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pdfMSSICS Appeals Screens in Full Path Order
This is a summary document about MSSICS Appeals screens. It contains screen facsimiles, notes about
each screen, and links to MSOM sections.
The screens shown are those used when there is an active claim iteration in MSSICS. If the claim was not
processed using MSSICS, Direct Update is used to record high level summary appeal information.
Information about Direct Update is found in MSOM BUSSR 002.007 and following.
The screens are shown in full path order, as if every possible screen could be present for an appeal
iteration. Most appeal iterations are very short. For example, a typical request for reconsideration for an
initial disability issue contains only five screens.
MSOM contains a comprehensive introductory chapter to MSSICS Appeals in MSOM MSSICS 020.001.
The screen facsimiles are from the MSSICS Detailed Functional Requirements. The key to the screen
values is:
X
9
S
P
B
V
User can enter alpha/numeric characters
User can enter numeric characters only
Prefilled by the system and cannot be overkeyed
Prefilled by the system and can be overkeyed
Sometimes prefilled by the system and if so, cannot be overkeyed
Sometimes prefilled by the system and may or may not be overkeyed. Sometimes completed by the
user.
If there are questions about the information in this document, please contact Paul Robie (410-965-9964).
February 6, 2007
OS, OASSIS, DSSIMS
1
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
APPEAL PERSON SELECTION
SSSSS SSSSSSSSSS
APSN
REQUESTED SSN SSS-SS-SSSS
SELECT: P
S
S
PERSON SSN
SSS-SS-SSSS
SSS-SS-SSSS
PERSON NAME
SSSSS SSSSSSSSSS
SSSSS SSSSSSSSSS
RELATIONSHIP
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
Notes:
A claim can have two people for whom an appeal request can be filed, the claimant and the
claimant spouse (a spouse who is also a claimant). Appeal Person Selection (APSN) allows you to
choose the person for whom the appeal request is filed.
APSN is presented when you select "Appeals" from SSI Main Menu (MSSI) for a claim that has a
claimant and a spouse with an EFFECTIVE FILING DATE.
MSOM MSSICS 020.002
February 6, 2007
OS, OASSIS, DSSIMS
2
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
APPEALS LIST
PAGE S OF APLS
SSSSS SSSSSSSSSS
SELECT APPEAL ITERATION (Y):
X
NEW APPEAL
X
X
X
X
X
X
X
X
X
X
X
X
X
NOTICE
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
UNIT
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
SSSSSS
OFFICE
SSS
SSS
SSS
SSS
SSS
SSS
SSS
SSS
SSS
SSS
SSS
SSS
SSS
DISPOSITION
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
SSSSSSSSSSS
APPEAL TYPE
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
APPEAL ISSUE
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
MORE (Y): V
Notes:
Appeals List/Appeal Status (APLS) serves multiple purposes:
o
Lists the appeal iterations, for the selected SSN, associated with the claim iteration on the
MSSICS pending file
o
Allows selection of one of the appeal iterations
o
Allows selection of a new appeal iteration
o
Displays the screens present in the selected existing appeal iteration
APLS is presented when you:
o
o
o
Select "Appeals" from SSI Main Menu (MSSI) and an appeal iteration is present
Select a person on Appeal Person Selection (APSN) for whom an appeal iteration is present
Select "APLS" from Person Screen Status (PERS)
MSOM MSSICS 020.003
February 6, 2007
OS, OASSIS, DSSIMS
3
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
APPEAL STATUS
PAGE SS OF APLS
SSSSS SSSSSSSSSS
SELECT APPEAL SCREEN: 99
NUMBER
SS
SS
SS
SS
SS
SS
SS
SS
SS
SS
SS
SS
SS
SS
SS
SCREEN NAME
ACRONYM
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSS
MORE (Y): V
Note:
MSOM MSSICS 020.003
February 6, 2007
OS, OASSIS, DSSIMS
4
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
CORE APPEAL DATA
ACAD
SSSSS SSSSSSSSSS
NAME: PPPPPPPPPPPPPPP PPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPP PPPP
DECISION BEING APPEALED NOTICE DATE (MMDDYY): 999999
INVOLVES REDUCTION, SUSPENSION, OR TERMINATION OF BENEFITS (Y/N): X
TITLE(S): P 9 9 9
ACTION TYPE: 9
TYPE: 9
1=TITLE II
1=INITIAL
2=TITLE VIII
3=TITLE XVI
2=POST ELIGIBILITY
4=TITLE XVIII
3=OTHER
1=RECONSIDERATION 2=HEARING 3=APPEALS COUNCIL REVIEW
5=FEDRO REVIEW 6=DECISION REVIEW BOARD REVIEW
4=COURT CASE
AUTHORIZED REPRESENTATIVE (Y/N): X
IF NO, REPRESENTATION EXPLAINED TO CLAIMANT (Y/N): X
NON CLAIMANT REQUESTOR TYPE: 9
1=REPRESENTATIVE PAYEE
2=AUTHORIZED REPRESENTATIVE
3=OTHER INDIVIDUAL
Notes:
Core Appeal Data (ACAD) collects basic information about an appeal request.
