TN 13 (09-02)

A. Policy

We send manually prepared notices when the SSI notice system cannot generate a notice or when an automated notice may be incorrect or incomplete. In some cases when a manual notice is required, we must suppress any systems-generated notice for the situation.

B. Procedure

1. Notice suppression required

a. Suppress automated notice-issue required manual notice

Suppress the automated notice and issue a required manual notice(s) when:

• There is a change in the TMR (e.g., DX to DI, DC to DI) before the appeal is effectuated;

• Claimant is awarded and has any month of N02 or N22 during the period of adjudication;

• Payments were made before effectuation (e.g., emergency advance or presumptive payments) and the NOTC segment on the SSR shows notice suppression (e.g., first four positions show 0000 or 0001) for any run date;

• Award or denial letter was previously produced (8025 or 8030 in the NOTC segment of the SSR);

• This is the first notice on start date records; or

• Record is in force pay/force due;

  NOTE: If notice suppression is input via the Miscellaneous Data (CMSC) screen or 1719B at any time prior to the appeal being effectuated and the NOTC segment of the SSR has not been updated, a notice will not be sent.

• The individual has a legal guardian who is not the representative payee on the record;

• The next month's check (potential overpayment month) can be reduced only if we manually prepare and send the advance notice;

• An overpayment due to excess resources is waived because it meets the conditions in SI 02260.035;

• The Goldberg/Kelly protected payment level changes because of subsequent events during a period of payment continuation. (See SI 02301.307 on manual Goldberg/Kelly notice procedures.);

• Changes in conversion data result in a reduced payment;

• Converted recipients lose grand-fathered protection; benefits are reduced or suspended (SI 01210.300D. and SI 01220.100C.3.),

• Substantial gainful work activity results in an IC denial;

• The F0 believes a systems-generated notice may be incorrect, inappropriate, or incomplete in a particular case situation; (If the FO is aware that an automated notice may cause questions or needs to give a fuller explanation in a particular case, it may send a manual notice.)

• A case involves a finding of N05 for any month(s) in the retroactive period;

• Records go into N07 and N08 after adjudication; (DPD must be input.)

• Death benefits are income to an individual (SI 00830.545);

• A case involves unstated income (SI 00810.035) in any month;

• Posting data obtained from computer matching covered by P.L. 100-503, which the recipient has not confirmed; (See SI 02310.005.)

• Start date records paid presumptive disability or blindness payments and then denied for nondisability reasons; (See NL 00801.015.)

• Claimant is awarded and has any month of N25 during the period of adjudication. See SI 00530.205 - Fugitive Felon Automated Case Processing (FFAP) for when the FFAP system issues the notice;

• Records go into N25 after adjudication. See SI 00530.205 - Fugitive Felon Automated Case Processing (FFAP) for when the FFAP system issues the notice;

• The date of entitlement (DOE) on the new record is earlier than the DOE on the old record and the new DOE is earlier than the first date in Computation History (CMPH) segment.

b. Automated SSI appeal effectuation notice

An automated SSI appeal effectuation notice for reversals of initial disability determinations will be generated when the appropriate systems input is made. See MSOM MSSICS 020.025. Otherwise, issue a manual notice using Form SSA-L8455-U2 for IC reconsideration reversals and Form SSA-L8456-U2 for affirmations of IC decisions (see NL 00802.050). Use Form SSA-L8457-U2 for post-eligibility (PE) cases (see NL 00803.095).

2. Notice suppression not required

The system cannot generate all notices. Issue a manual notice in the following situations:

• Claimant is denied for N02, N05, N07, N08, N22, N24, or N25.

• More than one factor of eligibility results in an initial claims (IC) denial;

• An individual is eligible, but you are still developing for a representative payee (S08). (See NL 00802.010D.5.)

• Advance notice is required for appointment of change in representative payees.

• The record is terminated for a reason other than death.

• The record is “awaiting spouse” (TMR-ES).

