Identification Number:
DI 81010 TN 32
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:FO Procedures - Electronic Process
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 810 – Electronic Disability Guide (eDG) Procedures for the Electronic Process
Subchapter 10 – FO Procedures - Electronic Process
Transmittal No. 32, 12/20/2019

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;
DQB: DE, PA, PE, TL;
OCO-ODO: BET, BTE, CR, CTE, CTE TEDE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECONR, RECOVR;
ODD-DDS: ADJ, DHU;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OHO/OAO: HQ;

Originating Component

ODP

Effective Date

Upon Receipt

Background

Office of Disability Policy (ODP) added new procedures for processing an electronic Comparison Point Decision (CPD) folder with an Expedited Reinstatement (EXR) paper folder, and for converting a CEF to a paper case. We also removed wording that wasn't useful to technicians. We added language as well as POMS references that would be useful to technicians. We rephrased some language to remove passive voice and instead use active voice.

Summary of Changes

DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations

In the overview, we removed old policy that said the Field Office (FO) should convert an electronic folder to paper and file the documents in a paper folder for a partially electronic case. We also added language to guide users where to go in this POMS section for procedures for the two scenarios in sections C and D.

In section A.1, we removed the first word "any" and replaced it with most since there are some MCS exclusions that can be established in EDCS utilizing the MCS Exclusion Information functionality.

In section A for the NOTE, we rephrased it to remove passive voice and instead use active voice. We also removed the last sentence below the note since it is not useful information to technicians.

In section A.2, we spelled out acronyms for the Social Security Administration (SSA) and the Disability Determination Services (DDS).

In section A.4, we removed information that is not useful to technicians. We added POMS references for paper procedures. We also added the POMS reference in this section that would be useful to technicians.

In section A.7, we replaced "statutorily" with "statutory" since it's the correct policy term. We also removed information that is not useful to technicians.

In section B, we removed an extra space in the first sentence between the last word in the sentence and the period.

In section C, in bullet number 3, we added form examples.

In section C, in bullet number 7, we reword it to provide clarity.

In section C, under the DDS instructions, in bullet number 2, we added form examples.

In section C, under the DDS instructions, in bullet number 3, we removed the word "determination" and replaced it with "case closure" to provide clarity, and we rephrased wording to remove passive voice and instead use active voice.

In section C, under the Hearing Office (HO) instructions, we removed redundant wording.

In section D, in the introduction, we spelled out Disability Insurance Benefits (DIB) and Childhood Disability Benefits (CDB).

In section D, in bullet number 1 for the NOTE, we removed the spelling of CDB since it was spelled earlier in the section. We made a correction to title "XVI" since it was misspelled.

In section D, in bullet number 4, we added the word "remark" to provide clarification.

We added section E. to introduce new steps for processing an electronic CPD with an EXR paper folder.

We added section F. to introduce new steps to converting a CEF to a paper case.

DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations

If any Electronic Disability Collect System (EDCS) exclusions are present for any claim associated with a case:

  • Establish a paper folder on the EDCS exclusion; and

  • Use EDCS to enter information on the non-exclusion claim, if applicable.

For details on distinguishing between claims, cases, and filings, see Electronic Disability (eDib) Glossary - DI 81001.010B.1.

If an individual has applied for benefits on multiple titles or Social Security Numbers (SSNs) and one or more of the claims is an EDCS exclusion, the Field Office (FO) must create a paper Modular Disability Folder (MDF) even though one of the claims is entered in EDCS. The paper folder then becomes the official folder. Refer to section C in this section for "Processing Multiple Claims When at Least one of the Claims is an EDCS Exclusion, and section D in this section "Processing an Initial Claim with a Continuing Disability Review" for specific FO, DDS, and OHO instructions for preparing and processing paper folders.

A. EDCS Exclusions

1. Modernized Claim Systems (MCS) Exclusions

Most claims that areMCS exclusions cannot be created in EDCS. For a listing of MCS exclusions, see MCS Exclusions - MSOM MCS 004.002.

NOTE: The FO can establish EDCS case for several types of stand-alone conversion actions that do not require applications utilizing the MCS Exclusion Information functionality. For more information on these type of cases, see DI 81010.020.

2. Federal Witness Protection Program and Changed-Identity Cases

Social Security Adminstration (SSA) has jurisdiction of any Title II or Title XVI disability claim filed by, or on behalf of, an individual who changed his or her identity under the guidance of the Department of Justice (e.g., witness protection program) or due to harassment (e.g., spousal abuse). The Disability Determination Services (DDS) does not have jurisdiction over “Witness Protection” or “Changed-Identity Cases.” Normally these cases are not filed in the FO. Due to their sensitive nature, never enter these cases into EDCS. You must complete a paper application and paper disability reports. For more information regarding Witness Protection Program and Changed-Identity Cases see DI 11055.115 Title XVI Changed-Identity Claims.

3. Celebrity Cases

For SSA purposes, a celebrity is defined as a person of extraordinary national prominence.

  • SSA systems will identify these cases and alert the interviewer if an exclusion applies.

