TN 15 (02-11)

GN 04440.247 Reviewing Informal Remand Cases

A. Introduction to informal remand procedure

The informal remand procedure was developed to provide a pre-hearing case review for hearing cases that have a strong likelihood of reversal of the adjudicating component’s initial or reconsideration determination. Either the field office (FO) or the Office of Disability Adjudication and Review (ODAR) generally identifies informal remand cases. When the FO identifies the case as an informal remand, they send it to the adjudicating component that made the unfavorable determination rather than to the ODAR hearing office. When ODAR identifies a case as an informal remand case, they forward the case to the adjudicating component.

For FO procedures, see DI 12010.015 and DI 12010.025.

For adjudicating component procedures, see DI 27520.001 and DI 27520.005.

NOTE: If the FO identifies the case as an informal remand, the case will be a paper case because this situation is exempt from electronic processing.

If ODAR identifies the case as an informal remand, the case can be a paper case or a certified electronic folder (CEF) case.

B. Process for reviewing informal remand cases

When the adjudicating component can make a fully favorable allowance, they prepare a reopening of the unfavorable initial or reconsideration determination.

Informal remand fully favorable allowance cases are subject to sampling for the pre-effectuation review, but are not subject to sampling for the quality assurance (QA) reviews. Consequently, there are no informal remand cases in the QA sample.

For paper cases, the adjudicating component follows the procedure in DI 27520.005 for informal remand cases and identifies them by the remark: Informal Remand Case in item 34 on the SSA-831-C3/U3 (Disability Determination and Transmittal) and on the routing form.

For CEF cases, informal remand cases are identified in the alerts and messages section in eView.

C. Procedure for reviewing informal remand cases

Review informal remand cases the same as any reopening determination, following regular review procedures with the following modifications.

NOTE: The adjudicating component is working under specified time frames to complete action on informal remands. The review component must do everything possible to ensure that quality review does not unduly delay the completion of the case.

1. Payment effectuation

Do not effectuate the informal remand determination. The FO effectuates payment and holds the case for 45 days pending claimant's request to proceed with the hearing. For procedure on processing fully favorable determinations, see DI 12010.025B.

2. Notices for paper cases

The adjudicating component does not release the notice(s) because the informal remand case is selected for quality review.

After the quality review is completed, release the notice(s), as appropriate, per DI 27520.005C. Send a copy of the SSA-831-C3/U3 and a copy of the notice to ODAR as specified in DI 27520.005C.

3. Routing for paper cases

Route the case to the FO for informal remand cases. Annotate the routing form: Informal Remand Case.

Route the case to the adjudicating component if a documentation deficiency has the potential to result in an affirmation of the denial or a less than fully favorable determination. If the adjudicating component finds the case cannot be reopened and a fully favorable determination is made after taking corrective action per the deficiency return, the adjudicating component must return the case to ODAR for the hearing.

4. Deficiency returns for paper cases

If you need to route the case to the adjudicating component for corrective action, advise the adjudicating component in the SSA-1774-U5 (Request for Corrective Action) to return the case to ODAR if corrective action results in an affirmation of the denial or a less than fully favorable determination.

5. Notices for CEF cases

The adjudicating component does not release the notice(s) because the Office of Quality Review selected the informal remand case for quality review.

Release the notice(s), as appropriate. ODAR will receive an electronic notification of the determination (there is no need to send a copy of the SSA-831-C3/U3 or notice(s) to ODAR).