ACAD is the screen that establishes the appeal request. If ACAD is not successfully transmitted,
then the system does not retain any information about the appeal request.
ACAD is presented in all appeal iterations. It is presented when you:
o
o
o
o
Select "Appeals" from SSI Main Menu (MSSI) with no appeal iterations present
Select "New Appeal" from the first page of Appeals List/Appeal Status (APLS)
Select "Core Appeal Data" from the second page of Appeals List/Appeal Status (APLS)
Select "ACAD" from Person Screen Status (PERS)
MSOM MSSICS 020.004
February 6, 2007
OS, OASSIS, DSSIMS
5
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
NON CLAIMANT REQUESTOR
SSSSS SSSSSSSSSS
ANCR
APPEAL REQUESTOR:
NAME: VVVVVVVVVVVVVVV VVVVVVVVVVVVVVV VVVVVVVVVVVVVVVVVVVV VVVV
TYPE SSSSSSSSSSSSSSSSSSSSSSSSS
IF NOT REPRESENTATIVE PAYEE OR AUTHORIZED REPRESENTATIVE:
RELATIONSHIP TO CLAIMANT: VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
ADDRESS: VVVVVVVVVVVVVVVVVVVVVV VVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVV VVVVVVVVVVVVVVVVVVVVVV
CITY: VVVVVVVVVVVVVVVVVVVVVV
STATE: VV
ZIP: VVVVV
DOMESTIC PHONE NUMBER: VVV VVV VVVV
PHONE INFORMATION: VVVVVVVVVV
FOREIGN PHONE NUMBER: VVVVVVVVVVVVVVV
FOREIGN COUNTRY: VVVVVVVVVVVVVVVVVVVVVV
POSTAL ZONE: VVVVVVVVVVVVVVV
CONSULAR CODE: VVV
STATE/COUNTY CODE: VVVVVV
Notes:
Non Claimant Requestor (ANCR) documents information about the requestor when the requestor is
other than the claimant.
Most appeal requests are received from claimants, however there are times when a representative
payee or appointed representative requests the appeal on behalf of the claimant.
Additionally, there are times when other persons insist on filing appeal requests, whether or not they
are the proper people to file an appeal request.
ANCR is presented when you complete NON CLAIMANT REQUESTOR TYPE on Core Appeal Data
(ACAD).
MSOM MSSICS 020.005
February 6, 2007
OS, OASSIS, DSSIMS
6
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
APPEAL ISSUE
AISS
SSSSS SSSSSSSSSS
SELECT (Y):
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
INITIAL DISABILITY
SUBSTANTIAL GAINFUL ACTIVITY
AGE 18 DISABILITY REDETERMINATION
MEDICAL CESSATION OF DISABILITY
AGE
CITIZENSHIP
MARITAL RELATIONSHIP
LIVING ARRANGEMENT - INCLUDES ISM AND VTR (1/3 REDUCTION)
INCOME
RESOURCES
PLAN TO ACHIEVE SELF SUPPORT
OVERPAYMENT
DENIED WAIVER
DISMISSAL
OTHER
IF OTHER, EXPLAIN: VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
Notes:
Appeal Issue (AISS) documents the issue or issues related to the appeal request.
AISS is presented in all appeal iterations.
MSOM MSSICS 020.006
February 6, 2007
OS, OASSIS, DSSIMS
7
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
MORE APPEAL DATA
AMAD
SSSSS SSSSSSSSSS
SUBMITTING ADDITIONAL EVIDENCE (Y/N): V
IF YES, SUBMITTING WITH APPEAL REQUEST (Y/N): V
IF NO, WILL SUBMIT BY (MMDDYY): VVVVVV
CLAIMANT TO APPEAR AT HEARING (Y/N): V
CLAIMANT TO APPEAR AT MEDICAL CESSATION RECONSIDERATION HEARING (Y/N): V
IF APPEAL REQUEST TRANSCRIBED FROM PAPER, SSA RECEIVED DATE (MMDDYY): VVVVVV
WITHDRAW APPEAL (Y): V
Notes:
More Appeal Data (AMAD) collects additional basic information about the appeal request.