  • FO employees must not make the decision to exclude a case based on celebrity status.

  • FO employees must complete paper disability reports in situations involving celebrities.

  • FO should follow normal case procedures.

4. Expedited Reinstatement (EXR) Cases

Although EDCS supports electronic continuing disability reviews (eCDRs), EXRs remain EDCS exclusions and must be processed as paper. For paper folder preparation procedures see DI 70005.001 and DI 70005.005. FO technician should not establish EXR cases as eCDRs. For instructions on processing EXR cases where the Comparison Point Decision (CPD) folder is a Certified Electronic Folder (CEF), refer to DI 81010.030E in this section.

5. Cases with Multiple Periods of Entitlement

EDCS does not support cases that involve multiple periods of entitlement.

6. End Stage Renal Disease (ESRD) Only Cases

Stand-alone claims for ESRD benefits are EDCS exclusions. Process ESRD cases in accordance with HI Based on End Stage Renal Disease - HI 00801.186 through Form SSA-892-U2 (ESRD Medical Determination) - HI 00801.308, and End-Stage Renal Disease (ESRD) Entitlement Provisions - DI 45001.001 through Medicare Disallowances - DI 45001.340.

For information on processing ESRD claims with a CEF, see Processing End Stage Renal Disease (ESRD) Cases - DI 81010.144.

7. Statutory Blind Determination Cases

During a work Continuing Disability Review (CDR), a beneficiary may allege having a visual impairment. These statutory blind determination cases are EDCS exclusions. Though these cases are processed as CDRs, the DDS must make an initial statutorily blind determination. For paper processing procedures, see DI 13010.135.

B. EDCS Limitations

Title II and Title XVI abbreviated applications (ABAPs) are two EDCS limitations. EDCS does not recognize them as valid claims and will not allow the FO to create a case.

The FO technician may initially establish an ABAP to process a technical denial. If the FO technician determines a technical denial is not appropriate, and the case will require a medical determination, the FO should follow the instructions below.

1. Title II

In order to create a case in EDCS for Title II claims with an ABAP:

  • Change or delete the abbreviated application coding on MCS; and

  • Process the claim as a full application.

Once the full claim is established:

  • The issue DDSDEC appears on the DW01; and

  • EDCS will allow case creation.

2. Title XVI

In order to create a case in EDCS for Title XVI claims with an ABAP, follow your office policy and either:

  • Change the ABAP to a full claim and enter the issue of “Application” on the Modernized Supplemental Security Income Claims System (MSSICS) DW01; or

  • Change the ABAP to a deferred claim and enter the issue of “DEFER APP” on the MSSICS DW01.

C. Processing Multiple Claims When At Least One of the Claims is an EDCS Exclusion

When multiple claims are filed at the same time and at least one of the claims is an EDCS exclusion, the official folder is paper. For partially electronic cases, the official folder is paper because there is no data in eView for the EDCS exclusion claim. Use EDCS to enter information on the non-exclusion claim(s), and file documentation that pertains solely to the excluded claim in the paper MDF. In eView, upload any documents that apply to both the electronic and the paper claim.

The FO will take the following actions to document both the electronic and paper folders properly:

  • Establish non-exclusion claim(s) in EDCS;

  • Create a paper MDF for EDCS exclusion claim(s);

  • File the documents that pertain solely to the excluded claim in the MDF (for example, SSA-831 form). In eView, upload any documents that apply to both the electronic and the paper claim (for example, SSA-3368, SSA-3441, and SSA-827);

  • Add a message to the EDCS case indicating that a related paper claim exists. Provide the current claim level, type, and Social Security Number (SSN) for the paper claim, conversion, or appeal along with the reason for the exclusion;

  • Update the paper folder indicator (PFI) in EDCS stating that a paper folder has been created for this filing, see DI 81010.085;

  • Transfer case in EDCS;

  • Print an EDCS routing form for the MDF and annotate the form with the following remark to shown an EDCS exclusion is associated with the case: “EDCS exclusion-associate with EDCS case transferred on MM/DD/YYYY."; and

  • Mail the paper MDF to the adjudicating office.

NOTE: If there is an EDCS case for a claim that has already been transferred out of the FO, and there is a subsequent claim filed that is an EDCS exclusion, follow the steps for creating the paper MDF in DI 81010.030C in this section. Utilize the Update After Transfer functionality when creating the message for the EDCS case stating that a paper claim exists, and inform the DDS that it is necessary to update the PFI in eView.

The DDS will:

  • Electronically process the electronic portion of the claim;

  • Only print documentation that pertains solely to the excluded claim (for example, SSA-831 and determination notice), and associate these items in the MDF for FO adjudication after making a determination;

  • In eView, upload any documents that apply to both the electronic and the paper claim. At case closure, the DDS will upload in eView a copy of the decisional documents (SSA-831/DDE) for the paper claim; and

  • Return the electronic and paper portions of the case to the FO after adjudication.

