Attachment 1. Rosetti Stipulation and Order; Approved by the Court on July 7, 1994; Entered by the Clerk of Court on July 8, 1994

Plaintiffs,

Civil No. 91-3389

Defendant.

WHEREAS, plaintiffs filed a class action complaint on May 28, 1991, challenging certain aspects of the Social Security Administration's (SSA) evaluation of claims of disability under titles II and/or XVI of the Social Security Act due to Human Immunodeficiency Virus (HIV) infection or Acquired Immune Deficiency Syndrome (AIDS);

WHEREAS, this court dismissed the action by orders dated March 31, 1992, and September 2, 1992, after a hearing;

WHEREAS, the Secretary of Health and Human Services published a final rule in the Federal Register, after public notice and comment, on the evaluation of claims of disability based on HIV infection or AIDS and an Immune System Listing on July 2, 1993;

WHEREAS, the United States Court of Appeals for the Third Circuit vacated the above-noted dismissal orders and remanded the case to consider plantiffs' motion for class certification on December 15, 1993;

WHEREAS, the United States Court of Appeals for the Third Circuit denied Defendant's Petition for Rehearing with Suggestion for Rehearing In Banc on March 9, 1994; and

WHEREAS, the parties wish to avoid further litigation in this matter and to fully and finally resolve this dispute,

IT IS HEREBY STIPULATED AND AGREED, by and between the parties, that:

1. 1. 

   The class certified under this Stipulation and Order includes individuals whose claims for disability benefits under titles II and/or XVI of the Social Security Act based in whole or in part on allegations of HIV infection or AIDS were finally denied or ceased, in whole or in part, while they were residents of Delaware, New Jersey, Pennsylvania, or the Virgin Islands, for medical reasons, or after March 22, 1991, (the first business day from 65 days prior to May 28, 1991, the date of filing of the complaint in this matter) and before July 2, 1993. The terms of this Stipulation and Order providing for review of claims shall not apply if an individual receives a final judicial decision on a claim that otherwise would be reviewed under the terms of this Stipulation and Order.

2. 2. 

   For the purpose of this Stipulation and Order, SSA shall provide relief to individuals in the class as follows:

   1. A. 

      Within forty-five days after the instructions referenced in paragraph 3, infra. have been issued, SSA shall, to the extent practicable, send an individual notice (attachment 1) by first-class mail to the last known address of every individual who resided in Delaware, New Jersey, Pennsylvania, or the Virgin Islands when their title II and/or XVI application for disability benefits was finally denied or ceased, for medical reasons, based on a determination or decision made on or after March 22, 1991, and through July 1, 1993, and whose primary or secondary diagnosis code from SSA's data processing systems was “0420” (AIDS) or “0430” (Symptomatic HIV) or “0440” (Asymptomatic HIV).

   2. B. 

      Individuals who receive the subparagraph (A) notice must, in order to obtain a review of their claim, return the reply form in the pre-addressed postage-prepaid envelope enclosed with the notice or through any Social Security field office within sixty days after presumptive receipt of the notice pursuant to 20 C.F.R. §§ 404.901 and 416.1401. If they do not respond within sixty days of receipt, their disability claim will not be reviewed under this Stipulation and Order unless the claimant provides SSA evidence of “good cause” for untimely response as defined in 20 C.F.R. §§ 404.511 and 416.1411. Individuals who do not receive the subparagraph (A) notice and wish to obtain a review of their claim may request review by contacting any SSA office until one year after the date the subparagraph (A) notices are mailed. Individuals who respond to the subparagraph (A) notice or who otherwise request review will receive an acknowledgment letter from SSA (attachment 2).

