TN 3 (09-89)

A. Procedure

Include the following when preparing the SSA-662 or an equivalent:

• statement of jurisdictional factors — filing of application, date of notice of initial determination, date of request for reconsideration;

• basis of request for reconsideration;

• statement of issues;

• brief nontechnical statement of the applicable provisions of the law and regulation;

• statement of the facts and evidence as presented;

• findings of fact;

• conclusions based on findings of fact and applicable law and regulations.

If the claimant failed to respond to a request for additional evidence, include a statement that the decision was made without the benefit of any additional evidence which might have supported his or her position.

NOTE: To prepare RECON SGA Affirmation notices, see DI 13010.145.

B. Exhibit - SSA-662 (Reconsideration Determination)

To view this form, go to SSA-662.