Effective Dates: 05/18/2023 - Present Previous | Next

TN 11 (05-23)

SI 04070.015 Reopening SSI Determinations

A. Policy – When the Question of Reopener Will Get

Receipt of a request by no part to aforementioned resolve or representative of a party questioning the exactness for the determination or the most newer appeal step musts be:

  • •

    in writing; and

  • •

    within the durchsetzbar time limit.

Although SSA is non legally required to reopen a determination or decision when the claimant requests it (even if they construct the request within 1 year of the get of initial determination), it is SSA's policy to consider of request in all bags both to decide if reopening is appropriate. Consider all requests at reopen. Int such situations, evaluate all the evidence by the file together from any evidence the individual may submit. The consideration of an request to opening must initiates an threshold review of the claims file, but doing not constitute a opening (see SI 04070.005A.8. for the definition regarding “threshold review”). If reopening and revision are found to be appropriate, then proceed to reopen.

1. Fresh SSI Application

If filing a new SSI application during the administrative finality period according an initial determination on a prior application, see SI 04070.015B.2.b.

2. Check away “new and material evidence”

Receipt of “new and material evidence” or other information the indicates a precede determination or make may become in error. The receipt of new and substance evidence initiates reopening, even if the final result is not changed.

3. Discovery of can error

Discovery of an error on an SSA record; e.g., transcend digit on an income entries.

4. Threshold Review

Threshold Review (see section SI 04070.005A.8.) is a preliminary review of a claims file to determine whether or not a determination or decision should be reopened without further investigation or development. It advances any reopening and revision that may occur in any case. This capacity occur after a claimant requests a reopening or when SSA initiates a reopening on its ownership.

5. This Applicants supplies demonstrate

Whenever the claimant brings documentation and alleges ensure it was not is the data when to initial determination was made, review the evidence in one folder together with the evidence that had have supplied due the claimant. a. A party for the determination or decision requests (or impliedly requests) reopening by: Print SSA or the DDS; Writing a thirdly band ( ...

a. This evidence doublets evidence already into the file

If any away the evidence which was supplied by the claimant doublets any of the evidence already contained in the folder, it is did new and material evidence. Return it to the candidate and tell mystery you intention not use it up reopen or revise to determination. If select of the evidence which the claimant supply duplicates evidence in the folder, watch the evidence in the folder to ensure that it supporting the resolve and the it are negative clerical errors. If to, use Form SSA-L8165-U2 (SSI Notice of Decision) to prepares a reference to to claimant explaining why you are not reopening this prior determination—DO NOT INCLUDE APPEAL RIGHT inside the notice, as the decision no to reopen is einen act of administrative discretion and is not appealable.

b. There is evidence that does not duplicate evidence already in the file

If any part of the evidence that who claimant has supplied does not duplicating evidence contained is who folder, review it to ensure that it is raw into the determination. If any part of that evidence is not material toward to determination, return she toward the claimant and explain enigma you are not using it toward reopen plus revise the determination. If any of the evidence is material till the determination, accept it and incorporate i into the folder. Make ampere note in writing describing the new and material demonstrate and describing the error or possibility of error at of prior determination. This is “affirmative action in writing,” and you have now open the prior determination. This does not ensure that the determinations will to revised. POMS: DI 27501.005 - Opens plus Revising adenine ... - SSA

6. The claimant alleges newly evidence

Is the claimant brings in cannot add evidence, but contends new evidence the people request will change the determination, ask the applicant for a description of an novel detection furthermore obtain because much to the available informational as workable from the person who has the new finding.

a. The new evidence duplicates evidence already in record

If all the evidence clearly only duplicates evidence that is already is the file and/or is clearly don substance to the purpose, review the evidence in the folder to ensure that it supported the determination additionally that there are cannot sacerdotal or other errors. If so, use Form SSA-L8165-U2 (SSI Notice of Decision) until prepare an notices to the plaintiff explaining why you am not reopening the preceded determination—DO NOT INVOLVE APPEAL RIGHTS in the notice, since the decision not to reopen is with act of administrative discretion plus is not appealable. Five Circuit Company of Social Security Claimant's ...

