TN 21 (02-14)

GN 04440.150 Processing Correct Disability Cases

A. Definition of correct cases

Correct cases are all:

  • Cases with no deficiencies;

  • Cases with corrected deficiencies; and

  • Cases adjudicated by the review component after assuming jurisdiction.

B. Procedure for processing initial and reconsideration cases

1. Processing certified electronic folder (CEF) cases

Process initial and reconsideration CEF cases as follows:

  • The Office of Quality Review (OQR) legacy system propagates the SSA-831-U3 (Disability Determination and Transmittal) signature, and date in blocks 37 and 38 and sends it to the Case Data section of the CEF. However, the SSA-831 reflected in the Case Documents section of the CEF does not change. When assuming jurisdiction of a case, refer to GN 04440.244 through GN 04440.245. To view an exhibit of the SSA-831, see DI 27015.006.

  • Ensure necessary data input of review results, including results of deficiency returns, to the OQR legacy system;

  • Effectuate the determination, if applicable;

  • If you require a subsequent field office (FO) action or notification, use the FO Alert functionality in the OQR legacy system at clearance to notify the FO of the alert or action needed;

  • Date and release the notice to the appropriate claimant or appointed representative, if applicable, per “Review and Release of Notices – Certified Electronic Folders (CEF)” in DI 81030.040.

2. Processing initial and reconsideration paper cases

Process initial and reconsideration paper cases as follows:

  • Sign and date the SSA-831-U3 in blocks 37 and 38. Refer to GN 04440.244 through GN 04440.245 when assuming jurisdiction of a case;

  • File and route the SSA-831-C3/U3 in accordance with GN 04440.150B.2., GN 04440.150B.3., or GN 04440.150B.4.;

  • Ensure necessary data input of review results, including results of deficiency returns, to the OQR legacy system;

  • Effectuate the determination, if applicable;

  • Remove and destroy the quality assurance (QA) or pre-effectuation review (PER) flag;

  • Annotate the SSA-559 (Claims Folder Material Transmittal), “QA/PER review completed,” and specify whether the case requires subsequent action;

  • Date and release the notice to the appropriate claimant or appointed representative, if applicable; and

  • Route the paper folder to the appropriate FO.

  • If the case also includes a continuing disability review (CDR) claim refer to GN 04440.150C in this section.

3. Filing the determination form on title II only claims and title XVI only claims

For paper title II only and title XVI only cases, place the original and FO copy of SSA-831-C3/U3 and SSA-4268-C4/U4 (Explanation of Determination) in the yellow front section of the modular disability folder (MDF) (labeled “Payment Documents/Decisions”).

For CEF title II only and title XVI only cases, store the SSA-831-C3/U3 and SSA-4268-C4/U4 in the Case Documents, Payment Documents/Decisions (Yellow Front) section of the CEF.

4. Filing the determination form in concurrent title II and title XVI cases

Take the following actions for a paper concurrent title II and title XVI case:

  • For title II portion only, place the original and FO copy of the SSA-831-C3/U3 and SSA-4268-C4/U4 in the Yellow Front section of the MDF.

  • For the title XVI portion of the paper claim place the SSA-831-C3/U3 and SSA-4268-C4/U4 on the left-hand side of the title XVI brown claims folder on top of all other determination-related material. If there is no title XVI brown claims folder, place the title XVI SSA-831-C3/U3 and SSA-4268-C4/U4 (if present) on top of the title II documents in the Yellow Front section of the MDF so the FO can easily remove and place them in the title XVI claims folder at the FO.

    NOTE: If there are two folders, place a copy of each determination in the other claim's folder per MDF instructions in DI 70005.005A.2.

In CEF cases, upload the title XVI SSA-831-C3/U3 and SSA-4268-C4/U4 to the Case Documents, Payment Documents/Decisions (Yellow Front) section of the CEF.

5. Routing the determination form

For paper determination forms prepared or corrected in the review component, route the data copy of the new or changed SSA-831-C3/U3 to the following Wilkes-Barre Data Operations Center (WBDOC) address per DI 11055.145:

Wilkes-Barre Data Operations Center
SSA WBDOC
P.O. Box 8300
Wilkes-Barre, Pennsylvania 18767-8300
ATTENTION: SSA-831-C3/U3

If you change one of the SSA-831-C3/U3 fields listed in GN 04440.941, you must send a copy of the revised SSA-831-C3/U3 to the WBDOC.

For “831-enabled” CEF cases, do not forward a copy of the new or corrected SSA-831-C3/U3 to the WBDOC.

For “non-831-enabled” CEF cases, if you change one of the SSA-831-C3/U3 fields listed in GN 04440.941, you must send a copy of the revised SSA-831-C3/U3 to the WBDOC.

6. Processing reopenings

Do not effectuate reopenings. Take the following actions to process reopenings:

  • For CEF cases, complete the FO Alert screen in the OQR legacy system, notifying the FO of any change in onset or filing date and of the need to effectuate the determination.

  • For paper cases, complete the FO Alert screen in the OQR legacy system. In addition, annotate the paper routing form that FO effectuation is needed and provide any other necessary instructions.

C. Procedure for CDR cases

Process CDR cases as follows:

  • Sign and date the paper SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI) or SSA-833-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II) in blocks 31 and 33. For correct CEF cases, you are not required to sign and date the SSA-832-C3/U3 or SSA-833-C3/U3. The OQR legacy system captures the necessary data upon clearance to inform subsequent reviewers that the determination was appropriate. When assuming jurisdiction of a case, refer to GN 04440.244 through GN 04440.245.

  • File the determination form in the Yellow Front section of the MDF for paper cases. For CEF cases, you only need to file the determination form in the Case Documents, Payment Documents/Decisions (Yellow Front) when you make a change to the form. For processing instructions see GN 04440.150B.2., GN 04440.150B.3., and GN 04440.150B.4. Effectuate the determination, if applicable.

  • In paper cases, if the folder is a brown folder, file the determination form in accordance with DI 11055.145.

  • Regardless if the claim is paper or CEF, the review component should effectuate title II cessations with the exception of potential 301 cases, recon CDRs, expedited reinstatements and title XVI cessations. For the title II exceptions and title XVI cessations, complete the FO Alert screen in the OQR legacy system to inform the FO that the determination is a cessation, and effectuation is necessary.

  • Ensure necessary data input of review results, including results of deficiency returns, to OQR’s legacy system.

  • Date and release the notice to the appropriate claimant, appointed representative, or representative payee. EXCEPTION: If the Office of Disability Operations or the Program Service Center will release the notice, you do not have to release it.

    1. Title II work activity medical continuances in work incentive cases, or

    2. reconsideration reversal notices.

  • Remove and destroy the QA or PER flag in paper cases.

    NOTE: The only time a PER flag or routing remark applies to a CDR is when the CDR is case 2, because CDRs only fall under the QA sample.

  • Route the folder to the appropriate component (FO, payment center, or L0(zero)E) per instructions for paper cases in DI 32010.001 and for CEFs in DI 81020.250B.

  • For paper cases, annotate the routing transmittal: “QA/PER review completed” and specify if the FO must take a subsequent action. For CEFs, if there is an action the FO needs to take, use the FO Alert functionality in the OQR legacy system at the time of clearance. OQR annotates the action needed on the FO Alert screen. This information propagates into the Message section of the CEF where subsequent reviewers can view it.

  • If the case includes an initial or reconsideration claim, refer to GN 04440.150B in this section.

NOTE: For continuances, remove any adjudicating component routing transmittal (e.g., SSA-408 (Route Slip)) noting “Potential 301 Case.” For cessations, annotate the routing transmittal “Potential 301 Case” if the adjudicating component did not include an SSA-408. For an exhibit of the SSA-408, see DI 14515.020.


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http://policy.ssa.gov/poms.nsf/lnx/0204440150
GN 04440.150 - Processing Correct Disability Cases - 12/28/2015
Batch run: 12/28/2015
Rev:12/28/2015