TN 12 (06-95)
GN 03103.110 SSA-636-U3 (Transmittal Notice — Hearing Case)
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).
A. Exhibit — Form SSA-636-U3
Printer Friendly Version
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.
2. WHEN USED
PSC cases (both RSI and DI);
NOTE: For ODO cases, use SSA-3583-U2 (see DI 42010.005).
3. WHO COMPLETES
Normally, servicing FO or PC, whichever has folder when hearing is requested.
1. HOW TO COMPLETE
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 or her.
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.”
2. DISTRIBUTION OF COPIES
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