TN 18 (08-23)

DI 13005.030 Field Office (FO) Personal Contact and Exceptions

A. Introduction to personal contact

SSA recommends, but does not require personal contact in each CDR case. Providing personal contact helps to ensure that individual have a full opportunity to present their case. The FO should make personal contact with:

  • the individual; if there is no mental impairment;

  • the individual only or both the individual and the representative payee, if there is one, when the individual has a physical impairment only; or

  • the representative payee only if there is one, when the individual has a mental impairment that is legally incompetent.

One of the purposes of the personal contact is to alleviate the individual or representative payee’s apprehension about the CDR by providing a thorough explanation of the CDR process, including the individual’s role in the process.

B. Policy on personal contact

Personal contact includes an overview of the CDR process, an explanation of the individual’s rights and responsibilities, and an explanation of the disability hearing process to which they are entitled at the reconsideration level. The disability hearing is a result of the implementation of Section 4 and Section 5 of P.L. 97-455.

Section 4 and Section 5 of P.L. 97-455 provide for an evidentiary disability hearing (known as a disability hearing) at the reconsideration level for Title II medical cessation cases. The regulations implementing this statute extend the disability hearing process to comparable Title XVI and concurrent (Title II and XVI) cases.

Inform the individual that, if they are dissatisfied with the outcome of the CDR, they have the right to request a reconsideration of the determination. The disability determination services (DDS) will perform a folder review and develop the reconsideration as it has in the past. However, due to P.L. 97-455, if the DDS cannot make a fully favorable determination after its review, the individual will be entitled to a disability hearing at the DDS before issuing an unfavorable determination. The explanation of the disability hearing should include a brief overview of the items covered in DI 12026.001 through DI 12026.020.

C. Procedures during personal contact

1. The personal contact interview

During the personal contact interview with the individual or representative payee:

  • Complete a form SSA-454-BK (Continuing Disability Review Report) and SSA-827 (Authorization to Release Medical Information to the Social Security Administration) or a local authorization form. Complete the form SSA-827 according to DI 11005.055 through DI 11005.057. For FO electronic case procedures, see DI 81010.000. The DDS will initiate the medical development. NOTE: If the individual meets the requirements for special handling as mentioned in DI 13005.025A, the FO must attempt to obtain two 3rd party contacts and document the information on the form SSA-454-BK in the Remarks.

  • Explain that they are responsible for submitting evidence to determine continuing disability. We will assist in obtaining this information but the individual must submit the names and addresses of treating sources and give permission for the Social Security Administration (SSA) to obtain the evidence.

  • Explain that a prompt response is required to any subsequent DDS contact or request, including a request to appear for a consultative examination (CE). Give careful attention to the possibility that the nature of the individual’s impairment(s) (for example, mental impairment) may hinder cooperation. Annotate the claim folder(s) to alert the DDS of possible difficulties. If the individual fails to cooperate and provide sufficient evidence or the individual’s whereabouts are unknown, refer to DI 13015.005 and DI 13015.013. Document the case folder(s) with all efforts made to obtain the individual’s cooperation.

  • Inform the individual that the CDR can be a lengthy process and medical sources do not always respond promptly. The DDS will need time to evaluate the evidence and if the claim folder(s) do not contain sufficient evidence for a determination, a CE would be required.

For FO instructions to create an electronic CDR (eCDR) in the Electronic Disability Collect System (EDCS), see DI 81010.230. After completing the personal interview in paper cases:

  • Add the form SSA-454-BK (Continuing Disability Review Report) and the form SSA-827 to the folder,

  • Prepare appropriate folder movement forms (for example, SSA-408 (Route Slip) or SSA-8028 (Supplemental Security Income Claims Control), and

  • Route the folder to the DDS using a SSA-408 (Route Slip) unless there is a deferral of the CDR and the folder returned to Office of Disability Operations (ODO)/Payment Service Center (PSC)-Disability Processing Branch (DPB).

2. Personal contact for Title XVI childhood disability cases

In addition to the form SSA-454-BK, also complete:

  1. a. 

    Form SSA-3881-BK (Questionnaire for Children Claiming SSI Benefits). To obtain the name of someone else who could help SSA obtain evidence about the child, see DI 11005.030B.2.

    NOTE: 

    It is extremely important that the FO make every effort to obtain the name of an “other responsible adult” when completing the form SSA-3881-BK, or to document the file when no third party is available.

  2. b. 

    The appropriate function report for the child (Function Report-Child Birth to 1st Birthday SSA-3375-BK, Function Report—Child Age 1 to 3rd Birthday SSA-3376-BK, Function Report-Child Age 3 to 6th Birthday SSA-3377-BK, Function Report – Child Age 6 to 12th Birthday SSA-3378-BK, or Function Report-Child Age 12 to 18th Birthday, SSA-3379-BK).

    NOTE: 

    For FO electronic case procedures, see DI 81010.000.

Advise the payee that they may be asked to provide evidence to show that the child is and has been receiving treatment, to the extent considered medically necessary and available, for the condition(s) that was the basis for providing benefits. Advise the payee that, if they refuse to comply with this requirement without good cause, we will decide if benefits should go to another payee, at which time the child’s record may be placed in administrative suspense until another payee can be found, or if the child should receive their own benefits directly.

D. Exceptions to personal contact

The FO may waive personal contact if:

  • The relationship between the representative payee and the individual is a professional one (for example, an institution, government agency);

  • The individual or representative payee agrees or requests that the CDR occurs by mail;

  • The individual resides in a foreign country, unless the individual is in a United States FO;

  • We receive a notice of work activity in a Title II medical improvement possible (MIP) or medical improvement not expected (MINE) diary case. We will not conduct a CDR immediately, unless we receive allegation of medical improvement. We will establish a trial work period (TWP) diary and send a notice informing the individual that we will contact him or her at the expiration of the TWP. For additional information on the TWP, see DI 13010.035; or

  • The ODO identifies the case as a Section 1619 CDR, see DI 13005.016.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0413005030
DI 13005.030 - Field Office (FO) Personal Contact and Exceptions - 08/03/2023
Batch run: 10/30/2024
Rev:08/03/2023