DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations
If any Electronic Disability Collect System (EDCS) exclusions or limitations are present for any claim associated with a case:
For details on distinguishing between claims, cases, and filings, see Electronic Disability (eDib) Glossary - DI 81001.010B.1.
If an individual has applied for benefits on multiple titles and/or Social Security Numbers (SSNs) and one or more of the claims is an EDCS Exclusion, a paper Modular Disability Folder (MDF) must be created even though one of the claims is in EDCS. The paper folder then becomes the official folder, and all information associated with the claim is printed and placed in the paper folder. However, data keyed into EDCS remains electronic and is still displayed in eView.
A. EDCS Exclusions
1. Modernized Claim Systems (MCS) or Modernized Supplemental Security Income Claim System (MSSICS) Exclusions
Any claim that is an MCS or MSSICS exclusion cannot be created in EDCS. For a listing of MCS and MSSICS exclusions, see:
NOTE: Several types of stand-alone conversion actions that do not require applications can be established in EDCS. For more information on these, see Creating Electronic Disability Collect System (EDCS) Cases - DI 81010.020B.
As updates for EDCS are released, situations that were EDCS exclusions in the past will be able to be established in EDCS.
2. Federal Witness Protection Program and Changed-Identity Cases
SSA has jurisdiction of any Title II or Title XVI disability claim filed by, or on behalf of, an individual who changed their identity under the guidance of the Department of Justice (e.g., witness protection program) or due to harassment (e.g., spousal abuse). The DDS does not have jurisdiction over “Witness Protection” or “Changed-Identity Cases”. Normally these cases are not filed in the FO. Due to their sensitive nature, never enter these cases into EDCS. You must complete a paper application and paper disability reports. For more information regarding Witness Protection Program and Changed-Identity Cases see, Title XVI Changed-Identity Claims - DI 11055.115..
3. Celebrity Cases
For SSA purposes, a celebrity is defined as a person of extraordinary national prominence.
SSA systems are programmed to identify these cases and the interviewer is advised if this exclusion applies.
FO employees must not make the decision that a case is excluded based on celebrity status.
There is no change in policy for handling cases for individuals with celebrity status.
Paper disability reports must be completed in situations involving celebrities.
4. Expedited Reinstatement (EXR) Cases Processed as CDRs
Although EDCS now supports electronic CDR (eCDR) processing EXRs are still EDCS exclusions.
5. Cases with Multiple Periods of Entitlement
EDCS does not support cases that involve multiple periods of entitlement.
NOTE: Special Disability Workload (SDW) cases are not EDCS exclusions unless one of the exclusions in Certified Electronic Folder Exclusions DI 81010.030A., applies.
6. End Stage Renal Disease (ESRD) Only Cases
Stand-alone claims for ESRD benefits are EDCS exclusions. Process ESRD cases in accordance with HI Based on End Stage Renal Disease - HI 00801.186 through Form SSA-892-U2 (ESRD Medical Determination) - HI 00801.308, and End-Stage Renal Disease (ESRD) Entitlement Provisions - DI 45001.001 through Medicare Disallowances - DI 45001.340.
For information on processing ESRD claims with a CEF, see Processing End Stage Renal Disease (ESRD) Cases - DI 81010.144.
REMINDER:Route the CMS-2728-U3 and brown folder to PC-7; PC-7 is the only PC that processes ESRD claims.
B. EDCS Limitations
Occasionally, a system limitation may prevent the FO from entering a new claim into EDCS when a related claim was previously entered on EDCS. If the FO encounters a problem with entering a new claim that cannot be resolved at the FO, the FO should call their regional EDCS Help Desk for assistance. If the problem still cannot be resolved, the new claim is an EDCS exclusion and the paper MDF becomes the official record for the entire case. Any associated CEF must be converted to paper.
Title II and Title XVI abbreviated applications (ABAPs) are the only two EDCS Limitations. EDCS does not recognize them as valid claims and will not allow a case to be created.
