Effective Dates: 08/18/2022 - Present Previous | Next

TN 7 (08-22)

DI 23007.005 Contacting the Claimant, Applicant, Appointed Representative, or Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence

This section describes who adjudicators must contact when a claimant does not comply with an initial request for evidence or action, or an initial notice of a consultative examination (CE) appointment. The instructions apply to initial and reconsideration cases using the adult sequential evaluation process (see DI 22001.001A). For a Title XVI disabled child (DC) case, see DI 25205.020. For a continuing disability review (CDR) case, see DI 28075.005.

A. Who to contact when the claim does not require special handling

The Disability Determination Services (DDS) must contact (by telephone or by letter) the:

  • •

    Claimant when the claimant does not have an applicant filing on their behalf, or an appointed representative (AR).

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    Claimant and applicant when the claimant has an applicant, but not an AR.

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    Claimant and AR when the claimant has an AR but not an applicant (for contact by letter). For contact by telephone, see DI 31001.010.

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    Claimant, AR, and applicant when the claimant has both (for contact by letter). For contact by telephone, see - DI 31001.010.

For whom to contact in a continuing disability review (CDR) case, see DI 28075.005B.

NOTE 1: For initial and reconsideration cases using the adult sequential evaluation process, you are not required to involve a representative payee unless the representative payee is also the third party or the applicant.

NOTE 2: When a claimant has a legal guardian, you must also contact the legal guardian (see GN 00502.139).

NOTE 3: When a claimant has an AR, they may ask you to communicate directly with the claimant or applicant for a specific issue. Comply with that request with one exception. When the claimant does not comply with the follow up request for evidence or action or does not attend the consultative examination (CE) appointment, first make a reasonable effort to contact the AR and give them 10 days to comply with your request. When the AR requests more time, determine a reasonable amount of time. A reasonable effort to contact an AR is the same as a reasonable effort to contact a third party (see DI 23007.010). When the AR does not contact you and assist with getting the claimant to submit the needed evidence or action, you may then stop attempts to get the claimant to comply with the request.

REMINDER: An adult claimant that has an applicant or AR does not require special handling, even if the claimant falls into one of the special handling categories.

B. Who to contact when the claim requires special handling

The DDS must contact (by telephone or by letter) the:

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    Claimant, and

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    Third party.

You may make a reasonable effort to involve a third party at any point in the process, but you may not discontinue attempts to develop evidence requiring the claimant's cooperation until you make a reasonable effort to identify and involve a third party (see DI 23007.010).

For claimants who require special handling, see DI 23007.001A.

For information on the third party, see DI 23007.001C.

For whom to contact in a Title XVI disabled child (DC) case, see DI 25205.020A.2.

For steps to confirm a CE with special handling, see DI 22510.019D.

IMPORTANT: You must make a reasonable effort to involve the third party from the current level of review. Do not use a third party from a prior folder or a prior appeal level.

1. Third party identified

a. Third party

When the claimant does not comply with your follow-up request for evidence or action, or does not confirm or misses the CE appointment, you must make a reasonable effort to involve the third party identified in Section 2 of the SSA-3368 (Disability Report - Adult), SSA-3441 (Disability Report - Appeal), or SSA-454 (Continuing Disability Review Report).

b. Additional third party

When the claimant does not comply with your follow-up request for evidence or action, or does not confirm or misses the CE appointment, and the FO has identified an additional third party in Section 11 of the SSA-3368, Section 10 of the SSA-3441, or Section 11 of the SSA-454, you must make a reasonable effort to involve the additional third party when the attempt with the other third party was not productive.

2. Third party not identified

When the claimant does not comply with your follow-up request for evidence or action, or does not confirm or misses the CE appointment, you must make a reasonable effort to identify a third party when the Field Office (FO) has not identified a third party or has not documented that the claimant refused to identify a third party. When the FO documented that the claimant refused to identify a third party, do not attempt to identify a third party.

When you identify a third party, contact them and attempt to get them to assist the claimant to cooperate with your request. When you are not able to identify a third party, or if you identify but are unable to involve the third party, stop attempts to get the claimant to comply with your request or to attend the CE appointment.

C. How to document your contact by telephone

1. If you speak to someone

If you speak to the claimant, applicant, AR, or third party, document the date and content of your conversation, and to whom you spoke, on a SSA-5002 (Report of Contact), a Case Note in the Disability Case Processing System (DCPS), a Claim Communication in the Electronic Claims Analysis Tool (eCAT), or the DDS worksheet.

For information on what to include in your conversation, see DI 22505.014A.1.a.

2. If you leave a message

If you leave a message for the claimant, applicant , AR, or third party, document the date and content of your message, and with whom you left it, on a SSA-5002 (Report of Contact), a Case Note in DCPS, a Claim Communication in eCAT, or the DDS worksheet.

For information on what to include in your message, see DI 22505.014A.1.b.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423007005
DI 23007.005 - Contacting the Claimant, Applicant, Appointed Representative, or Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence - 08/18/2022
Batch run: 10/23/2024
Rev:08/18/2022