   3. C. 

      If SSA determines that an individual who responded to the notice or otherwise requested review is not in fact a class member, SSA will notify the individual in writing (in the form of attachment 3, subject to revision) of the reason for that determination and that he or she has sixty days from receipt of the notification to write to the Office of the General Counsel (OGC), Department of Health and Human Services, 600 Altmeyer Building, 6401 Security Boulevard, Baltimore MD 21235, to disagree with the determination. If the individual does not write OGC disagreeing with the SSA determination within sixty days of receipt of the notification under this paragraph, the SSA class determination shall become binding and not be subject to further review. OGC will seek to resolve these class membership disputes; however, if the dispute cannot be resolved, OGC will write the individual stating that the individual must request district court review of the SSA class membership determination within sixty days of presumptive receipt (20 C.F.R. §§ 404.901 and 416.1401) of OGC's written communication, or the SSA class membership determination will become final and not be subject to further review. SSA shall contemporaneously provide class counsel with copies of all communications sent to potential class members who are determined not to be class members. In addition, SSA, upon request, will provide class counsel with reasonable and timely access to information concerning the implementation of this agreement, including access to potential class members' files for the purpose of resolving class membership issues, should they arise, subject to the requirements of the Privacy Act and any other applicable privacy statutes or regulations.

   4. D. 

      Claims will be reviewed as follows:

      1. 1. 

         After the instructions, referenced in paragraph 3, infra, have been issued, timely responder claims will be redetermined at the reconsideration level of administrative review, 20 C.F.R. §§ 404.907 and 416.1407, except as otherwise provided in this paragraph.

      2. 2. 

         The Secretary's rules, as they may hereinafter be amended, including the Immune System Listing for evaluating disability claims involving allegations of disabling HIV infection or AIDS, 20 C.F.R. Part 404, Subpart P, Appendix 1, will be used in making the redeterminations.

      3. 3. 

         The redeterminations will be based on the evidence of record upon which the claim is based; however, if the Disability Determination Services (DDS) cannot redetermine the claim under the Secretary's rules based on the original evidence of record, the DDS will request the necessary evidence relevant to the time period being redetermined. In addition, a class member will be permitted to submit any additional evidence relevant to the period being redetermined, and such additional, relevant evidence will be considered by DDS in making the redetermination.

      4. 4. 

         If the redetermination under this Stipulation and Order results in a finding that the individual was disabled, the claim will be reopened, and the evidence of the class member's disability from the period of the previous determination to the present, or to the date of a more recent allowance, will be evaluated and new determination will be issued.

      5. 5. 

         At the option of SSA, Rosetti claimants with subsequent disability claims active and simultaneously pending at any administrative level of review at the time their Rosetti claim is being evaluated may have all claims consolidated and reviewed simultaneously. SSA will use its best efforts to ensure that adjudication of the current claims is not delayed by such consolidation.

      6. 6. 

         SSA will exert its best efforts to resolve all claims of Rosetti class members as expeditiously as possible. See HALLEX, vol. 1, div. 2, June 1993, I-2-140.C (TERI cases); POMS DI E23020.001.

      7. 7. 

         Class members shall retain all rights to seek further administrative and judicial review of determinations or decisions made on readjudication in accordance with 42 U.S.C. § 405(g) and 20 C.F.R. Parts 404 and 416 (1993).

3. 3. 

   SSA will issue instructions to its adjudicators to implement the terms of this Stipulation. SSA will make a good faith effort to provide counsel for the plaintiffs with draft instructions within 120 days of the date on which the District Court enters judgment in this action pursuant to the terms of this Stipulation. Counsel for plaintiffs will make a good faith effort to provide SSA with their comments on these instructions within ten days of counsel's receipt of the instructions. SSA will make a good faith effort to issue final instructions within 45 days of receiving the comments from counsel for plaintiffs or, if no comments are received, within 45 days of the due date for such comments. SSA may, but is not required to, incorporate plaintiffs' comments into its instructions. SSA will provide counsel for plaintiffs with a copy of the final instructions issued to adjudicators and any subsequent revisions to the instructions. SSA will not review any prior determinations of Rosetti class members until final instructions have been issued.

4. 4. 

   Plaintiffs' counsel and defendant's counsel, by their signatures below, warrant that they are sole counsel to the plaintiffs and to the defendant, respectively, whose interests were represented in this action and that they are authorized to stipulate to the resolution of issues in this action.

5. 5. 

