Effective Dates: 11/10/2011 - Present Previous | Next

TN 13 (11-11)

GN 01010.275 Signatures on Adjudicative Forms

A. Signatures on screens and forms

Follow the instructions below relating to employee signatures on electronic screens and forms.

1. Electronic claims

If a claim is established, adjudicated or effectuated via Modernized Claims System (MCS), Automated 101 (A101), Electronic Form (EF101) or Manual Adjustment Credit and Award Data Entry (MACADE) process, the adjudicator's personal identification number (PIN) serves as the electronic signature.

2. Direct input screens

The adjudicator's PIN also serves as an electronic signature for direct input screens used to adjudicate a claim. These screens are secure because they are part of the same audit trail system that MCS, A101 and EF 101 process use. Accordingly, there is now a permanent electronic record available to identify the person adjudicating or effectuating a claim using direct input screens.

3. Paper claims forms

Field office (FO) and processing center (PC) personnel with delegated adjudicative authority (e.g., claims representative (CR) or claims authorizer (CA)) must sign and date all paper determination forms in the space provided for the adjudicator's signature and date. For specific information regarding signatures on paper claims forms, see GN 01010.001B.5 and GN 01010.053A.2.

FO determination forms received unsigned in the PC must be fully review by a CA. We do not allow signature stamps unless locally approved for use by disabled employees.

B. Signatures on special determinations

Authorized FO or PC personnel must also sign all special determinations including proof of support determinations. If you use the report of contact (RPOC) screen for a special determination, the PIN serves as a signature.

An authorized signature in the APPROVED block of the paper SSA-553 special determination form or other special determination form is acceptable even if you entered in the wrong space.

The above guidelines also apply to the SSA-892 used for adjudicating end-stage renal disease (ESRD) Medicare claims (see HI 00801.308B).

C. References

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201010275
GN 01010.275 - Signatures on Adjudicative Forms - 11/10/2011
Batch run: 11/10/2011
Rev:11/10/2011