TN 43 (11-94)
The FO will contact the class member to update the medical sources and work activity
information upon receipt of a DDS request for assistance. The FO may need to obtain
folders from the DDS. The work development tolerances detailed in DI 12586.080 are applicable to State of New York case developments.
NOTE: Do not establish a systems record until after an allowance is made.
Develop work activity as follows:
The FO will fully develop SGA prior to final readjudication only if work activity,
apparently at the SGA level, began within 12 months after onset and continues.
In general, after the updating action is complete, the FO will send the folder(s)
to the DDS or OHA for completion of the medical review.
See DI 12594.025B.3. if class member is represented.
The PC will ask the FO to obtain folder(s) if case control information indicates that
a folder for the potential class member is located in the FO.
Definition - A folder is considered lost if it cannot be located within 120 days of
the date the case is called up for screening (i.e., the date on which the alert is
generated) to decide whether the individual is a class member.
Case listed under code 170 - The individual is deemed to be a class member in the
absence of evidence to the contrary.
Case not listed under code 170 - If information available in the FO does not preclude class
membership, the FO will obtain the information needed to make a class membership decision
(see DI 12594.001) by contacting the potential class member and by using other sources, including:
Copies of prior SSA-831/832/833's that may have been retained in the FO (for diagnosis,
date of determination, residency, basis for denial, listing code, type of claim, and
level of denial);
Output from the MBR or SSR, for information leading to that found on the determination
form (e.g., diagnosis code, basis code, level of denial code, type of claim, and date
SSA-250's, if retained by FO.
The FO will not contact medical sources for this information.
If the DDS requests an update via an SSA-883-U3, complete the requested actions (see
Obtain SEQY to determine if earnings are different from those of original certified
earnings record. If date first insured or date last insured has changed since original
determination, annotate route slip to that effect when transmitting development to
Contact the class member or the representative (see DI 12594.025B.3.) for update of the claimant's medical condition and medical sources, as requested
by the DDS.
Use SSA-3441-F6 to obtain updated medical source and condition information. In terminated
cases, use an SSA-454-BK to update the folder.
Use SSA-3368-BK to obtain information in lost folder cases.
Obtain SSA-827's for all medical sources, as necessary.
Record work activity on an SSA-820 (SSA-821).
If SGA began within 12 months after onset and continues to present, prepare SSA-831-U3/C3
to reopen and revise original determination to denial based on SGA. Forward copies
of SSA-831-U3/C3 to the following addresses:
NOTE: If readjudication is ALJ jurisdiction, do not prepare SSA-831-U3/C3. Instead, advise
ALJ of SGA determination.
In all other situations involving work, forward folder to DDS/ALJ for readjudication.
SGA began within 12 months after onset - consider revising to SGA denial under rules
of administrative finality. If this SGA ended, forward to DDS/ ALJ so disability determination
can be made for period after SGA ended.
If SGA began later than 12 months after date of onset, notify DDS of work but take
no further action on work until readjudication of entire period up to present is completed.
Then, once completed SSA-832/833-U3/C3 is received, process trial work period, EPE,
and Section 1619 eligibility as appropriate.
Assist in locating folders upon request.
For cases not listed under code 170, if the folder is lost review information available
in FO to ascertain whether a determination was made, on or after June 1, 1980, denying
or ceasing disability under title II or title XVI.
If information available in FO establishes that no denial or cessation determination was made on or after June 1, 1980, forward folder
to DDS for screening. Advise DDS that folder is lost, and will not be reconstructed
because class membership cannot be established.
If information available in FO establishes that disability was denied or ceased under title II or title XVI on or after June 1, 1980, or if information is inconclusive in this regard, obtain information needed to make class
membership decision per b. below (also see DI 12594.005B.1.).
Reconstruction - Use SSA-3368-BK to obtain only information that will be helpful to
DDS in making class membership decision (see DI 12594.001 for requirements), for example:
query that includes DIG coding, or information about diagnoses;
statement from claimant as to whether he or she underwent a treadmill or other exercise
statement from claimant as to whether he or she resided in State of New York at time
of denial or cessation determination;
identity of treating medical sources during the one-year period preceding the date
of application, plus the additional period ending with the date of the determination.
After reconstruction pursuant to b. above is completed, forward all material to DDS
for screening decision.
If DDS decides that individual is class member:
Assist in reconstruction of folder per GN 03105.010. (This will include obtaining a replacement application.)
After FO reconstruction actions are completed, forward folder to DDS for completion
of reconstruction and for readjudication.
Assist in reconstruction of folder upon request. See GN 03105.010
After FO reconstruction actions are completed, forward folder to DDS for final screening
and for readjudication if appropriate.
DDS controls via NDDSS.
Title II - Use unit identifier “ZZZ” when establishing systems record.
Title XVI - Use code “C” in AP field when establishing systems record.