Identification Number:
DI 30005 TN 38
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Adjudicating Component Actions on Deficient Cases
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 300 – Quality Assurance
Subchapter 05 – Adjudicating Component Actions on Deficient Cases
Transmittal No. 38, 07/17/2020

Audience

PSC: DE, DEC;
OCO-OEIO: CR, FDE, RECONE;
DQB: DE, PL;
OCO-ODO: DC, DE, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

OQR

Effective Date

Upon Receipt

Background

We are making changes to the references in this POMS as they have changed.

 

Summary of Changes

DI 30005.231 Substantive Technical Corrective Action (TCA)

The references at the end of section B3 have been changed to reflect publication of revised sections DI 30005.202 through DI 30005.204.

DI 30005.231 Substantive Technical Corrective Action (TCA)

A. Substantive TCA definitions

A substantive Technical Corrective Action (TCA) alters some element related to the conclusion in a case. The two types of substantive TCAs are discussed below.

1. Regulation basis code TCAs

A regulation basis code TCA, also known as a decision basis code TCA, occurs when the adjudicating component completes the regulation basis code incorrectly on either the:

  • SSA-831-C3/U3 (Disability Determination and Transmittal---Item 22, Regulation Basis Code),

  • SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI---Item 11 or 12, “Reason For Continuance” or “Reason For Cessation), or

  • SSA-833-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II---Item 11 or 12, “Reason For Continuance” or “Reason For Cessation".

2. Group I or group II deficiencies in a non-sample case

Group I or group II deficiencies in a non-sample case (e.g., the non-sample claim in a concurrent title II/title XVI claim selected for the quality assurance sample) are considered a TCA.

See GN 04440.945 through GN 04440.946 for definitions of group I and group II deficiencies.

B. Correcting Substantive TCAs

Substantive TCAs are either corrected by the review component or returned to the adjudicating component for correction. The sections below explain the procedures for correcting substantive TCAs.

1. Regulation basis code TCA occurs in adverse reopenings, cessations or reconsiderations of adverse reopenings or cessations

The review component will:

  • notify the adjudicating component of the needed correction, via an SSA-847-U3, SSA Request for Case Action, and

  • return the case to the adjudicating component for correction.

2. Regulation basis code TCA occurs in all other types of cases

The review component will:

  • assume jurisdiction and prepare an amended determination.

  • prepare a new notice and rationale, if necessary.

  • enter the statement “SSA jurisdiction exercised. This amends the unapproved adjudicating component determination of MM/DD/YY”, in item 34 of the SSA-831 for initial or reconsideration claims.

  • enter the statement “SSA jurisdiction exercised. This amends the unapproved adjudicating component determination of MM/DD/YY", on the SSA-832 or SSA-833 for CDR claims.

  • prepare an SSA-847-U3, SSA Request For Case Action, explaining the reason for the regulation basis code change.

EXCEPTION: If the incorrect regulation basis code is due to an obvious typographical error, the review component may correct the regulation basis code entry on the determination form without assuming jurisdiction.

3. Group I and II deficiencies identified in a non-sample case

If the incorrect action occurs in a non-sample claim and the group I or group II deficiency or TCA definitions cover the incorrect action, the review component follows the corrective action procedures indicated for that deficiency or TCA.

NOTE: 

If an SSA-1774-U5 (Request For Corrective Action) is required, it will be labeled "Informational Only" and the review component will not code a deficiency in the disability case processing system.

See DI 30005.201 through DI 30005.204 for information regarding group I and group II deficiencies and DI 30005.232 for additional information regarding TCAs.


DI 30005 TN 38 - Adjudicating Component Actions on Deficient Cases - 7/17/2020