ADMINISTRATIVE ACTIONS THAT ARE INITIAL DETERMINATIONS
(See GN03101.070, GN03101.080, and SI04010.010)
NOTE: These lists cover the vast majority of
administrative actions that are initial
determinations. However, they are not all
inclusive.
Title II
1. Entitlement or continuing entitlement to benefits;
2. Reentitlement to benefits;
3. The amount of benefit;
4. A recomputation of benefit;
5. A reduction in disability benefits because benefits
under a worker's compensation law were also
received;
6. A deduction from benefits on account of work;
7. A deduction from disability benefits because of
claimant's refusal to accept rehabilitation services;
8. Termination of benefits;
9. Penalty deductions imposed because of failure to
report certain events;
10. Any overpayment or underpayment of benefits;
11. Whether an overpayment of benefits must be
repaid;
12. How an underpayment of benefits due a deceased
person will be paid;
13. The establishment or termination of a period of
disability;
14. A revision of an earnings record;
15. Whether the payment of benefits will be made, on
the claimant's behalf to a representative payee, u
nless the claimant is under age 18 or legally
incompetent;
16. Who will act as the payee if we determine that
representative payment will be made;
17. An offset of benefits because the claimant
previously received Supplemental Security Income
payments for the same period;
18. Whether completion of or continuation for a
specified period of time in an appropriate v
ocational rehabilitation program will significantly
increase thelikelihood that the claimant will not
have to return to the disability benefit rolls and
thus, whether the claimant's benefits may be
continued even though the claimant is not disabled;
19. Nonpayment of benefits because of claimant's
confinement for more than 30 continuous days in a
jail, prison, or other correctional institution for
conviction of a criminal offense;
20. Nonpayment of benefits because of claimant's
confinement for more than 30 continuous days in a
mental health institution or other medical facility
because a court found the individual was not guilty
for reason of insanity; a court found that he/she
was incompetent to stand trial or was unable to
stand trial for some other similar mental defect; or,
a court found that he/she was sexually dangerous.
Title XVI
1. Eligibility for, or the amount of, Supplemental
Security Income benefits;
2. Suspension, reduction, or termination of
Supplemental Security Income benefits;
3. Whether an overpayment of benefits must be
repaid;
4. Whether payments will be made, on claimant's
behalf to a representative payee, unless the
claimant is under age 18, legally incompetent,
or determined to be a drug addict or alcoholic;
5. Who will act as payee if we determine that
representative payment will be made;
6. Imposing penalties for failing to report important
information;
7. Drug addiction or alcoholism;
8. Whether claimant is eligible for special SSI
cash benefits;
9. Whether claimant is eligible for special SSI
eligibility status;
10. Claimant's disability; and
11. Whether completion of or continuation for a
specified period of time in an appropriate
vocational rehabilitation program will
significantly increase the likelihood that
claimant will not have to return to the disability
benefit rolls and thus, whether claimant's
benefits may be continued even though he or
she is not disabled.
NOTE: Every redetermination which gives an
individual the right of further review
constitutes an initial determination.
Title VIII (See VB 02501.035)
1. Meeting or failing to meet the qualifying and/or
entitlement factors for special veterans benefits
(SVB);
2. Reduction, suspension or termination of SVB
payments;
3. Applicability of a disqualifying event prior to
SVB entitlement;
4. Administrative actions in SVB cases similar to
those listed under Title II-items 3, 4, 10, 11 & 16.
Title XVIII
1. Entitlement to hospital insurance benefits
and to enrollment for supplementary
medical insurance benefits;
2. Disallowance (including denial of
application for HIB and denial of
application for enrollment for SMIB);
3. Termination of benefits (including
termination of entitlement to HI and SMI).
4. Initial determinations regarding Medicare Part B
income-related premium subsidy reductions.
Form SSA-561-U2 (03-2015) UF (03-2015)
