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
S SSS-SS-SSSS SSSSS SSSSSSSSSS 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.
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
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
X SS/SS/SSSS SSSSSS SSS SSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSS
MORE (Y): V
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
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
SS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS SSSS
MORE (Y): V
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
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
INTERNET MAILING/PAYMENT ADDRESS:
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SELECT MAILING/PAYMENT ADDRESS: 9 1=SSI 2=INTERNET
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
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
INTERNET RESIDENCE ADDRESS:
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
SELECT RESIDENCE ADDRESS: 9 1=SSI 2=INTERNET
Notes:
The 2nd 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
SSSSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSSSS
PHONE NUMBER: SSSSSSSSSSSSSSS
ALERT –DEVELOPMENT REQUIRED– REPRESENTATIVE DATA DIFFERS FROM SSA RECORD
Notes:
The 3rd 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
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
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
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
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
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.
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
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:
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
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).
APPEAL WITHDRAW APPEAL EVALUATION PAGE S OF AWDE
SSS-SS-SSSS SSSSS SSSSSSSSSS
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).
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
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
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).
APPEAL APPEAL LATE FILING EVALUATION PAGE S OF ALFE
SSS-SS-SSSS SSSSS SSSSSSSSSS
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).
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
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
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
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
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).
APPEAL PAYMENT CONTINUATION LATE FILING EVALUATION PAGE S OF APCE
SSS-SS-SSSS SSSSS SSSSSSSSSS
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).
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
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
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
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
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
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
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
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).
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
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
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:
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
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
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 | 2021-01-15 |