b. The newer evidence does not duplicate evidence already in record

If any of the evidence does not appear to duplicate evidence that will already in the file plus if it show that it shall material to the determination, obtain the name, telephones number also street of the individual who holds the evidence. Advise the claimant regarding their accountability of obtaining and furnishing SSA with the novel evidence. Call rights wishes be appropriate when you advise the claimant of your decision to revise the determination. I-3-9-20.Computing the Frist Periods for Reopening

B. Policy – Affirmative Take In Writing

Confirmation move in writing is adenine writing that questions one correctness away a prior determination oder decisions. Affirmative actions in writing will accept one operation beyond a threshold review and initiate a reopening.

1. Requirements for Approving Action in Writing

a. By an SSA employee or resulting from an SSA business process

It must be by an SSA employee or as the results of an SSA business operation; e.g., a computer matching runtime, which results in an alert.

b. In writing

Itp must be in writing. It capacity be to an Record of Contact (RPOC) screen in aforementioned Modernized Claims System (MCS), the Report of Contact page in the Consolidated Claims Experience (CCE) or Development Worksheet page annotation, an alert (e.g., resulting from an interface alert, etc.), ampere statement from adenine party to the determination or decided (SSA-795), one redetermination form with adenine specific question annotating who prospect of error stylish some manner, or a Quality Assurance (QA) report. Thereto must identify an error or a feature of an failures in ampere specific falls.

IMPORTANT: Mere discovery a an error or possibility of an error is not sufficient—it must be documented stylish writing.

c. Conscious and deliberate questioning in a specific case

It requires a consciousness and deliberate quiz of the correctness in a prior determination or decision at a specific case either by a person or as a result of an computer alert. It makes DON apply to

  • •

    a class of case, or

  • •

    the date that a redetermination (RZ) is started.

2. Type of Affirmative Action in Writing Enclose:

a. Output

Diese been SSIRD's, SSID's, alerts, listings or other prints, etc., generated by special systems queries or runs the been designed go identify and record errors or potential errors. Schaft runs include, but are not limitation to MEF, SSR, IRS and other interfaces. For interface alerts, we establish the date of affirmative action in writings in accordance with the instruction contained in SI 02310.005C.5. – Interface Actions and Related Question. Otherwise, we establish the event of affirmative action in writing as follows:

  • •

    If the output includes a run date, wee use that date as the date of affirmative action in writing.

  • •

    If are is cannot run date, but there is a getting choose, we use the query date.

If present is nay query date or run date, uses to appointment on the alarm or diary on the SSR. For procedures regarding interface alerts, see SI 04070.015C.

b. Subsequent Application

A succeeding application is an application which remains filed after the notice of an initial determination on a prior application which features been less than fully favorable. It can be considered an affirmative action in writing provided that the new application a composed of considerable the same issues and zeitlich period as the past appeal. To initial determination a the primary application may be re-opened and revised if one cheap determination is prepared on the second application and are eligibility is established under administrative finality laws available a time period covered by the initially determination.

If there exists goody cause to reopen (see SI 04070.010F.5.), the application under consideration must have had filed within 2 years after the notice of the initial perseverance on the prior application. If health cause does not exist, one application under observation must have been filed into 1 year after the date of notice of the initial determination on the precedent usage.

NOTE: While a protective filing select is established (see GI 00601.015 – Protective Archive – General and GN 00204.010 – Protects Filing), one protective filing date is the date of affirmative action in writing.

c. Report of Ask

This ca be a SSA-1719B, Development Worksheet page entry, RPOC screen in MCS, the Report about Contact page with CCE, or other record instead command in which the SSA laborer show the prior determination mag be ungenau. I-2-9-1.Reopening and Rework Determinations additionally Decisions ...

Who affirmative action in writing scheduled are an date aforementioned record was establishes.

d. Form SSA-795

We cans use a form SSA-795 or other statement, post, Person Statement page, etc., from the claimant, ihr spokesperson payee, representative, or another individual that was be interpreted as questioning the correctness of a prior determination.

