attached to the claims folder copy of the appeal form, for paper appeals see GN 03102.100.

  4. d) 

    Processing to completion the following kinds of reconsiderations:

2. Processing Center (PC)

The PC is responsible for processing all other non-medical reconsideration requests not listed in GN 03102.175B.1.d for the following:

  • RSI claims;

  • Medicare entitlement under Title XVIII;

  • DIB claims (age 54 and older);

  • DWB claims (age 54 and older);

  • CDB claims filed on a RIB account and CDB claims filed on a DIB account age 54 and older;

  • DWB claims disallowed for non-medical reasons;

  • Overpayments;

  • Waivers;

  • Post-entitlement issues.

NOTE: PCs are responsible for processing IRMAA reconsideration requests received directly from beneficiaries and requests transferred from the FO to the PC. When a PC receives a case from the FO, the PC determines if a manual action is required due to a processing limitation such as LESSDO. If no action has been taken by the FO and it appears the case was transferred in error, process the request and contact the FO to direct them to the instructions contained in HI 01140.005.

The PC receives reconsideration referrals from the FO through the Detailed Office and Organization Resource System (DOORS).

3. Great Lakes Program Service Center (GLPSC)

The GLPSC Disability Processing Branch processes reconsideration requests on career Railroad Retirement Board (RRB) disability cases, see DI 12045.065 and DI 11010.262.

4. Office of Disability Operations (ODO)

ODO reconsiders:

  • Non-medical issues on disability claims when the number holder (NH) is under age 54.

  • Non-medical issues on disability claims not specified as PC 1 through 6 jurisdictions.

  • Medicare Part A and Part B entitlement determinations relating to chronic renal disease.

5. Office of Earnings Operations (OEO)

OEO reconsiders earnings discrepancies forwarded by the FO or PC. For information about other components that may process reconsideration requests for earnings discrepancies, see RS 01405.005B.2.

6. Disability Determination Service (DDS)

DDS reconsiders medical determinations on initial claims, see DI 20101.010 and DI 12005.010.

The DDS Disability Hearing Unit (DHU) reconsiders medical cessations see DI 33000.000.

7. Office of International Operations (OIO)

OIO primarily serves claimants and beneficiaries residing outside the United States and processes reconsiderations in those instances. However, some claimants with Canadian addresses are serviced by FO on the northern border of the U.S, see Identification of Designated Border Offices GN 01715.320.

8. Subsidy Appeals Unit (SAU)

The appeal process for the Medicare Part D Subsidy determination does not include a reconsideration level of appeal. Instead, the appeal process for subsidy determinations consists of one formal SSA administrative step. The individual can choose a hearing by telephone or a case review. See Overview of Appeal Process for Medicare Part D Subsidy Determination HI 03040.001.

GN 03102.200 Claimant Requests Reconsideration

A. Responsibilities for handling Title II reconsideration requests

A claimant who is dissatisfied with an initial determination may request an appeal by either an online iAppeal submission or calling, visiting, or writing a field office (FO) or calling the national 800 number network (N8NN). N8NN agents handle the request per the instructions in TC 03001.020 Handling Appeal Requests. A wet signature is not required on an SSA-561-U2 (Request for Reconsideration) or any other written request for reconsideration. An oral request to appeal a determination or decision does not establish the required writing for an appeal.

1. Claimant walks into FO

  • If a claimant walks into the FO to request a reconsideration, per the instructions on interviewing a dissatisfied claimant in GN 03101.120, conduct the FO interview with the claimant. Include in the interview why the claimant is dissatisfied, explain the basis for the initial determination, the right to appeal, and the time limit for filing the appeal.

  • Assist the claimant with completing an SSA-561-U2 per the instructions in GN 03102.500 (Modernized Claim System---MCS) or GN 03102.225. For reconsiderations on medical denials, see DI 81010.150. For electronic continuing disability review (eCDR) medical cessations, see DI 81010.255.

  • Give the claimant the Document Processing System (DPS) reconsideration acknowledgment notice or a date stamped copy of the appeal request. This establishes the writing since a signature is not required on the reconsideration form.

  • Transfer a reconsideration that is not within the FO’s jurisdiction to the servicing processing center (PC) for processing or to the appropriate Disability Determination Service (DDS).

2. Claimant telephones the FO

  • If the claimant telephones the FO to request reconsideration, send the claimant an SSA-561-U2 to complete and return to the FO.

  • When the claimant returns the SSA-561-U2, if possible, establish the appeal request in MCS.

