GN 04440.204: Correcting Group I Deficiencies - General
Effective Dates: 04/18/2011 - Present
- TN 8 (06-04)
- GN 04440.204 Correcting Group I Deficiencies - General
- A. Policy — Corrective Action
- Group I deficiencies are returned to the adjudicating component for correction with some exceptions; i.e.,:
- * decisional deficiencies involving clear evidence that the claimant is engaging in SGA, and
- * procedural documentation deficiencies involving work activity issues only.
These deficiencies are sent to the FO for resolution of the issue. Refer to GN 04440.205 through GN 04440.211 for group I deficiencies that are sent to the FO for resolution. Non-recorded procedural documentation deficiencies in which the date last insured (DLI) for a Title II disabled worker claimant, the prescribed period for a disabled widow/er claimant or age 22 for a childhood disability claimant must be documented or verified are also sent to the FO for development. See GN 04440.235C.1.b.
- In addition, concurrent Title II/Title XVI initial and reconsideration cases with a group I medical or procedural documentation deficiency involving onset may be corrected post-effectuation; i.e., payment can be effectuated on the Title XVI claim while the development is being undertaken for the Title II claim. See GN 04440.207.
- B. Procedure — Review Component
- 1. Group I Deficiency Cases-Corrected By Adjudicating Component
- For those group I deficiency cases that are corrected by the adjudicating component, the quality reviewer will:
- * Prepare an SSA-1774-U5 and return the deficient case folder to the adjudicating component.
- * Request return of the corrected case for completion of the DDS Return (Results) Screens.
- NOTE: The original PRTF and/or RFC should remain in file as part of the audit trail. The original should be annotated “Do Not Process”.
- 2. Group I Deficiency Cases-Corrected By FO
- For those group I deficiency cases that are corrected by the FO, the quality reviewer will:
- * Prepare an SSA-5524-U3 and return the deficient case folder to the FO.
- * Ask the FO to notify you if they have jurisdiction of the case and they prepare a determination form so the DICARS results screen can be completed. The FO can notify you either by mailing or faxing a copy of the determination form or by phoning or e-mailing the information, if preferred.
- C. References
- See GN 04440.950, GN 04440.945, DI 30005.121 and DI 30005.123 for an explanation of the group I decisional and documentation deficiencies and the corresponding DICARS deficiency code.
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