GN 03104.400: Processing Appeals Council (AC) Decisions — Title II or Title XVI
Effective Dates: 01/12/2017 - Present
- TN 4 (04-01)
- GN 03104.400 Processing Appeals Council (AC) Decisions — Title II or Title XVI
- A. Policy
- For Title II awards, the Claims Authorizer (CA) uses the Modernized Claim System (MCS) when available to process the claim. If MCS is not available, the CA prepares an EF-101. The Benefit Authorizer (BA) uses MADCAP to complete the award notice.For Title XVI awards, the system generates a notice for disability awards. For non-disability awards, the field office (FO) sends a manual notice.
- For unfavorable Title II and XVI AC decisions, no notice is sent by the field office or processing center.
- B. Procedure
- 1. AC revises/reverses decision
- For title II notice language; refer to NL 00720.015 for MADCAP and NL 00725.000 for MCS paragraphs to include in the award notice. For title XVI award notice preparation, refer to NL 00802.000. Send copies of the award notice to the claimant (and his/her representative if any). In SSI cases, see SI 04030.070 for instructions regarding redeterminations after reversals.
- 2. AC decision involves SEI or wages
- If the AC's decision affects reporting or deleting of self-employment income or wages, make changes using the Earnings Modernization Item Correction screens.
- 3. Non-claims situations
- Notify the individual of the action taken on his/her earnings record using the appropriate MADCAP (NL 00720.015) or MCS (NL 00725.000) paragraphs.
- 4. Questionable AC decision
The AC decision must be effectuated as received unless it appears to contain a non-judgmental error. In such cases, immediately send a memorandum to ODAR with detailed rationale for requesting reopening under the rules of administrative finality. For guidelines, see GN 03103.260 for title II and SI 04030.060 for title XVI.
- 5. AC decisions affected by legislation or change of position
- Refer to GN 04001.100 for a more detailed discussion.
6. Retention of claims file in ODAR after unfavorable AC action If the AC denies the request for review or issues an unfavorable decision, it will hold the claim file for 120 + days pending a possible civil action. However, if the claims file shows the need for immediate action, request the folder from the appropriate ODAR location shown on Case Processing Management System (CPMS) or Appeals Review Processing System (ARPS). The folder is held either in the ODAR Megasite or the Disability Program Review Branch with jurisdiction over the case. The Megasite should be contacted by fax at (703) 605–8931 or (703) 605–8941.
x← This means that the line was removed and was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.