Effective Dates: 03/22/2016 - Present Previous | Next

TN 28 (10-18)

DI 22501.002 Responsibilities for Case Development of Disability Claims

CITATIONS:

20 CFR
404.1512 through 404.1518 and 416.912 through 416.918

A. Collaborative Case Development

Case development is a joint effort between the claimant or applicant (if different from the claimant), the claimant’s representative (if there is one), the field office (FO), Disability Determination Services (DDS), and when applicable, workload support units or Federal disability determination offices. It requires effective communication and coordinated teamwork. See DI 10005.010, Field Office (FO) and Disability Determination Services (DDS) Exchange of Information and Coordination of Actions. This section outlines key case development roles and responsibilities..

B. Claimant, applicant, and appointed representative case development responsibilities

1. When the claimant is the applicant

The claimant must:

  • •

    inform us about or submit all evidence known to him or her that relates to whether or not he or she is blind or disabled;

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    identify and inform us of his or her medical sources;

  • •

    provide any evidence, already in his or her possession, that is not contained in other medical records (for example, a functional assessment paid for by a third party);

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    cooperate with our case development requests (for example, to complete forms and provide information); and

  • •

    cooperate with our request to attend a consultative examination(s) (CE).

2. When the claimant is not the applicant

In most cases, a proper applicant is legally responsible (e.g., parent or legal guardian) to meet the claimant’s obligations for case development. This means the case development responsibilities of the applicant are identical to what they would be if the applicant were the claimant. If the applicant does not have a legal obligation, often the applicant will assist the claimant with case development responsibilities.

3. When the claimant has an appointed representative

The appointed representative has affirmative duties related to case development. An appointed representative must assist the claimant in meeting his or her responsibilities, including acting reasonably promptly in obtaining and submitting information and evidence that the claimant must submit. For a comprehensive list of a representative’s affirmative duties, see GN 03970.010 Rules of Conduct and Standards of Responsibility for Representatives.

4. References

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    GN 00204.003 Proper Applicant

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    GN 03970.010 Rules of Conduct and Standards of Responsibility for Representatives

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    DI 11010.525 Assisting Claimants Who are Unable to Provide Medical Evidence

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    DI 11010.530 Claimant Does Not Authorize Access to Medical Evidence Due to Religious or Personal Reasons

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    DI 23007.000 Failure to Cooperate

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    DI 31001.001 Claimant Representation

C. FO case development responsibilities

The FO has primary responsibility for technical factors, including work activity and substantial gainful activity (SGA) development. The FO initiates disability development and flags the disability folder to identify special development considerations.

1. Requirements for all disability claim types

The FO must:

  1. a. 

    obtain complete disability report information from the claimant or applicant (forms SSA-3368, Disability Report Adult; SSA-3441, Disability Report – Appeal; or SSA-3820, Disability Report - Child);

  2. b. 

    complete required SGA development on Form SSA 820-BK or SSA 821-BK and document the SGA (step one) finding on Form SSA 823 (SGA) or SSA 3367 (no SGA or clearly not SGA);

  3. c. 

    obtain a signed SSA-827, Authorization to Disclose Information to SSA;

  4. d. 

    document required technical information (form SSA-3367, Disability Report-Field Office) in Electronic Disability Collect System (EDCS), including:

    • •

      alleged onset date (AOD);

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      potential onset date (POD);

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      dates relevant to potential disability entitlement (for example, protective filing date, disability date first insured (DFI), disability date last insured (DLI), prescribed period (PP), etc.);

    • •

      dates relevant to potential blindness entitlement (for example, protective filing date, disability date first insured (DFI), disability date last insured (DLI), prescribed period (PP), etc.);

    • •

      prior filing information;

    • •

      presumptive disability (PD) or presumptive blindness (PB) findings;

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      FO observations about the claimant; and

    • •

      capability development.

IMPORTANT: If an adult claimant is homeless, will be difficult to contact, or will be unavailable for contact, in addition to the SSA-3367, SSA-3368, and SSA-827, the FO must also develop the SSA-3373, Function Report – Adult, and if appropriate, the SSA-3369, Work History Report.

2. Title XVI child claims

For title XVI child cases and continuing disability reviews (CDRs), the FO must also:

  • •

    obtain information on child function reports:

    • –

      SSA-3375, Function Report – Child Birth to 1st Birthday;

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      SSA-3376, Function Report – Child Age 1 to 3rd Birthday;

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      SSA-3377, Function Report – Child Age 3 to 6th Birthday;

    • –

      SSA-3378, Function Report – Child Age 6 to 12th Birthday;

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      SSA-3379, Function Report – Child Age 12 to 18th Birthday;

           and

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    complete the SSA-3881, Questionnaire For Children Claiming SSI Benefits, to record information about non-medical information.

D. DDS case development responsibilities

DDS is responsible for developing medical and vocational evidence to determine if the claimant is capable of performing SGA. The DDS should establish a cooperative relationship with the claimant early in the adjudicative process to assist in efficient case development.

The DDS must:

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    review all case documentation;

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    recognize and act to resolve questions and discrepancies in work activity;

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    obtain relevant evidence from a prior case folder, if indicated. For more information on determining the need for a prior folder, see DI 20505.010;

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    request medical and other information needed to adjudicate the claim;

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    make required efforts to get needed evidence;

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    take additional action to resolve insufficiencies or inconsistencies. For example, request CEs, re-contact sources, and ask claimant or others for additional information; and

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    document all efforts to obtain evidence. For more information on documenting the disability folder, see DI 20503.001E.

IMPORTANT: If the FO does not provide the DFI, DLI, statutory blindness DLI (if applicable), POD, an SGA finding, or any other technical information necessary to adjudicate the claim, the DDS must obtain the necessary information before adjudicating the claim.

NOTE: Be alert to the possible need to assist a claimant, particularly one who alleges a mental impairment.

E. References

  • •

    GN 00203.020 Identity of Claimants

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    GN 00204.003 Proper Applicant

  • •

    DI 10005.010 Field Office (FO) and Disability Determination Services (DDS) Exchange of Information and Coordination of Actions.

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    DI 10500.000 Substantial Gainful Activity

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    DI 11005.016 Forms Used in Disability Claims

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    DI 11005.045 Completing the SSA-3367 (Disability Report-Field Office)

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    DI 11010.525 Assisting Claimants who are Unable to Provide Medical Evidence

  • •

    DI 11010.530 Claimant Does Not Authorize Access to Medical Evidence Due to Religious or Personal Reasons

  • •

    DI 23007.000 Failure to Cooperate

  • •

    DI 24001.005 Work Activity Development Responsibilities

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    DI 31001.001 Claimant Representation

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    DI 31001.010 Disability Determination Services (DDS) Responsibilities When an Appointed Representative is Involved

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0422501002
DI 22501.002 - Responsibilities for Case Development of Disability Claims - 03/22/2016
Batch run: 11/19/2024
Rev:03/22/2016