Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions

Request for Hearing By Administrative Law Judge

MSSICS Appeals Screens in Path Order

Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions

OMB: 0960-0269

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0269 can be found here:

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MSSICS Appeals Screens in Full Path Order

This is a summary document about MSSICS Appeals screens. It contains screen facsimiles and notes about each screen.

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.

The screen facsimiles are from the MSSICS Detailed Functional Requirements. The key to the screen values is:

X	User can enter alpha/numeric characters
9	User can enter numeric characters only
S	Prefilled by the system and cannot be overkeyed
P	Prefilled by the system and can be overkeyed
B	Sometimes prefilled by the system and if so, cannot be overkeyed
V	Sometimes prefilled by the system and may or may not be overkeyed. Sometimes completed by the user.

APPEAL APPEAL PERSON SELECTION APSN

SSS-SS-SSSS SSSSS SSSSSSSSSS

REQUESTED SSN SSS-SS-SSSS

SELECT: P

PERSON SSN PERSON NAME RELATIONSHIP

S SSS-SS-SSSS SSSSS SSSSSSSSSS SSSSSSSSSSSSSSS

Shape1

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.
APPEAL APPEALS LIST PAGE S OF APLS

SSS-SS-SSSS SSSSS SSSSSSSSSS

SELECT APPEAL ITERATION (Y):

X NEW APPEAL

NOTICE UNIT OFFICE DISPOSITION APPEAL TYPE APPEAL ISSUE

X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS

MORE (Y): V

Shape2

Notes:

Appeals List/Appeal Status (APLS) serves multiple purposes:

Lists the appeal iterations, for the selected SSN, associated with the claim iteration on the MSSICS pending file

Allows selection of one of the appeal iterations

Allows selection of a new appeal iteration

Displays the screens present in the selected existing appeal iteration

APLS is presented when you:

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)

APPEAL APPEAL STATUS PAGE SS OF APLS

SSS-SS-SSSS SSSSS SSSSSSSSSS

SELECT APPEAL SCREEN: 99

NUMBER SCREEN NAME ACRONYM

SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS

MORE (Y): V

Shape3

Note:

Once you have selected an appeal iteration on page 1 of Appeals List/Appeal Status (APLS), you then select the screen within the appeal iteration that you want to be displayed.

If there are additional pages with appeal screens, you can advance to the next page without keying a selection.

MSSICS INTERNET DATA DIFFERENCES PAGE S OF AIDD SSS-SS-SSSS SSSSS SSSSSSSSSS

SSI NAME: SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSS SSSS

INTERNET NAME: SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSS SSSS

SELECT NAME: 9 1=SSI 2=INTERNET

SSI MAILING/PAYMENT ADDRESS:

SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS

INTERNET MAILING/PAYMENT ADDRESS:

SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS

SELECT MAILING/PAYMENT ADDRESS: 9 1=SSI 2=INTERNET

Shape4

Notes:

Internet Data Differences (AIDD) compares answers entered in iAppeals to data previously recorded in SSA systems.

Each of the 3 AIDD screens is presented only when the system identifies discrepant data.

The first AIDD screen displays differences in name and mailing address.

MSSICS INTERNET DATA DIFFERENCES PAGE S OF AIDD

SSS-SS-SSSS SSSSS SSSSSSSSSS

SSI PHONE NUMBER: SSSSSSSSSSSSSSS

INTERNET PHONE NUMBER: SSSSSSSSSSSSSSS

SELECT PHONE NUMBER: 9 1=SSI 2=INTERNET

SSI RESIDENCE ADDRESS:

SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS

INTERNET RESIDENCE ADDRESS:

SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS

SELECT RESIDENCE ADDRESS: 9 1=SSI 2=INTERNET

Shape5

Notes:

The 2^nd AIDD screen displays differences in phone number and residence address.

MSSICS INTERNET DATA DIFFERENCES PAGE S OF AIDD

SSS-SS-SSSS SSSSS SSSSSSSSSS

INTERNET REPRESENTATIVE DATA

NAME: SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSS SSSS

TYPE: SSSSSSSSSSSS

ADDRESS: SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS

SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS

PHONE NUMBER: SSSSSSSSSSSSSSS

ALERT –DEVELOPMENT REQUIRED– REPRESENTATIVE DATA DIFFERS FROM SSA RECORD

Shape6

Notes:

The 3^rd AIDD screen displays differences in appointed representative data.

