If a Failure to Cooperate (FTC)/SGA/technical denial is affirmed, process the unfavorable reconsideration decision through MCS;

If a FTC/SGA/technical appeal denial is reversed, do NOT establish a reconsideration segment on MCS. Instead, document the special determination and send the interim notice described in Processing a Reconsideration Request of an Initial Denial Based on Non-medical Issues - DI 12005.010 in the reestablished MCS claim per Processing Reconsideration Request of FO Determinations - DI 81010.145B.2.

The previously denied initial disability claim has to be reestablished on MCS. Create a new segment on MCS, using the original application/protective filing date, before sending the claim to DDS for a disability determination. The application receipt date is the date the FO received the request for reconsideration or implied request for reconsideration. The material file date (MFD) should be the same as the application receipt date. Enter the FDC of C on the DECI screen for (MI) purposes. The FDC code of C will exclude the time, from the original application date through the new application receipt date on the new DW01, from FO1 time. However, the time will not be excluded from the mean overall time on the case.

Open an appeal event to record the appeal information, and complete these screens with the following information:

• •

  ACAD - Enter an appeal level of RECONSIDERATION.

• •

  AISS Choose the appropriate appeal issue. For an N18 denial, enter an appeal issue of OTHER, and type in N18 next to EXPLAIN.

• •

  AJAS Leave the APPEAL STATUS as 1' PENDING IN APPEAL CONTROLLING OFFICE.

• •

  Consolidated Claims Experience (CCE) Development Worksheet - Enter a receipt date for the RECON REQ issue.

• •

  AJAS - After receipting in the RECON REQ issue on the CCE Development Worksheet, complete the APPEAL STATUS with '5' - DECISION EFFECTUATED.

• •

  ADIS - Enter DECISION TYPE as '1' - FULLY FAVORABLE, and enter the date of the interim notice in FULLY OR PARTIALLY FAVORABLE EFFECTUATION NOTICE DATE.

• •

  Build the SSR. The establishment of the APPE segment on the denied SSR will provide work credit for processing the SSI reconsideration, and the presence of the EFT date will prevent the appeal from pending on the WMI Appeals List.

Input a MANUAL CLEARANCE (2/12) to the denied record.

REMINDER: Day two will be Tuesday after a weekend, or the second workday after a holiday.)

Establish a new claim in MSSICS using the same application date. You may propagate the information from the MSSICS pending file that you just MANCLRd. Be sure to annotate REOPENED PRIOR CLAIM on CMSC to exclude the record from statistics. When you build the SSR, MSSICS will terminate the denied record and establish a new SSR in PSY:H80, unless you do full development and adjudicate the claim to pay.

By following the steps shown above, you will establish a new claim that will be controlled on the SSI WMI I/C PENDING list, and in the event the claim is allowed, most notices will be automated by the system. Your office will also receive work credit for an SSI RECONSIDERATION when you build the APPE segment to the prior SSR.

To process the eCDR reconsideration, EDCS users must open EDCS and establish a record.

IMPORTANT: When the CDR is a Title XVI only or concurrent, before initiating the eCDR appeal in EDCS, the user must use Modernized Supplemental Security Income Claim System (MSSICS) to update the SSR to document the filing of the medical cessation appeal as well as the statutory benefit continuation (SBC) election. If Direct SSR update is required, the FO can manually enter the required fields in EDCS on the CDR Information and Claims Information pages.

To create an eCDR appeal:

1. a. 

   Select CDR Reconsideration from the Select Case Level screen;

2. b. 

   Select OK button;

3. c. 

   Enter the appeal filing date on the confirm Case Creation screen, if not propagated;

4. d. 

   Select Create Case button;

5. e. 

   If the case information did not propagate from MSSICCS, key in the CDR information, the SSA-3367 (Disability Report-Field Office), and the SSA- 3441 (Disability Report-Appeal) data in EDCS on the Form(s) Selection screen; and

   NOTE: 

   The Copy from Prior button in EDCS will be enabled if information is available to copy from prior level(s). For example, if the SSA-3368 for Age 18 Redetermination is completed in EDCS, the EDCS user will have the ability to Copy from Prior (form 3368) when completing the SSA-3441 for an Age 18 Redetermination reconsideration or hearing level appeal.

6. f. 

   Enter appropriate limited data similar to the eCDR Initial CDR including:

   • •

     the Social Security Number (SSN);

   • •

     claim type;

   • •

     name;

   • •

     address;

   • •

     SBC information,

   • •

     attorney representative name and address; and

   • •

     representative payee name and address.