1. Title II
In order to create a case in EDCS for Title II claims with an ABAP:
Once the full claim is established:
2. Title XVI
In order to create a case in EDCS for Title XVI claims with an ABAP, follow your office policy and either:
Change the ABAP to a full claim and enter the issue of “Application” on the Modernized Supplemental Security Income Claims System (MSSICS) DW01; or
Change the ABAP to a deferred claim and enter the issue of “DEFER APP” on the MSSICS DW01.
C. Processing Multiple Claims When At Least One of the Claims is an EDCS Exclusion
When multiple claims are filed at the same time and at least one of the claims is an EDCS exclusion, the official folder is paper. Use EDCS to enter information and ensure ALL information on both claims is filed in the paper MDF. For procedures regarding adding an EDCS Exclusion after DDS transfer, see Sending an Electronic Disability Collect System (EDCS) Exclusion to the Disability Determination Services (DDS) after a Certified Electronic Folder (CEF) Has Been Established and Transferred - DI 81010.032.
Take the following actions to ensure that both the electronic and paper folders are documented properly:
Create a paper MDF;
Print sections A-D of the Certified Electronic Folder (CEF), excluding any temporary documents in the green section, and file the documents in the MDF;
Create a message on the EDCS case in eView indicating that an electronic and a paper claim exist. Provide the current claim level, type, and Social Security Number (SSN) for the paper claim, conversion, or appeal along with the reason for the exclusion.
Update paper folder indicators (if needed) in eView; and
Annotate the EDCS Routing Form to show that an EDCS Exclusion is associated with the case with the following: “EDCS exclusion-associate with claim transferred on MM/DD/YYYY”.
IMPORTANT: Disability folders contain documentation essential to the adjudication of a disability application. When a situation occurs that necessitates converting the CEF to a paper MDF, the entire contents of the CEF, including documentation from each adjudicative level (initial, reconsideration, hearing, etc.), must be printed and filed in the appropriate sections of the paper MDF following procedures in:
D. Processing Reconsideration Cases Where an Initial Level Claim Was Denied by the FO as a Technical or Substantial Gainful Activity (SGA) Denial
EDCS provides the ability to reactivate cases where the FO made an “FO Determination” for technical reasons. For details on reactivations, see Processing Field Office (FO) Technical Reactivations - DI 81010.110. For instructions on creating a paper folder for an exclusion case, refer to DI 81010.030C. of this section.
Reactivation only works if all claims for a case can be reactivated. If the case involves more than one claim and one of the claims can not be reactivated:
Once a FO Determination has been reactivated, see Processing Reconsideration Requests of FO Determinations - DI 81010.145 for processing guideline.
For more information regarding use of paper forms for reconsiderations on SGA denials, see:
Processing a Reconsideration Request of an Initial Denial Based on Non-medical Issues - DI 12005.015; and
Processing Requests for Reconsideration of Initial Denials Due to Substantial Gainful Activity (SGA) or and Earlier Onset was Precluded by SGA - DI 12005.020.
NOTE: Any partially completed SSA-3368 or SSA-3820 data initially entered into EDCS can be printed and used to complete the paper reports.
E. Processing an Initial Claim with a Pending CDR on Another Title
EDCS cannot process both an initial claim and an electronic CDR. Utilize these instructions until further information regarding this exclusion is received from the RO.
If an initial claim and a CDR are processed at the same time:
Enter the initial claim in EDCS;
Create a message in EDCS indicating that a paper folder was created for the filing;
Transfer the claim to DDS in EDCS.
NOTE: On the EDCS Transfer screen, include in remarks: “Paper folder created because a CDR is being sent with the initial claim;
Prepare a paper folder; and
Attach the EDCS Route Slip to the front of the paper MDF and mail the folder to DDS.
EDCS allows establishment of multiple pending claims for the following scenarios:
CDR Appeals Council (AC) or Federal Court (FC) level case, if a non-CDR case exists at the Initial (IN), Reconsideration (RC), or Hearing (HR) level.
A non-CDR case at the IN, RC, or HR level, if a pending case exists at the CDR AC or FC level.
A non-CDR case for the AC or FC level case, if a pending case exists at the CDR level for the IN, RC, or HR level.
CDR case for the IN, RC, or HR levels if a non-CDR case exists at the AC or FC level.