The public needs to submit additional paperwork to add or change their representative. Therefore, this screen informs SSA staff to develop the representative on the record.

APPEAL CORE APPEAL DATA ACAD

SSS-SS-SSSS SSSSS SSSSSSSSSS

DECISION BEING APPEALED NOTICE DATE (MMDDYY): 999999

INVOLVES REDUCTION, SUSPENSION, OR TERMINATION OF BENEFITS (Y/N): X

TITLE(S): P 9 9 9 1=TITLE II 2=TITLE VIII 3=TITLE XVI 4=TITLE XVIII

ACTION TYPE: 9 1=INITIAL 2=POST ELIGIBILITY 3=OTHER

TYPE: 9 1=RECONSIDERATION 2=HEARING 3=APPEALS COUNCIL REVIEW 4=COURT CASE

5=FEDRO REVIEW 6=DECISION REVIEW BOARD REVIEW

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

Shape7

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:

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)

APPEAL NON CLAIMANT REQUESTOR ANCR

SSS-SS-SSSS SSSSS SSSSSSSSSS

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 FOREIGN PHONE NUMBER: VVVVVVVVVVVVVVV

PHONE INFORMATION: VVVVVVVVVV

FOREIGN COUNTRY: VVVVVVVVVVVVVVVVVVVVVV POSTAL ZONE: VVVVVVVVVVVVVVV

CONSULAR CODE: VVV STATE/COUNTY CODE: VVVVVV

Shape8

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).

APPEAL APPEAL ISSUE AISS

SSS-SS-SSSS SSSSS SSSSSSSSSS

SELECT (Y):

V INITIAL DISABILITY

V SUBSTANTIAL GAINFUL ACTIVITY

V AGE 18 DISABILITY REDETERMINATION

V MEDICAL CESSATION OF DISABILITY

V AGE

V CITIZENSHIP

V MARITAL RELATIONSHIP

V LIVING ARRANGEMENT - INCLUDES ISM AND VTR (1/3 REDUCTION)

V INCOME

V RESOURCES

V PLAN TO ACHIEVE SELF SUPPORT

V OVERPAYMENT

V DENIED WAIVER

V DISMISSAL

V OTHER

IF OTHER, EXPLAIN: VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

Shape9

Notes:

Appeal Issue (AISS) documents the issue or issues related to the appeal request.
AISS is presented in all appeal iterations.

APPEAL MORE APPEAL DATA AMAD

SSS-SS-SSSS 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

Shape10

Notes:

More Appeal Data (AMAD) collects additional basic information about the appeal request.
AMAD is presented in all appeal iterations.

APPEAL CLAIMANT DISAGREEMENT EXPLANATION PAGE S OF ACDS

SSS-SS-SSSS SSSSS SSSSSSSSSS

I DISAGREE BECAUSE (PRINTED ON APPEAL OUTPUT):

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

MORE (Y): V

Shape11

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.

APPEAL CLAIMANT NOT TO APPEAR AT HEARING EXPLANATION PAGE S OF ANAH

SSS-SS-SSSS SSSSS SSSSSSSSSS

I WAIVE APPEARING AT THE HEARING BECAUSE (PRINTED ON APPEAL OUTPUT):

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

MORE (Y): V

Shape12

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:

CLAIMANT TO APPEAR AT MEDICAL CESSATION RECONSIDERATION HEARING (Y/N) on More Appeal Data (AMAD) with "N," or

CLAIMANT TO APPEAR AT HEARING (Y/N) on More Appeal Data (AMAD) with "N."

APPEAL WITHDRAW APPEAL EXPLANATION PAGE S OF AWDW

SSS-SS-SSSS SSSSS SSSSSSSSSS

I WITHDRAW THE REQUEST FOR APPEAL BECAUSE:

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

MORE (Y): V

Shape13

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).

APPEAL WITHDRAW APPEAL EVALUATION PAGE S OF AWDE

SSS-SS-SSSS SSSSS SSSSSSSSSS

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

MORE (Y): V

Shape14

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).

APPEAL APPEAL LATE FILING ALAT

SSS-SS-SSSS SSSSS SSSSSSSSSS

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

Shape15

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:

The appeal period ends on Saturday. The system displays the date of the following Monday.

