TN 21 (02-14)

GN 04440.228 Correcting Group II Work Activity Documentation Deficiencies

A. Introduction to correcting group II work activity documentation deficiencies

The adjudicating component is responsible for:

  • recognizing evidence of work activity the field office (FO) does not develop that may be pertinent to the period of disability, including unresolved questions and discrepancies on the SSA-3368-BK (Disability Report – Adult).

  • making the final determination as to whether a period of work was an unsuccessful work attempt (UWA) (except in continuing disability review (CDR) cases with no medical issue). For situations where substantial gainful activity (SGA) ceased after the alleged onset date see DI 24001.005H. For adjudicating component responsibilities for SGA development, see DI 24001.005A. For FO and adjudicating component responsibilities in work development, see DI 11010.140.

B. Policy for correcting group II work activity documentation deficiencies

This deficiency requires FO development of the unresolved work issue, that has the potential for changing the:

  • onset date,

  • ending date, or

  • cessation date the adjudicating component establishes.

Send an SSA-5524-U3 (Request for Assistance) directly to the FO for development of the work activity and an SSA-1774-U5 (Request for Corrective Action) to the adjudicating component to notify them of the deficiency.

NOTE: If the missing or inadequate documentation involves a relatively simple question, (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.

For an explanation of adjudicating component corrective action in group II work activity documentation deficiencies, see DI 30005.228.

C. Procedure for group II work activity documentation deficiency

If there is a group II work activity documentation deficiency, access the Modernized Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS) remarks screen or report of contact screen 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 or the report of contact screen;

  • take any necessary corrective action; and

  • prepare an SSA-1774-U5 explaining the deficiency.

For paper cases, send the SSA-1774-U5 to the adjudicating component without the folder. Attach copies of the documentation that support the deficiency.

For CEF cases, the weekly deficiency report will alert the adjudicating component of the deficiency.

2. Work activity not documented on MCS or MSSICS

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

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

  2. prepare an SSA-5524-U3; and

  3. ask the FO to investigate the work activity.

    NOTE: If the missing or inadequate documentation involves a relatively simple question, 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.

For instructions to the FO on return of the SSA-5524-U3 and SSA-831-C3/U3 (Disability Determination and Transmittal), 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) to the review component and routing of the case folder follow GN 04440.228D.

For paper cases, send the folder to the FO. When the FO resolves the work activity issue and returns the folder to the review component, follow GN 04440.228D.1.c.

For CEF cases, OQR retains jurisdiction of the case. When the FO resolves the work activity issue, OQR receives notification when the assistance request is closed.

D. FO routing instructions after they resolve the work issue

When you prepare the SSA-5524-U3, include instructions for the FO on folder routing and disposition of the SSA-5524-U3 and SSA-831-C3/U3 or SSA-832-C3/U3 or SSA-833-C3/U3. The FO routing depends on whether the unresolved work activity issue potentially affects the onset, ending or cessation date, and the case outcome after the FO completes development.

You should instruct the FO that, if after they resolve the work activity issue and a FO jurisdiction SGA denial or cessation is appropriate, the FO should:

  • effectuate the denial or cessation; and

  • close the assistance request.

For paper cases, instruct the FO to

  • 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.

For CEF cases, OQR receives notification when the FO closes the assistance request.

1. Work activity deficiency may affect onset or ending date

If the unresolved work activity has the potential to affect the onset or ending date, instruct the FO to route the case as follows, depending on whether the onset or ending date changes or remains the same.

a. Onset or ending date remains the same

If, after they resolve the work activity issue an UWA does not exist, the onset or ending date remains the same, the FO should:

  • effectuate the allowance;

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

For paper cases, the FO

  • sends 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 the determination is prepared rather than faxing or mailing a copy of the SSA-5524-U3 and SSA-831-C3/U3); and

  • forwards the folder to the appropriate storage facility, if applicable.

For CEF cases, OQR receives notification when the FO closes the assistance request.

NOTE: If, after they resolve the work activity issue, an UWA does exist, the FO should follow the procedure in GN 04440.228D.1.b., “Onset/Ending Date Changes/Possible Different Date.”

b. Onset or ending date changes after work activity resolved

If, after the FO resolves the work activity issue:

  • the onset or ending date changes to a different date, based on the work activity development, than the adjudicating component established onset date (EOD); or

  • an onset date earlier than the adjudicating component EOD; or

  • an ending date later than the adjudicating component established ending date is possible;

for paper cases, the FO should return the fully documented case folder directly to the review component.

For CEF cases, OQR receives notification when the FO closes the assistance request.

c. Review component action when the FO determines onset or ending date changes

When the FO determines the onset or ending date changes, and no further medical development is necessary:

  • correct the onset or ending date on the determination form; and

  • process the corrected case as usual per GN 04440.150.

When the FO determines an earlier onset date or a later ending date is possible, and further medical development is necessary:

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

  • request the additional documentation; and

  • control the return.

2. Work activity deficiency may affect cessation date

If, after the FO resolves the work activity issue, the work activity affects the medical cessation date, the FO should send the case to the adjudicating component.

  • NOTE: If, after the FO resolves the work activity issue a FO jurisdiction SGA denial or cessation is appropriate, the FO should effectuate the denial or cessation. For paper cases the FO should send copies of the SSA-5524-U3 and SSA-832-C3/U3 or SSA-833-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 mailing a copy of the SSA-5524-U3 and SSA-832-C3/U3 or SSA- 833-C3/U3); and

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

For CEF cases, OQR receives notification when the FO closes the assistance request.


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http://policy.ssa.gov/poms.nsf/lnx/0204440228
GN 04440.228 - Correcting Group II Work Activity Documentation Deficiencies - 02/11/2015
Batch run: 02/11/2015
Rev:02/11/2015