BASIC (05-03)

A. Policy - Advance Notice

An advance due process notice must be sent to the beneficiary/claimant and/or representative payee before an adverse action is taken when:

• A third party report is received which results in an adverse action, or

• An event discovered by SSA results in an adverse action.

  An advance notice of change in representative payee is NOT sent to beneficiaries living in foreign countries. The final notice in those cases must include a full explanation of appeal rights. (See GN 00505.044)

  See GN 00503.100 for the policy on sending an advance notice in representative payee situations to an adult or legally emancipated child.

1. Notice Content

If the beneficiary/claimant has a payee, send the notice to the representative payee and the beneficiary/claimant. The notice must state the:

• pending adverse action,

• reason for the action,

• the evidence used to make the determination,

• effect on benefits, and

• the number of days the beneficiary has to respond before SSA takes action.

2. Time Period For Rebuttal

For cases involving adverse actions or adjustments, the time frame for rebuttal is 10 days (plus 5 days for mailing) before SSA will take the adverse action.

For Title II cases involving automated computer and/or non-automated data match, the time frame for rebuttal is 30 days (plus 5 days for mailing).

For processing Title XVI alerts from computer matches see SI 02310.007.

For cases involving adverse claims see GN 01010.320 3a.

3. No Rebuttal From The Beneficiary Or Representative Payee

If we do not hear from the beneficiary/claimant or representative payee within the time-frame, assume the information in the letter is correct and take the adverse action.

B. Policy - Final Notice

The beneficiary/claimant (or payee) must receive a final notice for all events that result in an adverse action after the action is taken.

The notice must provide sufficient information for the beneficiary/claimant to make an informed appeal decision, such as the:

• action taken,

• basis for the action,

• appeal rights, and

• waiver provision if the report results in an overpayment.

C. References

See SI 02301.010 for title XVI procedures for acting on reports and SI 02301.300 for Goldberg/Kelly procedures.

See GN 03101.020 for Good Cause for Extending Time Limit