AMAD is presented in all appeal iterations.
MSOM MSSICS 020.007
February 6, 2007
OS, OASSIS, DSSIMS
8
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
CLAIMANT DISAGREEMENT EXPLANATION
SSSSS SSSSSSSSSS
PAGE S OF ACDS
I DISAGREE BECAUSE (PRINTED ON APPEAL OUTPUT):
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
MORE (Y): V
Notes:
Claimant Disagreement Explanation (ACDS) documents the claimant's explanation for the
disagreement with SSA's decision.
ACDS is entirely free format. There is no editing of what you key to this screen.
There are nine pages of ACDS available.
This information appears on the printed output.
ACDS is presented in all appeal iterations.
MSOM MSSICS 020.008
February 6, 2007
OS, OASSIS, DSSIMS
9
MSSICS Appeals Screens in Full Path Order
APPEAL
CLAIMANT NOT TO APPEAR AT HEARING EXPLANATION
SSS-SS-SSSS SSSSS SSSSSSSSSS
PAGE S OF ANAH
I WAIVE APPEARING AT THE HEARING BECAUSE (PRINTED ON APPEAL OUTPUT):
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
MORE (Y): V
Notes:
SSA presumes that it is in the claimant's best interest to appear at a Hearing. If the claimant does not
want to appear at the Hearing, SSA must document the claimant's reason.
Claimant Not To Appear At Hearing Explanation (ANAH) documents the claimant's reason for not
wanting to appear at a Hearing.
ANAH is entirely free format. There is no editing of what you key to this screen.
There are nine pages of ANAH available.
This information appears on the printed output.
ANAH is presented when you complete:
o CLAIMANT TO APPEAR AT MEDICAL CESSATION RECONSIDERATION HEARING
(Y/N) on More Appeal Data (AMAD) with "N," or
o CLAIMANT TO APPEAR AT HEARING (Y/N) on More Appeal Data (AMAD) with "N."
MSOM MSSICS 020.009
February 6, 2007
OS, OASSIS, DSSIMS
10
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
WITHDRAW APPEAL EXPLANATION
SSSSS SSSSSSSSSS
PAGE S OF AWDW
I WITHDRAW THE REQUEST FOR APPEAL BECAUSE:
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
MORE (Y): V
Notes:
Withdraw Appeal Explanation (AWDW) documents the claimant's reason for wanting to withdraw an
appeal request.
AWDW is entirely free format. There is no editing of what you key to this screen.
There are nine pages of AWDW available.
This information does not appear on the printed output. Be sure to obtain this over the claimant's
signature when required.
AWDW is presented when you complete WITHDRAW APPEAL (Y) with "Y" on More Appeal Data
(AMAD).
MSOM MSSICS 020.010
February 6, 2007
OS, OASSIS, DSSIMS
11
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
WITHDRAW APPEAL EVALUATION
SSSSS SSSSSSSSSS
PAGE S OF AWDE
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
MORE (Y): V
Notes:
Withdraw Appeal Evaluation (AWDE) documents SSA's evaluation of the claimant's request to
withdraw the appeal request. This evaluation is considered when disposing of the appeal request.
AWDE is entirely free format. There is no editing of what you key to this screen.
There are nine pages of AWDE available.
This information does not appear on printed output.
AWDE is presented when you complete WITHDRAW APPEAL (Y) with "Y" on More Appeal Data
(AMAD).
MSOM MSSICS 020.011
February 6, 2007
OS, OASSIS, DSSIMS
12
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
APPEAL LATE FILING
SSSSS SSSSSSSSSS
ALAT
APPEAL REQUESTED FOR DECISION NOTICE DATED SS/SS/SSSS
CALCULATED LAST DAY OF APPEAL PERIOD SS/SS/SSSS
IF APPEAL REQUEST TRANSCRIBED FROM PAPER, SSA RECEIVED DATE SS/SS/SSSS
CLAIMANT'S STATEMENT EXPLAINING LATE FILING (Y/N): V
EVALUATION OF LATE FILING REQUEST AND DOCUMENTATION (Y/N): V
DISPOSITION OF GOOD CAUSE FOR LATE FILING OF APPEAL REQUEST: P
1=ESTABLISHED
2=NOT ESTABLISHED
3=PENDING
Notes:
Appeal Late Filing (ALAT) documents late filing development and disposition for an appeal request.
ALAT is presented when the system calculates that the appeal request was not filed within
the allowed time period.
The system takes into account weekends and holidays that are standard known federal
holidays. It cannot take into account extraordinary non-work days. You must recognize and
take into account extraordinary non-work days.
