Effective Dates: 03/19/2026 - Present Previous | Next

TN 7 (03-26)

DI 11018.005 Failure to Cooperate-Insufficient Evidence Determination in an Initial Disability Claim

Citations: 20 CFR §404.1516; §416.916

This section provides field office instructions when, during the development of an initial disability claim, you have not received a response from the claimant to your requests for evidence or action.

NOTE: When the claimant's whereabouts are unknown or the claimant does not wish to pursue their claim, for Title II refer toDI 11010.045 and for Title XVI claimsDI 11055.085.

A. Field office (FO) interview responsibilities

During the disability claim interview:

1. Tell the claimant about the evidence we require

Provide the claimant with the following information:

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    A description of the specific evidence we require;

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    Why we require the evidence;

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    Where they can obtain the evidence, if known;

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    When we need to receive the evidence (allow at least 15 calendar days); and

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    What will happen if we do not receive the evidence by the due date (i.e., we may proceed to make a determination based on the evidence of record and we may deny the claim).

2. Attempt to obtain from the claimant a primary and an additional third-party contact

Providing a primary and additional third-party contact in the Contacts Section of the Electronic Disability Collect System (EDCS) or the paper form SSA-3368 Disability Report-Adult, gives the Disability Determination Services (DDS) another resource should they need assistance obtaining information or action from the claimant.

For more information on obtaining and documenting third-party contacts see DI 11005.023C.2.

IMPORTANT: While we highly encourage claimants provide third-party contacts for their claim, failure to provide a third-party contact is not a reason to deny the claim. Claimants may have valid reasons not to provide a third-party contact.

3. Provide the claimant with a notice of the required evidence

Send an initial request for the information needed via the applicable claims system, Document Processing System (DPS), or the Workload Action Center (WAC) (generally the SSA-L1043 for Title II and the SSA-L8003 for Title XVI). For documenting evidence requests, see GN 01010.410C.

B. FTC development

It is the claimant’s responsibility to submit evidence to establish eligibility or entitlement for disability benefits, when requested. When the claimant does not submit the requested evidence or action by the assigned date (a minimum of 15 calendar days must be provided), follow the instructions in this subsection.

NOTE: The claimant may not be capable of obtaining the evidence on their own and may need assistance. To determine whether special handling procedures apply and for guidance on providing assistance, refer to the following instructions:

  • •

    GN 00301.180 Identifying Claimants Who May Need Assistance

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    SI 00601.100 General Guidance for Information or Evidence

1. Review the file for required evidence

After the initial request, review the file and if the requested evidence or action remains unresolved, determine whether:

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    The claimant may need additional assistance or time to obtain the required evidence.

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    The third-party contact named during the interview can assist the claimant with submitting the requested evidence.

NOTE: 

Use judgement on whether it is appropriate to give the claimant longer than 15-days to respond. When determining what is a reasonable amount of time for the claimant to provide the requested evidence, consider the types and volume of documents requested, the source of the evidence, and whether the claimant is actively trying to obtain the evidence. For example, it may take a claimant longer to obtain a document from a source in another country or out of state.

2. Send a follow-up request with closeout language

Send a follow-up request explaining that we will make a determination based on the information and evidence available, and may deny the claim 30 days from the date of the original request if we do not receive the requested information or action.

IMPORTANT: You can always give the claimant more time if needed, however do not deny the claim earlier than 30 days from the original request date.

For more information on notice requirements see for Title II claimsGN 01010.410C.2 and for Title XVI claims SI 00601.120.

If using DPS, navigate to the Initial Claims folder and select the National version of the appropriate closeout notice:

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    Title II - Request for Information (Form SSA-L1045)

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    Title XVI - SSI Claim Information (Form SSA-L8009)

To ensure policy compliance and preservation of mandatory appeal rights language, do not make changes to mandatory notice language in DPS.

3. When to develop for FTC

Develop for FTC when:

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    The claimant does not respond to your initial request for evidence or action;

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    Any attempt to obtain assistance from the third-party contact, appointed representative, or representative payee is unsuccessful and;

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    The claimant does not respond to the follow-up notice.

C. Documentation requirements

Document all efforts to resolve FTC situations in the applicable claims system as follows:

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    Identify the outstanding issue on the development worksheet of the claims processing system along with the initial request and follow-up request dates.

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    Document the dates and results of all development efforts on a Report of Contact within the appropriate claims processing system.

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    If a paper folder exists, annotate the same information on a paper SSA-5002 and include it in the paper folder.

NOTE: For a technically denied claim established in EDCS, close the EDCS case as explained in DI 81010.140.

When a claimant does not respond to a request for information or additional development initiated by another decision-making component, follow the guidance below:

1. EDCS case transferred to the DDS

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    Document all efforts in EDCS through the Update-After-Transfer (UAT) function.

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    Use the Transfer/Updates feature to document your efforts on the form SSA-5002 and follow DI 81010.095C.

2. EDCS case transferred to Quality Review

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    While a disability claim is pending quality review (if selected), the FO may receive an assistance request to develop substantial gainful activity (SGA).

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    Use the EDCS Transfer/Updates feature to create the SSA-5002 to document your efforts, and store in the electronic folder.

D. FTC issue resolved

If the request for information or action is resolved at any point prior to the FO's insufficient evidence denial, forward the claim(s) to the DDS for a medical determination.