   The question whether plaintiffs are entitled to any attorney's fees, expenses, and/or costs, and, if so, the amount of such fees, expenses, and/or costs shall be determined at a later date by the parties or by the Court upon timely application by the plaintiffs. Notwithstanding any other provision of this Stipulation and Order, nothing in this Stipulation and Order is, or shall be offered or construed as, a finding or evidence of an admission by any party that the position of the defendant in this action was or was not substantially justified, nor is this Stipulation and Order an admission of liability on the part of defendant for the payment of any attorney's fees, expenses, or costs.

6. 6. 

   The parties will attempt to resolve any disputes arising under this Stipulation by negotiation between counsel or their designees. The parties reserve the right to seek a modification of the Stipulation from the court in the event of a change in the law.

7. 7. 

   Individuals in the class shall be barred and enjoined forever from:

   1. A. 

      prosecuting any claims or causes of action that have been or could be asserted by reason of, or with respect to, or in connection with, or that arise out of any of the matters alleged in this action; and

   2. B. 

      seeking judicial relief that would have the effect, directly or indirectly, of requiring that the redeterminations herein be reopened, redetermined, readjudicated, or otherwise reviewed in any manner by SSA.

      Nothing in this Stipulation shall prevent any class member from pursuing an individual administrative appeal, a request for reopening, or a judicial appeal, or from asserting that a legal standard was not applied, or was improperly applied, in his or her individual case.

8. 8. 

   The defendant, its administrators or successors, and any department, agency, or establishment of the United States and any officers, employees, agents, or successors of any such department, agency, or establishment, are hereby discharged and released from any claims and causes of action that have been asserted in this action, or administratively, by reason of, or with respect to, or in connection with, or that arise out of, any matters alleged in this action; provided, however, that nothing in this paragraph shall relieve the defendant of the duty to comply with this Stipulation and Order.

9. 9. 

   This Stipulation does not constitute an admission by the defendant of any pattern or practice that violates or fails to comply with any law, rule, or regulation dealing with any matter within the scope of the allegations contained in the complaint or otherwise raised by plaintiffs in this action.

10. 10. 

    Final judgment in accordance with the terms hereof shall be entered upon entry of this Stipulation and Order. This Stipulation and the covenants and conditions contained herein shall become effective upon entry of the Stipulation and Order as an Order of the Court. The Court will retain jurisdiction in this action only for the purpose of enforcing this Stipulation and Order, resolving disputes over whether claimants are entitled to redeterminations as provided by paragraph 2 of this Stipulation and Order, determining matters concerning modification of this Stipulation and Order pursuant to paragraph 6, and determining, upon timely application by plaintiffs, whether plaintiffs are entitled to attorney's fees, expenses, and/or costs.

/s/

/s/

DATE:
7/5/94

DATE: 6/30/94

DATED:
7/7/94

/s/

________________________________________

From: Department of Health and Human Services, Social Security Administration

________________________________________

We may owe you disability money. This is because of a court case called Rosetti v. Shalala.

We denied your old disability claim. You can ask us to look at your old claim again by sending in the enclosed reply form within 60 days.

IF YOU NOW GET MONEY FROM SOCIAL SECURITY

Even if you now get money from Social Security, we may still owe you more disability money.

WHAT YOU NEED TO DO IF YOU WANT US TO REVIEW YOUR CLAIM

FILL OUT THE ENCLOSED REPLY FORM AND SEND IT TO US NOW.

YOU HAVE ONLY 60 DAYS TO DO THIS. DO NOT WAIT OR YOU MAY LOSE THE RIGHT TO HAVE YOUR CLAIM REVIEWED.

WHAT WE WILL DO

If you ask us to look again at your old claim, we will review you case. We will see if you meet the standards in the Rosetti court order for a new review of you old claim. Under these standard, you may be eligible for a review of your old claim if we find that the answer is “yes” to all of the following questions:

1. 1. 

   Did you live in Delaware, New Jersey, Pennsylvania or the Virgin Islands when we denied your claim or ceased your benefits?

2. 2. 

   Was your claim denied or benefits ceased, in whole or in part, on or after March 22, 1991, and before July 2, 1993?

