It is extremely important that the Disability Determination Services (DDS) and Office
of Hearings Operations (OHO) be able to contact someone who knows about the claimant’s
impairment(s) and who can help in completing the claim if we have difficulty contacting
the claimant directly.
Enter the identifying information and language preference about this person in Section
2. Use Section 10 – "Remarks" to document the name, address, phone number, and relationship
to the claimant of an additional third party contact who knows about the claimant’s
medical conditions and can help with their claim. If the claimant refuses to provide
any third party contact, use the Remarks section to document the claimant's decision.
To avoid further delay, for internet appeals that do not require contact with the
claimant for other development, do not attempt to obtain an additional third party
contact. Instead, annotate the following remark: "Internet/mailed-in claim- no additional
third party contact obtained" in the EDCS Remarks section and transfer the appeal.
For claimants with limited English proficiency (LEP), also complete an SSA-795 (Statement Of Claimant Or Other Person) as appropriate (see DI 23040.001, DDS: Interpreters for Individuals with Limited English Proficiency (LEP) or Individuals
Requiring Language Assistance).
In questions 2.F. through 2.J., document the person completing this report as:
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The person who is applying for disability,
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The person listed in 2.A., or
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