The appeal period ends on Thanksgiving. The system displays the date of the Friday following Thanksgiving.

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.

APPEAL APPEAL LATE FILING EXPLANATION PAGE S OF ALFT

SSS-SS-SSSS SSSSS SSSSSSSSSS

THE REQUEST FOR APPEAL IS LATE BECAUSE (PRINTED ON APPEAL OUTPUT):

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

MORE (Y): V

Shape16

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).

APPEAL APPEAL LATE FILING EVALUATION PAGE S OF ALFE

SSS-SS-SSSS SSSSS SSSSSSSSSS

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

MORE (Y): V

Shape17

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).

APPEAL PAYMENT CONTINUATION PAGE 1 OF APCN

SSS-SS-SSSS SSSSS SSSSSSSSSS

STATUTORY BENEFIT CONTINUATION REQUESTED (Y/N): X

CLAIMANT INITIATED WAIVER OF PAYMENT CONTINUATION (Y/N): X

DECISION NOTICE GIVEN (NOT MAILED) (Y): X

Shape18

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

TYPE on Core Appeal Data (ACAD) with "1=RECONSIDERATION" and ISSUE TYPE is other than “OVERPAYMENT” or DENIED WAIVER” on Appeal Issue (AISS), or

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).

APPEAL PAYMENT CONTINUATION PAGE 2 OF APCN

SSS-SS-SSSS SSSSS SSSSSSSSSS

APPEAL REQUESTED FOR DECISION NOTICE DATED SS/SS/SSSS

CALCULATED LAST DAY OF CONTINUATION PERIOD SS/SS/SSSS

IF APPEAL REQUEST TRANSCRIBED FROM PAPER, SSA RECEIVED DATE 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

Shape19

Notes:

Page 2 of APCN is presented when the appeal request is received beyond the end of the continuation period.

APPEAL PAYMENT CONTINUATION PAGE 3 OF APCN

SSS-SS-SSSS SSSSS SSSSSSSSSS

STATUTORY BENEFIT BEGIN DATE SS/SSSS

STATUTORY BENEFIT END DATE (MMYY): BBBB

Shape20

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.”

APPEAL PAYMENT CONTINUATION LATE FILING EXPLANATION PAGE S OF APCT

SSS-SS-SSSS SSSSS SSSSSSSSSS

THE REQUEST FOR CONTINUATION IS LATE BECAUSE (PRINTED ON APPEAL OUTPUT):

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

MORE (Y): X

Shape21

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).

APPEAL PAYMENT CONTINUATION LATE FILING EVALUATION PAGE S OF APCE

SSS-SS-SSSS SSSSS SSSSSSSSSS

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

MORE (Y): X

Shape22

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).

APPEAL TITLE XVI RECONSIDERATION TYPE ARCN

SSS-SS-SSSS SSSSS SSSSSSSSSS

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

Shape23

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:

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

APPEAL INTERPRETER DATA PAGE 1 OF AINT

SSS-SS-SSSS SSSSS SSSSSSSSSS

INTERPRETER NEEDED (Y/N): V

INTERPRETER TYPE: V

1=MULTILINGUAL EMPLOYEE 2=SSA PROVIDED 3=THIRD PARTY

INTERPRETED LANGUAGE: VV

1=ENGLISH 14=AMERICAN INDIAN – OTHER

2=SPANISH 15=AMHARIC

3=AMERICAN SIGN LANGUAGE 16=ARABIC

4=ALASKA NATIVE 17=ARMENIAN

5=ALBANIAN 18=ASSYRIAN

6=AMERICAN INDIAN - APACHE 19=BENGALI

7=AMERICAN INDIAN – CHOCTAW 20=BOSNIAN

8=AMERICAN INDIAN – CROW 21=BULGARIAN

9=AMERICAN INDIAN – DAKOTA 22=BURMESE

10=AMERICAN INDIAN – LAKOTA 23=CAMBODIAN

11=AMERICAN INDIAN – NAKOTA 24=CHAMORRO

12=AMERICAN INDIAN – NAVAJO 25=CHINESE - CANTONESE

13=AMERICAN INDIAN – ZUNI 26=CHINESE – FORMOSAN

Shape24

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).

