TN 42 (08-95)
DI 42521.035 Effectuating Determinations/Decisions
The New York ODD conducts the Dixon review and prepares the determination on all screened-in cases where ODIO/NEPSC does not make a presumptive disability determination.
1. Title II
Fully and partially favorable title II determinations are effectuated by the PC.
2. Title XVI
Fully and partially favorable title XVI determinations are effectuated by the FOs.
Normal withholding procedures apply (e.g., Medicare, overpayment, attorney fees, Windfall Elimination Provision (WEP), etc.).
4. Systems process
Claims are either Award Processing Operation (APO) processing exclusions or non-CAPS. The FO must prepare District Office Final Authorization (DOFA) awards and send them to the processing center for processing via Manual Adjustment Credit and Award Processing (MADCAP).
To process award:
Apply the usual withholding procedures for Medicare, overpayments, attorney fees, Windfall Elimination Provision (WEP), etc.
In partially favorable DDS decisions, review the folder to verify that the DDS sent the personalized notice to the claimant explaining the partially favorable determination. If the DDS did not send the personalized notice, include language in the award notice.
If the DDS has made a favorable decision and there are no additional benefits due, follow normal procedures to effectuate the decision and send a notice per DI 42521.095, Exhibit 14.
In cases where the Dixon claim is favorable and there is a simultaneous cessation based on a later application, pay any of the retroactive benefits due.
For OHA cases, follow normal procedures for processing awards based on ALJ or AC decisions. Pay benefits without being bound by the OHA decision in a subsequent claim; except the case may not be reopened and revised to a less than fully favorable finding.
Place in current pay via MADCAP and ensure that payment is made for any retroactive months for which payments are due.
Prepare and release a notice to the claimant using language provided by the DDS on Form SSA-831-U3 (block 29) or Form SSA-865 and include work incentive language, if appropriate.
Provide the current representative(s) with a copy of the notice.
4. Unfavorable decisions
Take no action on unfavorable decisions: