TN 57 (09-19)

DI 11005.022 Completing and/or Reviewing Interview Forms

A. Disability interview forms

The disability interview forms have been designed for use in self-help situations and should be completed by the applicant when appropriate (DI 11005.018B.2). The questions are written at the sixth grade reading level, which is the SSA standard, and are self-explanatory. Therefore, no specific instructions are provided for their completion.

The completed forms provide the Disability Determination Services (DDS) with information it needs to make a disability determination, including a detailed explanation of the claimant's medical history, functional abilities, effects of pain, and any work history.

B. Responsibilities for completing disability interview forms

Field office (FO) interviewers or reviewers must ensure that information documented on forms that are the FO's responsibility (see DI 11005.018) is as complete and accurate as possible. Discrepancies in information contained in the file should be resolved before the claim is sent to the DDS (e.g., different dates last worked shown on the SSA-3368 and SSA-3369, or different onset dates on the forms).

For disability initial claims, appeals, or medical continuing disability reviews conducted in person or by telephone: It is the responsibility of the FO interviewer to obtain an additional third party contact who knows about the claimant's medical conditions and can help with the claim. Document the contact information in the remarks section of the SSA-3368/EDCS 3368, SSA-3441/EDCS 3441, or SSA-454/EDCS 454. When the claimant refuses to provide an additional third party contact, document the claimant's decision in the remarks section.

For disability claims, appeals, or medical CDRs filed online or submitted by mail, request an additional third party contact only when contact with the claimant is required for other development.

C. Disability interview forms procedures

Use the following guidelines when completing and reviewing the applicant's forms:

  • Every applicable question should be answered as completely and accurately as possible.

  • Enter “NA” when a question does not apply.

  • Addresses, including ZIP codes and telephone numbers, including area codes, must be complete, UNLESS a regional or local arrangement with the DDS permits a partial entry or a coded annotation in the medical source items.

  • For questions requesting a “Yes” or “No” answer, be sure the applicant has checked one block or the other (or explained why neither was appropriate), and provided an explanation when appropriate.

  • When no items are checked in questions requesting the applicant to check items on a list, make sure the applicant has not overlooked the question.

  • There should be an explanation in every place where an explanation is requested or where one would be appropriate in light of the applicant's answer.

  • Use the remarks section (SSA-3368, SSA-3441, SSA-454) - to explain any answers, elaborate on any sources listed, or supply additional sources of evidence.

  • Use the remarks section (SSA-3368, SSA-3441, SSA-454) - to record the name, address, phone number, and relationship to the claimant of an additional third party contact who knows about the claimant’s medical conditions and can help with the claim. If the claimant refuses to provide an additional contact, document the claimant's decision. To avoid further delay, for internet or mailed initial claims, appeals or CDRs that do not require contact with the claimant for other development, do not attempt to obtain an additional third party contact. Instead, annotate the following remark: "Internet/mailed-in claim- no additional third party contact obtained" in the EDCS Remarks section and transfer the claim, appeal, or CDR.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411005022
DI 11005.022 - Completing and/or Reviewing Interview Forms - 01/06/2020
Batch run: 01/06/2020
Rev:01/06/2020