Effective Dates: 12/30/2024 - Present

Identification Number:
DI 22501 TN 32
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Introduction - Case Development Procedures
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 225 – Case Development Procedures

Subchapter 01 – Introduction - Case Development Procedures

Transmittal No. 32, 12/30/2024

Audience

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

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Policy updated this section to be consistent with DI 26535.042, a new section that provides definitions of individuals and entities with whom we correspond and send notices and outlines who must receive correspondence when multiple parties are authorized to act on behalf of a claimant or are designated to assist a claimant.

Summary of Changes

DI 22501.002 Responsibilities for Case Development of Disability Claims

We updated this section as follows:

  • •

    Removed reference to the applicant throughout,

  • •

    Omitted the reference sections because we cite the relevant POMS throughout this subsection,

  • •

    Added references to GN 03970.010 Rules of Conduct and Standards of Responsibility for Representatives and DI 26535.042 Recipients of Correspondence and Notices - Initial Claims, and

  • •

    Made minor editorial changes throughout for clarity.

DI 22501.002 Responsibilities for Case Development of Disability Claims

CITATIONS:

20 CFR
404.1512 through 404.1518 and 416.912 through 416.918

A. Collaborative Case Development

Case development is a joint effort between the claimant, the claimant’s representative (if there is one), the field office (FO), Disability Determination Services (DDS), and when applicable, workload support units or Federal disability determination offices. It requires effective communication and coordinated teamwork.

For key case development roles and responsibilities, see DI 10005.010.

B. Claimant and appointed representative (AR) case development responsibilities

1. Claimant

The claimant must:

  • •

    Inform us about or submit all evidence known to him or her that relates to whether or not he or she is blind or disabled;

  • •

    Identify and inform us of his or her medical sources;

  • •

    Provide any evidence, already in his or her possession, that is not contained in other medical records (for example, a functional assessment paid for by a third party);

  • •

    Cooperate with our case development requests (for example, to complete forms and provide information); and

  • •

    Cooperate with our request to attend a consultative examination(s) (CE).

2. When the claimant has an AR

The AR has affirmative duties related to case development. The AR must assist the claimant in meeting their responsibilities, including acting with reasonable promptness when helping the claimant obtain and submit needed information and evidence. For a comprehensive list of the AR’s affirmative duties, see GN 03970.010.

For more information about contacting a represented claimant, see DI 31001.010.

C. FO case development responsibilities

The FO has the primary responsibility for technical factors, including work activity and substantial gainful activity (SGA) development. The FO initiates disability development and flags the disability folder to identify special development considerations.

1. Requirements for all disability claim types

The FO must:

  1. a. 

    Obtain complete disability report information from the claimant or applicant (Forms SSA-3368 (Disability Report – Adult); SSA-3441 (Disability Report – Appeal); or SSA-3820 (Disability Report -- Child));

  2. b. 

    Complete required SGA development on the SSA-820 (Work Activity Report – Self Employment) or SSA-821 (Work Activity Report – Employee) and document the SGA finding (step one of the sequential evaluation process) on the SSA-823 (Report of SGA Determination) for SGA or the SSA-3367 (Disability Report – Field Office) for no SGA or clearly not SGA);

  3. c. 

    Obtain a signed SSA-827 (Authorization to Disclose Information to SSA);

  4. d. 

    Document required technical information on the SSA-3367 in the Electronic Disability Collect System (EDCS), including:

    • •

      Alleged onset date (AOD);

    • •

      Potential onset date (POD);

    • •

      Dates relevant to potential disability entitlement (for example, protective filing date, date first insured (DFI), date last insured (DLI), prescribed period (PP), etc.);

    • •

      Dates relevant to potential blindness entitlement (for example, protective filing date, DFI, DLI, PP, etc.);

    • •

      Prior filing information;

    • •

      Presumptive disability (PD) or presumptive blindness (PB) findings;

    • •

      FO observations about the claimant; and

    • •

      Capability development.

IMPORTANT: If an adult claimant is homeless, may be difficult to contact, or may be unavailable for contact, in addition to the SSA-3367, SSA-3368-BK, and SSA-827, the FO must also develop the SSA-3373-BK (Function Report – Adult), and if appropriate, the SSA-3369-BK (Work History Report).

2. Title XVI child claims

For title XVI child cases and continuing disability reviews (CDR), the FO must also:

  • •

    Obtain information on the appropriate child function report:

    • –

      SSA-3375-BK (Function Report – Child (Birth to 1st Birthday));

    • –

      SSA-3376-BK (Function Report – Child (Age 1 to 3rd Birthday));

    • –

      SSA-3377-BK (Function Report – Child (Age 3 to 6th Birthday));

    • –

      SSA-3378-BK (Function Report – Child (Age 6 to 12th Birthday));

    • –

      SSA-3379-BK (Function Report – Child (Age 12 to 18th Birthday));

           and

  • •

    Complete the SSA-3881-BK (Questionnaire For Children Claiming SSI Benefits).

D. DDS case development responsibilities

The DDS is responsible for developing medical and non-medical evidence to determine if the claimant is capable of performing SGA. The DDS should establish a cooperative relationship with the claimant early in the adjudicative process to assist in efficient case development.

The DDS must:

  • •

    Review all case documentation;

  • •

    Recognize and act to resolve questions and discrepancies in work activity;

  • •

    Obtain relevant evidence from a prior case folder, if indicated. For electronic prior folders, the DDS must copy relevant evidence to the current filing. For more information on determining the need for a prior folder, see DI 20505.010;

  • •

    Request medical and other information needed to adjudicate the claim;

  • •

    Make required efforts to get needed evidence;

  • •

    Take additional action to resolve insufficiencies or inconsistencies. For example, request the CE(s), re-contact sources, and ask the claimant or others for additional information; and

  • •

    Document all efforts to obtain evidence. For more information on documenting the disability folder, see DI 20503.001E.

For more information on who must receive correspondence and notices during case development, see DI 26535.042.

IMPORTANT: If the FO does not provide the DFI, DLI, statutory blindness DLI (if applicable), POD, an SGA finding, or any other technical information necessary to adjudicate the claim, the DDS must obtain the necessary information before adjudicating the claim.

NOTE: Be alert to the possibility the claimant may need assistance, particularly when an alleged mental impairment exists.


DI 22501 TN 32 - Introduction - Case Development Procedures - 12/30/2024