   REMINDER: The FO must verify and update the appropriate address, telephone number, and representative information on the mainframe before transferring the reconsideration in EDCS.

7. g. 

   Reminders for the eCDR reconsideration include:

   • •

     Process the CDR appeal in EDCS, if the CDR being appealed was processed in EDCS;

   • •

     If Title XVI only or concurrent eCDR, complete MSSICCS prior to creating case in EDCS;

   • •

     Select and key in SSA-3441 data;

   • •

     Obtain an SSA-789 (Request for Reconsideration-Disability Cessation) and the appropriate number of SSA-827s (Authorization to Disclose Information to the Social Security Administration) from the individual, per regional instructions. Also obtain a SSA-3881 (Questionnaire for Children Claiming SSI Benefits) for SSI childhood disability claims;

   • •

     Fax paper documentation into the Certified Electronic Folder (CEF), and then dispose of the form per instructions in DI 81010.135;

   • •

     Add a valid (electronic or hardcopy) SSA-827 to the CEF; and

   • •

     Fax any development regarding SBC (for example, Report of Contact, SSA-792 (Statutory Benefit Continuation Election Statement), and any other documentation) into section E of the electronic folder DI 12027.001. Dispose of the development per DI 81010.135.

When transferring the eCDR reconsideration, the FO must:

• •

  Review the case and resolve any edits;

• •

  Select the Transfer/Updates tab in EDCS;

• •

  Answer the paper folder indicator (PFI) question (Note: if an electronic CPD is linked to the eCDR, the PFI will default to No);

• •

  Ensure Title II SBC fields are completed;

• •

  Transfer all parts of an eCDR, concurrent or multiple entitlements at the same time; and

• •

  Mail all paper folder(s) and paper documents not stored electronically,associated with the case to the DDS at the time of electronic transfer.

  NOTE 1: 

  The Disability Control File (DCF) CDRI screen automatically records the appeal(s) on the DCF after EDCS transfer. See MSOM CDR 001.025, for more information on transferring the eCDR reconsideration.

  NOTE 2: 

  The EDCS automatic updates to the DCF are for appeal cases only. The FO must still add initial CDR case movement to the DCF manually or through the Workload Action Center (WAC).

If a paper CPD folder exists:

• •

  Place any paper SSA-827s, SSA-3881 if appropriate, and any other relevant documents submitted by the beneficiary in the paper folder, and

• •

  Attach an EDCS routing form to the top of the folder and sends the folder to the DDS.

If the CPD folder is electronic, add all forms and documentation to the electronic file and transfer to the DDS.

The DDS or Disability Hearings Unit (DHU) returns both favorable and unfavorable determinations on all eCDR reconsiderations to the FO.

Upon receipt of a medical cessation determination from the DDS, take the following appropriate actions.

Title II only cases:

• •

  Review the MBR to ensure the applicable information received from EDCS and the DCF updated automatically;

• •

  Verify SBC termination, if applicable; and

• •

  Ensure the MBR is updated within 5 days. If the MBR does not update in 5 days, technicians should proceed with manual action to update the MBR. For potential manual actions, seeDI 12026.025B .

Title XVI and Concurrent cases:

• •

  Review both the SSID and MBR to ensure medical cessation appeal determination automatically posted;

• •

  Verify the SBC benefits have ended for BOTH titled programs; and

• •

  Ensure both the MBR and SSID are updated within 5 days. If the MBR and or SSID do not update in 5 days, technicians should proceed with manual actions to update the MBR and/or SSID. For potential manual actions, see DI 12026.025B .

Process eCDR hearings in EDCS and view them in eView.

IMPORTANT: When the CDR is a Title XVI only or concurrent, before initiating the eCDR appeal in EDCS, the CS must use MSSICS to update the SSID to document the filing of the medical cessation appeal as well as the SBC election, if applicable. If Direct SSR update is required, the FO can manually enter the required fields in EDCS on the CDR Information and Claims Information pages.

To process the eCDR hearing, EDCS users must open EDCS and establish a record by completing the following actions:

• •

  Select CDR Hearing from the Select Case Level screen;

• •

  Select OK button;

• •

  Enter the appeal filing date on the Confirm Case Creation screen, if it did not propagate from MSSICCS;

• •

  Select Create Case button;

  Key in the CDR information, the SSA-3367 (Disability Report-Field Office), and the SSA-3441 (Disability Report-Appeal) data in EDCS on the Form(s) Selection screen;

  NOTE: The Copy from Prior button in EDCS will be enabled if information is available to copy from prior level(s). For more information see Creating Electronic Disability Collect System (EDCS) Cases - DI 81010.020E.1.

