Verify the case status using the following procedures.

• •

  For certified electronic folders (CEF), review the status on the Case Selection Screen in eView, see screen details in DI 81005.025C.4. The case is complete only if the “Status” entry is “Closed” and the “Office Type” entry is “FO” or “PC.” If these fields contain any other entries, e.g., “OQR” as the “Office Type,” then the case is not complete.

• •

  For official paper cases housed in a modular disability folder (MDF), refer to the SSA-831 (Disability Determination and Transmittal) that the DDS or OQR completed.

The FO adjudicator is responsible for completely adjudicating and authorizing all Title XVI, and most Title II claims.

Title II claims that the FO processed to completion are district office final authorization (DOFA) cases. For more information about DOFA cases and adjudicator responsibilities, see GN 01010.008.

For non-DOFA cases, the FO adjudicator and the Processing Service Center (PSC) adjudicator share the adjudicative responsibilities. In these claims situations, the PSC reviews the FO's initial adjudication of the claim for accuracy and completeness, and the PSC is responsible for final authorization.

For more information about DOFA exclusions, see GN 01010.027.

Closely examine and evaluate all evidence from the case file (electronic or paper) and other evidence from SSA's records to determine if we need further evaluation or documentation, e.g., work activity or incarceration prior to adjudication. “Evidence,” includes but not limited to the:

• •

  Modernized Claims System (MCS)

• •

  Modernized Supplemental Security Income Claims System (MSSICS)

• •

  Disability Determination Services Query (DDSQ)

• •

  Case Processing & Management (CPMS)

• •

  Appeals Review Processing System (ARPS)

• •

  Claims File User Interface (CFUI)

• •

  Certified Electronic Folder (CEF)

• •

  Master Beneficiary Record (MBR)

• •

  Supplemental Security Record (SSR)

• •

  On-line Retrieval System (ORS)

• •

  Informational/Certified Earnings Record (ICER)

• •

  Prisoner Update Processing Systems (PUPS)

• •

  Evidence (EVID) screens in Shared Process Menu

• •

  Disability Control File (DCF)

• •

  Internet Database and Enhanced Leads and Appointment Systems (eLAS)

References:

• •

  GN 00301.286 Electronic Evidence Documentation and Retention

• •

  GN 01010.032 Records and Information Available to the FO for Adjudicative Purposes

• •

  DI 81010.000 FO Procedures - Electronic Process

If the FO has to recontact the claimant prior to adjudication, e.g., to obtain additional evidence, the FOs must ask the claimant about work activity or incarceration since the alleged onset date.

Document the claimant’s response on any of the following:

• •

  SSA-5002 (Report of Contact) (RPOC), or

• •

  RPOC screen in MCS or MSSICS.

For certified electronic folder (CEF) cases, fax a copy of the RPOC into the EF.

For non-CEF cases, put the SSA-5002 or copy of the RPOC into the paper folder.

NOTE: If there are other pending issues, e.g., workers compensation or public disability benefits (WC/PDB) with a particular case, consider asking or following up with the claimant at the time of recontact.

If the claimant answers “yes” to returning to work after the alleged onset date, evaluate the work, complete the appropriate Form SSA-820 (Work Activity Report for Self Employed Person) or the SSA-821 (Work Activity Report – Employee), and document the SGA determination.

References:

• •

  DI 10501.025 Responsibilities and Procedures – Work Issue Cases

• •

  DI 13010.105 Return to Work Within a Year of Onset (Title II)

• •

  DI 11010.140 Field Office (FO) and Disability Determination Services (DDS) Responsibilities in Work Development

• •

  DI 23501.000 Prisoner Cases – Table of Contents

Notify the PSC via the SSA-3601 (Claims Routing) to claims situations requiring additional actions or handling, see GN 01020.250. The adjudicator should be alert to situations that require manual entries on the SSA-3601, e.g., the FO may identify the existence of an unresolved issue from a prior claim.

Some actions that could require post-adjudicative resolution are:

• •

  An outstanding underpayment, or

• •

  A prior overpayment on the record.

In cases of a prior or potential overpayment, the FO determines the current overpayment status. Obtain the pertinent information via:

• •

  Recovery of Overpayments, Accounting and Reporting (ROAR)

• •

  Claimant interview

• •

  MBR or SSID

If recovery has not been waived, consider the possible need for related development, e.g., waiver or rate of adjustment, or remind the claimant of their repayment responsibilities. Document any actions taken in the claims file, and alert the PSC via the SSA-3601.

NOTE: For claims requiring an Automated 101 (A101) (when there is no SSA-3601), document the A101 remarks.

Complete adjudication includes ensuring that we take all necessary actions aside from the award or disallowance action. Examples of such actions are:

• •

  Obtaining earnings record adjustments,

• •

  Identifying the need for examination of an earlier claims file,

• •

  Establishing diaries, and

• •

  Resolving outstanding overpayments.