BASIC (08-03)

A. Policy

Alerts are generated in OCO when an individual requests Grant review. The alerts will be used to locate and retrieve folders.

B. Procedure - alert/query package

OCO will take the following actions on the alerts that are generated:

• Associate the alert/query package with the reply form.

• If the alert contains a remark, “LATE RESPONDER - GOOD CAUSE DETERMINATION NEEDED,” forward the alert/query package to the field office (FO) via a SSA-559, “Good Cause Determination Necessary.” Follow the procedures in DI 52530.015B.4. after the FO makes a good cause determination.

  NOTE: If there is an indication from any of the returned correspondence that the individual may have a mental impairment, there may be a basis to find good cause for late filing.

• Obtain PCACS or PPL ROQS and other case control queries to determine the current folder location.

• After the alert/query package is associated with the reply form, route the alert/query packages as follows:

1. Title XVI only

1. At Least One Folder in Wilkes-Barre (WB)

   OCO sends the alert/query package to WB. WB sends any folder(s) they locate to the Office of Hearings and Appeals (ODAR) for class member eligibility screening. (See DI 52530.005B.7. for the address of ODAR.)

2. No Folders in WB

   OCO sends the alert/query package to the office which has the folder(s) (i.e., the FO).

3. At Least One Folder in WB and at Least One Folder in the FO

   OCO sends the alert/query package to WB and instructs WB to associate the alert/query package with any folder(s) in WB and to forward the folder(s) to the FO to associate with any folder(s) in the FO.

2. Title II only - no folder in OCO

1. One or More Folders in the PSC or the Alert is PSC jurisdiction OCO sends the alert/query package to the PSC for association with the folder(s). The PSC sends folders that are retrieved to ODAR for class member eligibility screening.

2. All Folders in the PSC

   The PSC associates all folders and sends them to ODAR for class member eligibility screening.

3. At Least One Folder Not in the PSC or One or More Folders in the FO and No Folders in the PSC

   The PSC or OCO, as applicable, sends the alert/query package to the FO. The FO associates the package with the folders and sends the folders that are retrieved to ODAR for screening.

4. All Folders in the DDS

   OCO sends the alert/query package to the DDS for association with the folders and the DDS sends the folder and alert/package to ODAR for class member eligibility screening. If a subsequent claim is pending in the DDS, the DDS should process it separately.

5. One or More Folders in the FO, No Folders in the PSC

   OCO sends the alert/query package to the FO. The FO associates the package with the folders and sends the folders to ODAR for class member eligibility screening.

3. Title II only - one or more folders in OCO

1. All Folders in OCO

   OCO associates the folders with the alert/query package and sends the folders to ODAR for class member eligibility screening.

2. One or More Folders in the PSC or the Alert is PSC Jurisdiction

   OCO sends the alert/query package to the PSC for association with the PSC folder(s). The PSC sends the folders that are retrieved to ODAR for class member eligibility screening.

3. One or More Folders in the FO

   OCO sends its folder(s) to the FO. The FO associates all folders and sends them to ODAR for class member eligibility screening.

4. All Non-OCO Folders in the DDS

   OCO sends its folder(s) to the DDS for association with the folders in the DDS. The DDS sends the folder to ODAR for class member eligibility screening. If a subsequent claim is pending in the DDS, the DDS should process it separately.

5. No Folders in the FO or the PSC, One or More Folders in a Location Other Than the DDS

   • OCO obtains the folder(s) from all locations other than the DDS.

   • OCO forwards the folder(s) to the DDS for association with any folder(s) that the DDS may have.

   • The DDS sends all folders to ODAR for class member eligibility screening.

4. Actions after good cause determinations

For title II only and concurrent title II/XVI cases, if the FO establishes good cause, follow the procedures in DI 52530.015C. for folder retrieval. (The FO retrieves title XVI only folders from Wilkes Barre and associates any current folder(s) in the FO with the alert/query package. The FO then ships the alert/query package and all title XVI only folders to ODAR for class membership screening.)

