PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 290 – Reconsideration of Continuing Disability Review (CDR) Cases, and Reopenings Applicable to Disability Hearings (Pre-DHU Processing)Subchapter 05 – Development of EvidenceTransmittal No. 3, 03/17/2020
This is a QAT for grammar edits. The revisions do not change or introduce policy.
Summary of Changes
DI 29005.027 Whereabouts Unknown (WU) Occurs at the Pre-Hearing (PH) Level
Minor grammar revisions were made. There are no changes to existing policy.
Citations: 20 CFR
404.914 and 20 CFR 416.1414
This section addresses proper handling of WU at the PH level.
Whereabouts unknown status exists when the Social Security Administration (SSA) or the disability determination services (DDS) cannot locate an individual at the last known address and after completing all required actions to locate the beneficiary (or recipient).
WU may be a Group II exception and considered a reason to find disability has ended without determining the ability to engage in substantial gainful activity (SGA) for adults or determining that the impairment no longer causes marked and severe functional limitations for children.
When an individual timely requests reconsideration of an initial or revised medical cessation determination, he or she has the regulatory right to appear at a disability hearing unless he or she waives the right to appear.
When a WU issue arises, do not return the claim to the field office (FO) as a no determination (ND). The PH examiner must complete the actions outlined in section C. below when WU arises, such as upon receipt of returned mail.
Process a continuation if the PH examiner is able to make a fully favorable determination with the evidence in the claim(s) folder.
If the evidence in the claim(s) folder is sufficient to support a fully favorable determination, do not send the case to the disability hearing unit (DHU). The PH examiner will follow instructions in DI 29005.005C.
If the evidence in the claim(s) folder is not sufficient to support a fully favorable determination, the PH examiner must complete the following:
Complete all development not requiring the beneficiary's (or recipient's) cooperation;
Attempt at least one phone contact with the beneficiary (or recipient) and all other authorized persons, e.g., representative payee, authorized third party, and appointed representative;
Immediately request FO assistance if phone attempts are unsuccessful in locating the beneficiary (or recipient). The PH examiner must allow ten days, after the assistance request is sent, for the FO's response; AND
Document all actions to locate the beneficiary (or recipient) on an SSA-5002 Report of Contact or in the claim(s) folder.
Resume normal case processing if the beneficiary (or recipient) is located at any point of development.
If the evidence in the claim(s) folder is not sufficient to support a fully favorable determination, the PH examiner will follow instructions in DI 29025.001.
Do not return the case to the FO as a ND. Forward all adverse PH determinations to the DHU for a disability hearing.
When a WU issue arises at the DHU level, the disability hearing officer (DHO) is required to follow instructions in DI 33015.033.
When a WU issue arises at the PH level and is not resolved before the case is sent to the DHU, the DHO is not required to duplicate attempts of the following actions:
Development not requiring the beneficiary's (or recipient's) cooperation if the case file documents that development was completed at the PH level.
Requesting FO assistance to locate the beneficiary (or recipient) if the case file documents the request was completed at the PH level.
The DHO must follow all other instructions in DI 33015.033, even if completed at the PH level.