  • Send the claimant the DPS reconsideration acknowledgement notice or date stamped copy of the appeal request.

  • For reconsiderations on medical denials, see DI 81010.150. For eCDR medical cessations, see DI 81010.255.

  • Transfer a reconsideration that is not within the FO’s jurisdiction to the servicing PC for processing or to the appropriate DDS.

3. Claimant writes the FO

If the claimant submits his or her written appeal request via an iAppeal submission, mail, fax message, or email message, the FO takes the following actions:

  • Contacts the claimant for an interview to secure all needed information,

  • Establishes the appeal in MCS or establishes paper SSA-561-U2 for MCS exclusions and attaches a copy of the written request to any paper SSA-561-U2. For reconsiderations on medical denials, see DI 81010.150. For eCDR medical cessations, see DI 81010.255.

  • Sends the claimant the DPS reconsideration acknowledgment notice or a date stamped copy of the appeal request. This establishes the writing since a signature is not required on the reconsideration form.

  • Transfers a reconsideration that is not within the FO’s jurisdiction to the servicing PC for processing or to the appropriate DDS.

  • For information on an iAppeal submission, see GN 03101.125 and GN 03101.127.

B. Miscellaneous reconsideration situations

1. Request for reconsideration involves both Title II and Medicare issues

SSA is responsible for reconsideration requests on Medicare Parts A and B (Health Insurance/Supplemental Medical Insurance (HI/SMI)) entitlement. The Centers for Medicare and Medicaid Services (CMS) are responsible for reconsideration requests on Medicare benefit issues. If a claimant appeals a Medicare benefit issue at the time he or she appeals a Title II or HI/SMI entitlement issue, the FO assists him or her in completing a separate SSA-561-U2 for Title II and HI/SMI entitlement issue (s) and a CMS-2649 (Request for Reconsideration of part A Health Insurance Benefits) for Medicare benefit issues.

2. Reconsideration request from a claimant who speaks Spanish

If claimant visits the FO, ask him or her (his or her interpreter) to complete the Spanish version of Form SSA-561-U2-SP (see OS 15010.180). Translate into English on a regular Form SSA-561-U2, staple both forms together, and if appropriate send the forms to the PC with jurisdiction or to the appropriate DDS.

3. Grounds for dismissal of a request for reconsideration

SSA can dismiss a request for reconsideration for a number of reasons. Grounds for dismissing a request for reconsideration include, but are not limited to the following reasons:

  • request not based on an initial determination,

  • request filed by improper requestor,

  • request filed prematurely,

  • request filed late and good cause for late filing cannot be found, or

  • request filed on a SSA-561-U2 when it is clear that the individual only intended to request information, reduction of the overpayment recovery amount, or waiver of the overpayment.

4. Claimant asks to withdraw request for reconsideration

Advise the claimant that a reconsideration is a prerequisite for an administrative law judge (ALJ) hearing, and that if he or she withdraws the request, he or she will lose all future appeal rights on the claim or issue and that the initial determination becomes final. If the claimant decides to withdraw his or her request for reconsideration, advise him or her that the withdrawal request must be in writing and include the following information:

  • number holder’s name and social security number,

  • the claimant's name,

  • a statement of why the claimant wishes to withdraw the reconsideration, and

  • a statement that the claimant fully understands the effect of the withdrawal.

If appropriate, send the withdrawal request to the PC with jurisdiction of the request for reconsideration. For more information on component responsibility in the reconsideration process, see GN 03102.175.

NOTE: Never suggest to a claimant that he or she withdraw his or her request for reconsideration. Do not accept a withdrawal of a reconsideration request if doubt exists about the correctness of a benefit payment made.

5. Claimant dies while the request for reconsideration is pending

Determine if there is a person who may be entitled or adversely affected by the determination under appeal.

  • If you identify another party to the appeal, ask the person if he or she wishes to proceed with the request for reconsideration. If the person does not wish to pursue the appeal, obtain a signed statement from the person indicating he or she fully understands the effect, if any, of not pursuing the reconsideration.

  • For reconsiderations under the jurisdiction of a PC, contact the PC to report the claimant's death, and advise whether a substitute person wishes to pursue the request for reconsideration. Contact the DDS for reconsiderations under their jurisdiction.

C. References


GN 03102.300 Field Office (FO) Reconsideration Development of Request for Reconsideration

A. Policy

Before transferring the reconsideration ensure all issues are developed.

B. Procedure

Claimant is primarily responsible for submitting all pertinent evidence.

