TN 38 (09-15)
DI 28030.001 Initial Receipt of the Case by the Disability Determination Services (DDS)
A. Determining folder type
The electronic disability collect system (EDCS) houses the individual’s disability file information. The electronic folder (EF) consists of evidence, notices, and other information pertinent to the continuing disability review (CDR), and is accessible via an electronic viewer, eView. However, the official file may be paper or electronic depending on various aspects of the individual case. It is important to recognize the difference between these formats.
1. The certified electronic folder (CEF)
The CEF is the official electronic file. However, there may be an associated paper comparison point decision (CPD) file. To determine if the official folder is a CEF:
Open eView and search for the client on the Disability Folder Selection screen. Select the matching case and review the fourth column titled “CEF’. The indicator will show either as yes (Y) or No (N)
View the Status/History tab in eView. If the “Yes” button following the question “Is the official CDR folder electronic?” is selected, the official folder is a CEF.
2. The modular disability folder (MDF)
The MDF is the official paper file. However, there may be an associated EF. To determine if the official folder is an MDF:
If there is no associated EF, the official file is the MDF.
If there is an associated EF, access the Status/History tab in eView.
If the “No” button following the question “Is the official CDR folder electronic?” is selected, then the official folder is the MDF.
If there is a check in the box next to the paper folder indicator (PFI) “A paper folder has been created for this filing,” the official folder is the MDF.
NOTE: If the official folder is paper, file all documents and evidence in the MDF. You must also scan relevant documents into eView.
B. Referral of continuing disability review (CDR) cases to the DDS
The servicing field office (FO) will refer cases that require adjudication of a continuing disability (CD) issue to the DDS in the state where the individual resides. The DDS should make a determination on all referred claims.
1. Referral of the CEF
The FO transmits CEFs to the DDS, and forwards any associated paper MDFs or documents. The “CDR Dates/Types” on the “Case Data” tab in eView will indicate the type of case(s) involved and the reason for referral. For more information on the receipting of an electronic CDR (eCDR), see DI 81020.205.
2. Referral of the MDF
The FO will send MDFs to the DDS using Form SSA-408 (Route Slip). In cases involving dual Title II benefits (e.g., DIB/CDB), the DDS receives both files and makes a determination on both types of benefits. An SSI2 query response in the folder indicates whether Title XVI is involved.
The FO will clearly indicate the basis for the referral of the folder to the DDS on the most recent form SSA-5526-U3 (Request for Assistance – Disability) or other appropriate routing form.
C. CDR case documentation
Both electronic and paper case folders will include, as necessary:
SSA-454-BK (Continuing Disability Review Report) in adult cases, or
SSA-3368–BK (Disability Report – Adult) in Title XVI age-18 CDRs, or
SSA-3881-BK (Questionnaire for Children Claiming SSI Benefits) in Title XVI child cases.
A signed SSA-827 (Authorization to Disclose Information to the Social Security Administration).
The appropriate Function Report -- Child form (SSA-3375-BK through SSA-3379-BK).
If the FO or Office of Disability and International Operations-Office of Disability Operations/Program Service Centers (ODIO-ODO/PSC) investigated a work issue;
SSA-821-BK (Work Activity Report -- Employee), and/or
SSA-820-BK (Work Activity Report -- Self Employment), and
SSA-823 (Report of SGA Determination - For SSA Use Only).
Previous determinations including the evidence on which they were based.
Payment records with the determination of award.
Any medical evidence submitted by the individual during the continuing disability review (CDR) interview.
Other information deemed relevant by the FO (e.g., Form SSA-5002 (Report of Contact)).
D. Title XVI continuing disability review cases
1. General information
Events that prompt a CDR in Title II claims are applicable in Title XVI claims as well.
The DDS will conduct a review and make a determination for disabled or blind recipients:
previously suspended from eligibility for non-disability reasons, and
who wish to re-establish eligibility, and
an event that raises a CD issue occurred since the last disability determination.
Instructions on processing such cases are in DI 28075.300.
