TN 2 (02-10)

DI 10005.005 Field Office (FO) Disability Development

A. Processing overview

During the first contact with the claimant (or proper applicant), provide information about filing for disability benefits online at http://www.socialsecurity.gov/applyfordisability.

See Also:

  • GN 00204.055, Internet Claim (iClaim) Application; and

  • DI 81007.000, IDR Intake and Processing.

1. All claims situations

Regardless of the means of filing:

  • Develop and document any work issue after the alleged onset date for Substantial Gainful Activity (SGA) using an SSA-820 (Work Activity Report – Self Employed Person) or SSA-821 (Work Activity Report – Employee);

  • Develop for an earlier potential onset date when appropriate;

  • Provide assistance in securing supporting evidence;

  • Ask the claimant to provide any medical reports already in his or her possession; and

  • Report pertinent observations or perceptions of the claimant's appearance and behavior, e.g., noticeable disorders or abnormalities; unusual behavior.

Thoroughly develop an application and disability report to provide the disability claim information that is critical for the Disability Determination Services (DDS) to:

  • Develop the medical aspects of a claim; and

  • Prepare a medical or medical/vocational disability determination.

2. Claimant unable to file his or her application

For a claimant who is unable or chooses not to file the application and disability report online to completion:

  • Conduct an interview to help the claimant complete the appropriate application(s); and

  • Record the claimant's description of the disability onset, medical sources, and vocational history and resolve discrepancies as necessary by completing the appropriate disability report.

B. Specific development issues

In addition to the general outline of processing tasks described above, the FO must also complete specific disability development. FOs can frequently expedite DDS development requests by providing complete development at case transfer. Be sure to:

  • Document complete medical source names, addresses, and phone numbers;

  • Document all work activity after the alleged onset date (AOD);

  • Obtain a medical release (SSA-827 Authorization to Disclose Information to SSA);

  • Record the correct prescribed period and controlling date for all Disabled Widow(er)s’ Benefit (DWB) claims;

  • Annotate the date last insured (DLI) on the SSA-3367, Disability Report - Field Office;

  • Annotate the case with the appropriate flag (e.g., Homeless, TERI, etc.); and

  • Notify the DDS promptly regarding any material changes (e.g., insured status issues, change of address, etc.).

C. Create the disability folder

1. Certified Electronic Folder (CEF) cases

Create the CEF by establishing the disability case in the Electronic Disability Collect System (EDCS). If the claimant completed the disability report online, the Internet Disability Report (IDR) propagates in EDCS, otherwise, create the appropriate disability form(s) via EDCS.

NOTE: Complete an SSA-3369, Work History Report and an SSA-3373, Function Report - Adult, when the claimant is unavailable or would be difficult to contact at a later time (e.g., due to homelessness).

References:

  • DI 11005.016, Forms Used in Disability Claims

  • DI 81007.030, Establishing Internet Disability Report (IDR) Data in Electronic Disability Collect System (EDCS)

  • DI 81001.005, Certified Electronic Folder (CEF) Overview

  • DI 81010.020, Creating Electronic Disability Collect System (EDCS) Cases

  • DI 81010.025, Completing Electronic Disability Collect System (EDCS) Forms for Initial Claims

2. Paper Modular Disability Folder (MDF)

If the case cannot be established in EDCS and processed electronically, create a paper MDF to house the case.

References:

  • DI 70005.001, Paper Modular Disability Folder (MDF)

  • DI 70010.001, Paper Modular Disability Folder (MDF) — Field Office (FO) Procedures

  • DI 81010.030, Certified Electronic Folder (CEF) Exclusions and Limitations

D. Develop for a representative payee

If during the course of the interview, it appears that the claimant may be incapable of managing his or her benefits:

  • Request “Capability Development Needed” on the SSA-3367 in EDCS, or on the MCS Exclusion Information page in EDCS for the DDS to assess capability during their medical review.

  • Try to obtain the name, address, and telephone number of a close relative or friend who may be interested in assisting the claimant during the application process.

  • Develop for a representative payee, when appropriate.

See GN 00502.000, Determining the Need for, Developing and Selecting a Representative Payee for more information.

E. Document contact information when the claimant is homeless

When it is alleged or apparent that the claimant is homeless:

  • Annotate the file and attempt to obtain the name, address, and telephone number where the claimant can be contacted (relative, friend, soup kitchen, shelter, social agency, etc.).

  • Request a contact to serve as a third party who can receive copies of all correspondence sent to the claimant, with the claimant's authorization (e.g., SSA-3288, Consent for Release of Information or SSA-1696, Appointment of Representative).

  • Add the “Homeless” flag to the folder to notify the DDS.

  • Complete additional disability reports (e.g., SSA-3369, Work History Report and SSA-3373, Function Report - Adult) per DI 11005.018B.2.

See DI 11005.004 for detailed instructions about identifying and flagging homeless cases.

See DI 81010.080, Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS) for more information.

F. Updating a third-party address

When an office, general delivery, hospital, or institution address is given, obtain the claimant's home mailing address and telephone number and record the information in the application.

If the home address is unavailable, obtain the name, address, and telephone number of a friend, relative, or neighbor who can contact the claimant.

G. Working with third parties

Work with third parties while assisting the claimant, or deal directly with medical sources when a claimant requires special assistance due to immobility, homelessness, hospital confinement, mental illness, or inability to understand instructions or inability to effectively communicate with others.

H. Reconcile discrepancies

Reconcile material discrepancies between statements about work and other information in file such as the claimant’s earnings record (ER) and income and resources allegations.

I. Document special medical circumstances

If there are circumstances that prevent the claimant from keeping a consultative examination (CE) appointment, annotate the remarks section of the SSA-3367 to notify the DDS. This remark includes such issues as:

  • Lack of transportation;

  • Home confinement due to disability;

  • Inability to read; or

  • No telephone where claimant can be reached.

Inform the applicant of the importance of attending any consultative examination.

Initiate medical development in special arrangement situations or when the DDS, Processing Center (PC), or other office makes a request for it.

References:

J. Develop totalization issues

A totalization benefit is a U.S. or foreign social security benefit payable under the terms of a social security agreement based on combined U.S. and foreign coverage. The purpose of the totalization agreement is to help individuals who have not worked long enough under either the U.S. or foreign system to qualify for a benefit. Under these agreements, either country can count the number holder’s credits in the other country to help him or her meet the insured status requirements. In these claims, special processes apply.

References:

  • GN 01701.100, Overview of Totalization Benefits

  • GN 01702.400, Developing Medical Evidence in Claims for U.S. Totalization Disability Benefits

  • GN 01702.405, Associating Evidence From Prior Disability Folders

  • GN 01702.410, Routing of Claims for U.S. Totalization Disability Benefits

  • GN 01702.415, Development of Medical Evidence and Routing of Claims for Foreign Disability Benefits

K. Railroad Retirement Board (RRB) Involvement

The Great Lakes Program Service Center Disability Processing Branch (GLPSC-DPB) has jurisdiction of disability claims filed by claimants who have 60 or more months of railroad service after December 31, 1995 (or 120 or more months of railroad service prior to December 31, 1995) or who have filed or are entitled to a survivor annuity with RRB.

References:

  • DI 11010.262, Railroad (RR) Cases Sent to Great Lakes Program Service Center – Disability Processing Branch (GLPSC - DPB)

  • DI 11050.015, Jurisdiction of Disability (DIB) and Freeze Applications for Career Railroad (RR) Employee and Surviving Dependent RR Annuitant

L. Deferral and non-deferral of FO disability development

With the exception of the mandated situations as referenced below, interviewers must exercise their discretion when choosing to defer development based on the guidelines. Generally, if the interviewer is unsure about whether to defer or simultaneously develop a claim, defer the development. For the complete policy regarding deferring development see:

  • DI 11010.025, Guidelines for Deferral of Non-Medical Development

  • SI 00603.002, Explanation of Deferred and Simultaneous Development

M. References