TN 1 (01-01)

DI 13015.035 Title XVI Medical Folder(s) - FO Location

A. Policy

The FO is one of the most important links in upholding the integrity of SSA"s disability decisions/determinations and continuing payments. Finding or replacing missing/misplaced medical folders is extremely costly, as is the erroneous continuation of medical disability benefits to an individual who is no longer disabled but continues in pay because the CPD medical folder cannot be found. It is imperative that the FO finds the missing medical folder needed for the CDR.

B. Process - disability control file (DCF)

The Disability Control File (DCF) controls most medical direct release reviews initiated by Central Office (CO). (See Modernized Systems Operations Manual (MSOM) Chapters 185 for more detailed procedures on the DCF). The DCF determines folder location through the Current Folder Location (CFL) field reflected on the Supplemental Security Record (SSR) at the time the case is initially selected for a CDR. If a selected direct release medical review reflects a CFL of either the National Records Center (SSANRC) (i.e., LOO) or the Federal Records Center(s) (FRCs) (i.e., L86-L99, etc.), the DCF will automatically request the title XVI folder(s) and all related material stored in these locations. When the CFL is other than SSANRC/FRC, the DCF sends the direct release alert to the FO of jurisdiction (generally the DIS – Servicing DO Code displayed in the ADDR – Mailing Address Segment Identifier of a Supplemental Security Income (SSI) query).

1. Initial title XVI direct release CDR received in FO

Under the current initial DCF direct release process, the FO receives a paper direct release alert on its dedicated printer for each title XVI case for which medical folder retrieval is the FO"s responsibility. In addition, the FO can determine its most recent direct releases using the Office of Information Management (OIM) workload management system (WMS) screens found as function "25" on the SSA Main Menu. (See MSOM CDRWMI 003.001 - MSOM CDRWMI 005.001 for more detailed procedures on identifying new direct releases in the WMS system.)

NOTE: In the future, we plan to enhance the OIM WMS system and eliminate the "paper" direct release alerts by providing users with WMS screens to manipulate and control their new direct releases.

2. Initial title XVI direct release CDR received in SSANRC

SSANRC simultaneously retrieves all claims folder(s) and related posteligibility (PE) material/folder(s) stored in the SSANRC or the FRCs, and forwards it in one folder to the FO of jurisdiction. The SSANRC consolidates all the folder material into one folder by removing extraneous folder jackets and drop-filing their contents into the remaining folder. Prong-filed material remains together, and loose material is stapled or rubber-banded. Also, when necessary, a large folder is securely rubber-banded on the outside or an accordion folder is used to consolidate large quantities of claims and PE material.

C. Procedure

1. Spouse search

Currently the SSI Control System (SSICS) only tracks the Housed Under Number (HUN) of the SSI case. A person who was a spouse when they filed, but is currently entitled as an individual, may have their DIB data filed in the HUN folder of the individual that they were married to at the time of filing. In order to obtain the individual's DIB file, search prior records, and obtain AR33 requests for the HUN of any prior records.

NOTE: Apply screen-out criteria listed in DI 13005.020 before searching for the medical folder.

2. Queries to obtain for title XVI folder

Obtain the following queries to determine the location of the title XVI folder:

  • The SSID online query, or

  • The SSI2 online query with the CCTL segment, and

  • The offline SSI case control query (SSA-8028, AR25).

  • See DI 13015.080 for additional queries and helpful hints.

Keep all pertinent queries. Circle/highlight pertinent information, e.g., on the NUMI, circle/highlight any name change.

a. The SSID or the SSI2/CCTL query.

Both the SSID and the SSI2/CCTL show basic case control data; however, if the folder is not readily available and found obtain a SSID offline case control query (SSA-8028, AR25). Review all SSID's for all records for the SSN involved (e.g., RN1x3, RN2x3 and RN3x3). Look for other FOs who may have housed the folder at one time or another. Pay special attention to the XDO - Transmitting District Office code or RN1. The XDO Code is located in RCDR – Record Data line on a SSI query. The XDO may never have shipped the original folder to the SSANRC or to any other office.

b. The offline case control query (SSA 8028; AR25).

Obtain a Supplemental Security Income (SSI) offline query – Alert Response (AR) 25. The AR25 is an overnight query that provides up to six prior folder locations (SM 01201.050 and SM 01201.110).

c. EXAMPLE of 8028 offline query request.

TA: A AH: SMITH, A AR:25 MV: MMDDYY AN: XXX XX XXXX

If your review of the above queries indicates that another office (besides SSANRC/FRC) was involved, telephone and request them to conduct a search for the folder. See DI 13015.035B.3.

3. How to search for title XVI folder – in FO of jurisdiction

  1. Search for folder by last name.

  2. Look at a NUMI for different names used since date of filing. If it is difficult to determine which last name is on the folder, search using ALL known last names.

  3. Search in all locations until all possibilities (see DI 13015.080) are exhausted, including any specialized units within your FO, e.g., Court Cases, Appeals, DAA, etc.

  4. Check your shipping lists: the folder may have been shipped but not yet read in. Most childhood cases should be in the FOs. Claims for children under age 19 are still SSI shipping exclusions per SM 01201.155A. Many of these cases have been stored in local FO alternative storage areas. Remember to document on the SSA-5002 (see DI 13015.250) that you have carefully searched in your own office first, including any local alternative storage areas, until all possibilities have been exhausted, including those overflow filing cabinets and folders awaiting shipment etc.

  5. Folder found: See DI 13005.030.

  6. Folder not found: See DI 13015.035B.3. and DI 13015.080.

4. Unable to locate medical folder in FO of jurisdiction AR25 reflects other FOs

  1. Remember to document on the SSA-5002 that you have carefully searched in your own office first, including any local alternative storage areas, until all possibilities have been exhausted, including those overflow filing cabinets and folders awaiting shipment etc.

  2. Telephone and provide the other FO(s) with all potential names under which the folder could be filed.

  3. Advise them if there is something unusual/unique about the case, (e.g., DAA, Age 18, Low Birth Weight (LBW), etc.) that might help in the search. Childhood cases have been a shipping exclusion since mid-1995. Childhood cases may be stored in alternative storage areas.

  4. If the other FO cannot immediately locate the file, establish a tickle date in accordance with that FOs estimated time needed for a response to search request.

    NOTE: Establish tickle controls using the DCF worksheet (CDRW) located in MSOM CDR 001.013.

  5. Folder Found: Tickle for receipt.

  6. Folder Received in FO: See DI 13005.030.

  7. If unable to locate the folder(s), proceed to DI 13015.080.

5. Document search for medical folder

Document on the SSA-5002 (see DI 13015.250) all efforts to obtain the folder(s) for follow up purposes and to inform the next person/component who handles the case in order to reduce duplication of efforts.

Keep all pertinent queries in file. Circle/highlight pertinent information, e.g., on the NUMI circle/highlight any name change.


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http://policy.ssa.gov/poms.nsf/lnx/0413015035
DI 13015.035 - Title XVI Medical Folder(s) - FO Location - 03/14/2016
Batch run: 03/14/2016
Rev:03/14/2016