Social Security Act--Secs. 202(d)(1), 216(i)(2), 222(c), 223(a)(1), 223(f), 1614(a), 1619(a), 1631(j)(2)
Regulations--20 CFR 404.1571, 404.1588 - 404.1591, 404.1593 -404.1595, 404.1597, 416.988 - 416.990.
TN 16 (05-93)
DI 40505.001 Processing When Medical CDR Alert is Generated
See DI 55025.010 for medical CDR processing instructions for beneficiaries with Tickets to Work.
Potential CDR cases are selected from the MBR and housed in a data base called the Universal Mix Master File (UMMF). The records remain in the UMMF until authorization is received from the Office of Disability (OD).
OD selects cases from the UMMF. An item on the UMMF may represent a case with a matured medical diary, or a case with no medical diary (“unscheduled”).
When a case is selected from the UMMF, the system generates a mailer and a profile data sheet . The procedure may be modified as required by workload considerations.
REFERENCE: Processing completed CDR mailers (DI 40502.000)
1. Case Selected for CDR
If the case is selected for a CDR, locate the folder. In title II multiple entitlement situations, all disability folders will be located and associated. Note multiple entitlement on all routing forms.
Folder in PC or FARC -- obtain the folder
Folder in FO -- forward the mailer to the FO, unless case control query indicates the case has already been terminated. The PC will maintain a list of mailers and/or alerts sent to the FO, for monitoring purposes. The FO will notify the PC within 2 weeks of receipt of the mailer whether the folder has been located. If the FO has the folder, it will begin the CDR.
Folder not located -- Follow internal special search instructions in any case where the folder has not been located, or is in a location other than PC, FARC, or FO.
2. CDR Deferred
If the CDR is deferred after the mailer/profile is reviewed, reset the medical diary with an SSA-3500, using the instructions in DI 26525.000.
3. Suicide/Homicide (S/H)
Process S/H cases as follows:
Use a copy of the flag in DI 40505.900, Exhibit 3, to identify cases with evidence of S/H behavior. Annotate the flag.
Resolve any doubt about S/H behavior by flagging the case and explaining on a report of contact to be placed in file.