BASIC (04-00)

A. Policy-Initial Determination Defined

An initial determination:

• Is SSA's formal, written disposition of any legal or factual issue affecting an individual's right to or the amount of benefit payments or any other right provided by the Social Security Act. Claimants only have a right to appeal actions taken by SSA that are initial determinations.

• Can be made by any employee in the FO who is delegated authority to approve or disapprove applications for Social Security benefits, specifically the claims representative and higher level personnel with delegated authority. (Initial determinations in SVB cases are generally made by FO personnel.)

• Is subject to administrative and judicial review and is final and binding unless the claimant requests an appeal within 60 days or SSA finds good cause for extending the time period to file an appeal or SSA revises the initial determination.

Generally, when a claimant files for SVB, he/she receives both a notice of qualification and a notice of entitlement. Both claims notices constitute initial determinations and provide appeal rights as show above. (See VB 00101.005A.)

B. Policy-Change in Factual Situation

SSA may always make a new initial determination whenever a change occurs in the factual situation despite how much time elapses from the date of that change. The fact that SSA determines that a claimant meets the requirements for entitlement does not preclude SSA from making another determination that the claimant no longer meets those requirements at some subsequent date. The new determination is effective with the date of the change in the factual situation.

C. Policy-Failure to Make a Determination

Because failure to make a determination with respect to any claim or PE issue is not an initial determination, when such failure comes to SSA's attention, the claim or PE issue must be adjudicated.