3. 3. 

   Did you have Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) when we decided your claim?

If you do not meet the requirements, we will send you a letter that explains why.

If we find that you meet all the standards set out in the court order, we will give you a new disability decision on your old claim. You can submit new evidence about what your medical condition was at the time of the old decision. We will notify you about the new decision.

IF YOU HAVE ANY QUESTIONS

If you have any questions, you may call your local Social Security office. We can answer most questions over the phone. You can also write or visit any Social Security office. If you call or visit an office, please try to have this letter with you. It will help us answer your questions. The address and telephone number of the office that serves your area are:

You may also call us toll free at 1-800-772-1213 if you have any questions.

If you already have a lawyer or other legal representative, you may show the notice to him or her. You do not need a lawyer or legal representative to send the reply form back to Social Security.

ESTE ES UN AVISO IMPORTANTE RELACIONADO CON BENEFICIOS DE SEGURO SOCIAL FAVOR DE PEDIR QUE SE LO TRADUZCAN IMMEDATAMENTE Y DE LLAMA A SU OFICINA DE SEGURO SOCIAL PARA UNA EXPLICACION.

We are writing to tell you that we received your request for us to look at your past claim for disability benefits. If you are eligible for review, we will list the standards approved by the Court under the Rosetti v. Shalala settlement agreement.

We expect to receive many requests for review and it may take several months before we look at your file. When we start the review, we will decide if you are a member of the “class” of people included in the lawsuit.

If you have a legal representative helping you with your claim, you should contact him or her. You also may ask for legal help by contacting the lawyers in the Rosetti case. They are:

If you have any questions, you may call us toll free at 1-800-772-1218, or you may contact your local Social Security Office. The address and phone number of the Social Security Office that serves your area are shown below.

If you call to visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us to serve you more quickly.

You asked us to review your case under the terms of the Rosetti v. Shalala settlement agreement. We have looked at your case and have decided that you are not a Rosetti class member eligible for relief. This means that we will not review our earlier decision to deny or cease your benefits. The reason you are not a class member eligible for relief under the Rosetti settlement agreement is checked below.

You are not a Rosetti class member eligible for relief because:

[ ] You did not reside in Delaware, New Jersey,
Pennsylvania, or the Virgin Islands when your claim was denied or
your benefits ceased.

[ ] You did not receive a final decision denying
your claim or ceasing your benefits, in whole or in part, on or
after March 22, 1991 and before July 2, 1993.

[ ] Your disability claim was not based in
whole or in part on HIV or AIDS.

[ ] Your claim was denied for some reason other
than your medical condition. That reason was
_________________________

[ ] You have received a final decision by a
United States District Court in your claim for disability benefits
that would otherwise be covered by this settlement
agreement.

[ ] You have already received all the benefits
you could receive under the Rosetti settlement agreement.

[ ] Other:
______________________________________

It is important for you to know that we are not making a decision about whether you are disabled. We are deciding only that you are not a Rosetti class member eligible for relief.

You must writewithin 60 days of when you receive this notice to:

In addition, you may contact the lawyers representing the Rosetti class members, who can be reached as follows:

The Rosetti lawyers can advise you and, if appropriate, assist you in notifying Social Security that you disagree with the determination.

ESTE ES UN AVISO IMPORTANTE RELACIONADO CON BENEFICIOS DE SEGURO SOCIAL FAVOR DE PEDIR QUE SELO TRADUZCAN IMMEDIATAMENTE Y DE LLAMAR A SU OFICINA DE SEGURO SOCIAL PARA UNA EXPLICACTION.

Plaintiffs,

Civil No. 91-3389

Defendant.

Pursuant to 5 U.S.C. § 552a(b) (11), 42 U.S.C. § 1306(a), and 20 C.F.R. § 401.340, IT IS HEREBY ORDERED as follows:

1. 1. 

