TN 3 (02-97)

A. Introduction

The SSA-L8025 is the only notice for initial claims awards and is usually system-generated.

B. Description

The SSA-L8025 tells the claimant, representative payee, authorized representative and/or legal guardian:

• The amount of payment (retroactive and ongoing);

• The facts that affect the payment computation;

• Reporting responsibilities, Medicaid information, appeal information; and

• Other information specific to the case (e.g., interim assistance reimbursement, representative payee information, State supplementation information, etc.).

C. When To Use

The SSA-L8025 is sent either by the system or manually when the claimant:

• Is eligible for SSI (including cases in E01) for one or more months;

• Is due a retroactive but not an ongoing payment; or

• Is eligible for SSI at the time of adjudication, even if there were preceding months of ineligibility.

• Is eligible for SSI based on drug addiction and alcoholism (DAA). (See DI 90000.000 ff. for specific instructions.)

D. Procedure — Use Manual SSA-L8025-U2

Use manual SSA-L8025-U2 in the following actions.

1. Force Payment Cases

Issue a manual SSA-L8025-U2 when you put an initial claim into pay via force payment.

2. Start Date Record

When you establish a start date (SD) record for an eligible couple where previously only one member of the couple was eligible for SSI, send a manual SSA-L8025-U2 to the newly eligible member of the couple. Also, if the previously eligible member's payment changes when you establish an SD record, suppress the automated posteligibility (PE) notice and send the appropriate manual PE notice.

NOTE: The system does not generate an SSA-L8025 on SD records.

3. Effective Filing Date Later Than Actual Filing Date

1. The system generates the SSA-L8025 when the effective filing date is later than the actual filing date because of ineligibility due to:

   • Excess income (N01);

   • Excess resources (N04);

   • Residence in a public institution (N02); or

   • Absence from the United States (N03).

2. If the reasons for ineligibility are other than those in a. above, suppress the automated notice and issue a manual notice explaining the later date of eligibility.

4. Multicategory Eligibility

1. If a claimant applies for SSI under more than one category of eligibility, and the decision on the first category is an award but the decision on the second category is still pending:

   • Suppress the system-generated award notice;

   • Prepare a manual award notice addressing the first category of eligibility; and

   • Under caption 1907, “Your Payment Is Based On These Facts,” include paragraph CTEM03 (NL 00804.145).

2. If the claimant is also allowed for the second category of eligibility, follow procedures in SM 01301.605. The system will generate another notice in addition to the SSA-L8025-U2 you sent per a. above.

   • If an aged claim is also allowed for disability and/or blindness, the system will generate an SSA-L8151 with paragraph 2638 (NL 00804.195).

   • If a disabled and/or blind claimant is allowed for age, the notice will have paragraph 1130 (NL 00804.145).

3. If the second category is denied, see NL 00802.020C.2.

5. Suspension — No Payee

When an individual is eligible, but you are still developing for a representative payee (SO8), input notice suppression and prepare a manual SSA-L8025-U2.

6. Specific Policy Requirement

Whenever POMS specifically requires a manual paragraph(s) and you are in an initial claims situation, prepare a manual SSA-L8025-U2. Input notice suppression if appropriate.

E. References

1. Force Payment

• FO processing of force payment cases, SM 01701.010.

• Systems limitations in initial claims, SM 01701.005.

• Notices and due process in force payment situations, SM 01701.001.

2. Start Date

• Automatic notice suppression , SM 01301.675.

• Situations requiring SD records, SM 01801.012 and SM 01801.040.

• Notice suppression on start date cases, NL 00801.015.

• Use of force payment when an ineligible spouse becomes eligible, SM 01701.005.

3. Effective Filing Date Later Than Actual Filing Date

• Effective date of application, GN 00204.007.

4. Multicategory Eligibility

• Development of multicategory eligibility, SI 00501.300 ff.

• Optional State supplementation, SI 01410.001B.

• Instructions for input of the initial SSA-450-SI if a claimant applies under more than one category of eligibility, SM 01005.330 ff.