A GK notice is the advance notice of a proposed SSI adverse action for non-medical reasons. Advance notice is provided by the SSI Notice of Planned Action, Form SSA-L8155. It allows an individual time to appeal the action and continue to receive unreduced benefits.

An adverse action is an action that results in a reduction, suspension, or termination of SSI benefits. It is an initial determination with appeal rights.

The adverse action month (AVM) is the future month when the adverse action will reduce benefits unless an individual files an appeal within 10 days after receiving the GK notice. An individual may qualify for GK payment continuation in or after the AVM if an individual files an appeal within 60 days of receiving the GK notice or after the 60-day period when good cause exist for extending the time limit.

First-of-the-month payments are dated the first day of the month on the Supplemental Security Record (SSR). However, the actual payment to the individual is dated earlier when the first day of the month falls on a Saturday, Sunday, or Federal holiday, (see SM 01315.005).

A formal conference is an appeal method at the reconsideration level. It allows the individual to examine the evidence in file, to present witnesses, to present oral and documentary evidence, to request that SSA to obtain evidence and subpoena witnesses, and to be able to cross-examine these witnesses, (see SI 04020.020B.7.).

See SI 04020.050 for additional information about SSI Reconsideration Conferences.

See SI 04005.010 for additional information about the SSI Administrative Review Process.

An informal conference is an appeal method at the reconsideration level. It allows the individual to meet with the SSA decision maker who conducts the conference. Witnesses may also be presented (see SI 04020.050B.2.).

A case review is a procedural method at the of reconsideration level. It involves a thorough review of all evidence in the file, including evidence submitted by the claimant, their representative or otherwise secured by SSA. No conference is held with the individual.

The MBL is the new benefit amount due after the system posts an adverse action to the record.

The monthly benefit amount (MBA)is the total of all payments issued in the month and due for that month including first-of-the-month payments, underpayments, amounts (or voided amounts) withheld for overpayment recovery, penalty deductions and returned checks.

GK payment continuation is the term used for continuing or reinstating unreduced benefits until there is a decision at the first level of appeal. GK payment continuation applies only to non-disability determinations which result in a reduction, suspension, or termination of SSI benefits. GK payment continuation ends the month there is a determination on the reconsideration. See SI 02301.310 - Appeal and the Right to Goldberg Kelly (GK) Payment Continuation and SI 02301.313 - Appeal and the Protected Payment Level when a Reconsideration Request is filed 11- 60 Days After Receipt of a Notice of Planned Action for information about appeal and the right to payment continuation.

An individual's record goes into "protected payment status" to maintain or reinstate GK payment continuation. Special manual procedures are then required in most case to correct benefit amounts and issue notices. To correct protected payments due to changes which are under appeal including the Cost-of-Living Adjustment (COLA) (see SI 02301.325 - How to Pay the PPL and SI 02301.330 - How to Correct Benefits Based on Appeal Decision.)

SBC is the term used for continuing unreduced benefits during an appeal of a determination that an individual's disability ceased, did not exist, or is no longer disabling. SBC applies only to unfavorable medical disability determinations which result in the suspension or termination of disability benefits.

The PPL is the monthly benefit amount in effect prior to a proposed adverse action. It is the unreduced benefit amount that a recipient may continue to receive until there is a decision at the first level of appeal. The PPL can change during the appeal period due to changes in the recipient's circumstances or a change in the Federal Benefit Rate (FBR) due to a COLA.

A reduction in payment is a new monthly payment rate that is less than the payment rate due in the last regular month of payment.

The GK temporary period begins the day after the GK notice cutoff (usually between the 7^th to 9^th day of each month) and ends with the recurring tape cutoff (usually between the 15^th to 21^st day of the month). During this period, the system can reduce the following month's benefit when the FO produces an online GK notice or issues a manual GK notice. See SI 02301.301C.2.

GK procedures provide recipients with:

• •

  a written advance notice of an adverse action, and

• •

  time to question and appeal the action before it occurs, and

• •

  the right to a formal conference at the reconsideration level of appeal, and

• •

  the right to continue receiving unreduced benefits until there is a decision at the first level of appeal.

