BASIC (05-03)

A. Policy

An advance notice advising of SSA’s intent to take an adverse action/adjustment that affects the beneficiary’s right to receive benefits and/or the amount of benefits must be sent to the beneficiary/claimant and/or representative payee before any adverse action/adjustment is taken if SSA learned of the reason for the action from a source other than a first party report. The advance notice provides the due process required by law, gives the beneficiary the opportunity to protest the action before it is taken and minimizes the possibility of SSA taking an erroneous action which would incorrectly deprive the beneficiary/claimant of benefits.

A final notice of the determination is sent to the beneficiary/claimant after any action affecting benefits is taken regardless of the source of information leading to the action. This notice provides the beneficiary with the right to appeal the action taken.

B. Glossary

1. Adverse Action

An adverse action is a determination resulting in:

• Non-entitlement to benefits

• Termination of entitlement

• Benefit reduction

• Suspension

• Earnings record change.

NOTE: For Adverse Adjustment and Adverse Claim see GN 01010.310.

2. First Party Report

A first party report is an event reported by the beneficiary/claimant, representative payee or agent (i.e., lawyer, accountant); a competent adult entitled on the same SSN; a relative, friend or neighbor acting at the request of the beneficiary.

3. Third Party Report

A third party report is an event reported by someone other than a first party. It can also be an event discovered by SSA.

4. Event Discovered by SSA

An event discovered by SSA could be one of the following:

• Erroneous multiple payments.

• An incorrect original computation.

• An earnings record adjustment which results in a benefit reduction.

• A new entitlement that causes a decrease in benefits to others already entitled.

• A SSA clerical error requiring a decrease in benefits.

• A claims folder review that discloses a questionable entitlement factor.

• A case review, system’s run, diary action, etc. that requires an adverse action.

5. Complete Report

A complete report includes the claim number, name of beneficiary/claimant and sufficient information to make a determination. For example, a report of marriage is not complete if it does not contain information to establish whether the marriage was to another beneficiary that would or would not result in the termination of benefits. A first or third party report must be considered to be a complete report before taking the action.

6. Advance Notice

An advance notice is sent to the beneficiary/claimant and/or representative payee before an adverse action is taken. An advance notice of an adverse action does not provide appeal rights. See GN 03001.015A1 for the contents of the advance notice.

7. Final Notice

A final notice is a formal written notice containing appeal rights that is sent to the beneficiary/claimant and/or representative payee once an initial determination is made and the action is taken. The notice is sent for all events resulting in an adverse action. See GN 03001.015B for the contents of the final notice.

C. References

• GN 03101.000 for formal appeals procedure.

• GN 02201.000 for overpayment information.

• GN 02250.000 for waiver provisions.

• SI 02301.300 for detailed title XVI due process procedures.

• GN 01010.310 for adverse actions involving adverse claims and adverse adjustments.

• GN 01010.330 for FO procedures for handling Adverse Adjustments

• GN 01010.335 for PC procedures for handling Adverse Adjustments

• NL 00703.000 for Notices and Exhibit Letters