DI 23007.001 Failure to Cooperate and Insufficient Evidence Definitions

This subchapter, Failure to Cooperate and Insufficient Evidence (FTC), describes what adjudicators must do when a claimant does not comply with an initial request for evidence or action, or an initial notice of a consultative examination (CE) appointment. The instructions apply to initial and reconsideration level claims. This section provides definitions for terms used throughout the FTC subchapter.

For when the claimant does not comply with an initial request for evidence or action, see DI 22505.014.

For when the claimant does not comply with an initial notice of a CE appointment, see DI 22510.019.

A. Special handling

All claimants under age 18 require special handling.

Claimants age 65 or older require special handling when the claimant does not have an appointed representative (AR) or when the AR has asked us to deal directly with the claimant. For these claims, follow the instructions in DI 25015.025.

Other claims require special handling when the claimant does not have an applicant filing on their behalf or an AR, and at least one of the following applies:

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Homelessness,
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Illiteracy,
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Limited English proficiency (LEP),
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A severe, mental medically determinable impairment (MDI),
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Undergoing an age 18 redetermination, or
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Aged out of foster care in the last two years (identified by case flag).

NOTE: You must assume an alleged mental impairment to be a severe MDI unless you have evidence to the contrary. When you have such evidence, document it on a SSA-2506 (Psychiatric Review Technique) and do not apply special handling procedures.

REMEMBER: For claims requiring special handling, you must make at least one attempt to identify and involve a third party before you stop attempts to get the claimant's cooperation. Most claims will have a third party identified in Section 2 of the SSA-3368 (Disability Report - Adult), SSA-3441 (Disability Report - Appeal), or SSA-454 Continuing Disability Review Report). When the Field Office (FO) has identified an additional third party, the information will be in section 11 of the SSA-3368, Section 10 of the SSA-3441, or Section 11 of the SSA-454. You must make a reasonable effort to involve the additional third party when provided by FO and your efforts with the other third party was not productive. For additional information on making a reasonable effort to identify and involve a third party, see DI 23007.010.

B. Good reason

A good reason may include, but is not limited to, the following:

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Physical, mental, educational, and verbal limitations, including limited English proficiency (LEP),
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Personal illness,
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Death or serious illness in the family, or
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Other obstacles beyond the claimant's control.

C. Third party

Someone you can contact to help the claimant with their claim.

Third party information is in Section 2 of the SSA-3368 (Disability Report - Adult), SSA-3441 (Disability Report - Appeal), or SSA-454 (Continuing Disability Review Report). The FO may provide an additional third party in Section 11 (Remarks) of the SSA-3368, Section 10 of the SSA-3441, or Section 11 of the SSA-454.

When the FO documented that the claimant refused to identify a third party in the Remarks section, do not attempt to identify a third party. For the FO policy on documenting the refusal, see DI 11005.022B.

Examples of a third party may include, but are not limited to a:

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Relative,
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Friend,
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Member of religious or spiritual group,
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Labor union representative,
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Veterans group member, and
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Member of a senior citizens association.

NOTE: Do not use a third party from a prior folder or prior appeal levels.

D. Applicant

Anyone who has the right to sign a valid application on behalf of themselves, or on behalf of the claimant (see GN 00204.003).

E. Appointed representative (AR)

An individual who meets the qualifications listed in GN 03910.020B, and who the claimant appoints to act on their behalf in pursuing their claim or asserted rights before the Social Security Administration (SSA).

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423007001

DI 23007.001 - Failure to Cooperate and Insufficient Evidence Definitions - 08/02/2022
Batch run: 08/02/2022
Rev:08/02/2022

Program Operations Manual System (POMS)