• •

  Enter the reason for the appeal and limited data similar to the eCDR Initial CDR including:

1. a. 

   the SSN,

2. b. 

   claim type,

3. c. 

   name,

4. d. 

   address,

5. e. 

   statutory benefit continuation (SBC) information

6. f. 

   attorney representative name and address, and

7. g. 

   representative payee name and address;

REMINDER: Verify and update the appropriate address, telephone number, and representative information on the mainframe before transferring the hearing in EDCS.

• •

  Obtain a paper HA-501 (Request for Hearing by Administrative Law Judge) or written statement signed by the claimant and one SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)). Also obtain an SSA-3881 (Questionnaire for Children Claiming SSI Benefits) for SSI childhood disability claims. NOTE: Do not delay sending the eCDR hearing to the HO to obtain an SSA-3881 or an SSA-827;

• •

  Fax the front and back of the HA-501 or written statement signed by the claimant into the CEF, then dispose of the form per instructions in Storing Non-Medical Evidence in the Certified Electronic Folder DI 81010.135;

  NOTE: For SSI only appeals recorded in MSSICS, the FO may print the appeal request from MSSICS and fax a copy into the CEF. If one is provided, fax the SSA-827 to the CEF. For more detailed information about SSA-827 requirements for a hearing request, see Field Office Instructions for Obtaining Form SSA-827 - DI 11005.057.

• •

  Fax a good cause for late filing statement signed by the claimant into the CEF when appropriate;

• •

  Fax medical evidence submitted by the individual with the eCDR hearing request into the CEF per Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes DI 81010.090;

• •

  Fax any development regarding Statutory Benefit Continuation (SBC) (for example, Report of Contact, SSA-792, and any other documentation per Statutory Benefit Continuation (SBC) DI 12027.001 into the CEF. Dispose of the development per Storing Non-Medical Evidence in the Certified Electronic Folder DI 81010.135; and

• •

  Mail other forms (SSA-3881 and, SSA-821 (Work Activity Report-Employee), etc.) provided for the eCDR hearing to the HO. The HO scans the document into the CEF or sends the document to the contract scanner.

When transferring the eCDR request for hearing, the FO must:

• •

  Review the claim to resolve any edits;

• •

  Select the Transfer/Updates tab in EDCS;

• •

  Answer the paper folder indicator (PFI) question (NOTE: if an electronic CPD is linked to the eCDR, the PFI will default to No);

• •

  Ensure Title II Statutory Benefit Continuation (SBC) fields are completed

• •

  Transfer all parts of an eCDR, concurrent or multiple entitlements at the same time.

• •

  Mail all paper folder(s) associated with the case to the hearing office at the time of electronic transfer

  NOTE 1: The DCF CDRI screen automatically records the appeal(s) on the DCF after EDCS transfer. For more information on transferring the eCDR reconsideration, see MSOM CDR 001.025.

  NOTE 2: The EDCS automatic updates to the DCF are for appeal cases only, the FO must still add initial CDR case movement manually or through WAC

The EDCS routing form generates at the point of transfer if a paper folder is involved. (The CR has the option to print or cancel print of the routing form.)

If a paper CPD folder was used to make the cessation determination:

• •

  Place the SSA-827 and any other relevant documents including medical evidence submitted by the individual in the paper folder;

• •

  Print and attach an EDCS routing form to the top of the folder; and

• •

  Send the folder to the HO.

If the CPD folder is a CEF, attach the EDCS routing form to t any other relevant documents including medical evidence submitted by the individual and mail them to the HO.

Do not print an EDCS routing form if there are no paper documents or forms (for example, SSA-827s, SSA-792s, etc.) being sent. For more information on routing SSA-827s, see Field Office Instructions for Obtaining Form SSA-827 DI 11005.057.

When the FO receives an alert on the EDCS Claims Actions page notifying them of the HO decision on an eCDR appeal:

Title II only cases:

• •

  Review the MBR to ensure the applicable information received from EDCS and the DCF updated automatically.

• •

  No Post-entitlement Online System (POS) action is required.

• •

  Verify SBC termination, if applicable.

• •

  Ensure the MBR is updated within 5 days. If the MBR does not update in 5 days, technicians should proceed with manual action to update the MBR.

Title XVI and Concurrent cases:

• •

  Review both the SSID and MBR to ensure medical cessation appeal determination automatically posted;

• •

  Verify the SBC benefits have ended for BOTH titled programs

• •

  No POS action is required for the Title II claim.

• •

  Ensure both the MBR and SSID are updated within 5 days. If the MBR and or SSID do not update in 3-5 days, technicians should proceed with manual actions to update the MBR and or SSID.