• Underpayments are due the survivors of deceased claimants (SI 02101.008).

• When changing the reason for denial or ongoing suspension, the system will not issue the second notice. FOs must notify the individual of the new decision (denial or ineligibility).

  EXAMPLE: An individual is suspended for N17. Later we discover there are excess resources, and we overlay the field with N04. FOs must issue a manual notice for the excess resources.

• Recipient receives payment on more than one SSI record.

• Overpayment notice situations excluded from AONS (SM 01310.305).

• Full or partial denials of overpayment waiver requests.

• Most notices sent on start date records. (See NL 00801.015 and NL 00801.010B.1. for the one start date situation where notice suppression is required.)

• Force payment cases, one-time payments.

• Records are already in payment status (PS) N07, N08, S06 or S08, and we need to send a notice about an issue like an additional overpayment in the retroactive period.

• A change in the Type Master Record (TMR) during adjudication (i.e., from DB/DC to DM/DC).

3. Select the form

Select the form for the type of action and the appeal rights that apply. Appeal rights are preprinted on the forms. Use these forms for manual notices:

*There are 2 ways to request a reconsideration.

**The first level of appeal is a hearing.

***There are 3 ways to request a reconsideration.

NOTE: The notices listed above (except the SSA-L8165-U2) may be found on the Distributed Online Correspondence System (DOCS).

4. Prepare the notice

a. Notice standards

See SSA’s notice standards in NL 00610.000 for guidelines on readability, writing, grammar, organization, style, and appearance of notices.

b. Required notice content and format

Follow instructions in NL 00802.001 and NL 00803.001 for required notice content and format. Use paragraphs from standard notice language in NL 00804.100 whenever possible.

c. Overpayments rules

Follow SI 02201.025 and NL 00803.100 for overpayment notice rules.

d. Enclose appropriate pamphlets

Enclose the appropriate pamphlets (see NL 00801.001C.2.).

e. Spanish language notices and cover letters

Follow instructions in NL 00801.025 for Spanish language notices and Spanish language cover letters.

f. Separate notice-each member of eligible couple

Send each member of an eligible couple a separate notice.

g. Notices to rep payees and authorized third parties

Prepare and mail manual notices and the appropriate copies to representative payees and authorized third parties (authorized representatives and legal guardians).

NOTE: Remember to send copies of all notices, administrative actions, determinations, decisions, and requests for information or evidence to authorized third parties.

h. Rep payee cover sheet-SSA-L8176-U2

Attach representative payee cover sheet, SSA-L8176-U2, for overpayment notices to representative payees (NL 00803.150).

i. SSA-L4031 cover sheet

You may use the SSA-L4031, as a cover sheet for notices, come-in letters, or other letters sent both to the recipient and a payee or authorized representative. This notice is on the DOCS.

j. Issuing and dating notice

Issue the notice as soon as possible after the determination. Date the notice the day it is mailed.

k. Manual notice-individual's file

Place a copy of each manual notice in the individual's file.

C. References

• Policy Writers ToolKit Part 6 Beneficiary Notices, http://eis.ba.ssa.gov/toolkit/tk-600-table-con.htm

• SSA Notice Standards, NL 00610.001 through NL 00610.110

• Suppressing the Automated Notice, SM 01005.535, SM 01301.675, SM 01305.530, SM 01305.540 and SM 01301.675

• Manual Notices Required, SM 01305.520 and SI 02301.307 for manual Goldberg/Kelly notice procedures.

• AONS Processing, SM 01310.300.

• Preparing Initial Claims Notices, NL 00802.001.

• Preparing Post-eligibility Notices, NL 00803.001.

• Reconsideration Determinations, SI 04020.010 A. and SI 04020.010B.2.

• Favorable Administrative Law Judge Decisions, SI 04030.050 C.9.

• Standard Notice Language, NL 00804.100.

• Representative Payee Advance Notices, NL 00703.763.

• Formal Representative Payee Notices, NL 00703.821.