   Defendant may disclose to plaintiffs' counsel information required to be disclosed to plaintiffs' counsel under the Stipulation and Order executed by the parties in this case that is subject to restrictions on disclosure under the Privacy and Social Security Acts without obtaining the prior written consent of the individual to whom such records pertain, for the purposes of monitoring compliance with the Stipulation and Order, facilitating implementation of the Stipulation and Order, and assisting class members and potential class members in effectuating their rights under the Stipulation and Order. Such information consists of names, addresses, and claims files of potential class members, and other claimant-specific information reasonably relevant to the implementation of the Stipulation and Order.

2. 2. 

   Plaintiffs' counsel shall use the information disclosed pursuant to paragraph 1 of this Order only for the purposes described above. Except as provided in paragraph 4 of this Order, plaintiffs' counsel shall not make disclosures of such information except: (1) to each other; (2) to members of plaintiffs' counsel's staff; (3) to defendants or their agents or their counsel; (4) to the Court in this action; or (5) to other persons participating in the accomplishment of the purposes described in paragraph 1. Any disclosure to persons described in item (5) of the preceding sentence shall be conditioned upon such persons having read this Order and acknowledged in writing that they understand the Order and agree to be bound by it. Plaintiffs' counsel shall inform all non-attorney staff in their offices who have access to information subject to this order of the requirements of this order and shall instruct them to comply with its terms. Additionally, plaintiffs' counsel may disclose information pertaining to particular class members or potential class members to those particular individuals or to representatives acting on behalf of such individuals.

3. 3. 

   Plaintiffs' counsel and members of their staff shall limit the making of copies of the records disclosed pursuant to paragraph 1 of this Order to those necessary to the purposes described in paragraph 1. All such copies, and any documents created by plaintiffs' counsel or any member of their staff that contain information disclosed pursuant to paragraph 1, shall be kept confidential, consistent with the Rules of Professional Conduct. All such copies and documents concerning individuals who do not individually engage class counsel's assistance shall be returned to the defendant or destroyed upon the completion of implementation of the Stipulation and Order.

4. 4. 

   Nothing in this Order shall prejudice the rights of plaintiffs' counsel to use the information that they receive pursuant to the Stipulation and Order in this action that is not subject to restrictions on disclosure contained in the Privacy and Social Security Acts, or their rights to use information obtained outside of the context of the Stipulation and Order.

5. 5. 

   Failure to comply with this Order shall subject the responsible individual and/or his or her attorney to appropriate sanctions by the Court, including a finding of contempt.

6. 6. 

   This Order does not constitute any agreement or ruling as to the discoverability or admissibility of any record or information.

7. 7. 

   Upon twenty days' notice to the other parties, any party may seek modification of this order.

IT IS SO ORDERED this 7 day of July, 1994.

By: /s/

Approved:

/s/

_________________________

Dated:7/5/94

/s/

_________________________

Dated:6/30/94

Attorneys for Defendant

The terms “finally” and “final,” as used herein, refer to the date of the administrative decision that became the binding decision of the Secretary pursuant to 20 C.F.R. §§404.905, 404.921, 404.955, 404.972, 404.981, 416.1405, 416.1421, 416.1455, 416.1472 and 415.1481, and do not mean that a class member must have exhausted administrative remedies under sections 205(g) and (h) of the Social Security Act, 42 U.S.C. §405(g) and (h).

Attachment 2. ROSETTI COURT CASE FLAG/ALERT

Attachment 3. Route Slip or Case Flag for Screening

Rosetti Class Action Case

SCREENING NECESSARY

This claimant may be a Rosetti class member. The attached folder location information indicates that a current claim file is pending in your office. Accordingly, we are forwarding the attached alert [and prior claim file(s)] for association, screening for class membership, consolidation consideration and possible readjudication.

Please refer to HALLEX Temporary Instruction 5-4-44 for additional information and instructions.

Attachment 4. ROSETTI SCREENING SHEET

Items 1 - 4

You must consider all applications decided during the period covered by the court order when making the class membership determination. A SEPARATE SCREENING SHEET MUST BE PREPARED FOR EACH DIFFERENT CLAIM NUMBER. Multiple applications during the period covered by the court order on the same claim number should be screened on the same screening sheet.

