BASIC (04-00)

A. Policy

Initial determinations are those determinations that are subject to administrative and judicial review.

B. Examples

Initial determinations include, but are not limited to, determinations about:

1. Qualification, Entitlement, Suspension and Termination

The following are initial determinations:

• Meeting or failure to meet the qualifying events for SVB payments (see VB 00101.005 and VB 00102.001);

• Applicability of a disqualifying event prior to SVB entitlement (see VB 00102.005);

• Entitlement to SVB payments after beneficiaries move abroad;

• Disallowance of SVB payments for failure to reside outside the United States;

• Suspension of SVB payments on the basis of a disqualifying event or other event (e.g., return to the United States) occurring after SVB entitlement (see VB 00102.005);

• Termination of SVB payments;

• Reinstatement of payments, as well as denial of reinstatement, when the beneficiary has requested reinstatement in writing.

2. Amount of Benefit

The following are initial determinations:

• Amount of the SVB payment;

• Recomputation/revision in SVB payment amount on the basis of a change in "other benefit" income (see VB 00701.000 ff.);

• Determination that a deduction is not to be imposed or that a benefit is not to be withheld;

3. Overpayment and Underpayment

The following are initial determinations:

• The fact, amount and cause of an overpayment or underpayment and whether action to adjust or refund will be taken;

• Waiver of recovery of an overpayment.

4. Representative Payee

The following are initial determinations:

• Determinations as to the need to pay benefits through a representative payee because of a beneficiary's incapability to manage his/her own benefits are initial determinations;

• Determinations about who is selected or continued as a representative payee;

• Representative payee misuse cases regarding the negligence (or good acquittance) determination (see GN 00604.055);

5. Other

The following are initial determinations:

• Denial of request for withdrawal of a claim or for cancellation of a request for withdrawal of a claim;

• A claim for benefits based on alleged misinformation (see GN 00204.008 for more information on what is appealable).