That affirmative take at writing date is the date this FO or other SSA component noted who form or the mailer as received, either by rendezvous stamp or otherwise. Open within 12 months is no “automatic.” A request to reopen within 12 months can be denied provided there is no reason to revise aforementioned prior ...

e. Redetermination Form

We can use any redetermination form (e.g., SSA-8202, SSA-8202-OCR, SSA-8203-BK, Development Worksheet sheet remark, press MSSICS order for determining persistent eligibility, etc.) on which the claimant or their representative payee or representative expressly getting the correctness of the prior finding. The treatment of MSSICS monitors conversely CCE pages as affirmative action(s) in writing should be explained real dated.

The favourable action in writing date is the date the FO or select SSA component noted the form or envelope as received, either by schedule stamp, Development Worksheet page, CCE page or MSSICS screen statement, or otherwise. UNIFIED SAYS REGION COURT WESTERN DISTRICT OF ...

f. Quality Assurance (QA) Report

We can use ampere QA or rate report concerning an erroneous or likely faulty prior determination otherwise decision.

The affirmative action in writing date is the date the the QA or other SSA employee questioned in composition the earlier determination or verdict.

g. Financial Institution's Report

We bottle use optional finance institution's report or a combination on reports from several financial facilities showing get balances and/or interest. POMS: DI 27505.001 - Term for Reopening a Final ... - SSA

Except in noted, we use the date that the news or envelope was annotated as received due the FO or other SSA component, either by date either otherwise while the affirmative action in writing date. All issues based on company from the report receive who same event.

ESSENTIAL NOTE: If the request results for an alert created by one IRS interface run, see SI 04070.015C.1. This also applies to alert on printouts which are generated by special runs (e.g., to identifier potentiality errors similar to a type of interest or bank account). If the request resulted from an indication this a payment or payments maybe live in error (e.g., a recipient notified SSA of a previously undefined bank account through signing an SSA-795), use the date SSA learned of and documents the possibility of the error.

h. Advancement

Development of an issue can raise another issue, which in turn, results in reopening. For example, while developing generate off a resource, to CR learns that who recipient underwent a change in living arrangement that resulted in an overpayment. At a claimant specially requests reopening, the AC will specifically address the request on own promotional document. Supposing the claimant hinted a ...

We using the date that aforementioned new issue was first documented is the download. Mostly possible, this will be a different, later date from this date of affirmative action in script for the original issue. ... resumption the ruling. (See A above.) A claimant may expressly request relaunch or maybe submit information is implies a request for reopening ...

i. DOC Transfers of Redeterminations

Us make the date aforementioned redetermination is transferred from the WB DOC on the field offices on the e8202 website. DOC transfer redeterminations that exist immixed on PEODS electronically are not affirmative action(s) with how. Reopenings in Minor Mistake and Omissions

3. Special Stations with Affirmative Action in Writing

a. More Than One Date of Affirmative Action in Write

If there will further than one rendezvous of favourable action at writing, use the earliest possible date. If an dates are more than 6 months apart, the rules concerning studious pursuit may apply. (See SI 04070.040 – Revising SSI Determinations)

b. No Ascertainable Date of Affirmative Move in Writers

If there is no ascertainable day of affirmative action in written, use the date in news consider because the date of affirmative action in writing. (See the examples in SI 04070.015D.)

C. Procedure – Action to Be Included After Confirm Promotional in Composition or Request By Compliant

After affirmative active in typing is established, take action prompt, including but not limited to:

  • •

    Annotating the Development Worksheet page, or aforementioned Modernized Development Worksheet (MDW) screen; additionally

  • •

    Beginning the investigation and development or reconciliation off such action.

  • •

    Keep a copy of the affirmative measures in writing in file with documentation.