Fill in the identifying information as requested. Make sure the Claim Number, BIC/ID and SSN, if different from the claim number are correct and legible. (If SSN is different from claim number, copy SSN from BOAN/PAN field on alert).

Item 5

Complete this information last. Do not fill in the member/nonmember information in Item 5 until the screening process is completed.

Questions and Items 6-15 -- General

1. a. 

   In a multiple claims case, begin screening with the earliest claim in the Rosetti period and stop with the last claim in the Rosetti period. Remember, a separate screening sheet must be completed for each different claim number. Multiple claims covered by the court order under the same claim number should be screened on the same screening sheet.

2. b. 

   To answer the questions in DDS cases, use the SSA-831 for denial cases and SSA-832/833 for cessation cases. In OHA adjudicated cases, read the ALJ/AC decision to answer the questions.

3. c. 

   If the SSA-831/832/833 or OHA decision does not yield enough information to answer the questions, look further into the file.

4. d. 

   If the claim folder(s) cannot be located, but queries establish that the determination(s)/decision(s) was made outside the Rosetti timeframe, that the claim was denied for a nonmedical reason or that the claimant did not reside in Delaware, New Jersey, Pennsylvania or the Virgin Islands, screen out the claim(s) without reconstructing the lost folder(s). (See DI 42565.010B.5.c. for more information).

5. e. 

   If questions 6-8 are answered “NO,” or questions 9-12 are answered “YES,” check the nonmember block found in item 5.a. on the screening sheet, then enter the appropriate screenout code in Item 5.b. as directed in question 13 on the screening sheet.

6. f. 

   Remember to follow instructions for members/nonmembers.

Question 6

Screen for residency as of the date of the final determination/decision, not date of application. (See Question 7 for more information.) If the claimant was not a resident of Delaware, New Jersey, Pennsylvania or the Virgin Islands as of the date of the final decision, the claimant is not a class member eligible for relief under the Rosetti settlement.

Question 7

Screen for date of decision, not date of application. Individuals are potentially entitled to relief if they received a denial or less than fully favorable decision (e.g., later onset, closed period) between March 22, 1991, and July 1, 1993, inclusive, which became the final decision of the Secretary.

Question 8

Review Items 16a/b of the SSA-831 and Items 22/21 of the SSA-832/833. If diagnosis code 0420, 0430, or 0440 is present, indicate “YES” for Question 8 and go to the next question. If none of these codes are present, also review the disability interview form for an allegation of HIV infection, including AIDS. Look at Item D, page 1 of the SSA-3368-BK; Item 3a of the SSA-3820-F6; or Item 1a and 1c of the SSA-454-BK, or the OHA decision as applicable. If these items indicate that HIV infection or AIDS has been alleged, indicate “YES” for Question 8 and go to the next question.

Question 9

Check item 33 of the SSA-831 or item 11 of the SSA-832/833. The reg-basis codes that indicate a non-medical initial or post-adjudicative denial for title II are L1, L2, M7, M8, N1, N2 or S1. N01, N02, N03, N04, N05, N06, N09, N10, N11, N12, N13, N14, N17, N33, N44 (for adult claimants only) and N54, are the non-medical initial or post-adjudicative denial codes for title XVI. For a complete list of the title II denial codes see SM 00380.270. For a complete list of title XVI denial or payment status codes see SM 01005.440 and SM 01305.001F.

Question 10

Review the file and case control queries. Determine if a subsequent reversal was fully favorable, allowing the earliest possible entitlement/onset date as alleged on the Rosetti claim(s). In order for an individual to be screened out under this question, benefits must have been paid based on the earliest date of entitlement/eligibility. (If full retroactive benefits have not been paid, see DI 42565.010.C.6. for specific routing instructions).

Question 11

Review all claims files and queries to determine whether decision(s) made on or after July 2, 1993 readjudicated the merits of the entire period covered by the Rosetti claim(s).

Question 12

Screen to determine if a district or appellate court issued a final, i.e., unappealed, decision on the Rosetti application(s).

