On rare occasions instructions may not provide a notice that exactly fits a unique or complex case situation. However, Disability Determination Services (DDS) examiners may use independent judgment to decide what information must be included in notices not covered by instructions, provided the decisions are consistent with the notice standards outlined in NL 00603.020, Preparing a Notice for Situations Not Fully Covered by Instructions.

When the DDS prepares a notice or personalized explanation and the case is selected for Pre-effectuation Review (PER) or Quality Assurance (QA) review, DDS prepares an undated notice or explanation, according to the procedures outlined in DI 81020.130, Electronic Case Closure.

After review, the Disability Quality Branch (DQB) dates and releases notices to the claimant, and any authorized representative (e.g., attorney or non-attorney representative) at the conclusion of the review. The certified electronic folder (CEF) will include a dated image of the released notice, and the DQB does not need to annotate the CEF with the date the notice is released. The notice release date is entered in the OQR legacy system and can be viewed in eView on the Case Review screen under the Case Data tab.

References:

DI 81020.130, Electronic Case Closure

DI 81020.135, Federal Quality Review

The field office (FO) identifies those individuals, including representative payees, who should receive a Spanish notice by inserting the remark “Spanish Notice Required” in the 3367. The DDS prepares the notice according to the instructions in NL 00603.110, Spanish Language Notices.

REMINDER: If a Spanish notice is not available, include a Spanish cover letter with the English notice. See, Multilanguage Letter Insert for copy of the Spanish cover notice (Multilanguage Letter Insert), which is available for download and printing.

Specific notices are prepared for prisoner cases. The DDS may use these notices only when the exclusion of felony-related or confinement impairments under Section 223(d) (6) of the Social Security Act affects the outcome of the disability determination.

References:

• •

  DI 23501.020, Prisoner Case Notices

• •

  DI 23501.025, Prisoner Notice Finder Chart

The DDS prepares the personalized rationale for total and partially unfavorable medical determinations on the SSA-4268 (Explanation of Determination) and uses interim notice SSA-L1157 (Social Security Notice of Disability) to send the rationale to the party who receives the award notice. The DDS is able to send the interim notice unless:

• •

  the FO determines claimant is incapable; or

• •

  capability is in question.

If DDS is unable to send the interim notice because a capability issue is raised, the DDS places the personalized rationale in the:

• •

  (red) Jurisdictional Documents or Notices section of the Certified Electronic Folder (CEF) for release by the FO (See DI 81020.130 for electronic folder instructions); or

• •

  Modular Disability Folder (MDF) for release by the FO (EDCS exclusion cases only); and

• •

  Annotate item 34 of the SSA-831 (Disability Determination and Transmittal) with special notice instructions to the FO.

Effective June 30, 2008, special notice options are available to any applicant, beneficiary, claimant or recipient who applies for benefits under title II or title XVI if they are blind or tell us they need assistance because of a visual impairment. The policies and instructions on the preparation of special notification to the blind or visually impaired are located in NL 01000.000ff. Special Notice Options for the Blind or Visually Impaired.

In cases involving death, (depending on the status of the case) the DDS may be required to make a determination on the claim and prepare a notice. To determine the required DDS actions in Title II or Title XVI cases involving death, please see the following:

• •

  DI 23510.020, Death after Filing – Title II (Chart)

• •

  DI 23510.025, Death Prior to Filing – Title II (Chart)

• •

  DI 23510.030, Determination Paragraph for a Disability Insurance Benefit (DIB) Claim filed after Death (Chart)

• •

  DI 23510.035, Death after Filing – Title XVI (Chart)

• •

  DI 23510.040, Determination Paragraph, Death after Filing – Title XVI (Chart)

• •

  DI 81020.130, Electronic Case Closure

• •

  DI 81020.135, Federal Quality Review