Identification Number:
DI 11005 TN 70
Intended Audience:See Transmittal Sheet
Originating Office:ORDP
Title:Disability Interviews
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 110 – Initial Claims Processing
Subchapter 05 – Disability Interviews
Transmittal No. 70, 09/27/2021

Audience

PSC: CA, CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, ERE, FCR, FDE, FDEC, RECONE, RECONR, RECOVR;
FO/WSU/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OCO-ODO: BET, BTE, CR, CST, CTE, CTE TE, DE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: REF;

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Policy (ODP) is updating this POMS section to clarify the Field Office (FO) instructions for documenting prior claims. We are also updating the FO responsibilities for requesting prior paper folders.

Summary of Changes

DI 11005.085 Prior Claims Activity

We revised the content to improve usability throughout, such as using bullet lists, removing duplicative information, and adding cross-references to applicable policy.

In DI 11005.085B.1., we updated the list of sources where the FO may obtain prior folder information.

In DI 11005.085B.3., we updated the list of situations when the FO will request a prior paper folder.

In DI 11005.085B.5., we removed duplicative instructions. In addition, we relocated instructions for documenting the prior folder request to DI 11005.085B.7. and for transferring the new claim to Disability Determination Services (DDS) to DI 11005.085B.8.

In DI 11005.085B.6., we combined duplicative instructions.

 

DI 11005.085 Prior Claims Activity

A. Field Office (FO) responsibilities for prior claims

When a claimant files a new disability claim, the FO must determine whether the claimant has previously filed for disability benefits or payments administered by the Social Security Administration. The FO lists the prior filings with a medical determination or decision, or substantial gainful activity (SGA) denial, on the SSA-3367 (Disability Report - Field Office). The Disability Determination Services (DDS) does not need information on technical denials (e.g., N13, N04, N18, 090) unless there was a medical determination associated with the technical denial. For more information on documenting prior filings on the SSA-3367 (Disability Report - Field Office), see DI 11005.045A.3.

NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001.

B. FO procedures for prior claims

1. Identifying prior claims

The FO asks about prior filings early in the interview. The FO may obtain information from the following sources, as appropriate:

  • Master Beneficiary Record (MBR) query.

  • Processing Center Action Control System (PCACS) query.

  • Supplemental Security Income Display (SSID) query.

  • Case Processing and Management System (CPMS) query.

  • Disability Determination Services Query (DDSQ).

  • eView.

  • A printout of the pre-interview screen showing no prior claims activity.

2. Documenting the current folder

The FO completes item 7 on the SSA-3367 (Disability Report - Field Office) as outlined in DI 11005.045A.3 to document the prior filings. For more information on completing the SSA-3367 using the Electronic Disability Collect System (EDCS), see DI 81010.025A.2.

3. When to request and associate a prior paper folder(s)

When a prior folder is a certified electronic folder (CEF), the official folder is electronic and all of the evidence is available in eView. For information on determining if the prior folder is a CEF, see DI 81001.015. For more information on the types of folders, see DI 81001.005C.

When a claimant files a new claim, the FO must request the prior folder(s) if the official folder is paper in the following situations:

  1. a. 

    A prior folder(s) includes a medical determination or decision and is located in any FO.

  2. b. 

    An acquiescence ruling (AR) requires the DDS to consider the prior Administrative Law Judge (ALJ) or Appeals Council (AC) findings when making a determination.

  3. c. 

    Collateral estoppel potentially applies (see DI 11011.001).

  4. d. 

    Res judicata potentially applies (see DI 27516.001).

  5. e. 

    A prior allowance exists and benefits were terminated for medical or nonmedical reasons, such as incarceration, excess income or resources, failure to cooperate, etc.

  6. f. 

    A prior denial exists and the potential onset date (POD) in the new claim is within the prior period adjudicated.

  7. g. 

    Evidence indicates fraud or similar fault may be involved in the new or prior claims (see DI 11006.010).

  8. h. 

    A prior folder(s) is needed for any other reason, such as a special project.

4. How to locate a prior paper folder(s)

The FO locates the prior folder(s) by using:

Title II

Title XVI

  • Obtain queries, beginning with a PCACS query.

  • If PCACS indicates not in file (NIF), obtain a Full Master Beneficiary Record (FACT), DDSQ, and CPMS query.

  • If the prior folder still cannot be located, unarchive the prior Modernized Claims System (MCS) record and check the development worksheet (DW01) and Remarks for clues.

NOTE: If the prior folder contains a Title II denial over 5 years old and PCACS is NIF, the prior folder most likely has been destroyed.

  • Obtain queries, beginning with a SSID query.

  • If the prior folder cannot be located, obtain a DDSQ and CPMS query.

  • If the prior folder still cannot be located, unarchive the prior Modernized Supplemental Security Income Claims System (MSSICS) record and check the DW01 and Remarks for clues.

NOTE: Location codes: L47=Destroyed; L50=Lost; L51=Lost; J00=Lost.

5. How to find the contact information for the location code

The FO uses the Detailed Office/Organization Resource System (DOORS) to find the contact information for the location code, such as the telephone number, fax number, email address, etc.

6. How to request a prior paper folder(s)

IF

THEN

AND

AND

Title II folder is reading in PC7 - Office of Disability Operations (ODO) or Program Service Center (PSC).

Request the folder via PCACS Folder Request (see MS 04909.011).

The system generates an automatic follow-up after 14 days.

If no movement after 30 days, call or email the module (MOD) in ODO or PSC.

NOTE: The FO uses DOORS to find the contact information for the MOD.

Title XVI folder is reading in L00, L86, L88, L89, L94, L95, L96, L97, L98, L99, L01, etc.

Request the folder via SSA-8028 AR33 (see SM 01201.210).

If the folder is not received after 60 days, see SM 01201.235.

Title II or Title XVI folder is reading in a FO.

If the folder is located at another FO, the FO with the new claim will request the folder via telephone, fax, or email and ask that it be routed directly to the DDS.

NOTE: When contacting the FO to search for a prior folder(s), request a search using the claimant's current name. Reference all prior names used by the claimant because the folder may be stored under a different name.

If no reply in 7 days, make a second request.

If no reply in 14 days, make a third request to the FO manager.

Title II or Title XVI folder is reading in Docket & Files (5012), SSA National Records Center (N88 or N93) or Appeals Council (5801-5824).

Do not request the folder.

7. Documenting the paper folder requests in the current folder

The FO completes Item 7 on the SSA-3367 (Disability Report - Field Office) as outlined in DI 11005.045A.3 to document the prior folder request. For more information on completing the SSA-3367 using EDCS, see DI 81010.025A.2.

The FO must document request efforts and all responses (positive or negative) when trying to obtain the paper folder(s). No response is the same as a negative response. If the search is unsuccessful, the FO documents all locations searched, responses from these locations, and a summary of the efforts on a SSA-5002 (Report of Contact). This documentation must be available to the DDS in the current folder.

8. Transferring the new claim and the prior paper folder(s) to DDS

The FO documents the prior folder request as outlined in DI 11005.085B.7 in this section and will not delay transfer of the new claim to DDS while waiting for the prior folder(s). PCACS (for Title II claims) and the automated recall process (for Title XVI claims) send the prior folder(s) to the requesting office. The FO will forward the prior folder(s) to the DDS upon receipt. The FO will document on the SSA-408 (Route Slip) to associate the prior paper folder with the new claim.


DI 11005 TN 70 - Disability Interviews - 9/27/2021