Item 13

Self-explanatory

Item 14

Fill in the dates of the application(s), decision(s) and the level of adjudication of the final decision(s), that were reviewed in deciding class membership for the claim number in item 4. Remember a separate screening sheet must be prepared for each different claim number.

INSTRUCTIONS FOR MEMBERS

1. a. 

   Check the “MEMBER” block in item 5.a. of the screening sheet.

2. b. 

   Sign the form and retain the original screening sheet in the claim folder.

3. c. 

   OHA Headquarters components will send a copy of the screening sheet to:

   Office of Appellate Operations
   One Skyline Tower, Suite 701
   Attn: OAO Class Action Coordinator

   [The Class Action Coordinator will enter the screening sheet information from the screening sheet into a data base and forward the screening sheet to the Division of Litigation Analysis and Implementation (DLAI).]

   OHA Hearing Office (HO) components will send a copy of the screening sheet to:

   Office of Hearings and Appeals
   Division of Litigation Analysis and Implementation
   One Skyline Tower, Suite 702
   Falls Church, VA 22041-3255

   ATTN: RosettiCoordinator

   [DLAI will retain a copy of each screening sheet received from the OAO Class Action Coordinator or an HO and forward a copy to Litigation Staff at SSA Headquarters for entry into the Civil Action Tracking System.]

4. d. 

   Follow HALLEX HA 01540.044, Part V.B.3.b.

INSTRUCTIONS FOR NONMEMBERS

1. a. 

   Check the “NONMEMBER” block in item 5.a. and enter the appropriate screenout code (the number of the question that determined the individual is not a class member, numbers 6-12, see Item 13 on the screening sheet) in item 5.b.

2. b. 

   Follow items b. and c. above.

3. c. 

   Prepare and send the class membership denial letter (Attachment 6) to the claimant with a copy to his/her representative, if any, and class counsel. Retain a copy of the denial letter in the folder. Forward the claim file(s) as indicated in HALLEX I-5-444, Part V.B.3.a.

Attachment 5. Route Slip for Routing Class Member Alerts and Prior Claim File(s) to ODIO or PSC - OHA No Longer Has Current Claim

REMARKS

OHA received the attached alert [and prior claim file(s)] for screening and no longer has the current claim file. Our records show that you now have possession of the current claim. Accordingly, we are forwarding the alert and any accompanying prior claim file(s) for association with the current claim. After associating the alert with the current claim, please forward to ODIO, the NEPSC or MATPSC (using the address indicated on the alert) for screening and possible readjudication. SEE POMS DI 12565.005 OR DI 42565.005

Attachment

DO NOT use this form as a RECORD of approvals, concurrences, disposals, clearances, and similar actions.

Attachment 6. Notice of Non-Class Membership/Ineligibility for Relief

SOCIAL
SECURITY
NOTICE

Important Information

You asked us to review your case under the terms of the Rosetti v. Shalala settlement agreement. We have looked at your case and decided that you are not a Rosetti class member eligible for relief. This means that we will not review our earlier decision to deny or cease your benefits. The reason you are not a class member eligible for relief under the Rosetti settlement agreement is checked below.

You are not a Rosetti class member eligible for relief because:

It is important for you to know that we are not making a decision about whether you are currently disabled. We are deciding only that you are not a Rosetti class member eligible for relief.

You must write within 60 days of when you receive this notice to:

In addition, you may contact the lawyers representing the Rosetti class members, who can be reached as follows:

The Rosetti lawyers can advise you and, if appropriate, assist you in notifying Social Security that you disagree with this determination.

ESTE ES UN AVISO IMPORTANTE RELACIONADO CON BENEFICIOS DE SEGURO SOCIAL. FAVOR DE PEDIR QUE SE LO TRADUZCAN IMMEDIATAMENTE Y DE LLAMAR A SU OFFICINA DE SEGURO SOCIAL PARA UNA EXPLICACION.

