A regulation basis code TCA, also known as a decision basis code TCA, occurs when the adjudicating component completes the regulation basis code incorrectly on either the:

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  SSA-831-C3/U3 (Disability Determination and Transmittal---Item 22, Regulation Basis Code),

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  SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI---Item 11 or 12, “Reason For Continuance” or “Reason For Cessation), or

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  SSA-833-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II---Item 11 or 12, “Reason For Continuance” or “Reason For Cessation".

A group I or group II deficiencies in a non-sample case (e.g., the non-sample claim in a concurrent title II/title XVI claim selected for the quality assurance sample) are considered TCAs regardless of whether the group I or group II definitions covers the incorrect action.

See GN 04440.202, GN 04440.203, and GN 04440.204 for definitions of group I and group II deficiencies.

The FO has the primary responsibility for documenting required technical information including dates relevant to potential disability (and/or blindness) entitlement (e.g., protective filing date (PFD), disability date first insured (DFI), disability date last insured (DLI), or potential onset date (POD)). If the FO does not provide the technical information, or a documentation issues exists, and a group I or group II deficiency does not apply, this TCA applies.

The review component will:

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  notify the adjudicating component of the needed correction, via an SSA-847-U3, or Request for Case Action (SSA-1774-U5), and

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  return the case to the adjudicating component for correction.

The review component will:

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  assume jurisdiction and prepare an amended determination,

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  prepare a new notice and rationale, (if necessary),

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  enter the statement “SSA jurisdiction exercised. This amends the unapproved adjudicating component determination of MM/DD/YY”, in item 34 of the SSA-831 for initial or reconsideration claims,

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  enter the statement “SSA jurisdiction exercised. This amends the unapproved adjudicating component determination of MM/DD/YY", on the SSA-832 or SSA-833 for CDR claims, and

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  prepare an SSA-847-U3 or SSA-1774-U5, , explaining the reason for the regulation basis code change.

EXCEPTION: If the incorrect regulation basis code is due to an obvious typographical or data error, the review component may correct the regulation basis code entry on the determination form without assuming jurisdiction.

If the incorrect action occurs in a non-sample claim and the group I or group II deficiency or TCA definitions cover the incorrect action, the review component follows the corrective action procedures indicated for that deficiency or TCA.

NOTE: Create an SSA-847-U3 when citing TCAs per GN 04440.505, or an SSA-1774-U5 per GN 04440.501.

For information regarding group I and group II deficiencies, see GN 04440.202, GN 04440.203, and GN 04440.204. For additional information regarding TCAs, see GN 04440.230. See GN 04440.204 through GN 04440.220 for information regarding group I and group II deficiencies and GN 04440.232 for additional information regarding TCAs.

1. a. 

   To prepare the TCA, the review component will:

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     code the review screens prior to creating the return form so the information propagates accordingly,

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     prepare a Request for Assistance (SSA-5524-U3) and ask the FO to verify the technical information and document the Certified Electronic Folder (CEF),

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     prepare an SSA-847-U3, or an SSA-1774-U5, and notify the adjudicating component of the TCA,

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     control the return,

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     clear the case to the FO, and

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     send the SSA-5524-U3 and SSA-847-U3, or SSA-1774-U5 to the CEF during the clearance process.

2. b. 

   When the FO documents the CEF with their completed development of the technical information necessary and there is no substantive impact on the outcome of the claim, the review component will:

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     complete the applicable screens,

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     make changes to the determination forms(s) and notice(s) as appropriate, and

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     clear the case using standard procedures for completed cases or subsequent returns (as appropriate).

     NOTE:In the rare occurrence where there is a substantive change which impacts the period of disability, please follow the instruction in GN 04440.204B.3.e regarding group II decisional onset date changes made by the reviewing component.

3. c. 

   If an unexpected substantive corrective action by the adjudicating component is needed, the review component will:

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  code the review screens prior to creating a new SSA-847-U3 or SSA-1774-U5, so the information propagates accordingly

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  prepare a new SSA-847-U3 or SSA-1774-U5,

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  indicate the necessary corrective action,

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  inform the adjudicating component which review component they should transfer jurisdiction to upon completion of their actions,

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  send the SSA-847-U3 or SSA-1774-U5 to the CEF during the clearance process, and

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  clear the case to the adjudicating component (this action transfers jurisdiction to the adjudicating component).

  NOTE:

  For controlled returns, the review component will input the results data when the adjudicating component returns the corrected case.