For group II documentation deficiencies based on SGA, the review component will:
a. annotate all of the adjudicating component’s original determination and medical
assessment forms, as well as notices, in the CEF as “Do Not Process” or “Do Not Release”,
as applicable,
b. code the deficiency in the case processing system,
c. notify the FO, via an SSA-5524-U3, Request for Assistance, to explain that SGA
development is needed,
d. notify the adjudicating component, via an SSA-1774-U5, Request For Corrective Action,
to explain why the determination is not policy compliant and that the case will be
routed to the FO for SGA development, and
e. route the case to the FO.
All of the adjudicating component’s original determination and medical assessment
forms, as well as notices, must remain in the CEF as part of the audit trail.
After the FO resolves the work activity issue, if the onset date remains the
same, the FO will:
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•
effectuate the allowance,
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•
prepare and release any necessary personalized notices, and
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•
notify the review component of the outcome.
After the FO resolves the work activity issue, if the onset date changes,
the review component will:
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•
annotate all of the adjudicating component’s original determination and medical assessment
forms, as well as notices, in the CEF as “Do Not Process” or “Do Not Release”, as
applicable,
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•
code the deficiency in the case processing system,
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•
correct the onset or ending date on the SSA-831,
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•
prepare and release any necessary personalized notices, and
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•
route the case to the FO for effectuation.
All of the adjudicating component’s original determination and medical assessment
forms, as well as notices, must remain in the CEF as part of the audit trail.
If the FO determines an earlier onset date may be possible, and further
medical development is necessary to establish the onset date, the review
component will:
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•
prepare an informational SSA-1774-U5, Request For Corrective Action, to explain why
the case is not policy compliant and to request the adjudicating component to undertake
appropriate development,
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•
route the case to the adjudicating component for correction as a controlled return,
and
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•
follow-up with the adjudicating component in 60 days if the case has not been returned
to the review component.
After the review component has already cited a group II work activity documentation
deficiency, they may review the Modernized Claims System (MCS) or Modernized Supplemental
Security Income Claims System (MSSICS) remarks screen, the report of contact screen,
DWO1, or continuation pages, to determine if the FO resolved and electronically documented
the work activity issue. The review component MAY NOT cite a deficiency based on information
in MCS or MSSICS. However, they may resolve the onset issue using this information.