APPEAL INTERPRETER DATA PAGE 2 OF AINT

SSS-SS-SSSS SSSSS SSSSSSSSSS

INTERPRETED LANGUAGE: VV

27=CHINESE – MANDARIN 45=GUJARATHI 63=OROMO

28=CHINESE - MIEN 46=HEBREW 64=PASHTO

29=CHINESE – SHANGHAINESE 47=HINDI 65=PENNSYLVANIA DUTCH

30=CHINESE - TAIWANESE 48=HMONG 66=PERSIAN

31=CHINESE - TOISHANESE 49=HUNGARIAN 67=PIDGIN-HAWAIIAN

32=CHINESE – OTHER 50=ILOCANO 68=POLISH

33=CREOLE – CRIOLLO 51=INDONESIAN 69=PORTUGESE

34=CREOLE – FRENCH 52=ITALIAN 70=PUNJABI

35=CREOLE – HAITIAN 53=JAPANESE 71=ROMANIAN

36=CREOLE – OTHER 54=KHMER 72=RUSSIAN

37=CROATIAN 55=KOREAN 73=SAMOAN

38=CZECH 56=KURDISH 74=SERBO-CROATIAN

39=DUTCH 57=LAO (LAOTIAN) 75=SLOVAK

40=FARSI 58=LITHUANIAN 76=SOMALI

41=FINNISH 59=MACEDONIAN 77=SWAHILI

42=FRENCH 60=MALAYALAM 78=SWEDISH

43=GERMAN 61=MONGOLIAN 79=SYRIAC

44=GREEK 62=NORWEGIAN 80=TAGALOG

Shape25

Note:

APPEAL INTERPRETER DATA PAGE 3 OF AINT

SSS-SS-SSSS 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

Shape26

Note:

APPEAL TITLE XVI CONFERENCE RESULT ACON

SSS-SS-SSSS SSSSS SSSSSSSSSS

TYPE SSSSSSSSSSSSSSSSSSS CONFERENCE HELD DATE (MMDDYY): 999999

METHOD: 9 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

Shape27

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).

APPEAL CONFERENCE WITNESSES AWIT

SSS-SS-SSSS SSSSS SSSSSSSSSS

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 FOREIGN PHONE NUMBER: 999999999999999

PHONE INFORMATION: XXXXXXXXXX

FOREIGN COUNTRY: XXXXXXXXXXXXXXXXXXXXXX POSTAL ZONE: XXXXXXXXXXXXXXX

CONSULAR CODE: 999 STATE/COUNTY CODE: 99999X

ANOTHER WITNESS (Y): V

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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).

APPEAL OTHER CONFERENCE DETAILS PAGE S OF AOCD

SSS-SS-SSSS SSSSS SSSSSSSSSS

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

MORE (Y): V

Shape29

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).

APPEAL JURISDICTION AND STATUS AJAS

SSS-SS-SSSS SSSSS SSSSSSSSSS

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

Shape30

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.

APPEAL NON MEDICAL RECONSIDERATION DISPOSITION RATIONALE PAGE S OF ARAT

SSS-SS-SSSS SSSSS SSSSSSSSSS

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

MORE (Y): V

Shape31

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:

TYPE with “1=RECONSIDERATION” on Core Appeal Data (ACAD),

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

APPEAL REQUEST STATUS with “4=DECISION MADE BUT NOT EFFECTUATED” or “5=DECISION EFFECTUATED” on Jurisdiction and Status (AJAS).

APPEAL DISPOSITION ADIS

SSS-SS-SSSS 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

Shape32

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).

APPEAL COURT CASE DATA ACCD

SSS-SS-SSSS SSSSS SSSSSSSSSS

COURT CASE TYPE: V 1=INDIVIDUAL 2=CLASS ACTION

COURT DECISION OR OTHER DISPOSITION APPEALED (Y/N): X

IF YES, APPEALED BY: 9 1=CLAIMANT 2=SSA

Shape33

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:

TYPE with “4=COURT CASE” on Core Appeal Data (ACAD)

DECISION TYPE with “1=FULLY FAVORABLE,” “2=PARTIALLY FAVORABLE,” or “3=UNFAVORABLE” on Disposition (ADIS)

May 2, 2016

OS, OITBS, OITPBS, DSDRQ

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	APPEAL APPEAL PERSON SELECTION APSN
Author	207381
File Modified	0000-00-00
File Created	2021-01-23