TN 11 (05-98)

SI 00603.010 Policy and Procedure When Eligibility Is Questionable

A. When to use procedure

When eligibility is questionable, you may use the following procedure for applications and reconsiderations for both deferred development and simultaneous development claims to decide when to send the disability folder to DDS.

EXCEPTION: The procedure does not apply to concurrent claims where a disability determination is required for the title II portion of the claim.

B. Policy

If it appears likely that a claimant will notmeet nondisability eligibility in allmonths throughout the life of an application, a FO may delay sending the disability portion of a claim to the DDS for up to 30 calendar days from the date of receipt of the application or reconsideration request while developing the questionable issue.

C. Procedure - all claims

1. When to send disability folder

Send the disability folder at the earlier of the following points:

  • when development shows that the claimant likely meets the nondisability eligibility requirements, or

  • 30 calendar days after receipt of the application or reconsideration request.

2. Issue not resolved timely

If you have not resolved the issue within 30 days, send the disability folder to the DDS and continue to develop the questionable issue.

If you determine later that the claimant is ineligible for all months in the life of the application, advise the DDS immediately.

D. Procedure - deferred development

In a deferred development claim, develop the questionable issue only.

E. Procedure - simultaneous development

In a simultaneous development claim, you may develop all issues immediately or develop only the questionable issue.

If only the questionable issue is developed at first, develop the remaining issues once you send the disability folder.

EXCEPTION: In a TERI case, develop all issues immediately since these cases must be expedited whenever possible.

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SI 00603.010 - Policy and Procedure When Eligibility Is Questionable - 05/18/1998
Batch run: 08/14/2014