TN 4 (02-90)
DI 33020.005 Routing Cases After the Disability Hearing
A. Procedure - recon cessation
NOTE: See DI 33020.005A.2. for quality review sample cases and 3 below for exceptions to the procedures in DI 33020.005A.1a. through DI 33020.005A1.h.
1. Routing non-sample cases
Complete, sign and date the SSA-832 and/or SSA-833. Refer to DI 28084.050 for DHO signature requirements on these forms. Do not complete blocks 26–28, 30, 30A, and 32. Sign the forms in block 25 and/or 31.
Complete an SSA-831-U3 when applicable, e.g., reconsiderations of adverse revisions of initial determinations and escalated claims. See DI 27015.001, and DI 27530.000 for completion of form; however, do not complete blocks 30 through 32B. Sign the form in block 37, and leave the SSA code block blank.
Be sure the “Recon DHU” block on the above forms has been checked.
Place the claims folder copy and field office (FO) copy of the SSA-831-U3, SSA-832-U3 or SSA-833-U3 on the top of the left side of the folder.
Retain the State Agency copy of the determination form, and send the Vocational Rehabilitation (VR) copy to the servicing VR agency, if any.
File the original of the hearing decision and the claims folder copy of the notice of decision under the envelope on the top of the right side of the claims folder.
Forward the original of the notice and a copy of the DHO's decision to the claimant, and a copy of the notice and decision to the claimant's representative, if any. Follow NL 00603.105B.2. for mailing the notice with decision attached.
Perform required systems inputs. (If using the NDDSS, see SM 06001.001 for specific systems instructions. Otherwise, see SM 05901.000.)
Route the claims folder to the FO under cover of a properly completed SSA-2640 (Disability Hearing Case) unless the conditions noted in DI 33020.005A.2. or DI 33020.005A.3. apply. (See DI 33095.135 for an exhibit of Form SSA-2640.)
2. QR sample cases
Process the SSA-831-U3/SSA-832-U3/SSA-833-U3 as in DI 33020.005A.1.a., except leave all copies in the claims folder. (The review component (DQB or FDDS) will return the DHU copy upon completion of the review.)
Make a copy of the SSA-831-U3, SSA-832-U3, SSA- 833-U3 for the DHU's records, and enter “Quality Review Sample Case” in the remarks portion of the copy.
Place the claimant's (representative's) copy of the hearing decision and decision notice, the envelope(s) for mailing the notice and decision to claimant (representative), and a properly completed SSA-2640 in the claims folder. Make sure the decision and notice have not been punched, stapled or otherwise mutilated.
Update the case control system showing folder movement to the review component.
Route the claims folder to the review component under cover of an SSA-408 annotated “Medical Cessation - QR Action Required.” Indicate if the case is title II, XVI, or concurrent. Be sure Form SSA-3031 (Disability Hearing Quality Review Sample Case) is stapled under the SSA-408.
3. Exceptions to recon cessation routing
Special Review Cases
NOTE: This procedure does not apply to foreign claims or to cases with railroad involvement.
Route the title II claims folder via a properly completed SSA-2640 to the Office of Disability and International Operations (ODIO), or to the Program Service Center (PSC) if age 54 or older, if the cessation date has been revised, or if there is 301-VR involvement.
Process the SSA-832-U3/SSA-833-U3, hearing decision and notice as in DI 33020.005A.1 or DI 33020.005A.2 , but for 301 cases, place the SSA-832-U3/SSA-833-U3 in the claims folder for processing by the Processing Center (PC), i.e., do not input decisions in 301 cases. (See DI 33025.025 for additional information on 301 cases.)
Follow DI 33020.005A.1 and DI 33020.005A.2, but route non-QR cases to the Social Security Administration, Office of Disability and International Operations, P.O. Box 17769, Baltimore, MD 21203, Attn: Reconsideration Branch.
Concurrent Disability Insurance Benefits/Disabled Widow/ers, Including Surviving Divorced Spouse, Benefits (DIB/DWB) claims
Follow DI 33020.005A.1. and DI 33020.005A.2., and route the claims folders to the FO if the decision is the same on both claims. Route to the appropriate PC if the decisions are different, e.g., DIB continues, DWB ceased.