1. Developing evidence

Ask for all the evidence the claimant has or can obtain and fully develop questions raised by the claimant.

Document evidence requested but not obtained on Report of Contact (RPOC) outlining efforts to obtain that evidence.

Request any prior folder needed via email or administrative message.

Forward reconsideration request with related development to the appropriate office.

For recording evidence electronically, see Related Business Process Information, GN 00301.328.

2. Additional evidence not received

a. From the claimant

Send a letter informing the claimant that unless he or she submits the evidence within 10 days plus 5 days mail time or contacts the FO to explain the delay, we will forward the case to the appropriate office for a determination based on available evidence.

b. From other source

Request claimant to obtain the evidence if other source (e.g., employer, relative) refuses or does not respond within 10 business days of the request.

3. Processing Center (PC), Disability Determination Service (DDS) requests for additional evidence

Handle requests promptly and send a status report if the evidence is not sent within 15 business days.

4. Developing other factors of entitlement

Develop if it appears additional development may result in favorable action on contested issue.

5. Special issues

a. Accuracy of earnings record

  • Obtain a copy of the earnings record and review it with the claimant.

  • Provide a thorough explanation of the determination.

  • Obtain a signed statement from the claimant indicating his/her agreement or disagreement with the correctness of the earnings record.

  • Give claimant an SSA-561-U2 to complete if claimant still wishes to file a reconsideration.

  • Explore any disagreement and document findings on an RPOC and attach to the SSA-561-U2.

  • Refer to RM 03870.001 to determine when additional development may be necessary.

b. Federal employment involved

Refer to procedures in RS 01901.340.

c. Railroad Retirement Board (RRB) cases

Send to RRB if annuitant is not entitled to monthly social security benefits.

Railroad Retirement Board
Critical Case and Reconsideration (CCR) Section
844 Rush Street
Chicago, IL 60611

NOTE: A decision to transfer a claim to RRB is not an initial determination and cannot be appealed.

Advise claimants who telephone to contact the RRB. If claimant insists SSA make a determination on his/her application for Title II benefits, send request to Great Lakes Program Service Center (GLPSC).

d. Veteran's benefits

If SSA was unable to make certification to the Veteran's Administration because the claimant did not meet some Title II requirement other than insured status, the claim is disallowed under Title II and the claimant has a right to reconsideration.

Follow current reconsideration processing procedures.

e. Reconsideration of support determination when no claim is filed

Send the request for reconsideration to Office of Earnings Operations (OEO) to associate with the proof of support file. OEO will forward to the PC for reconsideration, see RS 01301.000.

GN 03102.325 Processing Center (PC) Reconsideration Processing Procedures

A. Policy

The Reconsideration Reviewer or Senior Claims Processing Specialist will review or develop only evidence which is necessary to render a correct reconsideration determination of the issue(s) being protested (and any other entitlement issues).

B. Procedure

1. Acknowledge Request

The PC will send a notice modeled after acknowledging receipt of appeal if the PC receives a reconsideration request directly.

2. Claimant Requests Information

If the claimant is merely asking for information, do not process as an appeal.

Send a letter to the claimant responding to the request for information and include a statement that the claimant should let us know if he or she was also asking that we take an appeal.

If the SSA-561-U2 is only requesting information, dismiss the reconsideration request and then provide the requested information to the individual.

3. Request Dismissed

If the request is dismissed because it was not timely filed, there was no good cause, or the contested issue was not an initial determination, send a dismissal notice explaining the reason(s) for dismissal. Do not include the appeal paragraph because a dismissal is final and cannot be appealed.

4. Developing Unrelated Issues

Develop the issue if it will not delay issuing the reconsideration determination. Otherwise:

  • Issue the reconsideration determination;

  • Refer the case to a claims specialist (CS) and document reason for the referral;

  • Request the CS to effectuate the reconsideration determination, resolve the issue, and prepare any necessary notices.

5. Delayed Determination

If the case will not be reviewed within 30 days of last contact with the claimant or the issue involves a question under consideration by Office of the General Counsel (OGC), or other component, notify the claimant that his or her case is being reconsidered and that we will send a notice when a determination is made.

If the case involves reconsideration of an overpayment determination and/or waiver relief and claimant's benefits are currently withheld to recover the overpayment in question, notify the claimant that:

  • his or her case is being reconsidered;

  • benefits will be resumed starting with current operating month;

  • benefits already withheld will still be withheld until all issues are resolved; and

  • we will send a notice when a determination is made.

