VB 02502.005: Reconsideration Requests

changes
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~~Effective Dates: 07/08/2014 - Present~~
Effective Dates: 04/25/2018 - Present
TN 1 (06-01)
VB 02502.005 Reconsideration Requests
A. Definitions
1. Reconsideration request
Any writing by the claimant, his or her representative payee or his or her representative after receipt of a notice of an initial determination that clearly expresses or implies a disagreement with that determination.
2. Dismissal
Dismissal of a request for reconsideration is the rejection of or refusal to accept the request. The effect is to make the prior action the final decision of the Commissioner of Social Security.
B. Policy
1. What constitutes a request for reconsideration
The following considerations apply to reconsideration requests:
* A reconsideration request must be in writing. Form SSA-561-U2 can be used for this purpose. (See VB 02502.005B.6.)
* Reconsideration requests can be either implied or expressly stated.
* An implied request exists when a claimant (or representative) submits a written statement disagreeing with an initial determination. (This may or may not be accompanied by additional evidence.)
The submission of additional evidence does not constitute an implied request unless it is accompanied by a written statement.
2. What is not a request for reconsideration
The following are not reconsideration requests:
* A written request for information or an explanation of SSA's determination;
* An oral inquiry or request for forms;
* A request for waiver of an overpayment;
* The submission of additional evidence that is not accompanied by a written statement.
See VB 02501.040 for actions that are not initial determinations and, therefore, not subject to reconsideration.
3. When to request reconsideration
A claimant should request reconsideration within 60 days after the date he or she receives the notice(s) of the initial determination on an SVB application or posteligibility event. Where SVB applications are concerned, this 60-day period can apply to both the notice of qualification for SVB and the notice of entitlement to SVB payments, if such notices are sent separately (see VB 00102.010C). Notice of an initial determination is presumed to be received 5 days after the date on the notice, unless it can be shown notice was received later. (See VB 02501.005 for extending the appeal period when notices are mailed to claimants abroad.)
4. Extension of time for filing a request
The time period for requesting reconsideration may be extended when the claimant (or his or her representative) makes the request in writing and establishes good cause for missing the time limit (see VB 02501.010).
Reconsideration requests submitted within the 60-day time limit to the proper authority or agency of a country with which the U.S. has a Totalization Agreement are considered timely filed (see VB 02501.005B).
5. Who may request a reconsideration
The following individuals may request a reconsideration:
* The claimant/beneficiary who is party to the initial determination;
* An appointed attorney or other qualified representative;
* A representative payee;
* Another individual who would be considered a proper applicant (see VB 00201.015);
* Someone other than the above individuals if the request clearly shows that it originated with the claimant and was made with his or her consent. (If consent is not documented, the claimant must be notified at his or her last known address before the initial determination is reconsidered.)
6. How to make a formal reconsideration request
The SSA-561-U2 (Request for Reconsideration) should be used to request reconsideration of initial determinations involving SVB qualification and/or entitlement. If an individual is contesting a posteligibility determination to reduce, suspend or terminate SVB payments, he or she should indicate on the SSA-561-U2 the type of reconsideration being requested (i.e., case review, informal conference, formal conference).
NOTE: Beneficiaries abroad should be advised that they must come to the United States at their own expense if they elect to have a conference.
7. Where to submit a request for reconsideration
A reconsideration request can be filed in any of the following places:
* An SSA office;
* The Foreign Service Post (FSP);
* The Federal Benefits Unit (FBU);
* A U.S. Embassy or Consulate abroad;
* A proper authority of a country with which the United States has a Totalization Agreement (see VB 02501.005B); or
* A Railroad Retirement Board office if the claimant has 10 or more years of service in the railroad industry.
8. Evidence received after initial determination
If the claimant (or his or her representative) submits evidence after the initial determination notice is issued, SSA considers the submission a request for reconsideration only if it is accompanied by a written statement (see VB 02502.005B.2.).
9. Revising determinations if circumstances change
An SVB application filed before the first month in which all eligibility requirements are met remains valid if the claimant meets all those requirements before a final determination is made. (If a hearing decision has been made, the application will remain in effect until the hearing decision is issued. See VB 02501.050.) If the facts concerning qualification or entitlement change before a final determination is reached, the prior determination must be updated and the claimant given notice of the updated determination (e.g., the claimant becomes eligible for SSI after his or her SVB application is filed but before the determination on SSI eligibility is final).
