The following applies when case folders are returned to the FO from the DDS.
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When to return cases:
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DDS should return initial claims to an FO only if:
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A disability determination has been made, and the case is not part of the Disability
Quality Branch’s (DQB) review component sample, or
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DDS does not need to make a disability determination on the case,
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The SSA-827 is not in the file, and
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The FO requests the claim be returned.
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When not to return cases:
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DDS should not return cases to an FO if a disability determination is needed. DDS
should request FO assistance, evidence, claimant contact, etc., by the most expeditious
method available (e.g., EDCS Assistance Request (AR)), keeping jurisdiction in the
DDS.
Exception: See “SGA issues” in Table 2, Examples, in this section.
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The DDS should return the case when it: (no FO contact required)
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Receives an F-9 alert (Title XVI file only, SM 05905.204).
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Receives a direct written request to withdraw the claim (DI 11010.075).
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Receives notification that the Title II claimant died within five months of Alleged
Onset Date (AOD) (DI 11010.075).
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Recognizes the case is under SSA jurisdiction:
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Prisoner case when the FO fails to respond to an AR (DI 23501.005).
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The FO should request that the DDS return the case when it:
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Receives notice of the SSI claimant’s death; the FO determines disability decision
is not needed (DI 11055.050).
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Receives notice that the Title II claimant died within five months of AOD (DI 11010.075.)
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Discovers the case is under SSA jurisdiction (DI 11010.075).
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The DDS should not return the case to the FO when:
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Failure to pursue or whereabouts unknown is an issue (DDS makes a determination),
DI 11010.045.
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The claimant moves to another state (send folder directly to other DDS after notifying
the FO). See DI 11010.255.
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Additional information is needed from the claimant (DDS contacts claimant).
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An SSI claimant attains age 65 (DDS tells the FO; DDS still makes determination).
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The case is part of a DQB review component sample.
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Collateral estoppel potentially applies but an earlier EOD is possible for Title II
entitlement (DI 27515.001).
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DDS should contact the FO for assistance (DDS keeps jurisdiction) when it:
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Receives a withdrawal request from the claimant via telephone (DI 11010.075).
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Is unable to secure form SSA-3369 from claimant (DI 10005.010).
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Needs assistance developing medical evidence (DI 11010.645).
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Needs assistance following up on medical evidence (DI 11010.520).
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Needs additional information from the claimant but has been unable to obtain it (DI 11010.485).
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Title II insured status alerts
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If DDS receives a systems-generated alert regarding Title II insured status, telephone
the FO to verify status before returning the folder.
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SGA issues
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FOs should resolve SGA issues prior to sending folders to DDS.
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If DDS receives a case with an unresolved SGA issue or discovers an SGA issue during
case development, the DDS should send an electronic assistance request (AR) in eView
to the FO requesting SGA development.
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