2. Conversion cases
Conversion cases involve recipients originally found disabled under a State plan (Aid to the Permanently and Totally Disabled/Aid to the Blind (APTD/AB)) and are now transitioned to federal Supplemental Security Income (SSI) benefits under Title XVI. For further information about evaluating State plan disability criteria during subsequent CDRs, see DI 23525.001.
If the case is a conversion case, the folder will contain the:
Recipient's name and address.
Welfare claim number.
Code of the State and county welfare office serving the individual in December 1973 (this identifies the State Plan that will always pertain to that case).
Date of any scheduled medical reexaminations.
Drug addiction or alcoholism (DAA) indicators, if applicable.
Representative payee information, if applicable (this will include the payee's name and address).
Basis for the CDR.
Earnings posted before the month of a scheduled medical review diary (if the CDR is required for reasons other than the maturation of a medical review diary).
The file may also contain medical evidence, subject to Regional Office guidelines.
3. Lost folder cases
The DDS may receive Title XVI cases for CDR development and determination where the MDF has been lost. Electronic CDRs (eCDR) will have a lost folder indicator and must contain documentation regarding the efforts made to locate the CPD. “Paper” cases are marked with a large green check on the upper right hand corner of the outside of the temporary folder. These temporary folders will include a completed SSA-454-BK that should contain sufficient disability information to begin processing the CDR. Lost folder cases should be developed and processed in accordance with the instructions in DI 28035.001.
E. DDS referral of CDR cases to another state DDS or federal office
1. The DDS determines a CDR is not appropriate
The DDS occasionally receives cases in which a CDR is not appropriate.
Examples of such case situations include:
The individual is currently in termination status.
The individual should be in termination status but no action was taken.
The individual is full retirement age or older.
An appropriate medical review diary is in the future and no intervening event warrants CD review.
There is a trial work period (TWP) determination pending.
A Title XVI recipient is temporarily out of the country.
A Title XVI recipient's whereabouts are unknown.
A Title XVI recipient’s benefits are in suspense for non-disability reasons (and there is no concurrent Title II CD issue).
The case is not within the DDS jurisdiction.
The beneficiary died since the last disability determination.
A CD issue does not exist.
The DDS will refer the case to another state DDS or federal office as needed using a no determination (ND) or transfer (TR) code on the National Disability Determination Services System (NDDSS) record.
2. How to refer a case
Prepare and place an SSA-5002 (Report of Contact) explaining the reason(s) for stopping the CDR in the case folder. For processing of electronic or paper folders proceed as follows:
a. Routing a CEF
To process a TR action, follow the instructions in DI 81020.125. For processing an ND action, follow the instructions in DI 81020.127. The DDS enters a ND or TR code and transmits the eCDR to the receiving component.
b. Routing an MDF
The DDS routes paper cases by attaching form SSA-408 (Route Slip) explaining the basis for the referral (e.g., “No Determination Case--Title II beneficiary is deceased.”). If systems input or corrective action is necessary, annotate the route slip with this information as well (e.g., “No Determination Case -- Prior Disability Cessation -- Input and Notice Release is Necessary.”).
DI 10005.015 Case File Movement
DI 20101.015 Social Security Administration (SSA) and Disability Determination Services (DDS) Jurisdictions- Continuing Disability Cases
DI 20101.035 Disability Determination Services (DDS) and Social Security (SSA) Jurisdictions when the Claimant Moves
DI 20101.045 Jurisdiction User’s Guide
DI 28003.005 Referral Of Continuing Disability Reviews (CDRs) to the Disability Determination Service (DDS), and DDS Screening of CDRs
DI 28035.001 Disability Determination Services (DDS) Initial Receipt and Development of Lost Folders/Medical Evidence for Continuing Disability Review (CDR)
DI 32010.005 No Decision Continuing Disability Review (CDR) Cases – Routing Instructions (Paper Cases Only)
DI 70005.005 Overview of the Paper Modular Disability Folder (MDF)
DI 80640.040 Case Transfers between Electronic Offices and Non-Electronic Offices
DI 81005.005 eView Overview
DI 81001.015 Determining if a Folder is a Certified Electronic Folder (CEF)
DI 81020.125 Electronic Case Routing Before Final Determination
GN 04440.010 Certified Electronic Folder (CEF)