F. Possible Reopenings of Disability Determinations in CEF – Case Requires DDS Action
This process will remain an EDCS exclusion until software upgrades reach all applicable components; currently there are only a few state DDSs that have the appropriate level software to process reopenings electronically. Utilize the following exclusions instructions until the reopenings feature is announced in your region.
If a closed DDS determination requires reopening, the case cannot be processed electronically. Convert the CEF to a paper folder if the prior determination requires reopening.
1. Determining If a Closed CEF Requires Reopening
If the FO questions the DDS determination based on a technical factor of entitlement (e.g., filing date, insured status, work issue, etc.):
Contact the disability examiner (DE) who processed the claim;
Explain the issue to the DDS contact;
Discuss whether the issue impacts the determination; and
Decide whether a possible reopening needs to be returned to the DDS for further review.
2. Documenting the CEF When It Is Not Necessary to Return a Possible Reopening to the DDS
If the FO questions the DDS determination based on an issue that does not affect the determination:
3. Creating a Paper Folder When It Is Necessary to Return a Possible Reopening to the DDS
After discussing the issue with the examiner, if it appears that a reopening is necessary:
Prepare a paper MDF for the case;
Print sections A - D of the CEF (exclude any temporary documents in the green section);
File the documents in the paper MDF;
Prepare a SSA-5002 eForm to document the issue and show that the paper folder is now the official record for this case;
Save the SSA-5002 to the CEF and file a printed copy in the MDF.
Use the Messages Information Screen in eView or EDCS to add the following message to the CEF: “Possible Reopening – Paper MDF created for this case MM/DD/YY”. Do not show an expiration date on the message.
Change the paper folder indicator in eView to show there is a paper folder for the current filing.
If the claim has not been processed, create a new DDS DEC issue on the DW01 to establish a manual control for the case.
If the claim has already been processed, establish a manual control, via the Modernized Development Worksheet (MDW).
Route the MDF to the DDS and show on the SSA-408: “Possible Reopening needed per contact with (DDS contact).
NOTE: DDS prints sections E-F of CEF and files them in the MDF.
4. FO Actions after DDS Completes Review of a Possible Reopening Case
If the DDS reopens and revises its decision, the FO:
If the DDS decides not to reopen the case, they:
Update the PFI in eView to reflect that the case is a CEF if the PFI has already been changed to reflect reopening;
NOTE: If DDS is unable to update the PFI, the FO will be asked to assist in changing the PFI.
Delete the message “Possible Reopening – Paper MDF created for the case MM/DD/YYYY” in eView; and
Contact the FO and the FO closes the controls.
G. Possible Reopening of Disability Determination in CEF Cases – Case Does Not Require DDS Action
If the FO needs to reopen the case when an SGA, insured status, or other non-medical issue arises after DDS makes a medical determination on a disability claim, the FO must:
Prepare a paper Modular Disability Folder (MDF) for the case;
Print sections A - F of the CEF (exclude any temporary documents in the green section);
File the documents in the paper MDF;
Prepare a Report of Contact SSA-5002 eForm to document the issue and show that the paper folder is now the official record for this case;
Save the report of contact to the CEF and file a printed copy in the MDF;
Use the Messages Information Screen in eView or EDCS to add the following message to the CEF: “Decision reopened – Paper MDF created for this case MM/DD/YY”. Do not show an expiration date on the message;
Change the PFI in eView to show there is a paper folder for the current filing; and
NOTE: If the FO is unable to change the PFI, the RO must be contacted for assistance.
Process the reopening and new determination using the MDF.
H. DDS Reopens a Prior Disability Claim before Sending the Case Back to the FO
If the DDS reopens a prior claim before sending the current filing back to the FO, they must:
When the FO receives the ND on the EDCS Actions Page follow instructions in Electronic Disability Collect System (EDCS) Actions Page - DI 81010.100.
I. Converting CEF Cases to Paper for Cases Sent to ODAR
If the FO receives a request for hearing and the case has converted to one of the exclusions listed in subsection A. of this section and cannot be processed electronically, the FO will prepare a paper MDF for the claim.
To create the paper folder, the FO should refer to DI 81010.030C. of this section – Processing Multiple Claims When at Least One of the Claims is an EDCS Exclusion.