Examples:
o
The appeal period ends on Saturday. The system displays the date of the following Monday.
o
The appeal period ends on Thanksgiving. The system displays the date of the Friday
following Thanksgiving.
o
A federal holiday is declared for the day of the funeral of a former President. The system
does not recognize this as a holiday and continues to display this date in this field.
MSOM MSSICS 020.012
February 6, 2007
OS, OASSIS, DSSIMS
13
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
APPEAL LATE FILING EXPLANATION
SSSSS SSSSSSSSSS
PAGE S OF ALFT
THE REQUEST FOR APPEAL IS LATE BECAUSE (PRINTED ON APPEAL OUTPUT):
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
MORE (Y): V
Notes:
Appeal Late Filing Explanation (ALFT) documents the claimant's explanation of why the appeal
request was not filed within the appeal period. This is required for development of good cause for
late filing.
ALFT is entirely free format. There is no editing of what you key to this screen.
There are nine pages of ALFT available.
This information appears on the printed output.
ALFT is presented when you complete CLAIMANT'S STATEMENT EXPLAINING LATE FILING
(Y/N) with "Y" on Appeal Late Filing (ALAT).
MSOM MSSICS 020.013
February 6, 2007
OS, OASSIS, DSSIMS
14
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
APPEAL LATE FILING EVALUATION
SSSSS SSSSSSSSSS
PAGE S OF ALFE
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
MORE (Y): V
Notes:
Appeal Late Filing Evaluation (ALFE) documents SSA's evaluation of the claimant's explanation and
documentation of why the appeal request was not filed within the appeal period. This is required for
development of good cause for late filing.
ALFE is entirely free format. There is no editing of what you key to this screen.
There are nine pages of ALFE available.
This information does not appear on printed output.
ALFE is presented when you complete EVALUATION OF LATE FILING REQUEST AND
DOCUMENTATION (Y/N) with "Y" on Appeal Late Filing (ALAT).
MSOM MSSICS 020.014
February 6, 2007
OS, OASSIS, DSSIMS
15
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
PAYMENT CONTINUATION
SSSSS SSSSSSSSSS
PAGE 1 OF APCN
STATUTORY BENEFIT CONTINUATION REQUESTED (Y/N): X
CLAIMANT INITIATED WAIVER OF PAYMENT CONTINUATION (Y/N): X
DECISION NOTICE GIVEN (NOT MAILED) (Y): X
Notes:
Payment Continuation (APCN) documents whether payment continuation is an issue, the claimant's
decision about payment continuation, and if applicable, late filing development and disposition for
payment continuation.
Page 1 of APCN is presented when you complete INVOLVES REDUCTION, SUSPENSION, OR
TERMINATION OF BENEFITS with “Y” on Core Appeal Data (ACAD) and
o
TYPE on Core Appeal Data (ACAD) with "1=RECONSIDERATION" and ISSUE TYPE is
other than “OVERPAYMENT” or DENIED WAIVER” on Appeal Issue (AISS), or
o
TYPE on Core Appeal Data (ACAD) with "2=HEARING" and ISSUE TYPE is “AGE 18
DISABILITY REDETERMINATION” or “MEDICAL CESSATION OF DISABILITY” on Appeal
Issue (AISS).
MSOM MSSICS 020.015
February 6, 2007
OS, OASSIS, DSSIMS
16
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
PAYMENT CONTINUATION
SSSSS SSSSSSSSSS
PAGE 2 OF APCN
APPEAL REQUESTED FOR DECISION NOTICE DATED
CALCULATED LAST DAY OF CONTINUATION PERIOD
IF APPEAL REQUEST TRANSCRIBED FROM PAPER, SSA RECEIVED DATE
SS/SS/SSSS
SS/SS/SSSS
SS/SS/SSSS
CLAIMANT'S STATEMENT EXPLAINING LATE FILING (Y/N): X
EVALUATION OF LATE FILING REQUEST AND DOCUMENTATION (Y/N): X
DISPOSITION OF GOOD CAUSE FOR LATE FILING OF CONTINUATION REQUEST: P
1=ESTABLISHED 2=NOT ESTABLISHED 3=PENDING
Notes:
Page 2 of APCN is presented when the appeal request is received beyond the end of the continuation
period.
MSOM MSSICS 020.015
February 6, 2007
OS, OASSIS, DSSIMS
17
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
PAYMENT CONTINUATION
SSSSS SSSSSSSSSS
STATUTORY BENEFIT BEGIN DATE
PAGE 3 OF APCN
SS/SSSS
STATUTORY BENEFIT END DATE (MMYY): BBBB
Notes:
Page 3 of APCN is presented when you complete STATUTORY BENEFIT CONTINUATION
REQUESTED with “Y” on page 1 of APCN and, when page 2 of APCN is presented, you complete
DISPOSITION OF GOOD CAUSE FOR LATE FILING OF CONTINUATION REQUESTED with
“1=ESTABLISHED.”
