TN 12 (07-08)

DI 27520.005 Disability Determination Services (DDS) Action upon Receipt of Informal Remand (IR) Cases

NOTE:  For Field Office (FO) information on processing Informal Remand electronically see DI 81010.141 Processing Electronic Informal Remands.     

For Disability Determination Services (DDS) information on processing Informal Remand electronically see DI 81020.119 Processing Electronic Informal Remands.

REMINDER: Cases must be reviewed by an adjudicator who did not participate in either the initial or the reconsideration determination.

A. IRs from Field Offices (FOs)

When an FO initiates the Informal Remand of a hearing request to the DDS, the DDS examiner must review the case immediately and prepare a revised allowance (or continuance, in the case of a Continuing Disability Review (CDR)) if possible based on the evidence in the folder. This chapter provides instruction for IRs in which the official folder is paper. DDSs that have the necessary upgrade to their case processing software can now process ODAR IRs electronically.

If the DDS cannot make a fully favorable revised determination based on the evidence of record:

  • Forward the folder and the request for hearing to the Office of Disability Adjudication and Review (ODAR) office specified on the Request for Review by Administrative Law Judge HA-501-U5 within 7 calendar days from the receipt of the folder in the DDS; and

  • Indicate on the Route Slip (SSA-408) to ODAR that the DDS could not take favorable action during the pre-Hearing review.

NOTE: Do not send a notice to the claimant in this situation.

B. IRs from ODAR

The DDS retains and completes actions for IRs on the following types of hearing requests:

  • Those received while the DDS is reopening the adverse reconsidered determination in order to make a favorable decision; and

  • Assistance Requests received from ODAR for additional development, which because of the additional evidence, can be reopened, and revised to a fully favorable determination.

IMPORTANT: If the case is electronic, remember to change the case type from AR to IR if necessary in eView.

REMINDERS

  • If only a partially favorable determination can be prepared, return the case to ODAR without any determination.

  • If a hearing request is filed while a case is in the DDS due to the return of a SSA-1774-U5 (Request for Corrective Action), and the determination cannot be reopened and favorably revised send an annotated copy of the SSA-1774-U5 to the Office of Quality Review (OQR) or the Division of Disability Quality Operations (DDQO) in accordance with Routing Reopened Cases DI 28501.030.

  • Return IRs from ODAR involving reconsideration determinations from a Disability Hearing Officer (DHO) or the Office of Disability Programs (ODP) to the Disability Hearing Unit (DHU) or ODP for consideration of reopening when it appears that a the DHU or ODP can make a fully favorable determination.

C. Reopening Process

When a reopening is applicable and a CEF is involved, follow the appropriate procedures in “Processing Reopenings” DI 81020.115.

1. Title II Reversal Warranted

  • Follow the usual process for a revised determination per “Notices and Other Actions In Common Reopening and Related Situations” DI 27530.010B. In addition, show “Informal Remand Case” in the remarks section of the Disability Determination and Transmittal (SSA-831-U5).

    NOTE: The DDS does not need to notify the claimant in Title II reversal cases.

  • Annotate the SSA-408 (Route Slip) “Informal Remand Case” and route the folder in accordance with the reconsideration reversal instructions in “Initial/Reconsideration/Reopening Cases” DI 32005.095.

  • Strip and route the determination form in accordance with “Stripping, Assembly, and Disposition of Copies of Disability Determination”.

  • Send a photocopy of the SSA-831 (Disability Determination and Transmittal) to ODAR via SSA-408 (Route Slip) annotated with “MM/DD/YYYY Fully Favorable Informal Remand”.

2. Title XVI Reversal Warranted

  • Follow the usual process for a revised determination per “Notices and Other Actions In Common Reopening and Related Situations” DI 27530.010B. In addition, show “Informal Remand Case” in the remarks section of the SSA-831-U5 (Disability Determination and Transmittal).

  • Prepare and release a notice of the revised determination on the form SSA-L8165-U2 (Supplemental Security Income Notice of Decision). Add paragraph 1414, 1415, 1424, or 1425 if a medical reexamination applies.

    NOTE: See model language for these notices in “Model Language for Title XVI Applicants (Informal Remands)” DI 27520.035.

  • Release one copy of the notice to the claimant (and representative, if applicable), retain one copy in the folder, and provide two copies of the notice and one copy of the SSA-831 to ODAR.

  • Annotate the SSA-408 (Route Slip) “Informal Remand Case” and forward case to FO.

3. Concurrent Title II - Title XVI Reversal Warranted

  • Process the Title XVI action, prepare notice, and notify ODAR in accordance with instructions subsection DI 27520.005C.2. of this chapter.

  • Forward folders to the FO for action on the Title II claim under the District Office Final Authorization (DOFA) process.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427520005
DI 27520.005 - Disability Determination Services (DDS) Action upon Receipt of Informal Remand (IR) Cases - 01/10/2017
Batch run: 01/10/2017
Rev:01/10/2017