TN 3 (02-20)

DI 23007.001 Failure to Cooperate and Insufficient Evidence Definitions

CITATIONS:

20 CFR 404.1512 through 404.1519t , and 416.912 through 416.919t

This subchapter, Failure to Cooperate and Insufficient Evidence (FTC), describes what adjudicators must do when a claimant does not comply with an initial, written request for evidence or action, or an initial, written notice of a consultative examination (CE) appointment. The instructions apply to initial and reconsideration level claims. This section provides definitions for terms used throughout the FTC subchapter.

For when the claimant does not comply with an initial, written request for evidence or action, see DI 22505.014.

For when the claimant does not comply with an initial, written notice of a CE appointment, see DI 22510.019.

A. Special handling

Claims require special handling when the claimant does not have an applicant filing on his or her behalf or an appointed representative, and at least one of the following applies:

  • Homelessness,

  • Illiteracy,

  • Limited English proficiency (LEP),

  • A severe, mental medically determinable impairment (MDI)

  • Under age 18,

  • Undergoing an age 18 redetermination, or

  • Aged out of foster care in the last two years (identified by case flag).

NOTE: You must assume an alleged mental impairment to be a severe MDI unless you have evidence to the contrary. When you have such evidence, document it on a SSA-2506 Psychiatric Review Technique and do not apply special handling procedures.

REMEMBER: For claims requiring special handling, you must make at least one attempt to identify and involve a third party before you stop attempts to get the claimant's cooperation. Most claims will have a third party identified in Section 2 of the SSA-3368 Disability Report -Adult, SSA-3441 Disability Report - Appeal, or SSA-454 Continuing Disability Review Report. When the Field Office (FO) has identified an additional third party, the information will be in section 11 of the SSA-3368, SSA-3441, or SSA-454. You must make a reasonable effort to involve the additional third party when provided by FO and your efforts with the other third party was not productive. For additional information on making a reasonable effort to identify and involve a third party, see DI 23007.010.

B. Good reason

A good reason may include, but is not limited to, the following:

  • Physical, mental, educational, and verbal limitations, including limited English proficiency (LEP),

  • Personal illness,

  • Death or serious illness in the family, or

  • Other obstacles beyond the claimant's control.

C. Third party

Someone you can contact to help the claimant with his or her claim.

Third party information is in Section 2 of the SSA-3368 Disability Report -Adult, SSA-3441 Disability Report - Appeal, or SSA-454 Continuing Disability Review Report. The FO may provide an additional third party in Section 11 of the SSA-3368, SSA-3441, or SSA-454.

When there is FO documentation that the claimant refused to identify a third party in the remarks, do not attempt to identify a third party. For the policy to document the refusal at the FO, see DI 11005.022B.

Examples of a third party may include, but are not limited to a:

  • Relative,

  • Friend,

  • Member of religious or spiritual group,

  • Labor union representative,

  • Veterans group member, and

  • Member of a senior citizens association.

NOTE: Do not use a third party from a prior folder or prior appeal levels.

D. Applicant

Anyone who has the right to sign a valid application on behalf of himself or herself, or on behalf of the claimant, see GN 00204.003.

E. Appointed representative

An individual who meets the qualifications listed in GN 03910.020B, and who the claimant appoints to act on his or her behalf in pursuing his or her claim or asserted rights before the Social Security Administration (SSA).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423007001
DI 23007.001 - Failure to Cooperate and Insufficient Evidence Definitions - 01/06/2020
Batch run: 02/20/2020
Rev:01/06/2020