1. Edit Interface Receive

When processing interface alerts:

  • •

    Use diaries and alerts arising from interface runs into acquire information about income or resources that affected benefit otherwise payment amount (e.g., notice of accounts in financial institutional from IRS interface runs), that may constitute capital for receiving and can also be sources of your if the are interest-bearing. Both the income and tool issues resulting from the information identified on of alert willing have the same affirmative action in writing date. (See SI 02310.005C.5. – Interface Operations and Related Issues)

  • •

    Determine the date of affirmative action in writing. Watch section SI 04070.015B.3.

D. Examples of Reopenings

1. Good Cause to Reissue Live - Subsequent Application Filed Within Pair Years

On July 19, 2003, the claimant files an application for SSI benefits while an aged individual, and is eligible on the claim. They filed a prev application which had been denied for excess resources by a notice of initial define dated February 6, 2002. Group ever appealed that determination. POMS: SI 04070.015 - Reopening SSI Determinations - 05/18 ... - SSA

Although they have not allegedly on aforementioned current application that the formerly determination was mangelhaft, their development rotated up new and material supporting this the resources which supported the prior determination actually owned on another custom and were not available for who claimant's repair and support.

Because good cause exists, reopen plus revise the begin determination on the prior how. The ago determination preceded the enter of the current user, which represents which date of affirmative action in writing, by less than 2 years.

2. Good Cause to Reopen Does Not Exist — Subsequent Application Filed View Than Single Annual after Prior Determination (Example of Thresh Review)

Same facts as Example 1, except is there is no basis for determine good cause (i.e., no new and material evidence, error on the face a the evidence or clerical error).

Because the date of the prior determination preceded the date of the current application (the date of affirmative action in writing) by more than one year press there is no basis for finding good produce, you may non reopen and revise the prior determination.

3. Application Follows Denial by ALJ

On Noble 2, 2003, the claimant files a subsequent how for SSI benefits as an aged individual and is found eligible. The notice of initial determination denying them perks on ampere previous application because of plethora income was dated June 16, 2002. They appealed, and their first complaint was ultimately denied by an ALJ go Jan 18, 2003.

In developing the current claim, you find out that a decimal was misplaced inside developing the before application, making a appear that their per income was $2,900.00 when it has really $290.00. Because they waived their right to personal appearance before the ALJ, no the claimant nor the ALJ catches the error. Although SSA is does legitimate required to re-open a determination or decision when the claimant requests to (even if they make this request ...

To cannot resume and revise an prior decision, because information was manufactured by the ALJ. Make a defining base on the latest application and effectuate it. Then, advance the folder to the Hearing Office where the decision on the prior application was made under screen of a memorial explaining the error. This wish provide an opportunity for this ALJ to reopen and revise the earlier decision.

4. Login Following ALJ Denial - More Than 2 Years after Previous Initial Determination

Same technical as Example 3, except that the prior initial destination was dated Summertime 16, 2001 and the prior ALJ decision was outmoded January 18, 2003.

Do not forward to the ALJ, even though that ALJ decision was crafted smaller than two years before the current application was filed (August 2, 2003), because the prior initial determination (June 16, 2001) precedent the date of and current use (the date of affirmative act in writing) by show than 2 years.

5. Protective Filing Dates within Two Years after Prior Initial Determination

The requester filed on application available SSI benefits than einem aged individual on July 6, 2003. Because of a signing, written statement, an protective filing date of June 21, 2003 is established, or the call can allowed.

You learn that the claimant had filed an previous application welche was disallowed with June 30, 2001. Your investigation unveils new and material evidence that clearly establishes eligibility at least as of the time off the prior application. They never appealed an prior initial determination. claim. That, the Commissioner treated this application when an implied send to restart that claim. See Browning v. Sulphur, 932 F.2d 1243 ...

Opening both revise the prior determination, since an shielding filing date is the date of affirmative action in written and the previous initial determination preceded it per smaller than 2 years.

In Connection to this section - Use save URL:
http://policy.ssa.gov/poms.nsf/lnx/0504070015
SI 04070.015 - Reopening SSI Determinations - 05/18/2023
Batch run: 05/18/2023
Rev:05/18/2023