TN 3 (01-89)

A. Definition

See GN 03101.040 for definition of initial determination.

B. Policy Principle

The rules of administrative finality apply only to initial determinations.

1. ADMINISTRATIVE FINALITY ONLY PROTECTS INITIAL DETERMINATIONS

Any action which is not an initial determination can be changed at any time and is not protected by the rules of administrative finality.

Since the failure to make a determinationwith respect to any claim or post-entitlement issue is not an initial determination, whenever such failure comes to the attention of SSA, an adjudication of the claim or PE issue is in order.

2. CHANGE IN FACTUAL SITUATION

Where a change occurs in the factual situation on which a determination was made, we may always make a new determination effective with the date of the changein the factual situation. This is so regardless of the time that elapses from the original determination before we are made aware of the change in facts.

EXAMPLE: If a child left his mother's care 5 years ago but we just find out about it now, we can now make a determination that the mother is no longer entitled effective 5 years ago.

3. FINDINGS OF FACT

In connection with an award or denial, we may make various findings of fact (e.g., date of birth or entitlement, amount of earnings, computation of benefit amount, etc.). All of those findings are merged into the initial determination of award or denial. Where a condition for reopening one of these findings is met, it opens up the entire initial determination, not just that one finding.

4. SEPARATE DETERMINATIONS FOR ENTITLEMENT AND TERMINATION

SSA makes initial determinations of entitlement to and termination of benefits. The fact that we previously determined that a claimant met the requirements for entitlement does not preclude us from making another determination that he/she meets the requirements for termination at some subsequent date.

EXAMPLE: If the date of the application is erroneously entered as the child's date of birth, we can still terminate the child when he/she actually turns age 18. The DOB shown on the award notice for the child is only for informational purposes. We did not make an initial determination as to the child's DOB when we entitled him; we only made a determination that he/she was under age 18.