TN 3 (11-08)

DI 81020.119 Processing Electronic Informal Remands

A. General – Defining informal remands

The Office of Disability Adjudication and Review (ODAR) Hearing Office may return selected claims to the Disability Determination Services (DDS) as Informal Remands (IR) per DI 27520.001. DDSs that have the necessary upgrade to their case processing software can now process ODAR IRs electronically.

B. DDS receipt of an electronic IR case

The DDS will:

  • Receive an Electronic Folder Interface (EFI) download for IR cases. In these cases, a paper folder is not received so the DDS must closely monitor the receipt queue.

  • Accept jurisdiction. If misrouted, the DDS can only reject jurisdiction to the originating ODAR or another DDS within the same State.

  • Receipt the case. The level is “IR”.

  • Assign the IR to an adjudicator who did not participate in either the initial or reconsideration determination. See DDS Action Upon Receipt of Informal Remand Cases DI 27520.005A.

C. DDS processing of an electronic IR case

Review earnings queries for possible work activity after the claimant’s alleged onset date (AOD) and follow normal case processing rules for development and adjudication.

1. Fully favorable determination

If the DDS can make a fully favorable determination on all claims in the case:

  • Prepare a revised SSA-831-U5 (Disability Determination and Transmittal) and enter “Informal Remand Case” in the remarks section (Item 34) of the SSA-831-U5. See DDS Action Upon Receipt of Informal Remand Cases DI 27520.005.

  • Close the claim on the DDS case processing system, the EFI, and the National Disability Determination Services System (NDDSS).

  • Prepare and release the required Notice of Determination (Title II and Title XVI) to the claimant advising of the revised determination.

  • Enter the decision code of UE (reversal without development) or VE (reversal with development).

  • Enter the Regulation Basis Code (RBC), the medical listing number (MLN) (if appropriate), diary date, and all other data per SM 06001.410B.6.

  • Enter SCF code of “E” to manually exclude the case from Office of Quality Performance (OQP) sampling.

  • Return the claim to the servicing Field Office (FO).

    NOTE: The EFI notifies ODAR of the fully favorable determination. ODAR accesses the CEF for copies of the claimant notices and the SSA-831-U5.

2. Unable to make a fully favorable determination

If, after development, the DDS cannot make a fully favorable determination on all claims:

  • Annotate the electronic folder (EF) with a SSA-5002 (Report of Contact), documenting the basis for the No Determination (ND) decision code.

  • Prepare a ND with ND reason Unable to Make a Fully Favorable Determination (UFFD). See Processing “No Determination” Claims DI 81020.127.

  • Return all claims to the originating ODAR that requested the IR.

D. DDS processing issues applicable to electronic IR cases

1. Reopening a prior period

a. Prior paper folder

If the DDS determines that a fully favorable determination can be made on all the current IR claims, and reopening a prior paper folder to establish an earlier onset date is also supported, all claims should be returned to the originating ODAR that requested the IR. The DDS should follow the instructions below to return the claim(s):

  • Document the EF with a SSA-5002 statement indicating that it appears that the case can be reopened with the application date of MM/DD/YYYY. The case is being transferred to the originating HO for potential reopening of the prior paper claim.

  • Prepare a ND with ND reason Hearing Office Recalls Claim (HORC).

  • Return the claim to the originating ODAR that requested the IR. ODAR has the ability to reopen a prior period without converting the current claim to paper.

b. Prior certified electronic folder

If the prior folder is a CEF, the DDS reopens the prior folder and adjudicates the fully favorable determination. If the prior folder is a CEF and the DDS does not have the capability to process electronic reopenings, follow the instructions in DI 81020.119D.1.a, for prior paper folders.

2. Reactivations

The DDS can reactivate Informal Remands if the DDS case processing system has the necessary system upgrades. An informal remand can only be reactivated by the DDS when the IR indicator is “Y” and the originating ODAR has not issued a dismissal. See Processing Medical Reactivations DI 81020.117.

3. HO recalls the IR case

If ODAR adds a message to the electronic IR (eIR) and contacts the DDS outside the EF requesting that the case be returned to ODAR:

  • Annotate the EF with a SSA-5002 documenting ODAR’s request.

  • Prepare a ND with ND reason HORC.

  • Return all claims in the eIR to the originating ODAR that requested the IR.

4. Claimant whereabouts unknown

Review the case to determine whether all claims can be reversed based on the evidence in file or if there is new evidence in the file that will substantiate a fully favorable determination.

a. If the DDS can make a fully favorable determination

  • Follow normal case processing instructions in DI 81020.119C.1.

  • Enter the claimant’s last known address in Item 5 of the SSA-831-U5. See Processing Whereabouts Unknown (WU) Cases DI 23005.001.

  • Enter “Claimant’s Whereabouts are Unknown” in the remarks section (Item 34) of the SSA-831-U5.

  • Send the notice to the claimant’s last known address, see DI 23005.001.

  • Return the claim to the servicing FO.

b. If the DDS cannot make a fully favorable determination

  • Follow normal case processing instructions in DI 81020.119C.2.

  • Annotate the EF with a SSA-5002 documenting that the claimant’s whereabouts are unknown.

  • Prepare a ND with ND reason UFFD.

  • Return the claim to the originating ODAR that requested the IR.

5. Failure to cooperate

  • Annotate the EF with a SSA-5002 documenting the failure issue.

  • Prepare a ND with ND reason UFFD.

  • Return the claim to the originating ODAR that requested the IR.

6. Work activity after AOD

If there is evidence of work that could adversely impact the period of eligibility:

  • Annotate the EF with a SSA-5002 documenting the work issue.

  • Prepare a ND with ND reason UFFD.

  • Return the claim to the originating ODAR that requested the IR.

7. Claimant Moves Out of State

  • Annotate the EF with a SSA-5002 documenting the claimant’s State of residence change and the new address, if known.

  • Prepare a ND with ND reason Send to Another Office (SDOF).

  • Return the claim to the originating ODAR that requested the IR.

8. Death in the waiting period

  • Annotate the EF with a SSA-5002 documenting the claimant’s death.

  • Prepare a ND with ND reason Death in Waiting Period (DTWP) for Title II claim(s) and if concurrent, use ND with ND reason UFFD for other claim(s) in the IR.

  • Return the claim to the originating ODAR that requested the IR.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0481020119
DI 81020.119 - Processing Electronic Informal Remands - 11/25/2008
Batch run: 01/27/2009
Rev:11/25/2008