Identification Number:
GN 04440 TN 76
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Determinations
Type:POMS Transmittals
Program:Title II (RSI),Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 40 – Federal Quality Review of Disability Determinations
Transmittal No. 76, 10/09/2019

Audience

PSC: DE, DEC;
OCO-OEIO: FDE;
DQB: DE, PL;
OCO-ODO: DE, DEC, DS, RECONE;

Originating Component

OQR

Effective Date

Upon Receipt

Background

The Office of Quality Review (OQR) is making editorial changes and completing updates throughout the quality review sections of the POMS to improve readability, add clarity, and ensure conformance with Plain Language Guidelines. Additionally, we are taking out any references to processing of paper cases as OQR no longer reviews paper cases.

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

GN 04440.150 Processing Correct Disability Cases

The title of this POMS section was revised to Processing Correct Or Corrected Disability Cases. This title more accurately reflects the content of this subchapter.

We removed all sections related to the processing of paper cases since OQR no longer reviews paper cases.

We made editorial changes throughout to improve readability, add clarity and ensure conformance with Plain Language Guidelines.

GN 04440.150 Processing Correct Or Corrected Disability Cases

A. Definition of correct or corrected cases

Correct or corrected cases are:

  • Cases with no deficiencies or no technical corrective actions (TCAs)

  • Cases with deficiencies or TCAs corrected by the review component

  • Cases with TCAs adjudicated by the review component after assuming jurisdiction

  • Cases with either deficiencies or TCAs corrected by the adjudicating component (i.e. return workload units)

B. Procedure for processing correct or corrected disability cases

1. Processing initial or reconsideration cases

For initial and reconsideration cases, the review component will:

  • Input review results, including results of deficiency returns, into the OQR case processing system.

  • Use the FO Alert functionality in the OQR case processing system at clearance to notify the FO of the alert or action needed, if applicable.

  • Revise the SSA-831-U3 (Disability Determination and Transmittal), if applicable.

  • Upload the revised SSA-831-U3 (Disability Determination and Transmittal), if applicable.

  • Effectuate the determination, if applicable.

  • Date and release the notice to the appropriate claimant or appointed representative, if applicable.

NOTE: Do not effectuate reopenings. The review component will complete the FO Alert screen in the OQR case processing system, notifying the FO of any change in onset or filing date and of the need to effectuate the determination.

2. Processing continuing disability review (CDR) cases

For CDR cases, the review component will:

  • Input review results, including results of deficiency returns, into the OQR case processing system.

  • Use the FO Alert functionality in the OQR case processing system at clearance to notify the FO of the alert or action needed, if applicable.

  • Revise the SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal), or SSA-833-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal), if applicable.

  • Upload the revised SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal), or SSA-833-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal), if applicable.

  • The review component should effectuate title II cessations with the exception of potential 301 cases, recon CDRs, expedited reinstatements and title XVI cessations.

  • For the title II exceptions and title XVI cessations, complete the FO Alert screen in the OQR case processing system to inform the FO that the determination is a cessation, and effectuation is necessary.

  • Date and release the notice to the appropriate claimant or appointed representative, if applicable.

  • Route the folder to the appropriate component per instructions in DI 81020.250B.

NOTE: The Office of Disability Operations or the Program Service Center will release the notice for Title II work activity medical continuances in work incentive cases and reconsideration reversal notices.


GN 04440 TN 76 - Federal Quality Review of Disability Determinations - 10/09/2019