TN 1 (06-04)
DI 22511.011 Contacting Claimants and Collateral Sources
Many factors can make an impact on the method selected for developing claimant and collateral evidence; e.g., geographical location, access to telephone, work schedules, etc. The manner in which such evidence is obtained must be left to the requestor's discretion.
B. Procedure -- General
There may be instances in which field office (FO) assistance is necessary to contact a potential collateral source or to recontact the claimant; e.g., where a face-to-face contact is needed. In such instances, the disability determination services (DDSs) should request the FO to make the contact. However, DDSs should request the FO's assistance only after they have been unsuccessful in contacting the source.
To ensure complete responses and to minimize followup contacts, the DDS should furnish the FO a list of specific questions to be asked of the source. The FO should be advised as to what type(s) of attempts the DDS has made to obtain the needed evidence. This will alert them to methods either to try or avoid.
C. Procedure -- Claimant Contact Techniques
Contact with the claimant should focus on those activities that he/she actually performs or can no longer perform due to the alleged impairment. The SSA-3373 asks questions requiring descriptive information about the claimant's activities and socialization that will permit judgments about the quality, effectiveness, independence, appropriateness, and sustainability of those activities and relationships. The SSA-3373 is not intended to address all situations. If a DDS, after reviewing responses on the SSA-3373, determines that additional information is necessary to fully evaluate a claimant's limitations in the ability to function, the DDS may use impairment-specific or case-specific questions to develop the additional information.
Verbatim quotes from the claimant are the preferred method of documentation whenever possible. For example, it is much more revealing to know that exact change has to be given to an individual for car fare and lunch than to state that the claimant has difficulty with elementary mathematical concepts. Describing an episode in which the individual could not make change and so either lost money or became confused or upset would be even more revealing.
2. Preparing For the Contact
Before contacting the claimant, thoroughly review the information already contained in file. This preparation will enable the reviewer to ask pertinent questions which can resolve inconsistencies or clarify ambiguities.
3. Contacting the Claimant
Insofar as possible, questions to the claimant that supplement or clarify information obtained on the SSA-3373 should be open-ended. Encourage the claimant to take the lead to provide a narrative response. Avoid leading questions such as, “You can't drive much with your bad back, can you?”
Techniques such as prompting or recasting a significant statement of the claimant's into a question are useful in eliciting details from the claimant. For example, if the claimant says, “I am too nervous to drive anymore,” the response might be “You cannot drive your car anymore? Why not?” or “Tell me about it.”
When the claimant has had an adequate opportunity to explain his/her functions and limitations, more structured questioning may be used. Even the opening moments of the contact may reveal situations that may require a different approach, however. For example, if the individual seems depressed, underproductive or too anxious to focus on a narrative response, questions may need to be more directive. Similarly, if the individual exhibits hyperactive behavior, he/she may respond with too much information, and the questions may need to be more restrictive to control the responses.
Remember that the functional areas (i.e., “B” criteria of the mental disorder listings) to be assessed are:
Activities of daily living,
Concentration, persistence and pace, and
Episodes of deterioration or decompensation.
Physical impairments also affect these areas of functioning. We look at how a claimant's physical and/or mental impairments restrict his or her ability to function in each of the areas. For example, in the area of socialization, the claimant needs to describe how his/her impairment affects the effectiveness, independence, appropriateness, and sustainability of his/her ability to function socially.
b. Focus on Selected Activities
Instead of trying to document all of the claimant's activities, select at least two of the activities the individual indicates he/she is currently performing. Choose activities that involve sufficient complexity so that a full description of the activities will permit evaluation of the qualities previously described. Complexity can be viewed in terms of relating to people, places, dates, and things. For example, does the activity involve interaction with other people? Does the activity take place at home, or must the individual travel to perform the activity? Does the activity require calculation or reading and understanding instructions? Does the activity require the use of tools, devices, or appliances?