MSOM MSSICS 020.015
February 6, 2007
OS, OASSIS, DSSIMS
18
MSSICS Appeals Screens in Full Path Order
APPEAL
PAYMENT CONTINUATION LATE FILING EXPLANATION
SSS-SS-SSSS SSSSS SSSSSSSSSS
PAGE S OF APCT
THE REQUEST FOR CONTINUATION IS LATE BECAUSE (PRINTED ON APPEAL OUTPUT):
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
MORE (Y): X
Notes:
Payment Continuation Late Filing Explanation (APCT) documents the claimant's explanation of
why the appeal request was not filed within the payment continuation period. This is required for
development of good cause for late filing.
APCT is entirely free format. There is no editing of what you key to this screen.
There are nine pages of APCT available.
This information appears on the printed output.
APCT is presented when you complete CLAIMANT'S STATEMENT EXPLAINING LATE FILING
(Y/N) with “Y” on Payment Continuation (APCN).
MSOM MSSICS 020.016
February 6, 2007
OS, OASSIS, DSSIMS
19
MSSICS Appeals Screens in Full Path Order
APPEAL
PAYMENT CONTINUATION LATE FILING EVALUATION
SSS-SS-SSSS SSSSS SSSSSSSSSS
PAGE S OF APCE
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
MORE (Y): X
Notes:
Payment Continuation Late Filing Evaluation (APCE) documents SSA's evaluation of the claimant's
explanation and documentation of why the appeal request was not filed within the continuation
period. This is required for development of good cause for late filing.
APCE is entirely free format. There is no editing of what you key to this screen.
There are nine pages of APCE available.
This information does not appear on printed output.
APCE is presented when you complete EVALUATION OF LATE FILING REQUEST AND
DOCUMENTATION (Y/N) with “Y” on Payment Continuation (APCN).
MSOM MSSICS 020.017
February 6, 2007
OS, OASSIS, DSSIMS
20
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
TITLE XVI RECONSIDERATION TYPE
SSSSS SSSSSSSSSS
ARCN
RECONSIDERATION TYPE: 9
1=CASE REVIEW
2=CONFERENCE
IF CONFERENCE,
TYPE: 9
1=INFORMAL
2=FORMAL
WITNESSES TO APPEAR (Y/N): X
SCHEDULED DATE (MMDDYY): 999999
SCHEDULED TIME (HHMM): 9999
HELD (Y/N): V
NOTES:
Title XVI Reconsideration Type (ARCN) documents the claimant's choice for the title XVI non-medical
reconsideration.
When the claimant selects a conference, ARCN also documents whether or not witnesses will
appear, the scheduled date, and whether or not the conference has been held.
ARCN is presented when you complete TYPE with “1=RECONSIDERATION” on Core Appeal Data
(ACAD) and SELECT (Y) on Appeal Issue (AISS) with “Y” for at least 1 of the following:
o
o
o
o
o
o
o
o
o
o
o
SUBSTANTIAL GAINFUL ACTIVITY
AGE
CITIZENSHIP
MARITAL RELATIONSHIP
LIVING ARRANGEMENT (INCLUDES VTR - 1/3 REDUCTION)
INCOME
RESOURCES
PLAN TO ACHIEVE SELF SUPPORT
OVERPAYMENT
DENIED WAIVER
OTHER
MSOM MSSICS 020.018
February 6, 2007
OS, OASSIS, DSSIMS
21
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
INTERPRETER DATA
PAGE 1 OF AINT
SSSSS SSSSSSSSSS
INTERPRETER NEEDED (Y/N): V
INTERPRETER TYPE: V
1=MULTILINGUAL EMPLOYEE
2=SSA PROVIDED
INTERPRETED LANGUAGE: VV
1=ENGLISH
2=SPANISH
3=AMERICAN SIGN LANGUAGE
4=ALASKA NATIVE
5=ALBANIAN
6=AMERICAN INDIAN - APACHE
7=AMERICAN INDIAN – CHOCTAW
8=AMERICAN INDIAN – CROW
9=AMERICAN INDIAN – DAKOTA
10=AMERICAN INDIAN – LAKOTA
11=AMERICAN INDIAN – NAKOTA
12=AMERICAN INDIAN – NAVAJO
13=AMERICAN INDIAN – ZUNI
3=THIRD PARTY
14=AMERICAN INDIAN – OTHER
15=AMHARIC
16=ARABIC
17=ARMENIAN
18=ASSYRIAN
19=BENGALI
20=BOSNIAN
21=BULGARIAN
22=BURMESE
23=CAMBODIAN
24=CHAMORRO
25=CHINESE - CANTONESE
26=CHINESE – FORMOSAN
Notes:
Interpreter Data (AINT) documents interpreter information for non-medical reconsideration
conferences.
