TN 8 (06-04)

GN 04440.217 Corrections to SSA-831-C3/U3

A. Introduction

For group II ending date decisional deficiencies and onset date deficiencies follow the procedure in GN 04440.217B. for changes to the SSA-831-C3/U3.

B. Procedure-review component

1. Correcting the SSA-831-C3/U3

Correct the appropriate blocks on the SSA-831-C3/U3 as follows:

a. Block No. 15 and 28

Enter the correct onset or ending dates.

b. Block No. 34

  • Enter: Corrected Determination.

  • Identify your specific review component.

c. Block No. 37 and 38

  • Ensure that both the quality reviewer and the review medical contractor/psychological contractor (MC/PC) sign and date the corrected SSA-831-C3/U3. See below for exceptions.

  • Use block 34 if more space is needed.

EXCEPTIONS: The review MC/PC does not have to sign the SSA-831-C3/U3 if:

  • the onset or ending date change is due to SGA; or

  • the conditions listed in GN 04440.244E.2. are met; i.e., the physician statement and signature are on an appropriate medical evaluation document in lieu of a MC/PC signature on the SSA-831-C3/U3. See GN 04440.135B.3. and DI 24501.002C.1.

2. Correcting the rationale

Correct SSA-4268-C4/U4 if a rationale is involved, as follows:

  • make corrections where necessary; or

  • prepare a new brief rationale, explaining which aspects of the adjudicating component's determination are adopted (i.e., facts, findings and conclusions), if any, and which aspects of the determination are changed;

  • referral to the SSA-1774-U5 is permitted in lieu of re-recitation of facts, if preparing a new rationale.

To Link to this section - Use this URL:
GN 04440.217 - Corrections to SSA-831-C3/U3 - 05/23/2017
Batch run: 05/24/2017