After receiving an IRR notification, the designated review component contact:
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identifies the original program leader (PL) who approved the deficiency and
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assigns the IRR in the IRR web-based tool to a designated OQR staff member who was
not involved in the original return.
The review component has 14 calendar days to respond to the IRR. When the review is complete, the review component will:
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code the IRR web-based tool,
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prepare a narrative response to the IRR in the IRR web-based tool,
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ensure that the IRR response addresses all relevant policy concerns or questions raised by the adjudicating component, and
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include policy and procedural references to support the response, unless the review
component agrees with the adjudicating component’s IRR, rescinds the deficiency, and
no further action is needed.
When the IRR response is ready for review, the OQR designated staff member will inform
the branch chief (BC) or other designated OQR manager. The BC, or other designated
OQR manager, will return the IRR to the OQR designated staff member if he or she declines
to sign the IRR response. The OQR designated staff member will make the requested
changes and resubmit the IRR to the BC, or other designated OQR manager, until achieving
concurrence. The BC, or other designated OQR manager, will close the IRR in the IRR
web-based tool. This action uploads the adjudicating component's IRR submission and
review component's IRR response to the certified electronic folder and the tool notifies
the adjudicating component by email that the response is available to view.
NOTE: The review component should not obtain medical contractor (MC) or psychological
contractor (PC) review(s) during the informal resolution request (IRR) process. MC/PC
review results must be coded in the case processing system per GN
04440.130D . The review component’s case processing system does not support coding results of
MC/PC reviews during the IRR process.
If the review component agrees that the adjudicating component’s determination was
policy compliant, the review component will rescind the deficiency in the IRR web-based
tool. Once the case is returned by the adjudicating component, the review component
will update the OQR case processing system database and clear the case according to
normal business processes.
If the review component disagrees with the adjudicating component’s IRR rationale
for policy compliance and affirms the deficiency, the adjudicating component must
take the requested corrective action(s) noted on the SSA-1774, Request for Corrective
Action, or SSA-847, SSA Request for Case Action, OR submit an RPC, if the case meets the criteria for RPC submission (see DI 30007.125 - Submitting a case for RPC).
If the adjudicating component decides to complete the requested corrective action(s),
the adjudicating component will return the case to the review component after completing
the actions. The review component will code and clear the case according to normal
business processes.
If the review component rescinds or corrects the deficiency within the IRR web-based
tool, the OQR case processing system database will be automatically updated with the
applied revisions to ensure that the rescinded or corrected deficiency is appropriately
recorded.
NOTE: When an IRR results in a rescission of a group II decisional deficiency that has
been transmitted to the field office for effectuation, and the final outcome of the
determination is changed, the case must be reactivated. The review component will
follow policy guidance in GN 04440.111 Reopenings Certified Electronic Folders (CEF) for reactivation and reopening.