• •

  Send a pre-decision notice to the individual explaining the evidence and the reasoning for the proposed adverse reopening.

• •

  The notice must include the right to submit additional evidence or arguments. Also, it must include the right to request a disability hearing before we make a formal adverse decision.

Send a notice containing the following elements to the individual and their representative prior to taking an adverse action:

1. 1. 

   Indicate that we are planning to reopen our previous decision. Also, indicate the reason for doing so (e.g., we received new evidence; we made an error).

2. 2. 

   The date of the proposed cessation.

3. 3. 

   A list and dates of all medical reports we used to make the preliminary judgment to revise. If we undertook development but did not receive all reports, we will provide a disclaimer statement that:

   We attempted to obtain the reports but were unable to do so, and

   We must make the decision based on the available evidence.

4. 4. 

   An explanation of why the evidence indicates that the individual is not disabled or blind. This information is similar to the information in a personalized decision notice (PDN).

5. 5. 

   An explanation that the individual may request a disability hearing and present any evidence or arguments in support of their belief that they are disabled. The individual must request this action within 10 days from receipt of the notice. The individual must complete the Form SSA-765 (Response to Notice of Revised Decision), and return it to the Disability Hearing Unit (DHU). Attach an SSA-765 to the notice so the individual can respond. We will make a formal decision if the individual fails to respond within 10 days.

6. 6. 

   An explanation of the effect of a formal adverse decision (i.e., benefits continue for two months after the cessation date).

7. 7. 

   An explanation of the right to have a disability hearing, including the right to representation, to bring witnesses and evidence. We will send notification of the date, place, and time of the hearing by mail.

For additional instructions related to the due process notice, see subsection C in this section.

Send all auxiliaries an advance notice of a proposed adverse action.

For model notice language, see DI 27525.005

Offer due process as shown in this subsection before revising a favorable decision to correct conflicting decisions.

• •

  Reopen and revise the prior DHO decision to conform to the ALJ's or AC's decision, or

• •

  Forward the case to the Office of Disability Operations (ODO) in central office to determine if there is a basis for reopening an ALJ's or AC's decision, e.g., material evidence is in the current case folder that was not available to the ALJ or AC, or error on the face of the evidence exists.

• •

  Prepare a revised decision if the Office of Hearings Operations (OHO) responds by stating that we will not reopen the ALJ's or AC's decision.

Forward the case to OHO’s central office to resolve the conflict. This action is necessary considering that DHO cannot reopen an ALJ's or AC's decision and that we must give the individual an opportunity for a hearing before revising a favorable decision to an unfavorable one.