I-5-4-48.Sharpe v. Sullivan and Martinez v. Bowen
| Purpose | |
| Background | |
| Class Definitions | |
| Processing Time Requirements | |
| Notice Requirements | |
| Interim Benefit Requirements | |
| Reporting Requirements | |
| Inquiries | |
| Exhibit A: Personalized 120-day Notice for Sharpe Disability Class Members | |
| Addresses of U.S. District Courts in New York State and Pro se Clerk Telephone Numbers | |
| Exhibit B: Personalized 90-day Notice for Sharpe Non-disability Class Members | |
| Exhibit C: Interim Benefits Notice for Sharpe Non-disability Class Members (to Be Sent by HO) | |
| Exhibit D: Notice to Accompany All Fully and Partially Favorable ALJ Decisions in Sharpe Class Member Cases | |
| Language to Accompany or be Incorporated into Request for Hearing Acknowledgment Notices in all Martinez Class Member Cases | |
| Exhibit E: Social Security Field Office Notice of Initiating Interim Benefits to Sharpe Class Members: Benefits Not Timely Effectuated by SSA After Issuance of ALJ Decision |
ISSUED: May 26, 1995
I. Purpose
This Temporary Instruction (TI) incorporates into HALLEX longstanding Regional Chief Administrative Law Judge (ALJ) instructions for implementing two related court orders: Sharpe v. Sullivan, 79 Civ. 1977 (CHS) (S.D.N.Y. Mar. 6, 1990) and Martinez v. Bowen, 73 C 900 (E.D.N.Y. Apr. 24, 1986).
II. Background
A. Sharpe
On July 10, 1980, the U.S. District Court for the Southern District of New York entered an Amended Order and Final Judgment setting forth certain notice and processing time requirements for Supplemental Security Income (SSI) claims by New York State residents who request ALJ hearings. That order also required payment of interim benefits in certain cases when the court-ordered processing time deadlines were not met.
On March 6, 1990, the court entered a Second Amended Order and Final Judgment which amended certain aspects of the July 10, 1980 order. OHA implemented the March 6, 1990 order in memoranda dated August 17, 22, 27 and 30 and November 9, 1990, from the Regional Chief ALJ for Region II.
B. Martinez
In 1978, the U.S. District Court for the Eastern District of New York issued orders prescribing time limits for holding hearings in title II disability claims by New York State residents. The orders mandated the payment of interim benefits if the time limits were not met and established requirements for monitoring compliance. On May 28, 1985, the court vacated its previous orders granting class-wide relief, but indicated that it intended to order alternate class-wide relief in the form of a notice. On April 24, 1986, the court ordered the Secretary to send a specific notice to all class members at the same time OHA acknowledges receipt of a claimant's request for hearing. On June 10, 1986, the Regional Chief ALJ for Region II issued a memorandum directing all New York hearing offices (HOs) to implement the court's order.
III. Class Definitions
A. Sharpe
The Sharpe class includes all claimants who:
have filed for SSI,
reside in New York State,
have received adverse determinations on their claims,
have filed requests for hearing, and
are awaiting either the holding of their hearings, the issuance of decisions, or effectuation of favorable decisions.
EXCEPTIONS:
A person is not a Sharpe class member if
(1) he or she is a Martinez class member by virtue of a concurrent claim for disability benefits under titles II and XVI; or
(2) he or she has been verified with the New York State Department of Social Services, or the appropriate local agency, to be receiving Interim Assistance benefits from the State of New York.
NOTE:
In New York State, the Interim Assistance benefit consists solely of home relief public assistance benefits; it does not include public assistance from Aid to Families with Dependant Children (AFDC). The HO may identify claimants as Interim Assistance recipients through evidence or statements already in file, hearing testimony or through an SSI2 query requesting the MPMT (miscellaneous payment data segment). An entry of GRC (grant reimbursement and state and county code) in the MPMT segment followed by a five-digit code beginning with 33 indicates receipt of Interim Assistance from New York State. (Program Operations Manual System (POMS) chapter SI 02003.000 provides more details on Interim Assistance Reimbursements.)
Because Interim Assistance recipients are not Sharpe class members, it is not necessary to send them any of the court ordered notices and they are not subject to the interim benefit procedures in Part VI. A. below.