Whenever possible, the adjudicator should choose to evaluate activities that are known to him/her. It is easier to evaluate quality and appropriateness if the adjudicator knows how the activity is customarily performed. This can also be a useful communications tool, as the enthusiasm of a shared interest may encourage the claimant to be more expansive.
Activities generally fall into categories such as:
Self-care (grooming, cleanliness, dressing).
Home maintenance (cleaning, cooking, shopping).
Social/religious (church attendance, family gathering, organizations, parties, etc.).
Economic (paying bills and taxes, budgeting income and expenses).
Hobbies (woodworking, sewing, photography, playing cards).
c. Specific Questions
There is no set list of questions to be used when claimant contacts are needed to clarify or supplement the SSA-3373. Instead, assess each individual case situation and determine the best questions to ask to know how, when, why, and what the claimant does and what, if any, problems have been noted and can be described.
There are many conditions, both physical and mental, that may limit function. In addition, medications or combinations of medications and side effects of various medications may also limit a claimant's ability to function. Therefore, if at all possible, ask questions that permit one to contrast the claimant's pre- and post-onset performance of an activity.
D. Procedure -- Collateral Source Contact
The SSA-3380 is used to collect information about a claimant's ability to perform the activities of daily living from third parties familiar with the claimant's ability to function, such as the claimant's spouse, relatives, neighbors, friends, clergy, teachers or employers. (The SSA-3380 is not mandatory for use in all cases. See DI 22511.007F.)
The SSA-3380 is not intended to address all situations. If a DDS, after reviewing responses on the SSA-3380, determines that additional information is necessary to fully evaluate a claimant's limitations in the ability to function, the DDS may use impairment-specific or case-specific questions to develop additional information. As with claimant contact, when contacting collateral sources, there is no set list of questions which is appropriate to clarify or supplement information obtained on the SSA-3380. The diverse nature of impairments and their functional manifestations, plus the variability of the relationship with collateral sources, all require an individual case-by-case approach.
2. Initiating the Contact
The collateral source should be told that the contact is related to an application for Social Security benefits and that the information will be used as evidence in the claim. The claimant's right to privacy should be guarded. If a mental impairment has been alleged, that fact should not be divulged. (See DI 22511.013A.)
Ask the individual to describe his/her relationship with the claimant. For example, does the individual live with the claimant or, if not, how often and under what circumstances does the individual see the claimant? Understanding the source's relationship with the claimant will help to determine the nature and depth of evidence he/she can furnish.
3. Guidelines For Collateral Source Contacts
Encourage the collateral source to tell in his/her own words what is known about the claimant's function in a specific activity. Questions should be restricted to the topic in which the respective source's evidence is needed.
For example, if the claimant attends church and the contact is a member of the clergy and indicates that he/she sees the claimant at services, questions about the frequency of attendance, degree of participation in services, and any problems during services might be explored. The member of the clergy might be asked if the claimant serves on any church committee, and if so, how he/she discharges that function.
If the source is a neighbor with only casual contact with the claimant, inquiry about house and yard maintenance or participation in civic associations might be appropriate.
Remember, it is not the specific activity that is important, but a description of the quality, effectiveness, appropriateness, sustainability and independence of participation in that activity that is significant. Encourage the source to describe what he/she has observed about the claimant in a given activity, but not to speculate or draw conclusions in areas outside personal knowledge or expertise. Stress the need for quality, rather than the quantity, of the information elicited during the contact. (See DI 22511.013C. for discussion on obtaining collateral evidence by telephone.)
E. Procedure -- Mail Requests to the Claimant or Collateral Source
1. Request to Claimants
When requesting information directly from the claimant, follow the procedures in DI 23007.005.
2. Request to Collateral Sources
For collateral sources through the mail, reasonable time must be given for the source to respond. A total of 30 calendar days from the date of the initial request must be allowed. Within this 30-calendar-day period, followup can be made at any point between 10 and 20 calendar days after the initial request. This allows a reasonable period of at least 10 calendar days for response to the initial and followup requests.
The file must be documented to show that every reasonable effort has been made to obtain the requested evidence.