TN 13 (11-11)

GN 01010.008 Field Office (FO) Adjudicative Responsibilities

A. Adjudicator’s performance quality

While there are various checks in the claims process to provide some measure of quality control, the quality of the process is substantially a reflection of the quality of the adjudicator's performance.

B. Policy on adjudicating claims

1. District office final authorization (DOFA)

DOFA refers to the action taken by a claims technician at a FO level to make an adjudicative determination on a claimants’ title II application for benefits. Currently, most of the initial claims are DOFA. There are four types of DOFA exclusions (see GN 01010.027B.3.).

2. Adjudicator responsibilities

Responsibilities include, but are not limited to, the following actions:

  1. Fully review the claim, identifying discrepancies that need development, or referral to the Office of the Inspector General (OIG) as per GN 04111.005.

  2. Review the earnings record (E/R) with the claimant for gaps or inconsistencies when required (see RS 01404.110B and RS 01404.110C). Refer to RS 01404.003 for complete instructions about reviewing the E/R with the number holder (N/H) and exceptions for internet claims.

  3. Make any necessary adjustments to resolve the Modernized Claim System (MCS) edits or alerts to include Numident corrections.

  4. Examine prior claims information relevant to the current claim using one or more of the following:

    • Cleared or archived title II screens (e.g., MCS);

    • Cleared or archived title XVI screens (e.g., Modernized Supplemental Security Income Claims System (MSSICS);

    • The evidence (EVID) screen);

    • The Claims File Record Management System (CFRMS) (see SM 08001.001);

    • Electronic View (eView) (see DI 81005.005);

    • FO records (see GN 01010.032).

  5. Identify other possible entitlement to benefits (see GN 00204.022).

  6. Identify, resolving or taking other appropriate action on prior overpayments (O/P), underpayments (U/P), and uncollected annual earnings test (AET) penalties.

  7. Develop and document all issues to include recording evidence electronically using MCS, MSSICS, or EVID. You must fax documents that you cannot record on MCS, MSSICS, or EVID into the electronic disability folder (eDIB) or the Non-Disability Repository (NDR) system (see GN 00301.322).

  8. Make the final determination to approve, disallow, or deny entitlement or eligibility to title II benefits or title XVI payments.

  9. Sign and date the adjudicative form (includes your electronic personal identification number (PIN) signature for the applicable determination screen in MCS, MSSICS, the automated 101 (A101) and electronic form (EF101) processes, and adjudicative direct input screens).

  10. Alert the processing center (PC) of the need for post adjudicative review of relevant issues in the claim.

  11. Effectuate SSA's initial determination on entitlement, usually via MCS earnings computation (EC). If effectuation through MCS EC is not possible, the adjudicator prepares an award manually via an A101 or EF101 or a denial via manual adjustment, credit and award process (MADCAP) and manual adjustment credit and award data entry (MACADE).

  12. Provide the proper notice to the claimant.

  13. Prepare and establish PC diaries or listings (see GN 01010.260).

  14. Recognize when an amended award is necessary.

  15. Review and identify other possible benefits to which the claimant may be entitled (see GN 00204.004 for more information).

C. Procedure for annotating routing screens and forms

1. Alert PC of special actions

Use the claim report of contact (RPOC), the BCRN screen in the A101 or the EFBCRN screen in the EF101 system to alert the PC of any special action requests. In addition, all related information must be stored in NDR or the Certified Electronic Folder (CEF) also known as eDIB.

2. PC action is required

The FO adjudicator must fax a written request to the Paperless Processing System of the PC of jurisdiction. See GN 01020.250 and MSOM MCS 014.010 for instructions. In addition, all related information must be stored in NDR or eDIB.

3. Establish a diary

If the PC needs to establish a diary and no RPOC screens are available, annotate the printed routing screen or paper form with a detailed description of the diary reason, including the evidence code, and prepare a paper report of contact (RC) with the detailed diary ra