Effective Dates: 07/27/2022 - Present Previous | Next

TN 37 (07-22)

DI 22505.014 Requesting Evidence or Action from the Claimant or Third Party

Disability Determination Services (DDS) may need to request that the claimant provide evidence or take action on his or her claim. Generally, DDS makes the initial request by letter. However, DDS may make the initial request by telephone. In some cases, the claimant may not comply with the initial request. This section explains what DDS must do to make a reasonable effort to get the claimant to comply with that initial request (whether by letter or telephone) before discontinuing efforts to obtain evidence that requires the claimant’s cooperation.

REMEMBER: Our goal is to ensure we take the necessary steps to secure all relevant evidence to make a determination, regardless of whether the claimant cooperates.

A. Follow up once when the claimant does not comply with your initial request for evidence or action

When the claimant does not comply within 10 calendar days from the date of your initial request for evidence (e.g., submitting a completed form) or action (e.g., calling a doctor to request they fax a medical record), follow up once by telephone or letter. Give the claimant 10 additional calendar days from the date of your follow-up to comply with your initial request, unless the claimant provides a good reason for you to give more time.

For determining with whom to follow up, see DI 23007.005.

For the definition of good reason, see DI 23007.001B.

For claimants who require special handling, see DI 23007.001A.

For how to make reasonable effort to identify and involve a third party, see DI 23007.010.

NOTE 1: When the claimant requires special handling and does not comply with your initial request for evidence or action in the additional time that you have given, you must also make a reasonable effort to identify and involve a third party.

NOTE 2: When there is FO documentation in the file that the claimant refused to identify a third party, do not attempt to identify a third party, see DI 11005.022B.

NOTE 3: When you have already stopped attempts to get the claimant to attend a consultative examination (CE) appointment in accordance with DI 22510.019, do not attempt to obtain the claimant’s cooperation in providing additional evidence or taking additional action. Make a determination using the sequential evaluation process, see DI 23007.015.

1. Follow up by telephone

When you follow up by telephone, you may either:

NOTE: When you do not speak to the claimant, applicant, appointed representative, or third party, and you cannot leave a message, follow up once by letter, see DI 22505.014A.2.

a. You speak to the claimant, applicant, appointed representative, or third party

Do the following during the conversation:

  • •

    Provide your contact information and explain the purpose of the call.

  • •

    Explain that the claimant must comply with your initial request for evidence or action. State that if the claimant does not comply with your initial request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

  • •

    When you need evidence, attempt to obtain it over the telephone. When you cannot obtain the evidence over the telephone, give the claimant 10 additional calendar days from the date of your telephone call to comply with your initial request for evidence, unless there is a good reason to give more time.

  • •

    When you need action, give the claimant 10 additional calendar days from the date of your telephone call to comply with your initial request for action, unless there is a good reason to give more time, and

  • •

    State that if the claimant does not comply with your initial request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

Document the date, content of your conversation, and to whom you spoke, on an SSA-5002 (Report of Contact), the Claims Communication section in the Electronic Claims Analysis Tool (eCAT), the Case Notes section in the Disability Case Processing Systems (DCPS), or the DDS worksheet.

For the definition of good reason, see DI 23007.001B.

b. You leave a message

You may leave a message on the voicemail recording system of a telephone number in the claim file that is attributable to the claimant, applicant, appointed representative, or third party. You may also leave a message with an adult who answers a telephone number in the claim file that is attributable to the claimant, applicant, appointed representative, or third party (e.g., the claimant’s spouse or an appointed representative’s assistant).

Include all of the following in the message:

  • •

    Provide your contact information and date that you called. Do not disclose any unnecessary personal information about the claimant,

  • •

    Explain that the claimant must comply with your initial request for evidence or action. Identify the evidence or action that you initially requested and give the claimant 10 additional calendar days from the date of your message to comply, and

  • •

    State that if the claimant does not comply with your initial request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

Document the date, and content of your message, and with whom you left it, on an SSA-5002 (Report of Contact), the Claims Communication section in eCAT, the Case Notes section in DCPS, or the DDS worksheet.

2. Follow up by letter

Include all of the following in the letter:

  • •

    Your contact information, date of your letter, and the method by which the claimant should provide any requested evidence (e.g. telephone, fax, mail),

  • •

    An explanation that the claimant must comply with your initial request for evidence or action. Identify the evidence or action that you initially requested and give the claimant 10 additional calendar days from the date of your letter to comply, and,

  • •

    A statement that if the claimant does not comply with your initial request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

B. When to make a determination based on the evidence in the file

When the claimant does not comply with your follow up attempt as described in DI 22505.014A of this section, make a determination using the sequential evaluation process based on the evidence in file, see DI 23007.015.

EXCEPTION 1: When the claimant has an appointed representative who asked you to communicate directly with the claimant, first contact the appointed representative once by telephone or letter to attempt to obtain the claimant’s cooperation before you make a determination using the sequential evaluation process based on the evidence in the file.

EXCEPTION 2: When the claimant requires special handling, make a reasonable effort to identify and involve a third party before you make a determination using the sequential evaluation process based on the evidence in the file.

For claimants who require special handling, see DI 23007.001A.

For how to make a reasonable effort to identify and involve a third party, see DI 23007.010.

REMEMBER: This section applies only to evidence or action that requires the claimant’s cooperation. You still must make every reasonable effort to develop a complete medical history without the claimant’s cooperation, see DI 22505.001A.2., prior to making a determination based on the evidence in the file.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0422505014
DI 22505.014 - Requesting Evidence or Action from the Claimant or Third Party - 07/27/2022
Batch run: 07/27/2022
Rev:07/27/2022