TN 12 (06-95)
NOTE: Disability Cases – refer to and transfer a case per the instructions in DI 81010.085 -Transferring Cases in the Electronic Disability Collect System (EDCS) if the official
folder for a case is the Certified Electronic Folder (CEF).
The SSA-636-U3 is used to transmit hearing folders to the ALJ. It can also be used
by the FO or PC to inform the ALJ of things he/she should know for the hearing.
PSC cases (both RSI and DI);
NOTE: For ODO cases, use SSA-3583-U2 (see DI 42010.005).
Normally, servicing FO or PC, whichever has folder when hearing is requested.
Complete all blocks at the top and bottom of the form. Use numerals for dates. In
the “From” box show the address of the office where the ALJ should send the case for effectuation
following the hearing. (If PSC, give address of Reconsideration Section or Disability
Review Section (DRS).) In SSI cases and DI non-disability denial cases, the FO is
the effectuating component.
Remarks — Used to Inform ALJ
Always indicate whether all factors of entitlement other than the factor being appealed,
have been met. Indicate any factors of entitlement not met and cite the authority
in the law and regulations.
Also inform the ALJ about factors such as:
Hardship, where a delay in scheduling hearing may disadvantage claimant, e. g., claimant
seriously ill and near death or a key witness is moving.
Cases involving support, allegations of support and amount of claimant's income which
have not been proved; e.g., fact that other income alleged exceeds amount of support
alleged. If the ALJ's findings of fact differ as to one of the allegations, he/she
will be on notice that the other allegation must be proved.
Effect of finding in favor of a contesting claimant in an adverse claimant situation.
The ALJ may bring in as a party to the hearing the claimant to whom monthly benefits
or an LSDP has been awarded. If he/she finds in favor of the contesting claimant,
he/she may decide whether the overpayment must be refunded, but he/she is not mandated
to decide on waiver of the overpayment or on any other issue which is not before him
Need for information as to deduction, suspension or termination events or adjustment
or waiver of recovery where pertinent to a complete disposition of the case.
Whether amount of SEI must be determined or proof of filing of SE tax returns is lacking,
if the issue pertains to SE income and if he/she finds that the earnings were SEI.
Any other facts affecting entitlement to benefits, a lump sum or a disability freeze,
the establishment of wages and SEI or the continued right to receive benefit payments.
If there is a protective filing date for the application, state the date and indicate
what document establishes it.
If a claimant files a request for hearing while an appeal is pending with the RRB
enter: “A copy of the HA-501-U5 has been forwarded to the Great Lakes PSC, DRS, P.O. Box
87755, Chicago, Illinois 60680-8115. They will send you any evidence or decision
from the RRB. If your decision is an affirmation, please send a copy of the decision
to GLPSC, DRS, P.O. Box 87755, Chicago, Illinois 60680-8115.”
Original (claims folder) Copy — PSC will place in folder as topmost document when
forwarding folder to FO. PSC will always send this copy to FO with a claims folder
attached. FO will attach to outside of file for transmittal to ALJ.
First Copy (Control or FO if SSI Case) — PSC or ODO may use to update controls or
may destroy. In SSI cases, the FO will retain.
Second Copy (RSI) — Destroy