Effective Dates: 12/27/2024 - Present Previous | Next

TN 8 (12-24)

DI 23007.001 Failure to Cooperate and Insufficient Evidence Definitions

This subchapter, Failure to Cooperate and Insufficient Evidence (FTC), describes what adjudicators must do when a claimant does not comply with an initial request for evidence or action, or an initial notice of a consultative examination (CE) appointment. The instructions apply to initial and reconsideration level claims. This section provides definitions for terms used throughout the FTC subchapter.

For when the claimant does not comply with an initial request for evidence or action, see DI 22505.014.

For when the claimant does not comply with an initial notice of a CE appointment, see DI 22510.019.

A. Special handling

All claims in which the claimant is under age 18 require special handling.

Claims in which the claimant is aged 65 or older require special handling when the claimant does not have an appointed representative (AR) or when the AR has asked us to deal directly with the claimant. For these claims, follow the instructions in DI 25015.025.

Other claims require special handling when the claimant does not have an AR, and at least one of the following applies:

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    Homelessness,

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    Illiteracy,

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    Limited English proficiency (LEP),

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    A severe, mental medically determinable impairment (MDI),

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    Undergoing an age 18 redetermination, or

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    Aged out of foster care in the last two years (identified by case flag).

NOTE: For purposes of determining whether special handling applies only, assume that an alleged mental impairment is medically determinable and severe, absent evidence to the contrary. When you have such evidence, document it on an SSA-2506 (Psychiatric Review Technique) and do not apply special handling procedures.

REMEMBER: For claims requiring special handling, you must make a reasonable effort to identify and involve at least one third party before you stop attempts to get the claimant's cooperation.

For more information on where to locate a third party (or parties) on the appropriate forms, see DI 23007.001C in this section.

For more information on making a reasonable effort to identify and involve a third party, see DI 23007.010.

B. Good reasons for non-cooperation

A good reason may include, but is not limited to, the following:

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    Physical, mental, educational, and verbal limitations, including limited English proficiency (LEP),

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    Personal illness,

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    Death or serious illness in the family, or

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    Other obstacles beyond the claimant's control.

C. Third party

Someone identified by the claimant you can contact who knows how to reach the claimant should they become unavailable and can help with their claim.

Examples of a third party might include, but are not limited to, a:

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    Relative,

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    Friend,

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    Member of religious or spiritual group,

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    Labor union representative,

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    Veterans group member, and

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    Member of a senior citizens association.

Third party information is located in Section 2 – "Contacts" of the SSA-3368 (Disability Report - Adult), SSA-3441 (Disability Report - Appeal), or SSA-454 (Continuing Disability Review Report). The FO may provide an additional third party in Section 2 – "Contacts" or Section 11 – "Remarks" of the SSA-3368, Section 10 – "Remarks" of the SSA-3441, or Section 11 – "Remarks" of the SSA-454.

Do not ask the claimant to identify any third parties when:

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    The claimant selects "No" in Section 2 – “Contacts” of the SSA-3368, indicating they are unable or unwilling to designate someone who knows how to reach them, and we can contact if they become unavailable, or

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    The FO documented the claimant refused to identify a third party in the Remarks section of the SSA-3441 or SSA-454.

NOTE: Do not use a third party from a prior folder or prior appeal levels.

D. Appointed representative (AR)

An individual the claimant appoints to represent them in their business before the Social Security Administration (SSA) (i.e., to act on the claimant's behalf and pursue the claimant's interests).

For more information on representation of claimants, see DI 31001.001.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423007001
DI 23007.001 - Failure to Cooperate and Insufficient Evidence Definitions - 12/27/2024
Batch run: 12/30/2024
Rev:12/27/2024