TN 4 (10-15)
DI 28040.105 Initial Notification of the Continuing Disability Review (CDR) in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases
A. Notification in MINE and MINE-equivalent cases
The field office (FO) sends MINE, or MINE-equivalent, cases to the disability determination services (DDS) without a completed SSA-454-BK (Continuing Disability Review Report), or any other contact with the individual, payee, or representative. The DDS is responsible for the first contact with the individual, payee, or representative. The DDS must notify this individual of the CDR by telephone and by written notification.
The DDS must be aware that many of these individuals may have been on the rolls for years and may never have had their cases reviewed. One of the primary objectives of the MINE and MINE-equivalent process is to deal sensitively with these severely impaired individuals.
Prior to initiating the CDR process, the disability examiner (DE) must obtain and review current Fraud Analysis and Coordination Team (FACT) and Supplemental Security Income Display (SSID) queries.
B. Telephone contact on MINE and MINE-equivalent cases
1. Overview of the telephone interview
The purpose of the MINE CDR telephone interview is to:
explain the purpose and nature of the review and answer any questions in a manner that is sensitive to the individual’s concerns and needs;
secure a statement that the impairment remains severe;
verify that the claimant is alive and not working; and
verify that none of the exceptions to the medical improvement review standard (MIRS) exist.
Telephone contact is intended to expedite the MINE process. The DE should make three attempts on successive dates, at different hours of the day in an effort to make contact. Make every effort to speak directly to the individual, payee, or representative. If an interpreter is needed, follow instructions in DI 23040.001.
Review the file, queries, and other available resources to locate a current telephone number if needed. The servicing FO may be a resource to locate individuals whose numbers are not readily available, particularly in Title XVI cases.
Be prepared to conduct the full interview during this initial phone contact if the individual, payee, or representative is prepared to provide the necessary CDR information and prefers to do so at that time.
NOTE: In Title XVI child cases, if there are any problems obtaining required information from the child’s payee or representative, make special efforts to identify and contact another adult or agency responsible for the child’s care. The general approach to failure issues in DI 25205.020 applies to CDRs as well as to initial claims situations.
The DE must document the name of any individual contacted, the information received, and attempts at contact using an SSA-5002 (Report of Contact), claims communication, or other SSA approved method. Sites using the electronic Claims Analysis Tool (eCAT) should refer to the eCAT User Guide for electronic CDR (eCDR) documentation guidance.
2. Contacting the individual, payee or representative
a. Making telephone contact
On making telephone contact, the disability examiner (DE) must:
Exercise a high level of sensitivity because of the severe nature of the impairment(s) in MINE and MINE-equivalent cases. The disabled individual has impairments that are not expected to improve. They have been on the rolls for at least 5 years, and this may be the first contact made regarding his or her disability.
Identify him or herself as an employee of an agency of the individual's State, calling on behalf of the Social Security Administration (SSA).
Explain that the law requires SSA to periodically review all disability cases. However, the review will mainly verify with the individual, and his or her medical sources, that the impairment continues to exist and has not improved.
Use the SSA-454-BK as a guide and the developmental guidelines in DI 28040.130 to determine what questions should be fully developed. Tailor the questions asked based on the nature of the impairment and the age of the disabled individual. For example, do not request answers to the work-related questions on the SSA-454-BK if the individual is a Title XVI child under age 15, unless there are indications the child may be working.
Answer all questions on the SSA-454, or annotate as “NA” (Not Applicable).
Obtain answers to any other questions pertinent to completing the CDR determination.
Inform the individual, payee or representative that we will send a confirmatory notice to the disabled individual.
b. Obtaining a signature on the SSA-827
Tell the individual, payee, or representative that we need a signed SSA-827 (Authorization to Disclose Information to the Social Security Administration) to allow doctors, hospitals, clinics, and other sources to give us information about the disabled person’s condition. Explain that we cannot complete his or her review until we have this signed form. Obtain signature on the SSA-827 using the attestation method(s) in DI 22501.007 if possible.
c. The individual, payee, or representative prefers to provide needed information in writing rather than by telephone
If the individual, payee, or representative prefers to provide needed information in writing rather than by telephone, the DDS must mail the confirmatory review notice, SSA-454, and SSA-827s, along with a return envelope to him or her. Instruct the individual to return these completed forms to the DDS, and explain that he or she may call the DE for questions about the forms or the process.
If the DDS does not receive the forms by 14 calendar days from the date of the confirmatory review notice, follow up with the individual via telephone. If applicable, follow the procedures outlined in DI 28040.110.
3. Case must be referred back to field office (FO)
If the case will be referred to the FO for any reason (e.g., personal contact, or work is alleged), inform the individual that an SSA office will be contacting him or her for further information. Take care not to unduly alarm the individual.
4. Speaking with someone other than the individual, payee, or representative
If an answering machine, voice mail system, or someone other than the individual, payee, or representative answers the call, leave a message for the individual to call the DE. Do not explain the specific request for evidence or action to anyone other than the individual, payee, or representative.
5. Unable to speak with anyone and cannot complete the initial phone contact
If the DE is unable to speak with anyone, proceed with the appropriate confirmatory review notice and further actions as shown in DI 28040.110.
C. Written notice of the CDR
1. Confirmatory review notice
The DDS must send a review notice confirming the start of the CDR process to the individual, payee, and representative. Select the appropriate confirmatory review notice based on the situations listed in the table in DI 28040.105C.2. in this section. All notices may be used for Title II, Title XVI, or concurrent Title II/XVI cases. After you have selected the appropriate notice, use the correct heading and type of case(s) for the notice. Include the DDS’s and the DE’s contact information in the notice.
Set a diary on the case for 14 calendar days from the date of the confirmatory review notice.
2. What confirmatory review notice to send
Initial Phone Contact
Confirmatory Review Notice Sample Text
Phone contact successful and SSA-454-BK completed via phone
DI 28040.300B.1. Exhibit - 1
Phone contact successful, but individual prefers to complete SSA-454-BK by mail
DI 28040.300B.2. Exhibit - 2
Initial phone contact unsuccessful
DI 28040.300B.3. Exhibit - 3
D. Attempts to contact are unsuccessful or unproductive
In cases where both telephone and written contact are unsuccessful, refer to the procedures in DI 28040.110.
DI 11005.056 Signature Requirements for Form SSA-827
DI 13005.040 Completion of Form SSA-454-BK (Continuing Disability Review Report) in Adult CDR Cases
DI 13005.040 Completion of Form SSA-454-BK in Title XVI Child Cases
DI 23040.001 DDS: Interpreters for Individuals with Limited English Proficiency (LEP) or Individuals Requiring Language Assistance
DI 23045.001 Translation of Foreign-Language Documents
DI 28030.010 Understanding and Using Supplemental Security Income Display (SSID, SSI2 or SSI3) Query Replies to Determine Title II Entitlement and Title XVI Eligibility
DI 28040.110 Attempts to Contact are Unsuccessful or Unproductive in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases
DI 81020.100 Electronic Assistance Requests (AR)
GN 03360.005 Releasing Information by Telephone