Determinations, Appeals and Decisions, and Reopenings

2189. What are Initial Determinations?
An “initial determination” is the first decision made on an application and generally involves eligibility for, or the amount of, SSI payments (including federally administered State supplementary payments). See also §2002.1 and §2197. For more information on what constitutes an initial determination and the other aspects of the initial determination, then see this section of the Handbook for more detailed information.

2190. What Administrative Actions are NOT initial determinations?
There are several examples of administrative actions, but they are not initial determinations, and to see the details of administrative actions that are not initial determinations, then see this section of the Handbook for more detailed information. See also §2189 and §2003 .

2191. How does the Appeals Process Work for SSI?
An eligible individual or eligible spouse who is a recipient or applicant for SSI payments has a right to appeal the SSA’s decision. To see more detail on how the appeal process works, whether or not you would be eligible for an extension, and how this might apply to your particular circumstances, then see this section of the Handbook for more detailed information. See also §2196 , §2014 , §2192, Section 2193 , Section 2194 , and Section 2195.

2192. What is a Reconsideration?
Reconsideration is the first step in the appeal process, and you must request a reconsideration after receiving notice of our determination if you want to appeal. Time limits apply so you should see this section if you are considering an appeal. See also §2004 and §2197 .

2193. What is a Hearing?
If you disagree with the reconsideration, then you request a hearing before an administrative law judge (ALJ) of the SSA's Office of Disability Adjudication and Review. To determine the details of a hearing such as how you request a hearing, and what is done after a hearing, whether you need a representative at the hearing, and other details about the hearing, then see this section of the Handbook for more detailed information. See also §2006.

2194. What is an Appeals Council Review?
If you are not satisfied with the action of the ALJ, then y you may request a review by the Appeals Council. The Appeals Council will then grant, deny, or dismiss your request for review as it decides is proper. To learn more about how you request an Appeals Council review, and what the Appeals Council does with the request for review, then see this section of the Handbook for more detailed information. See also §2013. You can make the request by letter or on a special form HA-520, Request for Review of Hearing Decision/Order, which is available at any Social Security office or online at: www.socialsecurity.gov/online.

2195. What is the Time Limit for Filing for Civil Action in a Federal District Court?
You must file for civil action in a Federal District Court within sixty (60) days under certain specific circumstances and to determine those specific circumstances, then see this section of the Handbook for more detailed information. See also §2014.2 .

2196. Can the Time Limit for Filing an Appeal or Hearing be Extended?
Your time limit for filing a request for reconsideration, hearing, or review by the Appeals Council, or a civil action in U.S. District Court may be extended under limited circumstances and to review those circumstances, then see this section of the Handbook for more detailed information. See also §2015 .

2197. Can I Reopen Determinations/Decisions Under the Rules of Administrative or are these Decisions Final?
Even though a determination, revised determination, decision, or revised decision has become final, it may be reopened and revised by the Social Security field office, reviewing office, ALJ, or Appeals Council within certain time limitations and under certain conditions, and to determine if your case falls under these limited circumstances, then see this section of the Handbook for more detailed information. See also §2016. . It is important to note that the decision to reopen or not to reopen is not an initial determination and is not subject to appeal.

We hope this has been helpful to get you started with understanding all the complexities of SSI. At Julie A. Rice, Attorney at Law, & Affiliates, we are experts at obtaining SSI Benefits for hundreds, if not thousands, of people, so please Contact Us for your free legal consultation. Please also remember that we handle these cases on a contingency fee basis meaning that you pay no legal fees unless we obtain benefits for you, and we look forward to hearing from you soon.

The following are more Resources that you might find helpful as well:

  1. The SSA’s page on SSI Law and Regulations will assist you in finding out which parts of the Social Security Act and the Code of Federal Regulations for the Social Security Administration are used to administer the SSI program;
  2. The links on the SSA’s SSI Resources page is helpful for information on how to find the nearest Social Security office, how to obtain a proof of income letter, etc.;
  3. If you already get benefits and are thinking about returning to work, please check out this link to a summary about SSI Work Incentives ; and
  4. Social Security Handbook

Please feel free to see our Resources Page on our Website under Social Security Disability and also our Frequently Asked Questions Page under Social Security Disability on our Website for more information.