NOTE: QR cases are handled as in DI 33020.005A.2. whether or not the decisions are the same on the two claims.
Drug Addiction/Alcoholism (DA/A) claims
Follow DI 33020.005A.1. and DI 33020.005A.2., but remove any DA/A Routing Flag before releasing the claims folder to the FO.
Follow DI 33020.005A.1. or DI 33020.005A.2., but route non-QR cases to the Great Lakes Program Service Center (GLPSC), Disability Review Section (DRS), P.O. Box 8470-A, Chicago, IL 60680.
B. Procedure - recon continuance
NOTE: See DI 33020.005B.2. for quality review sample cases and DI 33020.005B.3. for exceptions to the procedures in DI 33020.005B.1.a. through DI 33020.005B.1.f.
1. Routing non-sample cases
Complete, sign and date the SSA-831-U3, SSA-832-U3, and/or SSA-833-U3 and separate and distribute the copies as explained in DI 33020.005A.
Follow DI 33020.005A.1.e. and DI 33020.005A.1. for filing and releasing the DHO's decision and notice of decision.
Perform required systems inputs. (See references in DI 33020.005A.l.g.)
Route the title II claims folder to the appropriate PC for title II only and the title II portion of concurrent title II/title XVI cases. Send the folder under cover of a properly completed SSA-2640. (See DI 33095.135 for an exhibit of this form.) Annotate the remarks section of the SSA-2640 to show any action required, e.g., to update the Master Beneficiary Record with diary information, to reinstate benefits, to return the folder to files, etc.
Route title XVI only cases to the servicing FO. Annotate the SSA-2640 to show any FO action required.
Route the title XVI case in concurrent title II/XVI cases (if DHU has it) to the servicing FO. Send under cover of a properly completed SSA-2640. If the title XVI folder is not in the DHU, route only the SSA-832-U3 to the FO. Add to the SSA-2640 “FO Action Necessary.” Also include a copy of the SSA-833-U3 and annotate the SSA-2640 to show the SSA-833-U3 was forwarded for informational purposes.
NOTE: For electronic folders (EF) all final decisions, both favorable and unfavorable, are routed to the FO. If necessary, the FO will forward the EF to the Program Center. For more information see DI 81020.255 B.
2. QR sample cases
Process the SSA-831-U3/SSA-833-U3/SSA-832-U3 as in DI 33020.005A.1.
Follow DI 33020.005A.2.c. for handling the decision and decision notice.
Make a copy of the SSA-831-U3, SSA-832-U3, SSA- 833-U3 for DHU records as shown in DI 33020.005A.2.b.
Update the case control system showing folder movement only to the review component.
Route the claims folder to the review component via an SSA-408 annotated, “Recon Medical Continuance - QR Action Required”. On the SSA-408 show if the case is title II, XVI, or concurrent. Be sure an SSA-3031 (Disability Hearing Quality Review Sample Case) is stapled under the SSA-408.
3. Exceptions to recon continuance routing
Concurrent DIB/DWB claims
Medicare for Qualified Government Employment (MQGE) cases
Follow DI 33020.005A.1. or DI 33020.005A.2. Put “MQGE Recon Case” in the remarks section of the SSA-833-U3.
Follow DI 33020.005A.1. or DI 33020.005A.2. and forward the claims folder to GLPSC-DRS, P.O. Box 87755, Chicago, IL 60680-8115.
Show in the remarks section of the SSA-832-U3 “DA/A Case” if DA/ A is material to the hearing decision. Otherwise, except as noted below, process the case as in DI 33020.005A.1. or DI 33020.005A.2.
Copy any material received during the reconsideration process which would be helpful to a treatment referral agency. Fasten the copies to the inside back cover of the claims folder.
Route the claims folder to the FO via a properly completed SSA-2640. Check the “DA/A no longer involved in disability - Remove DA/A indicator” block of the SSA-2640 if it is determined that the individual is disabled independent of DA/A. (This is necessary because if an individual is disabled independent of DA/A, he or she is no longer subject to the representative payee and treatment requirements. He or she is also not subject to an automatic 12-month diary.)
NOTE: For electronic folders (EF) all final decisions, both favorable and unfavorable, are routed to the FO. If necessary, the FO will forward the EF to the Program Center. For more information see DI 81020.255B.