B. Martinez
The Martinez class includes all claimants who:
have filed for disability benefits under title II of the Social Security Act (this includes concurrent claims under titles II and XVI),
reside in New York State,
have filed requests for hearing, and
are awaiting either the holding of their hearings or the issuance of their decisions.
IV. Processing Time Requirements
A. Sharpe
The Sharpe order requires the Secretary to issue decisions to class members within 90 days for non-disability issue cases and “within a reasonable time” for disability issue cases. The order specifies certain extensions and exceptions to the 90-day time limit for non-disability issue cases as described below.
1. Pre-hearing Extensions
a. Claimant Unavailable for Hearing
If the claimant or representative reports that either is not available on the date for which a hearing is scheduled, the H0 must reschedule the hearing for a date within 45 days after the ALJ is informed that the claimant or the representative (if there is one) becomes available for a hearing. If no hearings are scheduled to be held in the area of the claimant's residence within the 45-day period, the HO will reschedule the hearing for the next hearing trip the ALJ makes to the area of the claimant's residence. However, if the claimant is willing to travel to the HO, the HO must schedule the hearing within the 45-day time limit. In the event of a claimant-requested postponement under this provision, the time limit for issuing a decision is extended by the length of time between the date that the hearing was originally scheduled and the date for which the hearing is rescheduled.
b. Request for Additional Evidence before a Hearing Is Held
If the ALJ requests additional evidence before the hearing, he or she must do so within 45 days after the request for hearing is filed. The ALJ must hold a hearing within 30 days after receiving the additional evidence. In the event of a pre-hearing request for evidence under this provision, the time limit for issuing a decision is extended by the length of time between the date that the ALJ requests the additional evidence and the date such evidence is received.
c. Claimant Requests Additional Time before a Hearing Is Held
If the claimant requests additional time to submit more evidence, or to obtain witnesses or representation, the time period for issuing a decision is extended by a period not to exceed the additional time granted.
d. Uncontrollable Circumstances
If the ALJ cannot hold the hearing within the timeframes specified above because of uncontrollable circumstances, e.g., natural catastrophe or the unexpected illness of the ALJ, the ALJ may ask the Regional Chief ALJ for an extension of time of up to 30 days. Excessive workload cannot constitute an uncontrollable circumstance. In the event that such an extension is granted, the time limit for issuing a decision is extended by the length of the extension granted.
2. Post-hearing Extensions: Uncontrollable Circumstances
If the ALJ cannot issue a decision within the time required by the court because of uncontrollable circumstances, e.g., natural catastrophe or the unexpected illness of the ALJ, the ALJ may ask the Regional Chief ALJ for an extension of time of up to 30 days. Excessive workload cannot constitute an uncontrollable circumstance. In the event that such an extension is granted, the time limit for issuing a decision is extended by the length of the extension granted. If the Regional Chief ALJ denies the request for extension, the ALJ must issue the decision within 5 working days following the denial of the request for extension.
3. Exceptions to Processing Time Requirements
a. Additional Evidence
If the ALJ requests additional evidence after the hearing, he or she must request it within 30 days after the hearing is held. The ALJ must issue the decision within 30 days after the additional evidence is received and the period for comment has ended (see b. below if a supplemental hearing is needed).
If the claimant wishes to submit additional evidence or written statements of fact and law, the ALJ must issue the decision within 30 days of receiving the additional evidence.
b. Supplemental Hearing
If, on the basis of additional evidence, the ALJ decides that a supplemental hearing is necessary, the ALJ must hold the hearing within 30 days of receiving the additional evidence, and must issue a decision within 30 days after holding the supplemental hearing.
c. Reassignments
If, after a hearing has been held, it is necessary to reassign a case to another ALJ because the original ALJ is unavailable, e.g., through resignation, retirement or illness, the Hearing Office Chief ALJ must reassign the case within 30 days of the date the Regional Chief ALJ learns of the unavailability. The new ALJ must issue a decision within 30 days of the reassignment unless another extension or exception applies, e.g., a new hearing may be required (see HALLEX I-2-8-40).
B. Martinez
The 1985 and 1986 Martinez orders eliminated all specific processing time deadlines for Martinez class members. However, Martinez class members may seek judicial relief if they believe their claims are being “unreasonably delayed.” The court ordered acknowledgment notice that the HOs must send to all class members describes how claimants can determine the status of their claims and the procedures available if they believe there has been an unreasonable delay (see Part V. B. below).