E. FTC issue not resolved

When the claimant does not respond to the FO's requests for evidence or action after following the procedures in DI 11018.005B, in this section, document the FO's actions to obtain the requested information or action from the claimant and the outcome of those actions. Continue to process the claim as follows:

1. Medical evidence or developmental evidence is in the file

Forward the claim to the DDS for a medical determination if the following is in the file:

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    Medical evidence, for the categories of evidence see DI 24503.005, or

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    A completed disability report (e.g. SSA-3368 (Disability Report - Adult)) and signed SSA-827 (Authorization to Disclose Information to SSA).

NOTE: 

Developmental evidence is not considered “in file” if the SSA-827 or the appropriate disability report is missing or not completed.

2. MER or developmental evidence is not in the file

Deny the claim for insufficient evidence following the steps, in this section, if the claimant:

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    Does not respond or provide the required evidence after our attempts to assist in obtaining the evidence are unsuccessful and after sending the closeout letter,

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    Does not ask for more time to submit the evidence, and

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    Meets the non-medical factors of entitlement.

    NOTE: 

    If the claimant does not meet a non-medical requirement, (e.g. does not meet Disability Insured Benefit (DIB) insured status or has excess income for Supplemental Security Income (SSI) eligibility), deny the claim for that specific reason.

For EDCS cases, process an FO “No Determination” (ND) to close the EDCS case per DI 81010.140.

3. Closeout process

Deny the claim for insufficient evidence (Title II) or failure to pursue (Title XVI) following these steps:

a. Title II claims

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    Use regulation basis code 0M5 if the individual has insured status or

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    Use regulation basis code 0M6 when the:

    - Date last insured (DLI) is in the past (DIB claims),

    - Prescribed period has ended Disabled Widow(er) Benefit (DWB) claims,

    - Re-entitlement period last met is prior to the date of the current determination Childhood Disability Benefit (CDB) claims.

    For a complete list of regulation basis codes, see DI 26510.045.

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    Prepare a manual denial letter via the DPS and mail the letter to the last known address.

    - Navigate to the Initial Claims folder and select a notice based on the claim type.

    - To ensure policy compliance and preservation of mandatory language about appeal rights, do not make any manual changes to the notice in DPS.

b. Title XVI claims

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    Deny the claim as "N18" failure to cooperate and

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    Issue a denial letter to the last known address. The claims processing system sends an automated denial letter to the last known address in most situations. For situations when a manual SSA-L8030 is required, see NL 00802.020.

For more information on N18 denials see SI 00601.110B.

4. FTC issue arises after a favorable medical determination

When an FTC issue occurs after the DDS makes a favorable determination, follow these instructions:

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    Title II claims: GN 01010.410 Failure to Submit Essential Evidence

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    Title XVI claims: SI 00601.110 Final Request - Failure to Cooperate (N18) - Initial Claims

F. Claimant submits requested evidence after insufficient evidence denial

1. Evidence submitted within the appeal period

When a claimant submits the requested information within the appeal period, treat the submission as an implied request for reconsideration and follow DI 12005.010.

NOTE: If you reverse the FO FTC denial, resume processing the initial application. Transfer the EDCS case to DDS as an initial claim. See procedures in DI 12005.010F.

2. Evidence submitted after the appeal period

When a claimant submits the requested information after the appeal period, treat the submission as an untimely implied request for reconsideration. We can process an untimely filed request for reconsideration if the claimant submits a written explanation for the delay and we determine good cause for late filing exists.

a. Good cause determination

Develop and document the file with a good cause determination by following the instructions in GN 03101.020 and DI 12005.015.

b. Good cause established

If you determine the claimant had good cause for the late filing, process the request for reconsideration as though the claimant filed it timely.

c. Good cause not established

If you determine the claimant did not have good cause for the late filing, follow the procedures in DI 12005.015C.

If the claimant wishes to file a new application, follow the instructions in DI 12005.015D.

If the claimant does not wish to file a new application, see DI 12005.015E.

3. Processing reconsideration requests of FO determinations

For instructions on how to process requests for reconsideration on technically denied claims, see:

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    DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial

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    DI 81010.145 Processing Reconsideration Requests of Field Office (FO) Determinations

4. Reopening M5/M6 insufficient evidence or N18 denial

If the claimant provides new and material evidence but the appeal period has already ended, consider reopening the claim following the guidelines inGN 04010.030. Generally, we do not reopen or revise a correct determination. If within the reopening time limits, apply reopening procedures only if the FTC denial was incorrect, and:

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    The claimant contacts us after the appeal period ended; or

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    You cannot establish good cause for an untimely filed reconsideration request.

EXAMPLE: A claimant who received a denial by the FO for insufficient evidence recontacts the FO after the appeal period has ended. The FO cannot find good cause for late filing of an appeal. The FO discovers that the FTC denial was incorrect because the requested evidence was submitted timely but was not associated with the claim. The FO can reopen the incorrect FTC denial.

For more information on reopening rules, refer to:

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    GN 04001.070 Do Not Reopen Correct Determinations- Operating Policy

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    SI 04070.010 Title XVI Administrative Finality - Reopening Policies

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    SI 00601.110B.10 Final Request- Failure to Cooperate (N18) Initial Claims

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411018005
DI 11018.005 - Failure to Cooperate-Insufficient Evidence Determination in an Initial Disability Claim - 03/19/2026
Batch run: 03/19/2026
Rev:03/19/2026