BASIC (03-86)

Cross refer to DI 42010.205.

Unfavorable ALJ decisions and dismissal actions are held by OHO with the claims folders for association of requests for AC review. If the applicant does not request review and the AC does not undertake review on its own motion, the file is returned to ODO/DRS after the period for appeal has expired.

A. OHO routing of claims file to ODO/DRS

OHO forwards the claims folder to ODO/DRS using the ALJ original HA-5051 U3 transmittal form. Unfavorable decisions and dismissals are usually noted, “Forwarded by OHO on (date).”

B. OHO review of favorable ALJ decisions (P.L. 96-265)

On October 1, 1981, OHO began a formal pre-effectuation review of a sample of title II and concurrent title II/title XVI ALJ decisions. This review is being done in response to section 304(g) of Public Law 96-265, which directed the Secretary to undertake a review of ALJ decisions. Hearing offices are advised as to which favorable disability decisions are to be referred to OHO's Central Office. If it is decided that the hearing decision is not in accordance with appropriate regulatory criteria, the AC will take the case on its own motion and notify the claimant, within 60 days of the ALJ decision, of the action being taken. If the case is not taken on its own motion, it will be referred to the proper effectuating component for prompt payment.