A waiver determination is an initial determination and is subject to appeal.  Appeal of an initial waiver determination provides an individual the opportunity to present new evidence, to make arguments, and to have an independent review of the facts. We may reverse the initial waiver determination and any finding based on the evidence we considered in making the initial waiver determination and any other evidence we receive. 

The type of appeal following an initial waiver determination for a Title II overpayment depends on whether:

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  we approved a waiver;

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  we denied a waiver after the individual appeared for a personal conference;

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  we denied a waiver based on the information in the file after the individual declined a personal conference or failed to appear for a second scheduled personal conference; or

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  the individual submitted both waiver request and an overpayment reconsideration request.

The appeal following an initial waiver determination for a Title XVI overpayment is always reconsideration. After we issue an initial waiver determination for a Title XVI overpayment, the individual may appeal only by requesting reconsideration.  The individual may request a hearing before an ALJ after they have requested reconsideration and we have made a decision on the request for reconsideration.  This is the appeal process for a Title XVI waiver determination regardless of whether the initial waiver determination is an approval or denial, regardless of whether the individual attended the personal conference, and regardless of whether the individual also requested reconsideration of the overpayment determination.

If reconsideration is the next level of appeal after the initial waiver determination, the individual must make the request within 60 days after receiving the initial waiver determination.  We presume the individual received notice 5 days after the date of the notice.  For more information on time limit to request reconsideration, refer to GN 03101.010 for Title II and SI 04005.012 for Title XVI.

If the individual requests reconsideration more than 65 days after the date of the initial waiver determination, the Field Office (FO) must develop and make a determination for good cause of late filing. For more information about developing for good cause, refer to GN 03101.020 for Title II and SI 04005.015 for Title XVI.

For Title II appeals, FO technicians should develop for good cause before forwarding the request to the Processing Center (PC).

For Title II input instructions, refer to MS 01106.003. For Title XVI input instructions, refer to MS 00302.007.

If the ALJ hearing is the next level of appeal after the initial waiver denial, the individual must make the request for hearing within 60 days after receiving the initial waiver determination.  We presume the individual received notice 5 days after the date of the notice.  For more information on the time limit to request a hearing, refer to GN 03101.010.

If the individual requests an ALJ hearing more than 65 days after the date of the initial waiver determination, the Office of Hearings Operations (OHO) makes good cause determinations for hearing requests. For more information about developing for good cause, refer to GN 03101.020.