BASIC (01-01)

A. Policy

1. When and Where to Send Revised Determination Notices

A notice is required whenever SSA revises an initial determination. SSA sends notices of revised determinations to the claimant or beneficiary at his/her last known address and to each of the following: representative payee, legal guardian and appointed representative (if any). (See VB 02507.050B.3. when SSA decides not to revise a determination or decision.)

2. Contents of Notice

The notice must state the basis for the revision and the effect(s) of the revision; it must inform the parties of their appeal rights.

3. Suspension, Termination or Reduction

If the revision results in suspension, termination or reduction of current benefits, the notice must inform the recipient of his/her rights to continued benefits and to reconsideration. (See VB 02501.025A.3.)

4. No Current Suspension, Termination or Reduction

If the revision affects a closed retroactive period only (i.e., current benefits are not affected), the notice will inform the recipient of his or her right to a hearing. (This also applies to revisions where the SVB recipient's current payment is increased.)

5. Evidence Not in the Record

If the Appeals Council (AC) or an Administrative Law Judge (ALJ) proposes a revision and the revision is based on evidence that is not in the record on which the prior determination or decision was based, the Office of Disability Adjudication and Review (ODAR) will issue a notice informing the claimant or beneficiary of the proposed action and the right to a hearing before any further action is taken.

6. Evidence on Record

If the AC or an ALJ proposes to revise a decision and the revision is based only on evidence included in the record on which the prior determination or decision is based, the ODAR will notify the claimant or beneficiary of the proposed action and all of his/her appeal rights.

B. Procedure - Notice Forms

1. Advance Notice of Payment Reduction, Suspension or Termination Required

Manually prepare the appropriate SVB notice as shown on Field Office Notice Software (FONS) for cases where current SVB payments will be reduced, suspended or terminated as a result of the revised determination. (See VB 05001.000 ff.) Add a paragraph indicating that “This determination replaces all previous determinations for the above period.”

NOTE: The beneficiary must be advised of the basis for the action and the right to reconsideration and payment continuation under the Goldberg/Kelly provisions.

2. Advance Notice of Action Not Required

Use the blank notice with SVB letterhead (when available on FONS), to manually prepare a letter patterned from SSA-L8100-U2 (Notice of Revised Determination) for all revised determinations which do not involve reduction, suspension or termination of an SVB beneficiary's current payments. This includes revised determinations where payments are reduced, suspended or terminated for a closed retroactive period only or situations where the SVB beneficiary's current payments are increased.

NOTE: This notice should advise the beneficiary of the basis for the revised determination and the right to a hearing by an ALJ.

Since the SSA-L8100-U2 is designed as an SSI notice (see NL 00803.030), the following changes should be made when it is used for SVB purposes:

1. Replace all references to “Supplemental Security Income” and “SSI” with “Special Veterans Benefits” and “SVB.”

2. If the beneficiary is outside the United States when the notice is issued, do not include headings and information about attending a hearing, including “How the Hearing Works” and “If You Want Help with Your Hearing.” Under “Do You Disagree With The Decision?” show the following text:

   • “If you disagree with the decision, you have the right to appeal. A person who has not seen your case will look at it. That person will be an Administrative Law Judge. In the rest of our letter, we'll call this person an ALJ. The ALJ will review those parts of the decision you disagree with and consider any new facts you have before deciding your case. We call this a hearing.

     • You have 60 days to ask for a hearing.

     • The 60 days start the day after you get this letter.

     • You have to ask for a hearing in writing.

     • You must have a good reason if you wait more than 60 days to ask for a hearing.

     • The ALJ conducts hearings only in the United States.

     • We will not pay your travel expenses to come to the United States for a hearing.

     • You may make your request for a hearing through any U.S. Social Security office or the Federal Benefits Unit in Manila, or you may write to us at the address shown at the top of this letter.”

3. For claimants and beneficiaries abroad, add the following heading and text under “If You Have Any Questions”:

   • “If you have questions, you should contact one of the offices shown below. You may also write to us at the address shown at the top of this letter. However, if you call or visit an office, please have this letter with you.

     • If you live in Canada, contact any U.S. Social Security office.

     • If you live in Guam, Puerto Rico, American Samoa or the U.S. Virgin Islands, you should contact the nearest U.S. Social Security office.

     • If you live in Mexico, contact any U.S. Social Security office or the nearest Federal Benefits Unit.

     • If you live in the Philippines, please call 523-1001 extension 2516 or 2645 from 8:00 am to 11:00 am or write/visit SSA Division, U.S. Department of Veterans Affairs, 1131 Roxas Boulevard, 0930 Manila.

     • If you live in any other country, you should contact the nearest Federal Benefits Unit.

3. Denial of Request to Reopen Prior Determination

If a claimant or beneficiary (or other individual specified in VB 02507.001C.4.) has requested reopening of a determination or decision, and there is no basis to reopen and revise, use the blank notice on FONS with the SVB letterhead (when available) and prepare a letter patterned from SSA-L8165-U2 (Important Information) to deny the request (see NL 00803.075). Take the following actions in completing the notice:

• Replace all references to “Supplemental Security Income” and “SSI” with “Special Veterans Benefits” and “SVB”;

• Explain why the determination or decision will not be reopened;

• Since the denial is not an initial determination do not include appeals paragraphs.