TN 8 (06-04)

GN 04440.204 Correcting Group I Deficiencies - General

A. Policy — Corrective Action

Group I deficiencies are returned to the adjudicating component for correction with some exceptions; i.e.,:

  • decisional deficiencies involving clear evidence that the claimant is engaging in SGA, and

  • procedural documentation deficiencies involving work activity issues only.

These deficiencies are sent to the FO for resolution of the issue. Refer to GN 04440.205 through GN 04440.211 for group I deficiencies that are sent to the FO for resolution. Non-recorded procedural documentation deficiencies in which the date last insured (DLI) for a Title II disabled worker claimant, the prescribed period for a disabled widow/er claimant or age 22 for a childhood disability claimant must be documented or verified are also sent to the FO for development. See GN 04440.235C.1.b.

In addition, concurrent Title II/Title XVI initial and reconsideration cases with a group I medical or procedural documentation deficiency involving onset may be corrected post-effectuation; i.e., payment can be effectuated on the Title XVI claim while the development is being undertaken for the Title II claim. See GN 04440.207.

B. Procedure — Review Component

1. Group I Deficiency Cases-Corrected By Adjudicating Component

For those group I deficiency cases that are corrected by the adjudicating component, the quality reviewer will:

  • Prepare an SSA-1774-U5 and return the deficient case folder to the adjudicating component.

  • Request return of the corrected case for completion of the DDS Return (Results) Screens.

NOTE: The original PRTF and/or RFC should remain in file as part of the audit trail. The original should be annotated “Do Not Process”.

2. Group I Deficiency Cases-Corrected By FO

For those group I deficiency cases that are corrected by the FO, the quality reviewer will:

  • Prepare an SSA-5524-U3 and return the deficient case folder to the FO.

  • Ask the FO to notify you if they have jurisdiction of the case and they prepare a determination form so the DICARS results screen can be completed. The FO can notify you either by mailing or faxing a copy of the determination form or by phoning or e-mailing the information, if preferred.

C. References

See GN 04440.950, GN 04440.945, DI 30005.121 and DI 30005.123 for an explanation of the group I decisional and documentation deficiencies and the corresponding DICARS deficiency code.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204440204
GN 04440.204 - Correcting Group I Deficiencies - General - 04/18/2011
Batch run: 04/18/2011
Rev:04/18/2011