GN NY01010.007 ADJUDICATIVE RESPONSIBILITIES (RTS 368 - 3/2012)
A. Handling claims of relatives and friends
Employees must disqualify themselves from acting on any official matter involving a relative or friend. Title II or Title XVI claims and representative payee applications filed by a relative or friend in the employee’s office must be brought to the attention of the field office (FO) management and processed in the resident FO. The resident FO district manager (DM) or assistant district manager (ADM) will assign the claim to an employee who has no direct connection with the claimant and review the claim prior to clearance. These claims do not routinely have to be reviewed by the Regional Office (RO) unless the relationship indicated in GN NY01010.007B applies.
B. Handling claims filed by an employee, an employee’s spouse, or member of the employee’s immediate household
Title II or Title XVI claims and representative payee applications filed by Social Security Administration employees (including employees of the Office of Disability Adjudication and Review, Regional Office of Quality Assurance, and Program Service Centers), their spouses, or members of the employees’ immediate household (living with the employee) should be processed, under the direction of the DM or ADM, in the resident FO by another employee and reviewed by the DM or ADM. The RO will review these cases after the DM or ADM’s review. Disability Determination Services (DDS) employees are not included in the scope for RO review.
Claims and representative payee applications filed by SSA employees, their spouses, or members of the employees’ immediate household (living with the employee) on behalf of someone else are also subject to the above reviews by both the DM or ADM and the RO (or higher level component, if appropriate). The term “SSA employee” includes current employees as well as individuals that have retired or left SSA employment within the last three years.
If the applicant is an SSA employee (or was a former employee) who works in his/her resident FO and is known by the adjudicator, the DM or ADM will assess the situation and either direct someone who does not know the applicant or request another FO that has no direct connection with the applicant to take the claim.
It is not necessary to question all applicants regarding any former employment with SSA. If the FO is aware of the applicant’s former employment with SSA, the claim should be handled per the instructions outlined in this supplement.
C. Processing instructions
All claims and representative payee applications filed by an employee, employee's spouse, or member of the employee's immediate household (meeting the descriptions stated in GN NY01010.007B) must be reviewed by the RO prior to final adjudication.
Claims should be handled in the following manner:
A member of management must complete the Report of Contact screens (i.e. RPOC screen in MCS, DROC screen in MSSICS, or RPRC screen in RPS) stating the applicant’s connection with SSA and that the claim has been reviewed by the DM or ADM. If the claim or application is being processed by an office other than the resident FO, include a brief explanation on the Report of Contact screen as well.
The DM or ADM must create an “EE CLM” issue on the Development Worksheet screens (i.e. DW01/DW02 screen for Title II or Title XVI claims and RDWK screen for representative payee applications), enter the date the claim was reviewed in the REC/RECEIVED field, and enter his/her initials in the Remarks field once the review is completed.
If the applicant is a member of management, the management review must be completed by a higher level component (e.g. if the applicant is a DM of a Level II office, management review must be done by the Level I office; if the applicant is a DM or ADM of a Level I office, management review is done at the Area Director’s level…etc.).
Ensure that all proofs and evidence supporting the determination are documented on the EVID screen or the Non-Disability Repository for Evidentiary Documents (NDRed) when appropriate.
To request RO review of an employee claim (Title II, Title XVI, concurrent claim, or a representative payee application), send an e-mail to the Center for Programs Support (CPS) mailbox (||NY CPS). Annotate “EMPLOYEE CLAIM REVIEW” in the subject line. In the body of the e-mail message, annotate if the claim is Title II, Title XVI, concurrent, or a representative payee application and include the claim number. For the representative payee application, include the SSN of the potential representative payee.
For cases involving disability, the requests for RO review are to be sent to CPS after the FO has received the DDS decision. For Title II disability claims, do not process non-medical completion on the DECI screen when sending the case to DDS. For Title XVI disability claims, the claim should remain in H80 until RO review is completed.
CPS will sign off on the Development Worksheet screens after reviewing the entire claim or representative payee application and proofs on the system. A DROC will be completed after CPS review of the Title XVI MSSICS claim.
Paper claims (e.g. EDCS exclusions) should be forwarded to SSA Regional Office, Center for Programs Support, Room 4060, 26 Federal Plaza, New York, N.Y 10278. The envelope should be annotated “Employee Claim”. The claim package must include an SSA-5002 stating the applicant’s connection with SSA and that the claim has been reviewed by the DM or ADM and a self-addressed returned envelope. After the claim has been reviewed by the RO, it will be returned to the FO for necessary input.