Attachment 7. Route Slip for Non-class Members/Ineligibility for Relief Cases

REMARKS

We have determined that this claimant is not a Rosetti class member entitled to relief. (See screening sheet and copy of notice of non-class membership/ineligibility for relief in the attached claim file(s).) We are forwarding this file to your office because the claimant disputes the non-class membership determination and class counsel has asked to review the file. SEE POMS DI 12565.005

Attachment

DO NOT use this form as a RECORD of approvals, concurrences, disposals, clearances, and similar actions.

Attachment 8. Text for Notice of Revised Class Membership/Eligibility for Relief Determination

In an earlier letter that we sent you, we said that you were not a class member eligible for relief under the Rosetti v. Shalala class action. After reviewing all of the facts, we have decided that you are a Rosetti class member eligible for relief. Therefore, we will review your claim using the standards approved by the court under the Rosetti v. Shalala settlement agreement.

We have received many requests for review and it may take several months before we look at your claim file.

If you think that you are disabled now, you should fill out a new application at any Social Security office.

If you have any questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at XXX-XXXX. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

If you have someone helping you with your claim, you should contact him or her. You may also ask for legal help by contacting a legal aid organization in your area.

Attachment 9. Rosetti Class Member Flag for Headquarters Use (DDS Readjudication - Retention Period Expired)

Rosetti Class Action Case

READJUDICATION NECESSARY

This claimant is a Rosetti class member. Accordingly, we are forwarding the attached claim file(s) to the DDS for readjudication.

[ Send folders to the appropriate DDS.]

Attachment 10. Rosetti Class Member Flag for Headquarters Use (DDS Readjudication - Retention Period Has Not Expired)

Rosetti Class Action Case

READJUDICATION NECESSARY

This claimant is a Rosetti class member. After expiration of the retention period, forward claim file(s) to the DDS for readjudication.

[Send folders to the appropriate DDS.]

Attachment 11. ALJ Dismissal to DDS

This case is before the Administrative Law Judge pursuant to a request for hearing filed on _________________ with respect to the application(s) filed on _________________.

In accordance with the Joint Stipulation of the parties and an order of the United States District Court for the Eastern District of Pennsylvania in the case of Rosetti v. Shalala, No. 91-3389 (E.D. Pa. July 7, 1994), the claimant has requested readjudication of the final (determination/decision) on the prior application(s) filed on ______________. The claimant has been identified as a Rosetti class member and is entitled to have the final administrative denial of the prior application(s) reviewed under the terms of the Stipulation and Order. Because the claimant's current claim shares certain issues in common with the prior claim, the undersigned hereby dismisses without prejudice the request for hearing.

The claimant's current application(s) will be associated with the prior claim(s) and forwarded to [identify the appropriate DDS by name] Disability Determination Service which will conduct the Rosetti readjudication.

The Disability Determination Service will notify the claimant of its new determination and of the claimant's right to file a new request for hearing.

Attachment 12. Notice Transmitting ALJ Order of Dismissal

Enclosed is an order of the Administrative Law Judge dismissing your request for hearing and returning your case to the [identify the appropriate DDS by name] Disability Determination Service which makes disability determinations for the Social Security Administration. Please read this notice and Order of Dismissal carefully.

What This Order Means

The Administrative Law Judge has sent your current claim and your Rosetti class member claim back to the [identify the appropriate DDS by name] Disability Determination Service for further processing. The enclosed order explains why.

The Next Action on Your Claim

The [identify the appropriate DDS by name] Disability Determination Service will contact you to tell you what you need to do. If you do not hear from the [identify the appropriate DDS by name] Disability Determination Service within 30 days, contact your local Social Security office.

Do You Have Any Questions?

If you have any questions, contact your local Social Security office. If you visit your local Social Security office, please bring this notice and the Administrative Law Judge's order with you.

Enclosure

Attachment 13. Rosetti Class Member Flag for HO Use (DDS Readjudication)

Rosetti Class Action Case

READJUDICATION NECESSARY

This claimant is a Rosetti class member. The attached Rosetti claim file was forwarded to this hearing office for possible consolidation with a current claim.

Accordingly, we are forwarding the attached alert and prior claim file(s) to your location for any necessary Rosetti readjudication action.

We are sending the alert and prior file(s) to: