TN 3 (02-11)

DI 10005.020 Field Office Adjudicative Responsibilities

A. Adjudication jurisdiction

Ensure the claim is in the field office (FO) jurisdiction prior to adjudication. The Disability Determination Services’ (DDS) disability determinations and the Office of Disability Adjudication and Review’s (ODAR) disability decisions are not final until the Office of Quality Performance’s (OQP) quality reviews are complete.

1. Verify the case status for electronic or paper cases

Verify the case status using the following procedures.

  • For certified electronic folders (CEF), review the status on the Case Selection Screen in eView, see screen details in DI 81005.025C.4. The case is complete only if the “Status” entry is “Closed” and the “Office Type” entry is “FO” or “PC.” If these fields contain any other entries, e.g., “OQA” as the “Office Type,” then the case is not complete.

  • For official paper cases housed in a modular disability folder (MDF), refer to the SSA-831 (Disability Determination and Transmittal) that the DDS or OQP completed.

The FO adjudicator is responsible for completely adjudicating and authorizing all Title XVI, and most Title II claims.

2. District office final authorization cases

Title II claims that the FO processed to completion are district office final authorization (DOFA) cases. For more information about DOFA cases and adjudicator responsibilities, see GN 01010.008.

3. Non-DOFA cases

For non-DOFA cases, the FO adjudicator and the Processing Service Center (PSC) adjudicator share the adjudicative responsibilities. In these claims situations, the PSC reviews the FO's initial adjudication of the claim for accuracy and completeness, and the PSC is responsible for final authorization.

For more information about DOFA exclusions, see GN 01010.027.

B. Adjudication procedure

1. Examine and evaluate the evidence

Closely examine and evaluate all evidence from the case file (electronic or paper) and other evidence from SSA's records to determine if we need further evaluation or documentation, e.g., work activity or incarceration prior to adjudication. “Evidence,” includes but not limited to the:

  • Modernized Claims System (MCS)

  • Modernized Supplemental Security Income Claims System (MSSICS)

  • Disability Determination Services Query (DDSQ)

  • Case Processing & Management (CPMS)

  • Appeals Review Processing System (ARPS)

  • Claims File Record Management System (CFRMS)

  • Certified Electronic Folder (CEF)

  • Master Beneficiary Record (MBR)

  • Supplemental Security Record (SSR)

  • On-line Retrieval System (ORS)

  • Informational/Certified Earnings Record (ICER)

  • Prisoner Update Processing Systems (PUPS)

  • Evidence (EVID) screens in Shared Process Menu

  • Disability Control File (DCF)

  • Internet Database and 800 # System

References:

  • GN 00301.286, Electronic Evidence Documentation and Retention

  • GN 01010.032, Records and Information Available to the FO for Adjudicative Purposes

  • DI 81010.000, FO Procedures - Electronic Process

2. If recontact is necessary prior to adjudication

If the FO has to recontact the claimant prior to adjudication, e.g., to obtain additional evidence, the FOs must ask the claimant about work activity or incarceration since the alleged onset date.

Document the claimant’s response on any of the following:

  • SSA-5002 (Report of Contact) (RPOC), or

  • RPOC screen in MCS or MSSICS.

For certified electronic folder (CEF) cases, fax a copy of the RPOC into the EF.

For non-CEF cases, put the SSA-5002 or copy of the RPOC into the paper folder.

NOTE: If there are other pending issues, e.g., workers compensation or public disability benefits (WC/PDB) with a particular case, consider asking or following up with the claimant at the time of recontact.

If the claimant answers “yes” to returning to work after the alleged onset date, evaluate the work, complete the appropriate Form SSA-820 (Work Activity Report for Self Employed Person) or the SSA-821 (Work Activity Report – Employee), and document the SGA determination.

References:

  • DI 10501.025, Responsibilities and Procedures – Work Issue Cases

  • DI 13010.105, Return to Work Within a Year of Onset (Title II)

  • DI 11010.140, Field Office (FO) and Disability Determination Services