Effective Dates: 11/28/2023 - Present Previous | Next

TN 35 (11-23)

DI 81020.075 Field Office (FO) Determinations

A. FO determinations

The FO may deny a disability claim due to non-medical technical factors (e.g., insured status, income, and resources) or determine the claimant is engaging in Substantial Gainful Activity (SGA) at any time. The Disability Determination Services (DDS) may have jurisdiction of the case when the FO determines that a claim should be denied for non-medical reasons. The FO completes a determination in Electronic Disability Collect System (EDCS) to dispose of the case. The claim is closed in the Certified Electronic Folder (CEF). If the case contains only one claim, the case is closed in the CEF. For FO instructions on processing non-medical denials, see Processing Field Office (FO) Determinations - DI 81010.140.

B. FO determination alert

The “FO determination alert” notifies the DDS of the FO determination through their case processing system. For more information about CEF alerts, see Certified Electronic Folder (CEF) Alerts - DI 81020.080.

1. FO determinations case data tab in eView

To view the FO determination:

  • •

    access eView,

  • •

    enter the SSN on the Disability Folder Selection screen,

  • •

    click on the Case Data tab, and

  • •

    select “FO Determination(s)”.

The following FO information is displayed:

  • •

    Determination date,

  • •

    Determination type,

  • •

    Reason,

  • •

    Name and phone number of the Claims Representative (CR) who made the determination, and

  • •

    FO code and address.

NOTE: The “FO Determination(s)” tab only appears if the FO has made a determination on the case.

2. DDS actions

After receiving the FO Determination alert, the DDS must immediately determine if all claims in the case have been closed. If the FO has not prepared an FO Determination on all claims in the case, the DDS continues processing the remaining claim(s) in the case. For those claims that have an FO Determination, the DDS will take the following actions:

If the DDS has initiated substantive development:

  • •

    resolve outstanding requests for information;

  • •

    cancel pending Consultative Exam(s) (CE);

  • •

    close the claim with a No Determination (ND) reason (For more information on ND reasons see DI 81020.127 Processing “No Determination” (ND) Claims); and

  • •

    send the claim to case closure.

If the DDS has not initiated substantive development:

  • •

    transfer (TR) the claim to the FO that made the FO Determination; and

  • •

    send the claim to case closure.

NOTE: If the FO inputs an FO Determination on a claim(s) while a reactivated case is pending at the DDS, follow the above procedures.

 

If the official folder is a paper Modular Disability Folder (MDF) or if a prior paper folder exists:

  • •

    Prepare an EDCS Routing Form from eView “Print Forms”, with the annotation “CEF transferred to (receiving FO) for non-medical denial” in the remarks section of the EDCS Routing Form. For instructions on preparing the routing form, see DI 81010.087. Attach any paper MDF to the EDCS Routing Form; and

  • •

    Mail the EDCS Routing Form with all attachments to the receiving FO.

NOTE: If an outstanding Assistance Request (AR) exists, the assisting DDS office receives a notification alert of the FO Determination. The requested DDS will advise the assisting DDS office of cancellation of the AR, if applicable. If the DDS sends a closure transaction after the FO closes the claim, the closure transaction fails. However, the DDS can still add documents and images to the CEF.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0481020075
DI 81020.075 - Field Office (FO) Determinations - 11/28/2023
Batch run: 11/28/2023
Rev:11/28/2023