TN 1 (06-86)

GN 01050.190 Assembly of Disability Claims Material—ODO or INTPSC Jurisdiction for Determination of Disability

To expedite processing of disability claims the following instructions should be carefully followed. Punch holes in the left margin of all file materials, not already prepunched, in accordance with GN 01050.150C. Enter NH's name and SSN on each piece of material not containing this information and remove any staples which will impede review of the case material in the DDS or ODO. Assemble the claims material on prongs in the following order from bottom to top. Excluded material is described in GN 01050.150B.

A. Material for the right side of the folder

  1. 1. 

    Application Form—The SSA-16-F6 and any statement which changes answers on the application form. If auxiliary applications are involved, place the lowest numbered application on top of the SSA-16-F6, the second lowest next, etc. In a DWB or CDB only case, if the application (SSA-10-BK, SSA-4-F6, etc.) is not sent to the PSC, place it in the same location which the SSA-16-F6 occupies in a DIB case.

  2. 2. 

    SS-5 or equivalent

  3. 3. 

    Proof of age

  4. 4. 

    Other proofs (except medical evidence).—This includes forms like SSA-760-F4, SSA-11 BK, etc.

  5. 5. 


  6. 6. 

    Nondisability correspondence and reports in chronological order with the most recent on top.

  7. 7. 

    SSA-794-C1.—If the case is forwarded to ODO for a determination of disability, the original, recertified, or photocopy of the SSA-794-C1 and any other developed earnings information must be included in the file.

  8. 8. 

    SSA-7011, SSA-1002, certification of RRB compensation forms; SEI evidence; and any other primary or secondary wage evidence.

  9. 9. 

    Special determination on SSA-553, SSA-7010-U5 or SSA-4500-U6

  10. 10. 


  11. 11. 

    SSA-827 series forms or other forms authorizing release of medical information.

  12. 12. 

    Disability correspondence and reports in chronological order, most recent on top.

  13. 13. 

    Material on continuing disability investigation or work activity after alleged date of onset.

  14. 14. 


  15. 15. 

    Authorization to release copy of award or disallowance notice for a private retirement plan administered by an employer or union.

  16. 16. 

    SSA-5002 reporting circumstances requiring special case handling in ODO such as hardship.

  17. 17. 

    Current SSA-831-U5—If a DIB claim is forwarded together with a CDB auxiliary claim, place the SSA-831-U5 for the DIB claims on top in the DIB folder and the SSA-831-U5 for the CDB claim on top in the CDB folder.

    NOTE: When the case is to be routed to ODO or INTPSC, send only the top three copies of the SSA-831-U5. The remaining copies can be destroyed.

  18. 18. 

    Bar Code Label

B. Material for the left side of the folder

Place the following material on prongs on the left side of the folder in the following order from bottom to top:

  1. 1. 

    SSA-101-U3 (Determination of Award), if prepared.

  2. 2. 


  3. 3. 

    Request for SSA information by State mental institutions.

  4. 4. 

    SSA-790 IDP

C. Assembly of material involving multiple applications

  1. 1. 

    Prepare separate folders where DIB and CDB or DWB are being forwarded. See GN 01050.170 and GN 01050.175.

  2. 2. 

    Show the child's or widow's full name and the WE's name and SSN on each piece of evidence for the child or widow.

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GN 01050.190 - Assembly of Disability Claims Material—ODO or INTPSC Jurisdiction for Determination of Disability - 11/05/2013
Batch run: 02/02/2015