The hearing office (HO) will:

  • Fax or scan documentation for the excluded paper claim into the electronic folder. This ensures all folder documentation is stored in the electronic folder at the hearing level. Documentation includes the application, development, notices, and decision;

  • Add a message in eView that all documents from the paper claim have been added to the electronic portion of the case. ; and

  • Print and mail or fax a copy of the hearing decision for the excluded claim to alert the FO or Program Service Center to process the decision.

IMPORTANT: When all claims in a case convert to paper, all documents must be printed. For example, when the DDS closes a case without a determination and the "No Determination" reason is to "Stop Electronic Processing," all documents must be printed and added to the paper folder.

D. Processing an Initial Claim with a Continuing Disability Review (CDR)

Multiple Pending Cases (MPC) are both an initial claim and a CDR for the same individual that are pending at the same time. For example, a Title XVI Age 18 Redetermination and a Title II Disability Insurance Benefits (DIB) or Childhood Disability Benefits (CDB) claim. EDCS cannot process MPC, unless one of the MPC scenarios below applies. The FO technician can process MPC by establishing one case in EDCS, and the second case as paper. Though one of the cases can be worked electronically, these cases are still official paper folders. Adjudicating components (for example, DDS) must print all documents at case closure and file in the paper folder.

NOTE: For MPC, the DDS must print all documents at case closure because MPC consists of two different classification folders (initial and CDR), and each folder should have its own documentation that supports the determination.

If an individual files an initial claim and has a pending CDR at the same time:

  • Enter the initial claim in EDCS and complete the disability forms;

    • NOTE: Certain CDB and Disabled Widow Beneficiary (DWB) cases do not require establishment of an MCS claim prior to creating an EDCS case. Supplemental Security Income (SSI) cases that cannot be established in MSSICS can be established in EDCS utilizing the Manual Title XVI creation functionality. For more information on conversion cases, see Childhood Disability Benefits (CDB) General - RS 00203.080 and DI 81010.020B.

  • Transfer the initial claim in EDCS. On the EDCS Transfer screen, check the paper folder indicator “A paper CDR is being processed together with this case”;

  • Complete CDR forms and associate them with the Comparison Point Decision (CPD) folder or create a paper MDF for the CDR;

  • Print the EDCS routing form to attach to the paper MDF. Annotate the EDCS routing form with the following remark to show that an EDCS Exclusion is associated with the case: “EDCS exclusion-associate paper CDR with EDCS initial case transferred on MM/DD/YYYY"; and

  • Mail the paper MDF to the adjudicating office.

The FO technician can establish MPC for the following scenarios in EDCS:

  • CDR Appeals Council (AC) or Federal Court (FC) level case, if a non-CDR case exists at the Initial (IN), Reconsideration (RC), or Hearing (HR) level;

  • A non-CDR case at the IN, RC, or HR level, if a pending CDR case exists at AC or FC level;

  • A non-CDR case for the AC or FC level case, if a pending CDR case exists at the IN, RC, or HR level;

  • CDR case for the IN, RC, or HR levels if a non-CDR case exists at the AC or FC level.

E. EXR filing and Certified Electronic Comparison Point Decision (CPD) Folder

When a previously entitled beneficiary or recipient files an EXR, the FO processes the case per DI 13050.045. If the CPD folder was processed in EDCS, the FO will:

  1. 1. 

    Fax all documents in the EXR package (see DI 13050.045B.2 ) to eView - use the MDF E barcode, and annotate the "Note" field with "EXR Documentation." If there is no eView record, use CFUI see DI 13050.045B.8.d.

  2. 2. 

    Create an MDF (paper folder) for the EXR filing.

  3. 3. 

    In eView, add a message to the closed case with the most recent favorable medical decision stating, “This case serves as the CPD folder for the EXR filing on MM/DD/YYYY.”

  4. 4. 

    For the EXR paper folder, add a Report of Contact (SSA-5002) stating, “Please reference electronic CPD folder in eView for EXR filing. The case with the most recent favorable medical decision was dated on MM/DD/YYYY.”

  5. 5. 

    Add EXR package documents to the paper folder.

  6. 6. 

    Attach the EXR flag to the paper folder.

  7. 7. 

    Mail paper folder to DDS.

The DDS and OHO will process EXR filing following normal processing procedures.

F. Converting existing CEFs to paper

There are certain scenarios that will require the CEF to be converted to paper case processing. When converting a CEF to a paper case, the FO will:

  1. 1. 

    Open the corrresponding case in eView.

  2. 2. 

    Lock the case for editing in eView.

  3. 3. 

    Select the Status/History Tab and check the box a paper folder has been created for this filing.

  4. 4. 

    Add a message (with no expiration date) explaining the reason for converting the case to paper and the date the case was converted to paper.

  5. 5. 

    Unlock the case in eView.

  6. 6. 

    Print sections A, B, and D of the case using single sided printing.

  7. 7. 

    Discard the barcode cover sheets.

  8. 8. 

    File the printed documents in the corresponding sections (A, B, and D) of the paper Modular Disability Folder (MDF).

 


DI 81010 TN 32 - FO Procedures - Electronic Process - 12/20/2019