TN 6 (11-05)

A. Policy

SSA will investigate and resolve any response or inquiry received from a beneficiary concerning the advance notice. The type of action required will depend on the nature of the issue raised and the manner in which the beneficiary responded.

Since the advance notice contains appeal rights, distinguish which responses to treat as formal requests for reconsideration and which ones can be disposed of informally as a protest. Afford formal due process rights when appropriate.

Treat the response as a request for reconsideration if the beneficiary expresses a desire to exercise formal appeal rights. Obtain an SSA-561-U2 and process accordingly. In addition, if the beneficiary is not satisfied with an informal explanation, advise him/her again of the right to a formal appeal.

Process a protest as a formal request for reconsideration only when the:

• protest is in writing (solicit an SSA-561-U2 if the protest is verbal),

• protest is made by the beneficiary or a person who can act for the beneficiary (see GN 00503.110), and

• issue at hand is an initial determination.

  While a third party inquiry does not require a response by SSA, investigate any report of a possible problem.

  NOTE: See GN 00501.015 to determine which component has responsibility for the actions described below.

B. Procedure - General

If the response disputes the payee selection or need for a payee and it is received before the effectuation of the payee appointment, the response must be resolved before the payee appointment is processed. Have the determination reviewed by a CR who was not involved in the original decision (or some other employee authorized to make initial determinations.)

If the issue cannot be resolved immediately, initiate direct payment to the beneficiary, if possible. (See GN 00504.105).

See GN 00503.120E.3. for procedures on handling requests to review the file.

C. Procedure - Protests

Resolve any inquiries arising from the advance notice. Review the information provided with the inquiry along with the evidence used in the initial determination. Request a face-to-face interview with the beneficiary to resolve any problems.

Record the protest on the Protest Details screen on eRPS per MS INTRANETERPS 012.004 to prevent the selection from being processed while you are resolving it. Document the rationale for your decision on the Make Note screen. (See MS INTRANETERPS 015.002 and MS INTRANETERPS 015.003.F).

1. Change in Initial Determination

The FO is responsible for sending all notices.

a. Capability Issue

If the protest involves the need for a payee and you decide that the beneficiary is capable, initiate direct payment immediately. The system will send the correct notice to the beneficiary if he/she had a payee. If the beneficiary is in direct pay, contact the beneficiary and advise him/her of the decision. Record the non-selection issue on eRPS and process the SSA-11 (“SSA-11” represents both the SSA-11-SG and SSA-11BK in this subchapter) normally.

b. Selection of Payee Issue

If the issue is the selection of a specific payee and you decide to select a different one, process the new SSA-11 in the normal procedure. The eRPS will send the beneficiary an advance notice of the revised selection. Allow the beneficiary time to appeal the revised determination. Record the non-selection issue for the first applicant on eRPS. The T2R notice system will send the notices to the new payee, beneficiary and former payee. The FO is responsible for sending the notices to the new payee and beneficiary in title XVI change of payee situations. The title XVI system will send these notices if the beneficiary was in direct pay. Also, always send the former payee notice manually on title XVI cases.

2. No Change in Initial Determination

If, after a thorough review, you decide that the original decision is correct, contact the beneficiary and advise him/her accordingly. If the beneficiary understands and agrees, document the decision on the Protest Decision Details screen. No further action is required. Follow MS INTRANETERPS 012.002 to initiate selection.

However, if the beneficiary still disagrees and wants to exercise his/her right to a formal appeal, obtain an SSA-561-U2 and process as indicated below.

D. Procedure - Reconsideration

Document the receipt of the reconsideration on the Add New Issue screen on eRPS. Compare the information provided when the protest is filed with the evidence used in the initial determination. Request a face-to-face interview with the beneficiary to resolve any problems. Also, document the rationale for the decision on the Protest Decision Details screen.

1. Reconsideration Filed before Effectuation

Record on the Protest Details screen that a “protest” has been filed to prevent effectuation, per MS INTRANETERPS 012.004.

2. Change in Initial Determination

All notices should be sent by the FO.

a. Capability Issue

If the reconsideration involves the need for a payee and you decide that the beneficiary is capable, initiate direct payment immediately. The system will send the correct notice to the beneficiary if he/she had a payee. If the beneficiary is in direct pay, send a manual reconsideration notice including the hearing paragraph. Record the non-selection issue on eRPS and process the SSA-11 normally.

b. Selection of Payee Issue

If the issue is the selection of a specific payee and you decide to select a different one, process the new SSA-11 in the normal procedure. The eRPS will send the beneficiary the advance notice of the revised selection. Allow the beneficiary the normal time to appeal the revised determination. Record the nonselection issue for the first applicant on eRPS.

For title II cases, the T2R notice system will send the notices to the new payee, beneficiary and former payee. The FO is responsible for sending the notices to the new payee, former payee and beneficiary in title XVI change of payee situations. The title XVI system will send these notices if the beneficiary was in direct pay. However, the FO must send the SSA-623 when a final accounting is needed.

3. No Change in Initial Determination

If you decide that the original decision is correct, effectuate the payee appointment and send a manual formal reconsideration notice including the hearing paragraph. (Use notice language similar to that in NL 00703.215 if the issue is the need for a payee. Use NL 00703.216 if the issue is selection of the payee.). Suppress the notice on title XVI cases and send the notices to the new payee, former payee and beneficiary manually.

E. Procedure - Reconsideration Filed after Effectuation

1. Change in Initial Determination

a. Capability Issue

If the reconsideration involves the need for a payee and you decide that the beneficiary is capable, initiate direct payment immediately (process a self application in RPS). The system will send the correct notice to the beneficiary. Contact the current payee per GN 00504.100B.1. However, on title XVI cases, the FO is responsible for sending the SSA-623 when a final accounting report is needed.

b. Selection of Payee Issue

If the issue is the selection of a specific payee and you decide to select a different one, process the new SSA-11 in the normal procedure. Contact the current payee per GN 00504.100B.1 The eRPS will send the beneficiary the advance notice of the revised selection. Allow the beneficiary the normal time to appeal the revised determination. For title II cases, the T2R notice system will send the proper notices. The FO is responsible for sending the notices to the beneficiary, payee and former payee on title XVI cases (see GN 00503.130 for notice language references).

2. No Change in Initial Determination

If you decide that the original decision is correct, send a manual formal reconsideration notice including the hearing paragraph. (Use notice language similar to that in NL 00703.215 if the issue is the need for a payee. Use NL 00703.216 if the issue is selection of the payee.).

3. Review of File

1. a. Honor a request for a review of the information in the file if made by a legally competent adult beneficiary, the legal guardian of an incompetent beneficiary or an authorized representative.

EXCEPTION: If you believe disclosure of medical information in file may pose a serious hazard to the beneficiary or the person who provided the information, request the beneficiary to designate a representative to review the file.

If the beneficiary does not designate a qualified representative, contact the Regional Office for a decision on disclosure.

b. If a person other than one specified in GN 00503.120E.3.a. requests review of the folder, see GN 03340.000 .

F. References

• GN 03305.000 - Disclosure information

• GN 03101.001 - Reconsideration procedures

• GN 00503.430 - Guide language for describing the legal basis for representative payee decisions when a State court, State agency or legal guardian is not appointed payee

• MS INTRANETERPS 015.002 - Make Note screen

  MS INTRANETERPS 015.003 – View Notes screen

  OM RPS 002.022 - RLST screen instructions

• NL 00703.763 - NL 00703.769 - Advance notice language

• NL 00703.821 - NL 00703.828 - Final notice language