TN 8 (06-04)

GN 04440.225 Correcting Group II Onset Date Documentation Deficiencies Post-Effectuation - Concurrent Title II/Title XVI Cases

A. Policy-corrective action

If payment can be made on the Title XVI portion of the claim, and none of the conditions listed in GN 04440.222A. exist, the case will be returned to the adjudicating component for onset date corrective action after effectuation of the Title XVI determination.

In concurrent initial claims, the folder and deficiency return will be sent to the adjudicating component and the Title XVI SSA-831-C3/U3 will be faxed or mailed to the FO. Exceptions to this routing policy are cases involving unresolved capability issues or cases in which the beneficiary has a DAA condition and is incapable of managing his/her benefits. These exception cases follow the same routing procedure as reconsideration claims as discussed below.

In concurrent reconsideration claims and concurrent initial claims that are an exception to the initial routing procedure, both claims folders will be routed to the FO for effectuation of the Title XVI determination. The deficiency return and supporting documentation will be faxed or mailed to the adjudicating component for the necessary action on the Title II claim.

See DI 11010.120 for a further explanation of when a partial award can be made.

NOTE: Refer to GN 04440.228 for processing cases with a work activity documentation deficiency that could affect the onset date.

B. Procedure-review component - initial cases

Take the following action in a concurrent initial claim unless the case involves an unresolved capability issue, or the beneficiary has a DAA condition and is incapable of managing his/her benefits (in which case, follow GN 04440.225.C.):

1. SSA-831-C3/U3 Action

  • Annotate block 34 of the Title XVI SSA-831-C3/U3:

Possible earlier onset date being developed on the Title II claim. DQB will send folders with the corrected onset date, if appropriate, after development is completed. Effectuate payment on the Title XVI claim. Do not effectuate payment on the Title II claim at this time.

  • Approve the Title XVI SSA-831-C3/U3.

  • Place a copy of the annotated Title XVI SSA-831-C3/U3 in the claims folder.

2. Deficiency return

  • Prepare an SSA-1774-U5 to the adjudicating component, and:

    • Request development of a possible earlier onset date for the Title II claim.

    • Instruct the adjudicating component to return the corrected case to the review component.

    • If the Title II claim is not the sample case, indicate that the adjudicating component is not being charged with a deficiency.

  • Release copies of the SSA-1774-U5 in accordance with GN 04440.501.

3. DICARS action

  • Code the appropriate group II onset date documentation deficiency when the Title II claim is the QR sample case. See GN 04440.125.

  • Control the return.

4. Additional actions

  • Prepare and/or release the Title XVI notice.

  • Effectuate the Title XVI determination or send the case for effectuation of the Title XVI determination.

  • Attach the special payment effectuation flag (see exhibit in GN 04440.940) to the annotated Title XVI SSA-831-C3/U3 and fax or mail the Title XVI SSA-831-C3/U3 to the appropriate FO. (The FO will effectuate payment.)

  • Document the file with the fax or mail action taken.

  • Send both claims folders with the covering SSA-1774-U5 to the adjudicating component for development of a possible earlier title II onset date.

REMINDER: Upon completion of all corrective action and return of the corrected case, enter the results data onto DICARS.

C. Procedure-review component – reconsideration and initial exception cases

Take the following action when the claim is a concurrent reconsideration claim or a concurrent initial claim that involves either an unresolved capability issue or a beneficiary who has a DAA condition and is incapable of managing his/her benefits:

1. SSA-831-C3/U3 a