Identification Number:
DI 25205 TN 5
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Evidence of Disability in Childhood Disability Cases
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 
DELAYED IMPLEMENTATION TRANSMITTAL (DIT)
DIT's ARE FOR FUTURE IMPLEMENTATION AND DISPLAYED
FOR INFORMATIONAL AND TRAINING PURPOSES ONLY

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 252 – Title XVI Child Claims Based on Disability
Subchapter 05 – Evidence of Disability in Childhood Disability Cases
Transmittal No. 5, 09/24/2019

Audience

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

Originating Component

ODP

Effective Date

11/04/2019

Background

Children under age 18 who file for Title XVI payments as a disabled child are not in a position to pursue their claims independently. To protect their interests, we require special efforts to identify another responsible adult or agency to assist the child when the applicant does not provide the information or action required to pursue the claims.

Summary of Changes

DI 25205.020 Failure to Cooperate and Insufficient Evidence in Title XVI Disabled Child (DC) Cases

We rewrote the instructions in this section to simplify and clarify instructions for adjudicators when an applicant for a child does not provide the information or action necessary to pursue the claim. We also clarified the policy on who not to contact for assistance. The revisions are consistent with the development procedures and documentation requirements for all cases involving failure to cooperate.

DI 25205.020 Failure to Cooperate and Insufficient Evidence in Title XVI Disabled Child (DC) Cases

In general, we follow the same policies and procedures for failure to cooperate and insufficient evidence for Title XVI child cases that we use for adult cases. However, we require certain special efforts and modifications, described in this section. These instructions supplement those in DI 22510.016, DI 22510.019, and DI 23007.000.

A. Policy on failure to cooperate (FTC) and insufficient evidence in Title XVI DC cases

A claimant who is a child is not ordinarily in a position to pursue his or her claim independently. Therefore, we will make special efforts to assist the child in pursuing his or her claim.

The applicant filing on behalf of the child, or the adult responsible for a child recipient, is responsible for cooperating in providing the evidence we need to make a determination. If the applicant does not cooperate in providing requested evidence or actions, we will make reasonable efforts to identify and involve another adult or agency responsible for the child's care to assist the child.

Reasonable efforts to identify another adult or agency responsible for the child's care are outlined in DI 25205.020A below. See DI 23007.010B for the methods of contact you may use to identify the adult or agency.

If you have identified another adult or agency responsible for the child's care, follow DI 23007.010C for making reasonable efforts to involve the adult or agency.

1. When to contact another responsible party or agency

If the applicant is not providing the required information or cooperation, always attempt to obtain the assistance of another responsible adult or agency.

2. Which responsible party to contact when FTC occurs

a. Appointed representative

See DI 22501.002B3 for case development responsibilities when there is an appointed representative. If the appointed representative requested the DDS to communicate directly with the applicant and there is FTC, contact the appointed representative to request assistance.

b. Designated third party contact in the file

Contact the person or agency designated by the applicant or the representative payee. The designated person or agency is usually identified in:

c. Designated third party contact not in file

Review the evidence in file to identify another responsible adult or agency who is most likely to assist in pursuing the claim. Make a reasonable judgment, based on the information in file or provided by the applicant, to determine if there is another responsible party who can help the child pursue the claim.

  • Child welfare or other agency has legal custody of the child:

If the applicant is not cooperating, contact the agency with legal custody to request the needed information or assistance. An agency with legal custody is responsible for providing the information we need, even if the applicant is someone else (for example, a foster parent with physical custody).

NOTE: Information about a legal guardian is in Section 2A of the SSA-3820 or the Case Information screen on the Case Data tab in eView.

  • Child resides with the uncooperative applicant and another parent, relative, or adult:

Consider contacting another adult in the household.

  • Child resides with someone other than the applicant:

Consider contacting the person with whom the child is residing if the applicant is not cooperating. For example, the child's mother is the applicant but the child resides with the grandmother. Consider contacting the grandmother to assist the child in pursuing the claim.

  • Child regularly cared for in another household:

If the child is frequently in the care of a relative who does not live in the same household, consider asking that person to assist the child.

NOTE: If the field office (FO) has not identified a third-party contact, the DDS is only required to contact an identified legal guardian. Although they must consider contacting other third parties, they may determine that further contact is not appropriate based on the facts of the case.

3. Who not to contact for assistance

It is not always appropriate to request assistance from a third party that you identify in the file. There are often liability issues for third parties, such as teachers or day care providers. There can also be potential issues involving relationships among family members. Specifically, DO NOT:

  • Request assistance from a noncustodial parent unless the applicant or representative payee has named the person;

  • Request assistance from a third party identified in a prior claim or continuing disability review (CDR) unless the applicant or representative payee has identified the person in the current action;

  • Request assistance from a day care provider unless the provider has a familial relationship with the child or is identified by the applicant or representative payee; or

  • Ask school professionals to take the child to a consultative examination or complete the child function report (forms SSA-3375-BK through SSA-3379-BK).

B. Procedure for handling FTC in title XVI DC cases

1. Contacting the applicant for evidence or action

Follow the procedures in DI 22505.014 for initial requests for evidence or action, DI 22505.014 follow-up requests, and DI 22510.017 and DI 22510.019 for consultative examination (CE) notice and confirmation procedures.

Do not ask the applicant for another responsible adult or agency who can help if the FO has already done so. Assume that the FO asked the applicant to provide the name of another person if the appropriate section of the disability report form (see DI 25205.020A2b) is completed, even if the question is answered "No."

If the appropriate section of the disability report form was not completed by the FO and you contact the applicant, ask whether there is another adult who helps care for the child and might be willing to help obtain additional information, if necessary. It is not necessary to ask the applicant for another responsible adult who can help if the FO has already done so.

2. When there is FTC by the applicant

Follow the special handling procedures in DI 23007.005 and DI 23007.010 for contacting a third party and following up with third party contacts, as supplemented by the procedures in DI 25205.020B.

3. Applicant appears unable to pursue the claim

If it appears that the applicant does not understand what is required or is otherwise unwilling to cooperate, contact the applicant to explain the information needed. If this is unsuccessful, consider contact with another responsible adult or agency.

If an applicant is not able to adequately pursue a child's claim and the child's claim is allowed, alert the FO of a potential payee issue.

4. Good cause exception

Determine whether there is a good reason for the FTC. See DI 23007.001B.

5. Third party unavailable or unwilling to assist the child

Document the file with all efforts to involve a third party, including date and time of contacts, names of contacts, and information conveyed. For information on documenting reasonable effort to obtain third party assistance, see DI 23007.005.

6. Documenting contacts with a third party

Follow the procedures in DI 23007.005C for documenting the third party contacts.

7. Completing case development when an applicant does not cooperate sufficiently

Follow the procedures in DI 23007.015B for completing case development.

8. Making a determination based on the evidence in file

Follow the procedures in DI 23007.015 for making a determination based on the evidence in file.

C. References

DI 22505.014 Requesting Evidence or Action from the Claimant or a Responsible Party

DI 22510.016 Consultative Examination (CE) Appointment and Special Scheduling Procedures

DI 22510.019 Consultative Examination (CE) Appointment Notice Follow-up and Reminder

DI 23007.001 Failure to Cooperate and Insufficient Evidence - Definitions

DI 23007.005 Contacting the Claimant, Applicant, Appointed Representative, or Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence

DI 23007.010 Reasonable Effort to Identify and Involve a Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence

DI 23007.015 Making a Determination Based on the Evidence in the File

 



DI 25205 TN 5 - Evidence of Disability in Childhood Disability Cases - 11/04/2019