Effective Dates: 10/05/2023 - Present Previous | Next

TN 5 (10-23)

SI 04020.060 Effectuating Supplemental Security Income (SSI) Reconsideration Determinations

A. Policy — Notice of reconsideration determination

The notice must be mailed to the claimant's last known address, and it must include specific reasons for the determination and administrative law judge (ALJ) hearing rights. If appropriate, it must also include an explanation of how to use Expedited Appeals Process (EAP). For EAP information, see SI 04060.000.

B. Procedure — General

1. Effectuating reconsideration determinations

For Modernized SSI Claims System (MSSICS) cases, update the applicable appeal screens including AJAS (Jurisdiction and Status) and ADIS (Disposition) with the determination, see MS 04420.023 and MS 04420.025. For non-MSSICS cases, update the UAPD (Appeal Disposition) screen using direct Supplemental Security Record (SSR) update, see MS 00302.010. An automated SSI appeal effectuation notice for reversals of initial disability determinations will be generated when the appropriate systems input is made. If a manual effectuation notice is required, use Form SSA-L8455-U2 for initial claims (IC) reconsideration reversals and Form SSA-L8456-U2 for affirmations of IC decisions. For information on the SSA-L8455-U2 and SSA-L8456-U2, see NL 00802.050. Use Form SSA-L8457-U2 for post-eligibility (PE) cases. For information on the SSA-L8457-U2, see NL 00803.095.

NOTE: These forms are available on Document Processing System (DPS).

If the reconsideration reverses a prior medical denial but the claim now is being denied for non-medical reasons, include stock paragraph 1407 in the notice. For information on paragraph 1407, see NL 00804.200.

NOTE: Validate direct deposit, address, and phone number information prior to effectuating appeal decisions.

For the reconsideration procedure for initial claims involving medical issues, see DI 12005.000.

2. Evidence received after reconsideration determination has been rendered

Review the case in light of any evidence which has been received directly from the claimant or from anyone who might write on behalf of the claimant.

a. Evidence does not justify reopening or revision

If the evidence does not meet the criteria for reopening, handle as follows:

  • •

    If the appeal period has not expired and the claimant or representative writes or submits additional evidence which clearly indicates disagreement with the reconsideration determination, treat the submission as a request for hearing and process in accordance with SI 04030.020. Give the submission of the new evidence as the reason for disagreement with the prior determination.

  • •

    If the appeal period has expired, develop for good cause. Send the good cause development along with the hearing request to the hearing office (HO). The ALJ will determine whether there is good cause for late filing of the request for a hearing.

b. Revised reconsideration determination is appropriate

If, based on the additional evidence, the reconsideration determination should be revised to make a fully favorable determination and the rules of administrative finality permit reopening, see SI 04030.020B.6, SI 04030.020B.7, and SI 04070.000, then appropriately reopen and revise it. Advise the claimant by the notice of the revised reconsideration determination (SSA-L8100-U2) that the claimant has the right to a hearing. For information on the SSA-L8100-U2, see NL 00803.025 and NL 00803.030.

3. Claimant wants to file new claim -- Adverse reconsiderations

Explain that the claimant might lose benefits by filing a new application instead of requesting appeal. Stress the importance of requesting appeal within 60 days. If the claimant persists, take a new application.

NOTE: The res judicata language appears on the revised Form SSA-L8030-U2 (Notice of Disapproved Claim) under the caption “New Application.” For a description of Form SSA- L8030-U2 and instructions on its completion, see NL 00802.020 and NL 00802.025. For a definition of “res judicata”, see GN 03101.160A.

C. Procedure — Completion of form

1. SSA-8450 (District Office Record of SSI Reconsideration)

a. Purpose

Use this form to make a complete record of a reconsideration in non-MSSICS cases. Complete the record-of-conference portion for formal conferences.

b. Name of spouse and SSN

Fill in the name and SSN of claimant's spouse, if any, whether spouse is eligible or not.

c. Date of initial determination

Fill in the date of notice of the initial determination.

d. Issue

Check one or more of these blocks to indicate the issue in dispute. Use the space provided to explain the basis for the disagreement, i.e., why the claimant believes the determination on the issue was incorrect. Also, use this space to indicate if the appeal involves a concurrent Title II/Title XVI common issue.

REMINDER: If more space is needed, use a separate sheet of paper.

e. Was new evidence obtained?

If new evidence was obtained in the course of the reconsideration, indicate details of the evidence in the space provided, i.e., the nature (documentary, oral), the source (claimant, third party), witnesses, etc.

REMINDER: If more space is needed, use a separate sheet of paper.

f. Was new evidence presented during or after conference?

Check “yes” if any new evidence was presented for the first time during or after the conference.

g. Pertinent details

Use this space to give any pertinent information about the conference not covered by the various check blocks. Note such facts as whether the claimant appeared at the conference alone or was accompanied by a relative or friend, whether claimant was advised of the reconsideration determination at the conference, whether the claimant requested a hearing during the conference. Also record any particular difficulty arranging or conducting the conference, whether an interpreter was needed, setting of the conference (e.g., district manager's office), length of conference, and any unusual claimant reaction (favorable or unfavorable) to notice of initial determination received or the reconsideration procedure.

h. Reconsideration determination

Check the appropriate block to indicate whether the initial determination was affirmed, reversed, or modified upon reconsideration.

i. Rationale supporting determination

Use this space to explain the reasoning applied in arriving at the reconsideration determination.

Give a concise and orderly statement of the pertinent facts. Describe the evidence from which the facts were taken, if not described in the “new evidence” section. Summarize letters, report of contact, etc., if pertinent, rather than quoting them at length.

If there is claimant disagreement with the facts and this disagreement is not resolved to the claimant's satisfaction, show why it cannot be resolved and include all versions, showing who gave which.

Show the conclusions reached and the reasons for them. Do not merely repeat the facts.

Show how conflicting allegations have been resolved, and why the allegations or evidence accepted were given greater weight.

Cite the authority for the findings, e.g., the applicable sections of the Act, the regulations, etc.

j. Signature and effectuation

Give the date the determination was made and the date effectuated if different from date of determination, sign, and show title in the block provided.

2. Exhibit - SSA-8450 (District Office Record of SSI Reconsideration)

To view this form, go to SSA-8450.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0504020060
SI 04020.060 - Effectuating Supplemental Security Income (SSI) Reconsideration Determinations - 10/05/2023
Batch run: 10/05/2023
Rev:10/05/2023