TN 11 (08-23)

DI 12026.027 Completion of the SSA-770-U4 Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation

A. Overview of the SSA-770-U4

The SSA-770-U4 allows a substitute party to pursue the appeal of a deceased individual. For more information on the substitution of party, see DI 29005.025 Individual Dies before a Determination is made on a Request for Reconsideration Continuing Disability Review (CDR).

Complete the SSA-770-U4 as follows:

1. 1. 

   Complete the identifying information about the deceased and check the appropriate box to indicate the substitute party’s relationship to the deceased.

2. 2. 

   Check the appropriate box if the substitute party has in their care the deceased’s child(ren) under age18, (or an eligible student) or disabled child.

3. 3. 

   Check the appropriate box whether the substitute party wishes to proceed or does not wish to proceed with a reconsideration requested by the deceased. For additional instructions on completing this response, see paragraphs C and D below.

4. 4. 

   Have the substitute party sign the form, print their full name, complete the mailing address, telephone number, and date, where designated.

5. 5. 

   If the substitute party signs by a mark ‘X,’ two witnesses must sign the form and complete the address information where designated.

B. Substitute party wishes to proceed with the reconsideration of the disability cessation

The individual recognized as a substitute party to the reconsideration must choose at least one of the three selections and submit the SSA-770-U4. Check box 1 on the form. In addition, check box 'a,' 'b,' or 'c,' as indicated on the form.

1. 1. 

   The substitute party indicates they will attend the disability hearing already scheduled. If the substitute party would like to attend the hearing already scheduled, they will select, ‘a’ on the SSA-770-U4.

2. 2. 

   The substitute party requests a change in the scheduled hearing. If the substitute party requests a change in the time or place of the scheduled hearing, they will select, ‘b’ on the SSA-770-U4. Handle a request to change a scheduled hearing by a substitute party as follows

   • •

     Attach form SSA-769-U4 (Request For Change In Time/Place of Disability Hearing)

   • •

     Complete the appropriate information on behalf of the deceased claimant and the substitute party in the designated spaces.

   • •

     Inform the substitute party that they will receive notification of the change in time or place of the disability hearing if approved by a representative of the Disability Hearing Unit (DHU).

3. 3. 

   The substitute party indicates they do not wish to attend the disability hearing. If the substitute party does not wish to attend the disability hearing, they will select 'c' on the SSA-770-U4. Take the following actions:

   • •

     Inform the substitute party of the consequences concerning the request to not attend the hearing and have them sign form SSA-773-U4 (Waiver of Right to Appear-Disability Hearing).

   • •

     Attach the SSA-773-U4 with only the deceased claimant's name and social security number (SSN).

   • •

     Inform the substitute party that they will receive notification of the reconsideration determination.

C. Substitute party states that they want to withdraw the reconsideration request

If the individual does not wish to proceed with the reconsideration of a disability cessation requested by the deceased, check box 2. Take the following actions:

1. 1. 

   Inform the substitute party of their potential liability for an overpayment as well as their eligibility for a potential underpayment that may result from the reconsideration decision.

2. 2. 

   Attach the SSA-773-U4 with only the deceased claimant's name and SSN.

3. 3. 

   Inform the substitute party that unless the overpayment is $200 or more, recovery of an overpayment from a deceased claimant's estate is not considered. If, after the explanation, the substitute party is not interested in pursuing the reconsideration, have them complete the appropriate box on the SSA-770-U4. For additional information regarding a claimant’s potential liability of overpayment and eligibility for an underpayment, see:

• •

  DI 11055.050 Claimant Dies after Filing and Prior to a Disability Determination and,

• •

  DI 23020.010 Potential or Actual Overpayment Cases