V. Notice Requirements
A. Sharpe
In all title XVI disability issue class member cases in which a hearing has not been held or a decision rendered within 120 days after the date the claimant files a request for hearing, the HO must send the individualized notice contained in Exhibit A of the court's order (see Attachment 1) to the claimant, with a copy to the claimant's representative, if any. The HO must also send copies of all Exhibit A notices to counsel for the Sharpe class at the address shown on that attachment. The notice must contain an individualized explanation of why SSA has not yet held a hearing or issued a decision. To the extent applicable, the individualized explanation should indicate which of the extensions or exceptions listed in Part IV. A. above apply. The notice must contain the address(es) of the appropriate U.S. District Court and the pro se clerk's telephone number, which can be determined from the list in Attachment 2. The HO must mail the Exhibit A notice 120 days after the request for hearing is filed or within 10 days thereafter.
NOTE:
The 10-day period for mailing the Exhibit A notices cannot be extended (i.e, the exceptions and extensions in Part IV. A. above do not apply to the mailing of notices.)
In all title XVI non-disability issue class member cases in which a hearing has not been held or a decision rendered within 90 days after the date the claimant files a request for hearing, and the Secretary will not be paying interim benefits as explained in Part VI. A. below, the HO must send the individualized notice contained in Exhibit B of the court's order (see Attachment 3) to the claimant, with a copy to the claimant's representative, if any. The HO must also send copies of all Exhibit B notices to counsel for the Sharpe class at the address shown on that exhibit. The notice must contain an individualized explanation of why SSA has not yet held a hearing or issued a decision. The individualized explanation should indicate which of the extensions or exceptions listed in Part IV. A. above apply. (If none applies, the Exhibit B notice is inappropriate and the HO must initiate interim benefits — see Part VI. A. below.) The notice must contain the address(es) of the appropriate U.S. District Court and the pro se clerk's telephone number, which can be determined from the list in Attachment 2. The HO must mail the Exhibit B notice 90 days after the request for hearing is filed or within 10 days thereafter.
NOTE:
The 10-day period for mailing the Exhibit B notices cannot be extended (i.e., the exceptions and extensions in Part IV. A. above do not apply to the mailing of notices.)
In all title XVI non-disability issue class member cases in which the Secretary will be paying interim benefits as explained in Part VI. A. below, the HO must send the notice contained in Exhibit C of the court's order (see Attachment 4) to the claimant, with a copy to the claimant's representative, if any. (Although the notice contains the Social Security field office address, the HO will prepare and release it.) This notice advises the claimant that he or she will receive prospective interim benefits until a decision is issued. The HO must mail the Exhibit C notice 90 days after the request for hearing is filed or within 10 days thereafter.
In all title XVI class member cases, both disability and non-disability issue cases, in which an ALJ issues a fully or partially favorable decision, the HO must send the claimant the notice contained in Exhibit D of the court's order (see Attachment 5) with the claimant's copy of the decision. The HO must also send a copy to the claimant's representative, if any, and to the Sharpe class counsel.
In Exhibit D, the HO must indicate the appropriate time limits which apply to calculation and payment of SSI payment amounts. If the ALJ's decision does not address all elements of SSI eligibility (e.g., income, resources,and residency) for the entire period on which the ALJ rules favorably, the Exhibit D notice must reflect a 60-day time limit for calculation of benefit amounts and a 75-day time limit for payment of benefits. If the ALJ's decision does address all elements of SSI eligibility for the entire period on which the ALJ rules favorably, the time limits are 20 days for calculation of benefits and 35 days for payment.
B. Martinez
In all title II and title II/title XVI concurrent disability claims, the HO must advise the claimant, and representative, if any, of the claimant's right to petition the district court for relief, including interim benefits, if he or she believes his or her case is being unreasonably delayed. The HO must do this at the time it acknowledges receipt of the claimant's request for hearing, either by including the Attachment 6 language in the acknowledgment notice, or by including a separate notice containing Attachment 6 language with the acknowledgement letter when it is sent.