6. Withdrawal Of Request For Reconsideration

Notify the claimant of the decision. If the request is approved, inform claimant that withdrawal can be canceled by filing a written request with SSA within 60 days after date claimant receives this notice, see GN 03102.200B.4.

7. Claimant Dies

In the event of claimant death, process the death termination. If there are no other parties, dismiss the request for reconsideration unless there is an overpayment on the record with no waiver request. A reconsidered determination should be rendered since recovery from the estate is possible, see GN 03102.200B.5.

 

GN 03102.350 Claimant Sends Reconsideration Request to Processing Center (PC) — Procedure

A. Acknowledge Request

See GN 03102.325B.1 for acknowledging request. Inform field office (FO) of request. Ask the FO to interview the claimant if the basis for the request is not clear or to send a copy of the report of interview if the FO had an interview with the claimant regarding the issue after the claimant received the notice of initial determination.

B. Medical Issue Involved

Send the request to the Disability Processing Branch for resolution and proper referral out of the PC, see DI 12005.001.

GN 03102.400 Reconsideration of Claims Involving Railroad Compensation — Procedure

A. Railroad Retirement Board (RRB) Verification

If an individual who has less than 120 service months or less than 60 service months after December 31, 1995 files for reconsideration claiming he/she has additional RRB compensation that can be used by SSA, send the relevant material from the system and/or the file to RRB for a determination using the following address.

Railroad Retirement Board
Attention: Chief, Certification Division
844 Rush Street
Chicago, IL 60611

B. No Additional Compensation

If no additional compensation is established, RRB will send an explanatory letter to claimant and include copy for our files.

Do not send an additional letter to the claimant unless request also includes issues other than RRB compensation.

C. Additional Compensation

If RRB development establishes additional compensation, RRB will prepare a recertification of its records and notify the Processing Center (PC). The PC will take any necessary action based on the recertification.

D. Great Lakes Program Service Center (GLPSC) Only

If a claimant, who is not entitled to social security benefits because RRB has survivor jurisdiction, insists SSA make a determination on his/her application for Title II benefits, request that RRB verify the survivor jurisdiction determination previously provided. Only RRB has the authority to make a survivor jurisdiction determination (RS 01601.100B.9). Any evidence the claimant may furnish, e.g., evidence of non-RRB employment which might break the current connection, should be forwarded to RRB. If RRB verifies that a survivor's annuity or lump-sum death payment is, will, or could have been payable under the RRB, disallow the claim and treat as an initial and a reconsideration determination. Inform claimant in the letter of the right to hearing.

GN 03102.425 Reconsideration Notices of Determination

A. Procedure - initial determination affirmed

1. Non-disability issue—Processing Center (PC) actions

  • Prepare Form SSA-662 (Reconsideration Determination) or the equivalent. For instructions on how to complete the SSA-662 or an equivalent, see GN 03102.450.

  • Prepare the transmittal letter in NL 00703.474 (Reconsideration Affirmation of Prior Decision).

  • Enclose the Office of Hearings Operations (OHO) pamphlet, “Your Right to an Administrative Law Judge Hearing and Appeals Council Review of Your Social Security Case” (SSA Pub 70-10281). Show as an enclosure on the transmittal letter except as provided below.

    EXCEPTION: The OHO pamphlet is not applicable to Medicare entitlement claims denied for non-medical reasons or to foreign claimants.

  • Send the original notice of reconsideration determination to the claimant with the transmittal letter.

    NOTE: It is no longer necessary to prepare copies of the notice for the folder or the Field Office (FO) if the notice is available on the Online Retrieval System (ORS).

  • Date all copies of the notice so that it can be determined whether the time limits for filing an appeal are met, and to facilitate computing the time periods involved for reopening and revising under the rules of administrative finality.

2. Disability issue in Retirement and Survivors Insurance (RSI) case—PC actions

  • Incorporate the language furnished by the disability component in the reconsideration determination.

  • Prepare a letter instead of the SSA-662 if the disability language does not fit into the determination.

  • Follow procedures in GN 03102.425A.1 in this section.

    NOTE: To prepare reconsideration substantial gainful activity (SGA) Affirmation notices, see DI 13010.145.

B. Procedure - initial determination reversed

1. Special determinations—PC actions

  • Prepare a Special Determination, see Special Determinations for Claims Adjudication, GN 01010.360. Explain the reasons and evidence used to revise the initial determination.

    NOTE: The Reconsideration Reviewer or Senior Claims Processing Specialist is responsible for adding or modifying paragraphs in the Special Determination.

  • Make a copy for the FO and the claims folder if not available on ORS.

