426-6        CASE CONTROLS DURING THE SSISupplemental Security Income APPEAL PROCESS

426-6 A.   VERIFICATION TIMEFRAMES

Under Interim Assistance Reimbursement provisions, SSASocial Security Administration will notify the Claims Unit of initial SSISupplemental Security Income approval or denial decisions for all SSISupplemental Security Income applicants for whom they have an IARInterim Assistance Reimbursement authorization on file.  However, SSASocial Security Administration will not notify the Claims Unit about an SSISupplemental Security Income applicant's appeal status, unless the appeal is successful, in which case SSASocial Security Administration will notify the Claims Unit of the SSISupplemental Security Income approval.  The Claims Unit will in turn notify the case worker responsible for the applicant's Interim Assistance case.

Since the time required at each step of the SSISupplemental Security Income appeals process varies widely by appeal stage, by individual circumstances, and even by the time of year, periodic checks with the Social Security Administration to verify the status of SSISupplemental Security Income appeals are necessary to ensure that the SSISupplemental Security Income applicant or recipient has continued the appeals process as required for continued Interim Assistance benefits.

Although the applicant or recipient is responsible for reporting any changes in appeal status, follow-up may be necessary if the client does not report the change.  When the client is represented by an attorney or paralegal, the case worker should use that person as a source of verification during the appeal process.  The SDXState Data Exchange paper printout is another source of verification of SSISupplemental Security Income appeal status.  Field staff may also contact their local servicing SSASocial Security Administration district office to verify SSISupplemental Security Income appeal status if the information is not readily available through other sources.

Reconsideration.  After a reconsideration with SSISupplemental Security Income has been filed, verify the status within 90 days after the date the client filed the request.  

Administrative Law Judge hearing.  If the client files a hearing request, seek the scheduled date of the hearing within 60 days of the time the client filed and schedule periodic inquiries for verification of the hearing status approximately every 90 days after the scheduled hearing date.

Appeals Council review.  After a request for Appeals Council review is filed, verify the decision status approximately every 120 days.

426-6 B.   NOTICE REQUIREMENTS

An initial finding of no blindness or disability by SSASocial Security Administration forms the basis for the denial of an APAAdult Public Assistance application.  Written notice of APAAdult Public Assistance denial must be sent to the APAAdult Public Assistance applicant whenever a case worker becomes aware of an initial SSASocial Security Administration finding of no blindness or disability.  The denial notice must inform the client that the APAAdult Public Assistance application is denied, and that continued eligibility for Interim Assistance may still exist if the individual appeals the SSISupplemental Security Income decision.  If the appeal process results in a final finding of blindness or disability, the APAAdult Public Assistance application shall be reevaluated.

IAInterim Assistance benefits must be continued for a reasonable period of time after a case worker becomes aware of an adverse SSISupplemental Security Income decision from any level except the final Appeals Council review, to allow the client time to appear, offer good cause, file an appeal to the next level, etc.  Written notice of Interim Assistance closure must be sent to each client immediately upon discovery of each adverse SSISupplemental Security Income decision or notice of failure to appear at an SSISupplemental Security Income hearing.    SSISupplemental Security Income allows up to 60 days from the point of notice of adverse action for the client to file for the next level of appeal.   APA denial notices must give the client at least 30 days to offer proof of re-entry into the SSISupplemental Security Income appeals process.

The 30-day period for a client to offer proof of re-entry into the SSISupplemental Security Income appeals process may be extended by the case worker's prudent judgment if there is good reason to believe that 30 days is inadequate for the client to appeal or to offer good cause for not appearing.  Examples of good cause are remoteness from an SSASocial Security Administration or Alaska Legal Services office and personal or family illness.

When the appeals process ends because of the client's written withdrawal, a 10-day advance notice of closure is sufficient.