AINT is presented when you complete RECONSIDERATION TYPE with “2=CONFERENCE” on Title
XVI Reconsideration Type (ARCN).
MSOM MSSICS 020.019
February 6, 2007
OS, OASSIS, DSSIMS
22
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
INTERPRETER DATA
PAGE 2 OF AINT
SSSSS SSSSSSSSSS
INTERPRETED LANGUAGE: VV
27=CHINESE – MANDARIN
28=CHINESE - MIEN
29=CHINESE – SHANGHAINESE
30=CHINESE - TAIWANESE
31=CHINESE - TOISHANESE
32=CHINESE – OTHER
33=CREOLE – CRIOLLO
34=CREOLE – FRENCH
35=CREOLE – HAITIAN
36=CREOLE – OTHER
37=CROATIAN
38=CZECH
39=DUTCH
40=FARSI
41=FINNISH
42=FRENCH
43=GERMAN
44=GREEK
45=GUJARATHI
46=HEBREW
47=HINDI
48=HMONG
49=HUNGARIAN
50=ILOCANO
51=INDONESIAN
52=ITALIAN
53=JAPANESE
54=KHMER
55=KOREAN
56=KURDISH
57=LAO (LAOTIAN)
58=LITHUANIAN
59=MACEDONIAN
60=MALAYALAM
61=MONGOLIAN
62=NORWEGIAN
Note:
MSOM MSSICS 020.019
February 6, 2007
OS, OASSIS, DSSIMS
23
63=OROMO
64=PASHTO
65=PENNSYLVANIA DUTCH
66=PERSIAN
67=PIDGIN-HAWAIIAN
68=POLISH
69=PORTUGESE
70=PUNJABI
71=ROMANIAN
72=RUSSIAN
73=SAMOAN
74=SERBO-CROATIAN
75=SLOVAK
76=SOMALI
77=SWAHILI
78=SWEDISH
79=SYRIAC
80=TAGALOG
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
INTERPRETER DATA
PAGE 3 OF AINT
SSSSS SSSSSSSSSS
INTERPRETED LANGUAGE: VV
81=THAI
82=TONGAN
83=TURKISH
84=TWI (FANTI)
85=UKRAINIAN
86=URDU
87=VIETNAMESE
88=YIDDISH
89=YUGOSLAVIAN
90=OTHER
IF OTHER, SPECIFY: VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
Note:
MSOM MSSICS 020.019
February 6, 2007
OS, OASSIS, DSSIMS
24
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
TITLE XVI CONFERENCE RESULT
SSSSS SSSSSSSSSS
TYPE SSSSSSSSSSSSSSSSSSS
METHOD: 9
ACON
CONFERENCE HELD DATE (MMDDYY): 999999
1=BY TELEPHONE
2=IN PERSON - FIELD OFFICE
3=IN PERSON - OTHER LOCATION:
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
AUTHORIZED REPRESENTATIVE PRESENT (Y/N): X
NEW EVIDENCE PRESENTED DURING OR AFTER CONFERENCE (Y/N): X
OTHER CONFERENCE DETAILS (Y): X
Notes:
Title XVI Conference Result (ACON) documents the title XVI reconsideration conference.
ACON is presented when you complete HELD (Y/N) with "Y" on Title XVI Reconsideration Type
(ARCN).
MSOM MSSICS 020.020
February 6, 2007
OS, OASSIS, DSSIMS
25
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
CONFERENCE WITNESSES
SSSSS SSSSSSSSSS
AWIT
APPEARED AT CONFERENCE (Y/N): X
RELATIONSHIP: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
NAME: XXXXXXXXXXXXXXX XXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXX XXXX
ADDRESS: XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX
CITY: XXXXXXXXXXXXXXXXXXXXXX
STATE: XX
ZIP: 99999
DOMESTIC PHONE NUMBER: 999 999 9999
PHONE INFORMATION: XXXXXXXXXX
FOREIGN PHONE NUMBER: 999999999999999
FOREIGN COUNTRY: XXXXXXXXXXXXXXXXXXXXXX
POSTAL ZONE: XXXXXXXXXXXXXXX
CONSULAR CODE: 999
STATE/COUNTY CODE: 99999X
ANOTHER WITNESS (Y): V
Notes:
Conference Witnesses (AWIT) documents information about witnesses for title XVI reconsideration
conferences.
