TN 21 (02-14)

GN 04440.211 Correcting Group I Work Activity Procedural Documentation Deficiencies

A. Introduction to correcting group I work activity procedural documentation deficiencies

The adjudicating component is responsible for recognizing evidence of work activity the field office (FO) does not develop, which may be pertinent to the disability determination, including unresolved questions and discrepancies on the SSA-3368-BK (Disability Report - Adult), SSA-3369-BK (Work History Report), or other documents in file. The adjudicating component is also responsible for making the final determination as to whether a period of work was an unsuccessful work attempt (except in continuing disability review (CDR) cases with no medical issue). For an explanation of adjudicating component responsibility for SGA development, see DI 24001.005, and for FO and adjudicating component responsibilities in work development, see DI 11010.140.

B. Policy for correcting group I work activity procedural documentation deficiencies

Send group I procedural documentation deficiencies involving work activity to the FO for resolution of the work activity issue and, when appropriate, preparation of a substantial gainful activity (SGA) denial or cessation. For an explanation of adjudicating component corrective action procedures for group I work activity deficiencies see DI 30005.217.

NOTE: The quality reviewer should complete the medical review of the case before determining how to route a case containing an unresolved work activity issue. For procedures on how to correct group I procedural documentation deficiencies involving work activity see GN 04440.211C in this section.

C. Procedure for correcting group I procedural documentation deficiencies involving work activity

If there is a group I procedural documentation deficiency involving unresolved work activity, access the Modernized Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS) remarks screen, report of contact screen, DWO1, or continuation pages to see if the FO resolved and electronically documented the work activity issue.

1. Work activity documented on MCS or MSSICS

If the FO resolved and documented the work activity issue on MCS or MSSICS:

• document the file with the information shown on the MCS or MSSICS remarks screen, report of contact screen, or the DWOL and continuation pages;

• take any necessary corrective action; and

• prepare an SSA-1774-U5 (Request for Corrective Action) explaining the deficiency. If the case is paper, send the SSA-1774-U5 to the adjudicating component without the folder. Attach copies of the documentation that support the deficiency.

CAUTION: If the MCS or MSSICS information clearly shows the claimant is engaging in SGA, forward the case to the FO for preparation of an SGA denial or cessation.

2. Work activity not documented on MCS or MSSICS

If the information is not available or inadequate on MCS or MSSICS, take the following actions:

• prepare an SSA-1774-U5 to inform the adjudicating component of the deficiency;

• correct any incorrect entries on the portion of the SSA-831-C3/U3 (Disability Determination and Transmittal) or 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) prepared by the adjudicating component other than the onset date; e.g., the diary date.

• prepare an SSA-5524-U3 (Request for Assistance) and ask the FO to investigate the work activity and determine if an SGA denial or cessation is appropriate;

• and if the case is paper, send it to the FO.

To obtain instructions for the FO on return of the:

• SSA-5524-U3 and

• SSA-831-C3/U3,

• SSA-832 or

• SSA-833-C3/U3.

To the review component and routing of the case folder, follow GN 04440.211D.

When the FO returns the folder to the review component after resolving the work activity issue follow GN 04440.211D.3.b. in this section.

NOTE: If the missing or inadequate documentation involves a relatively simple question that the FO could resolve without the folder, e.g., when did the claimant actually stop work, the review component has the option to telephone, email, or fax the request to the FO rather than preparing an SSA-5524-U3. When using this expedited process, the review component must document the conversation and outcome on a SSA-5002 (Report of Contact) and add it to the folder.

D. FO routing instructions after resolving the work issue

Include the following folder routing instructions for the FO in the SSA-5524-U3.

1. SGA denial or cessation appropriate

If, after resolving the work activity issue, a FO jurisdiction SGA denial or cessation is appropriate, the FO should:

• effectuate the denial or cessation;

• send copies of the SSA-5524-U3 and SSA-831-C3/U3, SSA-832-C3/U3 or SSA-833-C3/U3 to the review component for results data input; and

• retain the folder in the FO for the appropriate time period.

NOTE: If preferred, the FO can notify the review component by phone or email when they prepare the determination rather than faxing or sending a copy of the SSA-831-C3/U3.

If the FO does not send a copy of the determination timely, see GN 04440.202B.3.

2. SGA denial not appropriate when onset date remains the same

If, after the FO resolves the work activity issue:

• a FO jurisdiction SGA denial is not appropriate; and

• the onset date remains the same;

then the FO should:

• effectuate the allowance;

• date and release the DDS prepared notice in file to the claimant;

• send copies of the SSA-5524-U3 and SSA-831-C3/U3 to the review component for results data input; (If preferred, the FO can notify the review component by phone or email when they prepare the determination rather than faxing or sending a copy of the SSA-831-C3/U3.); and

• forward the folder to the appropriate storage facility.

If the FO does not send a copy of the determination timely, see GN 04440.202B.3.

3. SGA denial not appropriate when onset date changes or possible earlier onset

a. FO routing instructions

If, after the FO resolves the work activity issue:

• FO jurisdiction SGA denial is not appropriate and the onset date changes to a different date than the adjudicating component established onset date (EOD) as a result of the work activity; or

• an earlier onset date may be possible;

the FO should return the fully documented case folder directly to the review component.

b. Review component action when the FO returns the case

When the FO returns the case because the onset date changes, and no further medical development is necessary to establish the onset date;

• correct the onset date on the determination form; and

• process the corrected case as usual per GN 04440.150.

When the FO returns the case because an earlier onset date may be possible, and further medical development is necessary to establish the onset date:

• prepare an informational SSA-1774-U5 to the adjudicating component;

• request the additional documentation and send the case to the adjudicating component; and

• control the return.