  • Prepare a letter with the reconsideration paragraph for notices of revised or reversed determinations on other claims issues and post-adjudication issues (e.g., earnings discrepancies, work deductions).

  • Effectuate the revised/reversed determination.

2. Informing the claimant of a reversal

An award certificate or letter informs the claimant of a reversed determination on a claim previously disallowed or denied.

NOTE: Verify claimant direct deposit, address, and phone information prior to effectuating appeal decisions. Include language in the notice similar to paragraph DID029 reminding claimant to notify SSA of direct deposit and address changes.

C. Procedure for posting reconsideration determinations

After you complete the reconsideration screens, the Modernized Claim System (MCS) displays the Appeal Disposition (DISP) for completion. This screen records information on the reconsideration determination.

If the reconsideration determination is not on ORS, send a copy to the servicing FO. In addition, post a Master Beneficiary Record (MBR) special message to alert any component, including 800 number agents, of the disposition of the reconsideration request.

D. Reference

MSOM MS 03510.001 - Title II Appeals Screens-Overview

GN 03102.450 Form SSA-662, Reconsideration Determination

A. Procedure

Include the following when preparing the SSA-662 or an equivalent:

  • statement of jurisdictional factors — filing of application, date of notice of initial determination, date of request for reconsideration;

  • basis of request for reconsideration;

  • statement of issues;

  • brief nontechnical statement of the applicable provisions of the law and regulation;

  • statement of the facts and evidence as presented;

  • findings of fact;

  • conclusions based on findings of fact and applicable law and regulations.

If the claimant failed to respond to a request for additional evidence, include a statement that the decision was made without the benefit of any additional evidence which might have supported his or her position.

NOTE: To prepare reconsideration substantial gainful activity (SGA) Affirmation notices, see DI 13010.145.

B. Exhibit - SSA-662 (Reconsideration Determination)

 

To view this form, go to SSA-662.

GN 03102.475 New Claim, Evidence or Correspondence Involving Identical Issue Received After Reconsideration

A. Introduction

This section explains the actions to take when a claimant after reconsideration files a new application, submits additional evidence or writes to the field office (FO) or Processing Center (PC) instead of requesting a hearing.

B. Policy

PC will review the case in light of the new application, new evidence, and/ or the correspondence and determine the action to take.

C. Procedure

1. New Application filed - no new and material evidence and no change in law or regulations

Apply the doctrine of res judicata, see GN 03101.160 and GN 04040.010.

Advise claimant that new application involves the same issue and is based on the same facts and law as the previous application; therefore, the prior determination is binding on that issue.

Inform claimant of right to reconsideration on whether the issue is the same as that previously determined.

If the reconsideration determination is that the issue is the one previously determined, advise the claimant of the right to a hearing on whether the issue is the same as that previously determined.

2. Additional evidence received - reconsideration affirmed

a. Time Limit for Requesting a Hearing Has Not Expired.

Send the claimant a letter explaining reasons for the reconsideration determination that affirmed the initial determination and advise of the right to appeal and the time limit for filing an appeal. When additional evidence indicates that the claimant disagrees with the reconsideration determination, refer to GN 03103.010B.4.

b. Time Limit for Requesting a Hearing Has Expired.

Refer to GN 03101.020 for the rules on extending time limit for good cause.

3. Reconsideration determination - reopening and revising

If the reconsideration determination should be reopened and revised under the rules of administrative finality, take the appropriate action and include the appropriate hearing paragraph.

See GN 04001.000 for administrative finality rules.

GN 03102.500 MCS (Modernized Claims System) Claims - Reconsiderations

A. Procedure

Whenever possible, load appeals on MCS. See MSOM MS 03504.002 for those appeals that cannot or should not be taken on MCS.

Use the applicable electronic screen (e.g., RPOC, DROC, RMKS, BCRN, etc.) to record substantive data from document(s) submitted. When appropriate, use the Evidence screen to identify the type of electronic or paper evidentiary document used as proof and the applicable SSN and/or electronic system/screen or field where the data is housed (e.g., MCS -NMAR; RPOC; MBR - SP MSG; etc.). See GN 01010.007 for more information on adjudicative responsibilities.

A formal request for reconsideration on an MCS claim is filed through the appeals screens that record information about the appeal request and decision.

Develop and clear through MCS.

B. Reference

MSOM MS 03510.001 Title II Appeals Screens - Overview

 


GN 03102 TN 8 - Reconsideration (Title II and Entitlement Under Title XVIII) - 7/26/2021