The name of the person who creates the SSA-1774-U5 form will propagate in the "REVIEWER" field at the bottom left of the SSA-1774-U5.
If the primary basis of the deficiency involves a medical, psychological, or psychiatric issue, you must manually enter at least one name in the "MEDICAL REVIEWER" field located under the "REVIEWER" field on the SSA-1774-U5.
If the primary basis of the deficiency does not involve a medical, psychological, or psychiatric issue, the "MEDICAL REVIEWER" field may be left blank.
The approving official must manually enter information in the "OFFICE", "APPROVED", and "DATE" fields. The “DATE” fields include those located at the top and bottom right of the SSA-1774-U5 and must coincide with the date the case returns to the adjudicating component.