Individuals may not waive written advance notice of an adverse action, but they may waive their right to payment continuation in writing (see SI 02301.310). They may also choose a case review or an informal conference instead of a formal conference (see SI 04020.020B.7.).

See SI 04020.050 for additional information about SSI Reconsideration Conferences.

See SI 04005.010 for additional information about the SSI Administrative Review Process.

When FOs discuss changes that result in adverse actions with recipients, they explain fully the effect of changes and recipients' rights under GK procedures. Instructions are in SI 02301.310.

Advance notice is generally required for an adverse action. However, the following situations are exceptions to GK procedures and do not require advance notice:

• •

  A recipient dies (T01)

• •

  A recipient's representative payee dies or is no longer available or suitable to act as payee (S08)

• •

  A recipient's whereabouts are unknown (S06)

• •

  A check returned for miscellaneous reasons (S07)

• •

  A recipient voluntarily requests termination (N19)

• •

  A State assumes responsibility for administration of State supplementary payments

• •

  An advance notice was previously sent, but the adverse action did not occur.

These individuals receive an advance notice:

• •

  Legally competent adult recipients

• •

  Representative payees

• •

  Both members of an eligible couple when the action reduces the total couple's payment and changes the payment amount to each (even if the result is an increased payment to one member)

• •

  Appointed representatives and legal guardians. (See NL 00801.001 about Supplemental Security Income (SSI) notification policy and procedures.)

The SSI Notice of Planned Action (SSA-L8155) is the form used to provide advance notice. The system issues an automated GK notice on an SSA-L8155-SM (SSI Notice of Planned Action).

An online GK Notice (SSA-L8155) is produced by the system when an adverse action is input during the GK temporary period and selected by the FO to print.

In situations where an automated notice must be suppressed or the notice cannot be produced online, FOs prepare a manual GK notice on an SSA-L8155-U2 (SSI Notice of Planned Action) or on another standard notice form with the appropriate appeal rights.

The advance notice must explain:

• •

  the basis for the adverse action, and

• •

  how the adverse action affects eligibility and payment amount, and

• •

  how to appeal, and

• •

  that unreduced benefits will continue until a decision is made at the first appeal level if the individual files an appeal within 10 days after receiving the notice.

The advance notice must be mailed at least 15 days (or handed to the individual at least 10 days) BEFORE the first day of the adverse action month.

The individual has a full 60 days after the date on the notice to appeal and qualify for GK payment continuation, although the individual's benefits will be interrupted if they do not appeal within 10 days of receipt (i.e. before the adverse action month).

We presume that receipt is 5 days after the date on the mailed notice unless there is a reason to believe otherwise.

See:

• •

  SI 02301.301 Overview of Goldberg/Kelly (GK) Processing,

• •

  SI 02301.305 Online Goldberg Kelly (GK) Notices,

• •

  SI 02301.307 Manual Goldberg Kelly (GK) Notice Procedures, and

• •

  SM 01305.530 Initial Adverse Action Events Requiring an Online or Manual Notice which explain when the FO must issue a manual or online GK notice.

• •

  MS 04502.001 Computation Menu (CPMN) and MS 04502.002 Goldberg/Kelly (DBGK) for more information about the GK systems processes.

Recipients qualify for GK payment continuation at the Protected Payment Level (PPL) when they appeal an adverse action:

• •

  within 60 days after receiving the advance notice

- Recipients who appeal within 10 days of receiving the advance notice should receive continued or reinstated payment at the protected payment level (PPL)

- Recipients who appeal 11 or more days after, but within 60 days of receiving the advance notice may experience a reduction in payment but will be reinstated to payment at the PPL.

OR

• •

  after the 60 day period and good cause exist for extending the time limit.

EXCEPTIONS: GK payment continuation at the PPL does not apply to:

• •

  certain erroneous payment cases (see SI 02301.315),

• •

  collection of a penalty unless the recipient also appeals the overpayment determination (see SI 02301.100 through SI 02301.110), and

• •

  medical cessation cases. When appealing these cases, individuals must elect Statutory Benefit Continuation (not GK) and can elect it at the reconsideration and hearing levels of appeal (see DI 12027.000).