Three iterations of AWIT are available.
AWIT is presented when you complete WITNESSES TO APPEAR (Y/N) with “Y” on Title XVI
Reconsideration Type (ARCN).
MSOM MSSICS 020.021
February 6, 2007
OS, OASSIS, DSSIMS
26
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
OTHER CONFERENCE DETAILS
SSSSS SSSSSSSSSS
PAGE S OF AOCD
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
MORE (Y): V
Notes:
Other Conference Details (AOCD) documents narrative information about the conference.
AOCD is entirely free format. There is no editing of what you key to this screen.
There are nine pages of AOCD available.
This information does not appear on printed output.
AOCD is presented when you complete OTHER CONFERENCE DETAILS (Y) with “Y” on TITLE XVI
CONFERENCE RESULT (ACON).
MSOM MSSICS 020.022
February 6, 2007
OS, OASSIS, DSSIMS
27
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
JURISDICTION AND STATUS
SSSSS SSSSSSSSSS
AJAS
SERVICING OFFICE SSS
CLAIM PREFERRED OFFICE SSS
UNIT: PPPPPP
APPEAL CONTROLLING OFFICE: PPP
APPEAL REQUEST STATUS: P
1=PENDING IN APPEAL CONTROLLING OFFICE
2=REFERRED TO ANOTHER OFFICE FOR DECISION
3=REMANDED TO ANOTHER OFFICE FOR DECISION
4=DECISION MADE BUT NOT EFFECTUATED
5=DECISION EFFECTUATED
6=OTHER DISPOSITION
REFERRED OR REMANDED FOR APPEAL DECISION TO OFFICE: VVV
REFERRED OR REMANDED DATE (MMDDYY): VVVVVV
Notes:
Jurisdiction and Status (AJAS) collects information about the jurisdiction and status of the appeal
iteration.
Workload management systems control the appeal iteration independent of the claim iteration. AJAS
collects your unit and office code designation for the appeal iteration. These determine where the
appeal iteration information appears on listings.
AJAS collects your determination about the appeal iteration status. Status information on AJAS
determines when Disposition (ADIS) is presented in the path.
Referral information is also collected on AJAS. When you indicate that the appeal request has been
referred to a Disability Determination Service (DDS) site, the system notifies the National Disability
Determination Services System (NDDSS).
When you indicate that the appeal request has been referred to a DDS site or to an Office of
Disability Adjudication and Review site, it is assumed that you are forwarding the request with the
case folder. The system notifies SSI Control System (SSICS) of the movement.
AJAS is presented in all appeal iterations.
MSOM MSSICS 020.023
February 6, 2007
OS, OASSIS, DSSIMS
28
MSSICS Appeals Screens in Full Path Order
APPEAL NON MEDICAL RECONSIDERATION DISPOSITION RATIONALE
SSS-SS-SSSS SSSSS SSSSSSSSSS
PAGE S OF ARAT
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
MORE (Y): V
Notes:
Non Medical Reconsideration Disposition Rationale (ARAT) documents the rationale for the
reconsidered decision.
ARAT is entirely free format. There is no editing of what you key to this screen.
There are nine pages of ARAT available.
This information does not appear on printed output.
ARAT is presented when you complete the following 3 elements:
o
TYPE with “1=RECONSIDERATION” on Core Appeal Data (ACAD),
o
SELECT (Y) with “Y” on Appeal Issue (AISS) for at least one of the following: SUBSTANTIAL
GAINFUL ACTIVITY, AGE, CITIZENSHIP, MARITAL RELATIONSHIP, LIVING
ARRANGEMENT (INCLUDES VTR - 1/3 REDUCTION), INCOME, RESOURCES, PLAN TO
ACHIEVE SELF SUPPORT, OVERPAYMENT, DENIED WAIVER, OTHER
o
APPEAL REQUEST STATUS with “4=DECISION MADE BUT NOT EFFECTUATED” or
“5=DECISION EFFECTUATED” on Jurisdiction and Status (AJAS).
