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Medically Reactivated Claim
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“Original Decision Not Changed”
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The claim was medically reactivated, but after development, DDS determines:
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•
The original decision still applies; and
-
•
No SSA 831 data was changed.
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The claim status and jurisdiction returns to the same as it was before the medical
reactivation.
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NO
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“Mistakenly Reactivated”
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The claim was medically reactivated by mistake. Should only be selected when there
have been no changes at all to the claim. If non-decisional changes have been made,
the user selects “original decision not changed”
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The claim status and jurisdiction returns to the same as it was before the medical
reactivation.
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NO
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CDR
Initial Claims Only
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“No CDR Issue”
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After receipting a CDR claim, the DDS determines that one of the screen-out reasons
applies (per DI 28030.001E. and DI 28003.005) or the claimant dies.
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The claim is closed with jurisdiction at the FO.
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YES
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CDR Recons Only
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“PH Transfer to DH”
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The DDS is unable to make a favorable decision after the Pre-Hearing review (PH) and
the case must be routed to the Disability Hearings Unit (DHU). (For more information
on Pre Hearing Favorable Decision see DI 81020.255B.1.b.)
NOTE: Enter the appropriate DDS as the destination.
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An electronic folder interface (EFI) download is created and the claim level changes
to DH.
The claim status is “pending” and jurisdiction to the specified office.
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NO
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CDR Recons Only
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“DH Transfer to PH”
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The DHU determines that a case needs to be returned for PH review. (For more information
on DHU Processing see DI 81020.255B.2.b.)
NOTE: Enter the appropriate DDS as the destination.
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An EFI download is created and the claim level changes to PH.
The claim status is “pending” and jurisdiction to the specified office.
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NO
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CDR Recons at FDDS Only
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“DHU Quality Review - Disagree”
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The Federal DDS disagrees with a DHU decision and routes the case to the DHU.
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An EFI download is created and sent to the DHU.
The claim status is “pending” and jurisdiction to the specified office.
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NO
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Title II DIB or DWB
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“Death in Waiting Period”
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The claimant dies during the waiting period. For a concurrent Informal Remand (IR)
case, the Title II claim(s) uses the ND reason code “death in the waiting period”
and the Title XVI claim(s) uses the ND reason code, “unable to make a fully favorable
determination”.
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The claim is closed with jurisdiction at the FO. An IR claim is closed with jurisdiction
at the originating Hearing Office (HO).
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YES
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Any Claim
(except reopened claims)
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“FO Determination Requested”
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The DDS determines that a FO determination is needed (for example, the claimant has
returned to work) and routes the claim to the FO.
NOTE: For OQR returns when the controlled return is “Y” enter the OQR office as the destination
after corrective action is complete. After review, OQR routes the claim to the FO.
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The claim status is “pending” with claim jurisdiction at the FO.
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YES
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“Send to Another Office”
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The DDS has performed substantive work on the claim but the claim must be routed to
another office (e.g., the claimant moves to another state). Selecting this ND Reason
allows the DDS to receive workload credit.
NOTE: If the DDS has not performed substantive work, or if they expect to receive the case
back, then use the Transfer decision code (DEC=TR).
For reactivated claims, the DDS must cancel the reactivation before the claim can
be
sent to any office outside of the DDS state.
Reminder: When sending cases to another disability case processing component for workload
assistance and the final determination will be made by the receiving office, use the
Transfer (TR) decision code rather than a No Determination (ND) decision code to ensure
proper workload credit. For information on transferring cases for workload assistance
see DI 81020.125 Electronic Case Routing Before Final Determination.
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An EFI download is sent to the designated office.
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YES
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“Stop Electronic Processing”
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The DDS determines that a prior claim needs to be reopened, so electronic processing
must cease on the current CEF per Processing Reopenings on Certified Electronic Folders
(CEF) - DI 81020.115
NOTE: Enter the DDS as the destination and prepare a SSA-5002 (Report of Contact) and an
electronic folder message.
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The claim status changes to “Transferred” with jurisdiction of the claim at the DDS
office. The “Transferred” status means that electronic processing has stopped.
Current Paper Folder Indicator must reflect paper
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NO
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Informal Remand
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Unable to Make a Fully Favorable Decision (UFFD)
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The DDS is unable to make a fully favorable allowance on the basis of evidence in
file.
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The claim is returned to the originating HO.
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NO
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Hearing Office Recall (HORC)
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ODAR recalls the Informal Remand, or the DDS determines a fully favorable determination
can be made on a CEF IR claim and a reopening of a prior paper folder is necessary.
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The claim is returned to the originating HO.
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NO
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Subsequent Claim Filed
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“Stop Processing Common Issue (DDS)”
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A new initial claim is filed and an appeal is pending at the Appeals Council or remanded
to the Hearing Office. DDS action not needed on new initial claim.
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DDS stops working the new initial claim.
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YES
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