Recipients who qualify for payment continuation may choose to waive it. After waiving it, they may reconsider and receive it (including retroactive benefits) at any time before the first appeal decision.

See SI 02301.310C.6 - Appeal and the Right to Goldberg Kelly (GK) Payment Continuation and SI 02301.415 - SSA-263-U2, Waiver of Supplemental Security Income Payment Continuation .

• •

  the change fully so that the individual understands the effect on benefits,

• •

  the right to receive written notice of the change before it occurs (if a GK notice has not been issued),

• •

  the individual has 60 days to appeal and continue to receive unreduced benefits after receiving the notice, but only 10 days to appeal to continue receiving unreduced benefits without interruption,

• •

  unreduced benefits continue only until there is a decision at the first appeal level,

• •

  unreduced benefits may be waived,

• •

  even after waiving unreduced benefits, the individual may request them any time before the appeal decision on the reconsideration occurs and have them restored back to the first month they were reduced or stopped,

• •

  the recipient might have to pay back incorrect payments if they lose the appeal, and

• •

  reporting responsibilities.

CAUTION: When payment continuation results in overpayment, a recipient may still meet the requirements for waiver of recovery in SI 02260.001.

• •

  suggest waiving payment continuation to avoid an overpayment, or

• •

  take a signed statement about the possibility of an overpayment, or

• •

  encourage or try to influence an individual to make a decision regarding payment continuation, or

• •

  suggest accepting a reduction in the PPL based on changes that are not being appealed. An individual must on their own initiative request a reduced benefit.

When a recipient or payee reports a change to the field office (FO) in person that results in an adverse action and wishes to appeal at the same time:

• •

  input the change,

• •

  immediately prepare an online or manual GK notice and hand it to the recipient, and

• •

  take the reconsideration request.

Determine the presumed notice receipt date:

• •

  Count 5 calendar days after the date on the notice.

• •

  If the notice is not available on the online retrieval system (ORS), count 12 calendar days after the notice run date in the NOTC segment on the SSR (7 days notice processing and 5 days mailing) or use the notice date in the DUPR segment on the SSR.

• •

  If the receipt date is a non-delivery day for the Post Office, extend the receipt date to the next delivery day.

IMPORTANT: If the notice cannot be found on the ORS, consider accepting a reasonable allegation of the receipt date since notice run dates on the Supplemental Security Record (SSR) are not always accurate and mailing of notices may not occur on time. See SI 02301.301B.3. and SI 02301.301B.4. about notice processing.

Determine the 60-day time limit to file the reconsideration request and qualify for payment continuation:

• •

  Count 60 days after the notice receipt date as determined above.

• •

  If the 60th day is a non-work day for SSA, extend the time limit to the next work day.

If the recipient does not file the reconsideration request within the 60-day time limit, advise the recipient that they must explain in writing the reason for missing the time limit. For instructions on developing good cause, see SI 04020.020B.2. through SI 04020.020B.3.

Give the recipient a completed Form SSA-94 (Receipt of SSI Appeal Request) only when they qualify for GK payment continuation at the PPL and do not waive it, or when they request it later after waiving it.

See SI 02301.410 for an exhibit of the SSA-94.

If the recipient qualifies for GK payment continuation at the PPL and on their own initiative chooses against it:

• •

  obtain a signed Form SSA-263-U2 (Waiver of Supplemental Security Income Payment Continuation),

• •

  retain the original copy in the recipient's file, and

• •

  give the duplicate copy to the recipient.

See SI 02301.415 for an exhibit of the SSA-263-U2.

If you cannot issue an appeal decision the same day as the appeal is received, follow instructions in SI 02301.315 - Erroneous Payments and GK Payment Continuation to continue (or restore) benefits at the PPL. If you can issue an appeal decision the same day the appeal is received, input a due process data (DPD) entry following SM 01305.570A2 - Processing of Initial Appeal Decision.

To input appeals data, refer to MS 04420.001 - Appeals-Overview and MS 00302.007 - Appeal Process.