TN 3 (02-97)

A. Description

Generally, the SSA-L8165 is used to explain actions that are not initial determinations and, therefore, not subject to appeal. For this reason, there are no preprinted appeal rights on the SSA-L8165. The manual version of this form is blank except for the letterhead.

EXCEPTION: Use certain appeal language on the manual SSA-L8165-U2 for: ALJ reversals as discussed in the second bullet below; and certain representative payee issues (see sixth bullet).

B. When to use — Manual Notice

Send a manual SSA-L8165-U2 to:

• Notify a claimant that presumptive disability/blindness (PD/PB) payments will begin or end;

• Notify a claimant (representative payee, authorized representative and /or legal guardian) about effectuation of an administrative law judge (ALJ) decision when the ALJ decision does not address all factors of eligibility.

• Deny a duplicate application;

• Dismiss a request for reconsideration not filed timely;

• Notify an individual that we are not going to reopen or revise a prior determination.

• Notify individuals about representative payee issues not requiring appeal rights.

• Notify a claimant when his/her recurring SSI check precedes the retroactive check, that we are sending the retroactive check to the State to repay it for furnishing interim assistance;

• Abate a claim due to an improper applicant;

• Explain administrative actions that do not have appeal rights per SI 04010.010C; and

• Notify the claimant (representative payee, authorized representative and/or legal guardian) about an attorney fee under the attorney fee agreement process.

C. Process

The system automatically generates an SSA-L8165 when:

1. PD/PB Cases

• The FO or DDS transmits a determination to pay PD/PB payments (the system sends an SSA-L8165 with paragraphs 1420, 1431, 1418 and 1419 (NL 00804.205) telling the claimant we will send checks for 6 months); and

• Six months have elapsed and the DDS has not made a final decision (the system sends a second SSA-L8165 with paragraph 1432 explaining that the checks will stop).

  NOTE: The initial claims notices system generates appropriate paragraphs on automated award and denial notices when a claimant is receiving or has received PD/PB payments pending a final determination.

2. IAR Cases

For situations described in SI 02003.040, the system generates an SSA-L8165 to the State agency using paragraphs 1070, 1071 or 1072 (See NL 00804.125 for the language).

D. Procedure

1. ALJ Reversals

1. Always suppress the system-generated posteligibility notice and issue an SSA-L8165-U2 manually when effectuating an ALJ reversal per B. above.

2. When completing the SSA-L8165-U2 for an ALJ effectuation, follow instructions for completing the SSA-L8025 in NL 00802.010. If the FO determines that the claimant is ineligible for some reason(s) not addressed by the ALJ decision, follow the instructions for completing the SSA-L8030 in NL 00802.020 to complete the SSA-L8165-U2.

   NOTE: System-generated posteligibility notices (i.e., the SSA-L8100 and SSA-L8151) are not acceptable substitutes for the SSA-L8165 since these posteligibility notices are not for initial claims situations. Also, do not use an SSA-L8025 or SSA-L8030 since these notices are only for the initial determination on the claim.

2. Duplicate Claim

1. If the claimant files a duplicate claim, issue a manual SSA-L8165-U2 with paragraph MISM50 (NL 00804.240).

2. If someone else files a duplicate claim on behalf of the claimant, issue a manual SSA-L8165-U2 with paragraph MISM51 (NL 00804.240) to the applicant.

3. Dismissal of Reconsideration Request

To dismiss a request for a reconsideration that was not filed timely, issue a manual SSA-L8165-U2 with paragraph RECM50 (NL 00804.224) followed by paragraph 1481 (NL 00804.240).

4. Representative Payee Cases

Issue an SSA-L8165-U2 using the appropriate notice language in NL 00703.000 for representative payee issues not requiring appeal rights.

5. IAR Check to the State

To notify a claimant that we are sending a retroactive check to the State to repay interim assistance when the recurring SSI check to the claimant precedes the retroactive check, issue a manual SSA-L8165-U2. (See SI 02003.030B and SI 02003.035C.2.)

6. Abatement Cases

To abate a claim due to an improper applicant. (See SI 00601.012B);

7. Cases With Attorney Fees

The Fee Agreement Notice will contain only information pertinent to representative fees, e.g., determinations on the fee agreement and fee amount.

E. References

• ALJ decision notices, SI 04030.050C.9.

• Title XVI offset cases with attorney fee involvement,
  SI 02006.205.

• Representative payee language, NL 00703.821, NL 00703.824, NL 00703.825, NL 00703.826, NL 00703.828, and NL 00804.185.