TN 88 (12-23)

GN 01010.365 Formal and Informal Determinations

A. Policy on documenting special determination

All conflicting information discovered during the development process must be resolved before final adjudication. The Adjudicator is responsible for researching and developing all information needed to record formal or informal special determination.

Formal determinations are required to cite authority in the Act or regulations along with details of facts that lead to the conclusion, while an informal determination can be less structured, handwritten, and with no citation of authority. However, both determinations are required to provide sufficient information to justify each conclusion.

B. Formal determinations

1. Examples of situations requiring a formal determination:

  • To record the use of a legal precedent (see GN 01010.810);

  • To record findings in a personal conference concerning overpayment recovery or in situations involving reconsiderations and higher appeals, (see GN 02250.015 and GN 02270.015);

  • State employee earnings or coverage issues (see RS 01505.042);

  • Evidence for death, disappearance or presumed death (see GN 00304.001);

  • One- half support information (see RS 01301.210);

  • Misuse or negligence of an individual or organizational representative payee (see GN 00604.030);

  • If called for in other sections of the POMS.

2. Examples of situations not requiring a formal determination:

  • There is an existing precedent which is still in effect; or

  • The various earnings or coverage tolerance rules apply.

3. Procedure for documenting formal determinations

All determinations (paper or electronic) must contain the following information. For format of electronic determinations refer to GN 01010.360B.3.

a. Formal format for paper forms (e.g. SSA-553)

  • The originating field office (FO) code and name;

  • The number holder (NH)’s name, and;

  • The claimant’s name (if different) and relationship to NH.

b. Issue to be resolved

State briefly the specific issue involved, the pertinent sections of the Act, and the purpose of the determination. If this is a state or local coverage earnings determination, include the alleged employer's name and address, the period(s) of employment involved and the employer's federal earnings identification number (EIN), if known.

c. Facts

  • Give a concise and orderly statement of the relevant facts.

  • List the evidence that was considered;

  • Summarize reports of contact, contracts, etc.

  • If the information provided by the NH is contradictory and cannot be resolved, explain why the discrepancies cannot be resolved.

  • State whether the amounts in question (if state or local coverage or earnings issues) have been reported to the NH's record.

d. Determination

You must provide a clear conclusion based on the listed facts. Do not repeat the facts as your sole conclusion. You must describe how conflicting allegations have been resolved and how you evaluated the allegations or evidence accepted, according to its probative value.

e. Authority

Cite the authority for the finding (e.g., the Act, regulations, Social Security rulings, Commissioner's rulings, court decisions, applicable POMS sections, related similar situations, precedents of general applicability or precedents based upon an opinion of the Office of the General Counsel (OGC)).

f. Signature

The adjudicator or other authorized individual completing the form must sign and date the paper determination along with their official title below the signature. The adjudicator's personal identification number (PIN) serves as the electronic signature for the report of contact (RPOC). NOTE: Completion of the "Approved By" field on the SSA-553 depends on the policy, which the determination will be based. Refer to the specific policy or procedure, which the adjudicator or other authorized individual will be basing the determination, to determine if approval is needed. If the specific policy requires approval, the SSA-553 then requires an approver.

g. Subsequent formal determinations

Occasionally, the Processing Center (PC) discovers new relevant information resulting in a new or revised determination. If this happens, the PC must inform the FO of the action taken and provide them with a copy of the new formal determination.

C. Informal determinations

The most commonly used determinations by the adjudicator are the informal determinations. We use informal determinations in situations in which we need further clarification of an outstanding issue and, it must be resolved. Informal determinations are also required when a POMS specifically requires one. The following is a list of the most common situations of informal determinations:

1. Earnings or coverage issues

  • Resolve an employer or employee relationship issue in a family corporation.

  • Establish secondary evidence of earnings under common disaster emergency procedures.

  • Development of earnings alert query (EARQ) alerts as per RS 01404.003.

2. Representative payee issues

3. Overpayments (O/P)

4. Disallowances

  • Relationship not established;

  • Child dependency not met;

  • Failure to establish other requirement for entitlement.

5. Other examples include:

  • Resolution of conflicting material in file;

  • Resolution of issues that reverse a prior determination under the rules of administrative finality; and

  • Issue resolution where the conclusion is not obvious from evidence in file.

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GN 01010.365 - Formal and Informal Determinations - 12/11/2023
Batch run: 12/11/2023