MSOM MSSICS 020.024
February 6, 2007
OS, OASSIS, DSSIMS
29
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
DISPOSITION
ADIS
SSSSS SSSSSSSSSS
DECISION TYPE: 9
1=FULLY FAVORABLE
2=PARTIALLY FAVORABLE
3=UNFAVORABLE
DECISION DATE (MMDDYY): 999999
FULLY OR PARTIALLY FAVORABLE EFFECTUATION NOTICE DATE (MMDDYY): 999999
OTHER DISPOSITION TYPE: 9
1=SIGNED REQUEST NOT RECEIVED
2=DISMISSED
3=CLOSED FOR OTHER REASON
OTHER DISPOSITION DATE (MMDDYY): 999999
IF DISMISSED, REASON: 9
1=DECISION CANNOT BE APPEALED
2=FILED BY IMPROPER REQUESTOR
3=FILED PREMATURELY
4=FILED LATE WITHOUT GOOD CAUSE
5=WITHDRAWN
6=CLAIMANT DIED
7=ABANDONED
Notes:
Disposition (ADIS) documents the disposition of the appeal request.
ADIS is presented when you complete APPEAL REQUEST STATUS with “4=DECISION MADE BUT
NOT EFFECTUATED,” “5=DECISION EFFECTUATED,” or “6=OTHER DISPOSITION” on
Jurisdiction and Status (AJAS).
MSOM MSSICS 020.025
February 6, 2007
OS, OASSIS, DSSIMS
30
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
COURT CASE DATA
SSSSS SSSSSSSSSS
COURT CASE TYPE: V
1=INDIVIDUAL
ACCD
2=CLASS ACTION
COURT DECISION OR OTHER DISPOSITION APPEALED (Y/N): X
IF YES, APPEALED BY: 9
1=CLAIMANT
2=SSA
Notes:
Court Case Data (ACCD) documents information about a court case for which a decision or other
disposition has been made.
ACCD is presented when you complete both of the following:
o
TYPE with “4=COURT CASE” on Core Appeal Data (ACAD)
o
DECISION TYPE with “1=FULLY FAVORABLE,” “2=PARTIALLY FAVORABLE,” or
“3=UNFAVORABLE” on Disposition (ADIS)
MSOM MSSICS 020.026
February 6, 2007
OS, OASSIS, DSSIMS
31
MSSICS Appeals Screens in Full Path Order
APPEAL
SSS-SS-SSSS
INTERSCREEN EDITS FOR APPEALS
SSSSS SSSSSSSSSS
PAGE S OF APDT
MESSAGES:
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
MORE MESSAGES: S
PRINT (SELECT ONE): 9
1 = ALL
2 = SCREEN
Notes:
Interscreen Edits for Appeals (APDT) displays edit messages which are produced by discrepancies
among fields on different Appeals screens. It also displays edit messages generated when appeal
request information does not agree with Disbility Service Improvement (DSI) information in the
Electronic Disability Collect System (EDCS) Structured Data Repository (SDR).
APDT is presented when there are interscreen edits and or DSI edits for an appeal iteration and you
either:
o
o
Complete all screens in the appeal iteration or
Select APDT on Appeals List/Status (APLS)
MSOM MSSICS 028.003
February 6, 2007
OS, OASSIS, DSSIMS
32
MSSICS Appeals Screens in Full Path Order
MSSICS
SSS-SS-SSSS
SSSSS
MAILING/PAYMENT ADDRESS
SSSSSSSSSS
ADDR: PPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPP
CITY: PPPPPPPPPPPPPPPPPPPPPP
PAGE 1 OF ADDR
TRANSFER TO: XXXX
PPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPP
STATE: PP
ZIP: PPPPP
FOREIGN COUNTRY: PPPPPPPPPPPPPPPPPPPPPP
POSTAL ZONE: PPPPPPPPPPPPPPP
CONSULAR CODE: PPP
STATE/COUNTY CODE: 99999X
DOMESTIC PHONE NO: PPP PPP PPPP
FOREIGN PHONE NO: PPPPPPPPPPPPPPP
PHONE INFO: XXXXXXXXXX
EXPLAIN C/O ADDRESS: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
DIRECT DEPOSIT (Y/N): X
BANK NO: PPPPPPPPP
ACCT TYPE (C/S): P
ACCT NO: PPPPPPPPPPPPPPPPP
SELECT NOTICE OPTION: 9
1=REGULAR
3=REGULAR WITH FOLLOW-UP PHONE CONTACT
2=CERTIFIED
4=BRAILLE
REMARKS (Y): X
Notes:
This is not a separate address for the appeal iteration. It is the mailing/payment address from the
claim. Mailing/Payment Address (ADDR) is presented any time an appeal iteration is established.
This permits SSA to confirm and update the claimant’s address.
MSOM MSSICS 008.005
February 6, 2007
OS, OASSIS, DSSIMS
33
| File Type | application/pdf |
| File Title | APPEAL APPEAL PERSON SELECTION APSN |
| Author | 207381 |
| File Modified | 2014-07-23 |
| File Created | 2014-07-23 |