10. Dismissal of a reconsideration request
Grounds for dismissal include:
* Request for reconsideration of an action that is not an initial determination.
* Request filed more than 60 days after the claimant received notice of the initial determination and good cause for late filing cannot be found.
NOTE: Even if this condition exists, examine the case to determine whether there is a basis for reopening and revising the determination under the rules of administrative finality (see VB 02507.000ff)).
* Claimant died after the request was filed, unless the request involves the amount or existence of an overpayment and waiver has not been requested. (In this case, a reconsidered determination should be rendered since recovery from the estate may be possible).
* The claimant's address is unknown after reasonable efforts have been made to locate the claimant.
* The claimant indicates in writing that he or she wishes to withdraw the request. (See VB 02502.005B.11.)
11. Withdrawal of a reconsideration request
A claimant (or his or her representative) can withdraw a reconsideration request by submitting a signed statement indicating that he or she understands the effects of the withdrawal.
C. Procedure — handling reconsideration dismissals and withdrawals
1. Dismissal
When you dismiss a request for reconsideration:
* Inform the claimant (and representative, if any) of the dismissal and the reasons. (See SI 04020.020C.2.)
* Do not include an appeals rights paragraph, but advise the claimant that he or she may file a new application if eligibility requirements are met in the future.
* Make any necessary systems input.
2. Withdrawal
When a claimant requests withdrawal of his or her reconsideration request:
* Advise the claimant (and representative, if any) who wants to withdraw a reconsideration request that reconsideration is a prerequisite for a hearing and that by withdrawing the request the claimant will lose all future appeal rights on the claim.
* Obtain a request in writing, signed by the claimant or his or her representative, including a statement indicating the claimant fully understands the effect of the withdrawal.
* Forward the material to the FO with jurisdiction of the claimant's file. (See VB 00901.015.)
CAUTION: It is never appropriate to suggest withdrawal of a request for reconsideration.
D. Procedure — handling third-party requests for reconsideration
1. Inquirer calls at the FO
If the inquirer calls at the FO (without the claimant) and is not an authorized representative or representative payee:
* Follow procedures in SI 04020.020D.1. (Replace references to “SSI” with “SVB.”)
* Replace Publication 05-11008 enclosure with Publication 05-10058.
2. Inquirer contacts the FO by letter
If the FO receives a letter from a third party requesting reconsideration on behalf of the claimant:
* Follow procedures in SI 04020.020D.2. (Replace references to “SSI” with “SVB.”)
* Replace Publication 05-11008 enclosure with Publication 05-10058.
~~3. Inquirer visits, telephones or writes to an FSP~~
3. Inquirer visits, telephones or writes to an FBU
~~In cases where the inquirer visits or telephones the FSP:~~
In cases where the inquirer visits or telephones the FBU:
* Obtain a request in writing from him or her and forward it to the appropriate processing site (see VB 00901.025).
* Advise the inquirer that SSA will contact the claimant.
* If the inquirer writes to the FSP, forward the letter to the appropriate processing site.
* If the inquirer writes to the FBU, forward the letter to the appropriate processing site.
* Advise the inquirer of the referral of the letter.
~~4. Inquirer visits, telephones or writes to the FSP without the claimant~~
4. Inquirer visits, telephones or writes to the FBU without the claimant
~~If the inquirer calls at the FSP (without the claimant) and is not an authorized representative or representative payee:~~
If the inquirer calls at the FBU (without the claimant) and is not an authorized representative or representative payee:
* Advise the inquirer that you will contact the claimant about filing for reconsideration.
* Advise the claimant of the third-party inquiry and determine if he or she wishes to pursue a request for reconsideration.
* If the claimant wants to file for reconsideration, obtain SSA-561-U2.
(See VB 02502.005B.6)
* Obtain SSA-1696-U3 if the claimant wants to appoint the individual making the inquiry (or someone else) as his representative.
* Forward the material to the appropriate processing site (see VB 00901.025).
5. Member of Congress writes to FO
Carefully review the inquiry. Ordinarily, a congressional inquiry about a determination affecting a constituent is a request for information or for an explanation. However, in some cases, the inquiry or letter from the claimant (a copy of which may be enclosed with the congressional inquiry) constitutes an expressed or implied request for reconsideration. In such cases, the FO must decide whether the inquiry constitutes an implied request based on the wording of the letter. (Resolve doubts in favor of finding it to be an implied request.)
If the inquiry is found to be a reconsideration request, follow procedures in SI 04020.020D.3. (Replace references to “SSI” with “SVB.” Unless a posteligibility decision to reduce, suspend or terminate SVB payments is involved, omit text and fill-ins advising the claimant/beneficiary how he or she can appeal.)

POMS Reference

VB 02502.005: Reconsideration Requests