VI. Interim Benefit Requirements
A. Sharpe
The Sharpe order requires the Secretary to pay interim benefits in all title XVI non-disability class member cases in which a decision has not been issued within 90 days after the date the claimant files a request for hearing, subject to any of the time extensions or exceptions listed in Part IV. A. above. If the 90 days expire on or before the fifteenth day of the month, entitlement to interim benefits is effective as of the first day of that month. If the 90 days expire after the fifteenth of the month, entitlement is effective as of the first day of the following month.
The HO must monitor Sharpe cases to ensure that the HO timely requests payment of benefits when appropriate. The HO must initiate interim benefits within the same 90 to 100-day timeframe for mailing the Exhibit C notice (Attachment 4) as described in Part V. A. 3. above.
To initiate interim benefits, the HO must send a memorandum, via E-Mail, to the Regional Chief ALJ, Region II, with a copy to the Regional Commissioner. The Regional Commissioner's E-Mail address is:
| ¦¦NY ARC POS RSI/SSI BRANCH |
The memorandum should contain the following information:
| Subject: Sharpe Case Requiring Interim Benefits | |
|
Claimant: |
If the claimant is already in payment status, do not initiate interim benefits. Instead, send the claimant an Exhibit B notice explaining the reason(s) for the delay and advising that no interim benefits are payable because he or she is already receiving benefits.
When the ALJ issues a decision, send another E-Mail memorandum to the Regional Chief ALJ, with a copy to the Regional Commissioner, repeating the above information and indicating the following:
| Stop Date: | |
| Date of Decision: | |
| Type of Decision: |
No interim benefits are payable before the issuance of an ALJ decision in disability issue cases.
The Sharpe order provides that the Secretary must pay interim benefits after a favorable ALJ decision is issued, for both disability and non-disability issue claims, if effectuation of benefits is not made within the time limits spelled out in the order. SSA field offices initiate these payments through the Regional Commissioner's Office and advise the claimant using the notice contained in Exhibit E of the court's order (Attachment 7).
OHA's only involvement is to send the Exhibit D notice discussed above, advising the claimant of the applicable timeframes.
B. Martinez
The Martinez order currently in effect contains no interim benefit requirements.
VII. Reporting Requirements
A. Sharpe
The Sharpe order requires the Secretary to submit certain processing time reports on a quarterly basis. All HOs handling claims from residents of New York State must use the Hearing Office Tracking System (HOTS) program furnished by the Regional Office to identify Sharpe cases and to gather the required statistics. The HOs must submit quarterly reports to the Regional Office by the third Friday following the end of each calendar quarter.
B. Martinez
The Martinez order currently in effect contains no reporting requirements.
VIII. Inquiries
HO personnel should direct any questions to their Regional Office. Regional Office personnel should contact the Division of Field Practices and Procedures in the Office of the Chief Administrative Law Judge at (703) 305-0022. Headquarters personnel should contact the Division of Litigation Analysis and Implementation in the Office of Policy, Planning and Evaluation at 305-0724.
Attachment 3. Exhibit B: Personalized 90-day Notice for Sharpe Non-disability Class Members
| SOCIAL SECURITY ADMINISTRATION | |
| _________________________________________________________________________ | |
| Office of Hearings and Appeals | |
| HO address and | |
| telephone number |
SSN:
Claimant's Name
Address
City, State, Zip
Dear _______________:
You requested a hearing before an Administrative Law Judge on [Insert request for hearing date.], over 90 days ago.
Your hearing does not involve a disability issue, and therefore you have the right under the Social Security Act to a hearing and a decision within 90 days after your hearing request. Under a federal district court order in Sharpe v. Sullivan, 79 Civ. 1977 (CSH) (S.D.N.Y.), we are required to pay interim benefits to claimants to whom we have not issued a hearing decision within 90 days after a hearing request. However, under the order, we do not have to pay interim benefits when certain special exceptions apply.
We believe that we are not required to pay you interim benefits at this time because of the following special exception(s) that applies(apply) to your case: [Insert explanation, referring to all applicable exceptions and extensions. See Part IV. A.]
If you want more information concerning the status of your case or if you want us to act more quickly on your case, you may call or write to us at the above phone number and address. Ask to speak to a [hearing assistant/hearing office clerk].
