SSA - POMS: DI DAL10005.001 - Return Of Case Folders To FOs From DDS

A. Background

Questions have arisen about when DDS should return initial claims folders to an FO prior to making a disability determination.

B. Basic rules

When to return folders

DDS should return initial claims folders to an FO only if:

A disability decision has been made, or DDS will not need to make a disability decision on the case.

When not to return folders

DDS should not return cases to an FO if a disability decision is needed. DDS should request FO assistance, evidence, claimant contact, etc., by the most expeditious method such as telephone, FAX, or SSA-883, keeping the folders in DDS.

C. Examples

DDS should return folder

(no FO contact required)

DDS receives F-9 alert (TXVI file only, DI 11055.055).

DDS receives a direct written request to withdraw claim (DI 11010.075)

Title II claimant dies within five months of AOD (DI 11010.075)

MQGE claimant dies (DI 11010.075).

DDS recognizes case as being SSA jurisdiction:

Career railroad or RR annuitant (DI 11010.262),

Individual in U.S. Possessions (DI 11010.255),

Foreign claim (DI 11010.275),

Emergency clause (DI 11055.110 and DI 11010.290),

Title II claimant currently entitled to another title II disability benefit )

SGA case (DI 10501.001),

Changed identity claim, (DI 11010.270),

Res judicata (S1 denial code) case (DI 11010.075)

The FO should request DDS to return folder

The FO discovers technical denial is applicable (either title, DI 11010.040).

SSI claimant dies; the FO determines disability decision is not needed (DI 11055.050).

The FO receives request for withdrawal (DI 11010.075).

The FO discovers case is SSA jurisdiction (DI 11010.075).

DDS should not return folder to the FO

Failure to pursue or whereabouts unknown (DDS should make decision).

Claimant moves to another State (send folder directly to other DDS after notifying the FO, DI 11010.255).

Additional information needed from claimant (DDS contacts claimant)

SSI claimant attains age 65 (DDS tells the FO; DDS still makes decision.).

DDS should telephone or FAX SSA-883 to the FO for assistance (DDS keeps folder unless the FO requests it)

DDS learns SSI claimant has died (DI 11055.050B).

DDS learns title II claimant has died (DI 11010.630C).

Claimant tells DDS on telephone that the claimant wants to withdraw claim (DI 11010.075).

DDS is unable to secure SSA-3369 from claimant.

DDS needs to contact claimant's employer (DI 11010.145).

DDS needs proof of age (DI 11010.640).

DDS learns of change of address or representative payee issue (DI 11010.630 through DI 11010.635).

DDS needs assistance in developing medical evidence (DI 11010.645).

DDS needs assistance in following up on medical evidence (DI 11010.520).

DDS needs additional information from claimant but has been unable to obtain it (DI 11010.485).

D. Other situations

Title II insured status alerts	If DDS receives a systems-generated alert regarding title II insured status, telephone the FO to verify status before returning the folder
SGA Issues	FOs should resolve SGA issues prior to sending folders to DDS. If DDS receives a case with an unresolved SGA issue or discovers an SGA issue during case development, DDS should telephone the FO immediately. Unless the work clearly is not SGA, the folder will then be sent back to the FO. The FO should be notified before the folder is returned
Other Issues	Many situations not described in this supplement may indicate a need for FO/DDS coordination and assistance. Use the telephone to coordinate actions in these situations. FAX should be used to transmit assistance requests and subsequent documentation. The FO should handle all requests promptly and thoroughly. DDS follow-up efforts should follow the guidelines discussed in the "FO Responsibilities" section below.

E. FO responsibilities

Providing complete initial development

FOs can frequently prevent DDS development requests by providing DDS with complete development when claims material is first sent. Delays occur when the FO fails to:

Secure a properly completed SSA-3368 and SSA-3369;

Secure SSA-3820, SSA-3881, and Activities of Daily Living (ADL) form for all SSI children's claims;

Secure ADL form where required by POMS for all other cases;

Route to DDS, with FO disposition annotated, SSA-4814/4815 (Physician's Report on Adult/Child With Allegation of HIV) received in the FO after file has been routed to DDS;

Follow POMS guidelines for SSA-827 completion and adhere to criteria (specific wording, original and witnessed signatures, etc.) established by medical sources;

Obtain current SSA-827s for reconsideration requests;

Document complete medical source names and addresses;

Address all work activity after alleged onset date;

Record the prescribed period and controlling date for all disabled surviving spouse's claims;

Annotate the DLI on the transmittal form (DI02, DI16, SSA-831, etc.);

Explain to the claimant at the initial interview DDS' role and the possibility of a CE request;

Translate all SSA-3368s and SSA-3369s completed in a foreign language prior to forwarding to DDS; and

Promptly notify DDS regarding insured status issues, change of address, etc.

Responding to DDS Development Requests

FOs should respond promptly to all DDS assistance/development requests made by telephone, FAX or mail SSA-833. If information or assistance cannot be immediately provided, FOs should establish a control on these requests and furnish the development or a status report (including expected completion date) to DDS within 14 days of the request. DDS should follow up with the FO if no response is received. In special situations (second follow-ups, extreme problem cases, etc.), DDS may request Regional Office assistance.

Social Security

Program Operations Manual System (POMS)

DI DAL10005.001 Return Of Case Folders To FOs From DDS

A. Background

B. Basic rules

C. Examples

D. Other situations

E. FO responsibilities