TN 18 (08-25)

QR 04440.501 Completion of the SSA-1774-U5, Request for Corrective Action

 

A. Use of an SSA-1774-U5

Quality Review (QR) completes an SSA-1774-U5 to return group I and group II deficiencies, as well as some technical corrective actions, that may affect the disability determination or the period of disability, to the adjudicating component.

For additional information regarding the types of transmittal forms and an exhibit of the SSA-1774-U5, see the references:

B. Procedure for completing an SSA-1774-U5

The sections below explain how to complete the SSA-1774-U5 form.

1. How to complete the fields

Information from QR's case processing system electronically propagates sections 1 through 6 and 8 through 11 of the SSA-1774-U5. NOTE: The “date” field in section 1 does not automatically propagate and must be entered manually. See GN 04440.501B.4.

Manually enter onset information in section 7 for deficient initial and recon disability determinations. Complete the alleged onset (AOD) field. Enter the adjudicating component’s established onset date (EOD) for all allowance determinations. Complete the reviewer onset date (ROD) field when a group I decisional deficiency results in a favorable disability determination or a group II decisional deficiency warrants a different onset date.

For complete and accurate data propagation, quality reviewers must complete all QR case processing system coding prior to creating the SSA-1774-U5. Following completion of the appropriate review screens, quality reviewers must:

  • Review the propagated fields for accuracy and make any necessary changes in QR’s case processing systems, as applicable.

  • Incorporate policy references into the case discussion.

2. How to format and organize the narrative discussion

The following sections explain how to complete the narrative fields on the SSA-1774-U5.

a. Narrative fields

The narrative fields on the SSA-1774-U5 include:

  • Item 11 ("ACTION REQUESTED AND RATIONALE") on the first page and

  • A 20,000 character maximum limit.

In item 11, summarize the relevant facts of the case and clearly state:

  • the policy issue,

  • reasons why the case is deficient, and

  • necessary corrective action(s).

To explain or justify the deficiency, do not use:

  • Disability Policy’s policy memorandums,

  • PolicyNet Questions and Answers (Q & As) or

  • other similar written guidelines that are not part of National policy.

NOTE: Quality reviewers cannot cite a Q & A as the sole basis for a deficiency, but may refer to a Q & A on the SSA-1774-U5, for clarification purposes only, as long as the Q & A is not expired or archived.

Acceptable references include:

  • The Program Operations Manual System (POMS)

  • The Social Security Act

  • Regulations

  • Social Security and Acquiescence Rulings

  • Administrative and Emergency Messages

Follow the appropriate format when completing each section of the narrative discussion on the SSA-1774-U5, as explained here.

b. The header section of the SSA-1774-U5

The QR case processing system propagates the header section onto the SSA-1774-U5 form. The heading will differ based on the type of review and deficiency code.

  • QR’s case processing system propagates a heading that includes the deficiency group, deficiency category, deficiency sub-category, and primary/other deficiency.

c. How to complete the “ISSUE” section

Provide a brief summary to describe the basis of the deficiency. Two to three sentences is generally sufficient.

d. How to complete the "CASE DISCUSSION & POLICY ANALYSIS" section, including relevant policy citations

Follow the Federal Plain Language Guidelines, as enacted by the Plain Language Act of 2010, when writing the narrative discussion of the SSA-1774-U5.

If applicable to the return, the section should include:

  • A brief statement of the claimant's allegations and the alleged onset date.

  • Discussion of the vocational issues, including incorporation of specific policy references to support any deficiency findings.

  • Discussion of the medical issues, with respect to sufficiency of documentation or medical severity, as it relates to listing requirements or impact on the claimant's residual functional capacity (RFC). Include incorporation of specific policy references.

  • Discussion of symptom evaluation, medical source statements, all opinion evidence, and any related policy.

  • Discussion of the earnings issue(s) or other work activity issues which requires development.

DO NOT:

  • Cut and paste POMS sections into the return without providing a discussion of the policy interpretation and how it specifically applies to the cited deficiency.

  • Provide a list of references or cite a range of POMS chapters.

  • Cite a POMS table of contents or introductory section, unless the introductory section contains specific instructions related to the deficiency (e.g., introductory text in specific Listing of Impairments).

NOTE: Be very specific. Adjudicating components,Disability Policy's Request for Program Consultation staff, and subsequent reviewers must be able to identify the incorrectly applied policy to determine the proper course of corrective action(s).

e. How to complete the “REQUEST FOR CORRECTIVE” section

Explicitly state the action(s) necessary to correct the deficiency.

If documentation is necessary, specify the type of documentation. Do not direct the adjudicating component to purchase a consultative examination or otherwise tell them how to obtain the evidence. For additional information on routing and correcting deficient cases, see GN 04440.202,GN 04440.203, and GN 04440.204.

If the return does not require corrective action by the adjudicating component, include the statement, “No corrective action required”.

3. SSA-1774-U5 Signatures

The name of the person who creates the SSA-1774-U5 form will propagate in the "QR Quality Reviewer Signature" field at the bottom left of the QR Disability Determination Explanation (DDE).

The name of the person who approved the SSA-1774-U5 will propagate under the "Approved" field at the bottom of the Request for Corrective Action section.

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1304440501
QR 04440.501 - Completion of the SSA-1774-U5, Request for Corrective Action - 08/14/2025
Batch run: 08/14/2025
Rev:08/14/2025