If you believe that we have unreasonably delayed your case, you have a right to seek help in the United States District Court for the [Northern/Southern/Eastern/Western] District of New York. You may make a motion to a judge for an Order directing us to provide your hearing and/or decision promptly and to pay you benefits (“interim benefits”) while we do this. The Court is located at the following location(s):
[See Attachment 2 for a list of district court addresses and pro se clerk telephone numbers.]
If you need help making this motion in court, there are “pro se” clerks in the Courthouse to assist you. The “pro se” clerk's telephone number is listed in the above paragraph.
You may also wish to consult an attorney about your rights. Free legal services may be available if you qualify for them due to financial need.
A list of attorneys who may be able to provide free services is attached.
| Administrative Law Judge | |
| Attachment | |
cc: The Legal Aid Society
Civil Appeals Law
Reform Unit
Sharpe
Compliance
11 Park Place
New York, New York 10007
[Representative's name & address]
Attachment 4. Exhibit C: Interim Benefits Notice for Sharpe Non-disability Class Members (to Be Sent by HO)
| SOCIAL SECURITY ADMINISTRATION | |
| _________________________________________________________________________ | |
| Office of Hearings and Appeals | |
| HO address and | |
| telephone number |
SSN:
Claimant's Name
Address
City, State, Zip
Dear _______________:
Because your Supplemental Security Income (SSI) case does not involve a disability issue, the Social Security Administration is generally required to issue a decision after hearing within 90 days after your hearing request is filed. Because we have not decided your claim within this time limit, we will shortly begin sending you special interim benefit payments. These payments are required under a federal district court order in Sharpe v. Sullivan, 79 Civ. 1977 (CSH) (S.D.N.Y.).
If you do not begin to receive your special interim benefit payments within two weeks of the date of this letter, you may call a claims representative at our toll free number,
1-800-772-1213. You may also call this number if you do not wish to receive these special interim payments while awaiting a decision in your case.
Please keep the following in mind:
1. If you receive a favorable decision after hearing, you will stop receiving special interim benefits and will begin receiving your regular benefits.
If we learn that the amount of the special interim benefits we paid to you is higher than the regular benefits you should have received for the same time period, we will decide that you were overpaid. In that case, we will mail you a written notice that explains how we computed the overpayment, how we will collect the overpayment, and how you may appeal our decision that you were overpaid. The notice will also tell you how you may request a waiver of the overpayment. If we agree to waive the overpayment, we will not take any steps to collect the overpaid amount from you.
If, on the other hand, we learn that the amount of the special interim benefits we paid you is lower than the regular benefit amount you should have received for the same time period, we will promptly pay you the amount by which you were underpaid and send you a written notice that explains how the underpayment was computed.
2. If you receive an unfavorable decision after hearing, your special interim benefit payments will stop, and the special interim benefit payments you have received will be considered an overpayment. You will have all the rights described above, including the right to appeal our decision and to ask us to waive recovery of the overpayment.
| Field Office Manager | |
| Attachment | |
cc: The Legal Aid Society
Civil Appeals Law
Reform Unit
Sharpe
Compliance
11 Park Place
New York, New York 10007
[Representative's name & address]
Attachment 5. Exhibit D: Notice to Accompany All Fully and Partially Favorable ALJ Decisions in Sharpe Class Member Cases
| SOCIAL SECURITY ADMINISTRATION | |
| _________________________________________________________________________ | |
| Office of Hearings and Appeals | |
| HO address and | |
| telephone number |
SSN:
Claimant's Name
Address
City, State, Zip
Dear _______________:
As the enclosed Administrative Law Judge hearing decision explains, we have found that you are eligible to receive Supplemental Security Income payments.
We will calculate your current and retroactive monthly benefit amounts within [60 days/20 days because we do not need more information on your financial eligibility] and we will send you your current and retroactive benefits within [75/35] days unless special exceptions apply. You have the right to prompt payment of your benefits because of a federal district court order in Sharpe v. Sullivan, 79 Civ. 1977 (CSH) (S.D.N.Y.).
If you have any questions or need additional information, please call our toll free number 1-800-772-1213 and ask for a claims representative.
| Administrative Law Judge | |
| Attachment | |
cc: The Legal Aid Society
Civil Appeals Law
Reform Unit
Sharpe
Compliance
11 Park Place
New York, New York 10007
[Representative's name & address]