TN 121 (08-20)

GN 04440.015 Federal Quality Review of Certified Electronic Folder (CEF) Cases

A. Introduction to the federal quality review

The Office of Quality Review (OQR) conducts a federal quality review of disability cases in OQR review components located in the 10 regions and OQR Baltimore. The OQR review components were formerly called disability quality branches.

B. Official folder is a modular disability folder (MDF) or CEF

Federal quality review of adjudicating component disability determinations provides general quality review processing instructions for review components to use when returning or correcting deficient Certified Electronic Folder (CEF) cases.

C. Quality review sample selection

The automated sample selection process selects OQR’s quality review sample cases during the adjudicating component’s case closure process and prior to effectuation of the determination.

  • The adjudicating component receives an alert during the case closure process, via the National Disability Determination Services System (NDDSS), when a CEF case is selected for federal quality review.

  • Both NDDSS and eView display an indicator when the case has been selected for federal quality review. NDDSS only shows that the case has been selected for review and the original review component as the destination. Some CEF cases are automatically transferred to other review components. This transfer is only visible in eView. The only place to see where a case is being, or has been, reviewed, is in eView.

  • CEF cases selected for federal quality review are electronically transferred to the appropriate review component for quality review (e.g., quality assurance review, pre-effectuation review, special studies, etc.).

For information regarding eView, refer to DI 81005.005 (eView Overview).

D. Results of OQR quality review

Results of federal quality reviews are as follows:

1. Non-deficient (correct) cases:

The review component completes the quality review and case processing system coding and clears the CEF case to the field office (FO), program service center, National Records Center, or PC7, for effectuation of the determination.

2. Deficient cases:

If a case is found to be deficient, the review component will either:

  • route the CEF back to the adjudicating component for corrective action(s) or

  • complete the needed corrective action(s) and route the CEF to the FO to effectuate the determination.

For additional information regarding deficiencies,see GN 04440.202 (Group I Decisional Deficiencies), GN 04440.203 (Group I Documentation Deficiencies), and GN 04440.204 (Group II Deficiencies).

3. FO action needed:

The review component may request assistance from the FO for additional development (e.g., substantial gainful activity development) prior to completing a quality review. Refer to GN 04440.510 (Completing the SSA-5524-U3, Request for Assistance), for additional information regarding requesting FO assistance.

E. Process for federal quality review

For CEF cases, OQR quality reviews may be electronically directed to an “out-of-region” review component or the “home” review component.

For further information, refer to DI 81020.135 (Federal Quality Review (QR)).

F. Adjudicating component and review component disagreement when a paper MDF is the agency's official folder and no CEF exists

The adjudicating component follows OQR's established rebuttal process, as described in GN 04440.401 through GN 04440.425 and DI 30005.501 through DI 30005.550.

G. Adjudicating component and review component disagreement when the CEF is the agency's official folder

The adjudicating component follows the guidance in DI 30005.501 (Resolving Deficiency Disagreements --- Informal Resolution Request (IRR) and Request for Program Consultation (RPC)).

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GN 04440.015 - Federal Quality Review of Certified Electronic Folder (CEF) Cases - 01/28/2014
Batch run: 08/05/2020