TN 5 (11-08)

DI 81010.141 Processing Electronic Informal Remands

A. Overview

Informal Remand (IR) cases from the Office of Disability Adjudication and Review (ODAR), Hearing Offices (HO) are no longer Certified Electronic Folder (CEF) exclusions. However, Field Office (FO), Disability Determination Services (DDS), and Office of Quality Performance (OQP) users will not have access to this feature until the relevant state DDS legacy system is upgraded to release 13.0. Users will be notified on a state-by-state basis when this feature is activated. Once activated, EDCS will add new alerts to the EDCS Actions Page. DDSs that have the necessary upgrade to their case processing software can process HO IRs electronically.

NOTE: FO IRs remain CEF exclusions. Follow current procedures for processing paper FO IRs in DI 27520.005B. - DDS Action upon Receipt of Informal Remand Cases).

B. Processing a fully favorable IR determination

When the FO receives a fully favorable determination on an IR from the DDS, the Electronic Disability Collect System (EDCS) Action Page displays an Action Item (AI) indicating “Informal Remand-DDS Determination Added.” When opened the AI shows “Decision: Allowance-Informal Remand (IR)”.

To process a fully favorable IR determination:

  • Use the procedures in DI 12010.025 – Action Following a Favorable Determination by the Disability Determination Service (DDS) in Informal Remand Cases

  • Review the case to ensure both the application date and onset dates are correct.

  • Update the appeal decision in MCS/MSSICS

REMINDER: The HO receives this information via their Case Processing and Management System (CPMS from the DDS); do not fax a copy of the SSA-5002 to ODAR.

NOTE: The eView Case Selection screen and Case Status screen show the case as closed at the hearing level. The Claims Action History reflects that a DDS Determination was made at the Hearing Level. The next action on Claims Action History is reflected when the HO dismisses the hearing.

C. Request for the hearing to proceed is received

If the claimant or representative requests that the hearing proceed:

  • Fax a copy of the SSA-795 (Statement of Claimant or Other Person) into the CEF. For more information on faxing into the CEF see DI 81010.090 - Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes, and

  • Fax a copy of the SSA-795 to the originating HO.

NOTE: This is the only way the HO will know that a hearing must proceed.

D. Non-medical technical issues discovered after fully favorable determination

When the FO receives a fully favorable determination and realizes that non-medical technical issues exist:

  • Document the CEF using eForms SSA-5002 with detailed information about a possible technical denial and advise the HO not to dismiss the hearing, and

  • Fax a copy of the SSA-5002 to the originating HO. This is the only way the HO will know they must follow existing procedures to process the hearing.

NOTE: The FO does not receive partially favorable determinations. The DDS only sends the case to the FO if all claims result in a fully favorable determination. Otherwise, the DDS returns the case to the HO, and the HO follows existing procedures to process the hearing.

E. Work issues

Limited work development is necessary if work issues that would impact the period of eligibility are found after the DDS medical determination. Review the earnings record, NDNH, SEQY and/or DEQY.

1. Work determined not SGA

If work is determined not to be SGA, process the determinations per DI 12010.025 – Action Following a Favorable Determination by the Disability Determination Service (DDS) in Informal Remand Cases.

2. Work determined SGA

If work is determined to be SGA:

  • Document the CEF with the findings using eForms SSA-5002, and

  • Fax a copy of the SSA-5002 to the originating HO. This is the only way the HO will know they must follow existing procedures to process the hearing.

F. Unable to locate the claimant

When the FO receives a fully favorable IR determination and cannot determine the whereabouts of the claimant: