Identification Number:
QR 04440 TN 10
Intended Audience:OQR
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Det
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part QR – Quality Review

Chapter 044 – Quality Appraisal

Subchapter 40 – Federal Quality Review of Disability Det

Transmittal No. 10, 07/23/2025

Originating Component

OQR

Effective Date

Upon Receipt

Background

Quality Review is moving materials from Part GN Chapter 044 to the appropriate Part QR new Chapter 044. This new section is part of a conversion series of Quality Review GN sections to the new QR Chapter 044.

Summary of Changes

QR 04440.231 Substantive Technical Corrective Actions (TCAs)

We copied GN 04440.231 to establish QR 04440.231.

QR 04440.231 Substantive Technical Corrective Actions (TCAs)

A. Substantive TCA definitions

A substantive TCA changes some element of the determination or has the potential to change some element of the determination, and it is not classified as a group I or group II deficiency. 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

A group I or group II deficiency 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 TCAs regardless of whether the group I or group II definitions covers the incorrect action.

See GN 04440.232, GN 04440.203, and GN 04440.204 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 must:

  • notify the adjudicating component of the needed correction via Request for Case Action or Request for Corrective 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, and

  • prepare a Request for Case Action or Request for Corrective Action, explaining the reason for the regulation basis code change.

EXCEPTION: If the incorrect regulation basis code is due to an obvious typographical or data entry 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: Create a Request for Case Action when citing TCAs per GN 04440.505 or a Request for Corrective Action per GN 04440.501.

For information regarding group I and group II deficiencies, see GN 04440.202, GN 04440.203, and GN 04440.204. For additional information regarding TCAs, see GN 04440.230.



QR 04440 TN 10 - Federal Quality Review of Disability Det - 7/23/2025