C. Procedure - folder retrieval

After an individual requests Grant review, OCO and the PSCs will retrieve folders as follows:

1. Determining folder location

1. Examine the PCACS and other case control queries in the alert/query package to determine the existence and location of the folder(s) and verify the SSN.

2. If none of the queries and/or alerts yield a folder location, examine the Master Beneficiary Record (MBR)/Supplemental Security Record (SSR) to verify that the Social Security Number (SSN) is correct. If the query package does not match the information on the alert, obtain a Civil Action Tracking Systems (CATS) name query. If the respondent is correctly shown on CATS, the incorrect alert should be annotated and forwarded to ODAR so that the incorrect alert can be deleted from CATS.

3. If no correct CATS record exists, send the individual the “SSN Verification Notice” in DI 52530.095I., Exhibit 9. Include a courtesy return envelope addressed to ODAR. Send the alert/query package and a copy of the notice to ODAR. (See DI 52530.005B.7. for the address.)

4. Process as a lost folder (see DI 52530.015C.4.) if the folder is not shown on the case control system and a thorough folder search (within 120 days of the initial folder request date) is unsuccessful.

2. Folder retrieval

1. OCO will locate and retrieve all available title II medical folders covered by the Grant timeframes as well as subsequent claims, except claims that are in ODAR. In concurrent title II/title XVI cases, do not request the title XVI folder if the title II folder contains the relevant medical evidence.

2. Request the folder(s) from the Federal Records Center, Federal Archives and Records Center or other PC storage location(s) as needed.

3. Diary and follow-up on the requests as needed.

4. Associate all multiple claims folders.

5. Review the available folder(s) to determine if all pertinent folder(s) have been obtained. If there is a missing folder(s), ascertain whether the missing folder(s) is a Grant folder by determining whether the decision date on the OHAQ in the available folder is within the Grant timeframes.

   • If the missing folder is a Grant folder, follow DI 52530.015C.4.

   • If the missing folder is not a Grant folder, annotate the alert “Grant Folder Located - Unable to Locate Other Folder.”

6. Place the alert/query package and folder search documentation (i.e., Court Case Folder Retrieval Worksheet) in a manila folder jacket and attach it to the front cover of the folder, and prong file the reply form on the right side of the folder and forward the folder(s) to ODAR at the address shown in DI 52530.005B.7. for class member eligibility screening.

3. Claim pending - Grant folder not located

If a claim is pending and the Grant folder cannot be located:

1. Contact the FO, DDS or ODAR to find out whether the prior folder is associated with a pending claim.

2. If the prior folder is with a pending claim and the pending folder is located in the:

   • FO

     Request the FO to send the Grant folder(s) to OCO or the appropriate PSC for association with the alert/query package.

   • DDS

     Request the DDS to send the Grant folder(s) to OCO or the appropriate PSC for association with the alert/query package.

     NOTE: Consolidation of the current claim with the Grant claim may occur after ODAR screening and DDS development of the Grant claim. As necessary, the DDS may want to photocopy the Grant file materials.

   • Hearing Office

     Forward the Grant folder(s) to ODAR Headquarters. See DI 52530.005.B.7. for the address.

   • ODAR Headquarters

     Send the alert/query package to the address in DI 52530.005B.7.

3. If the Grant folder is not associated with the pending claim, follow the instructions in DI 52530.015C.4.

4. If the Grant claim is pending in court, forward the alert to ODAR Headquarters at the address in DI 52530.005B.7.

4. Lost/Destroyed folders

1. If the claims folder cannot be located but the queries establish that the determination was made outside the Grant timeframes (see DI 52530.001B.2., forward the case to ODAR (see address in DI 52530.005B.7.) along with the queries showing no decision within the time period.

2. If all missing claims cannot be screened out, presume the individual to be a class member and retrieve all available folders. Determine whether any missing folder is a Grant folder by considering whether any decision date is in the Grant timeframes decided by the subject ALJ.

3. Notify the ODAR Class Action Coordinator that the Grant claim file is missing and that the individual is a presumed class member.

4. If a pertinent folder cannot be located within 120 days of the alert date; then:

   • Prepare a manila folder jacket to hold the reply form, alert, related queries, and documentation of attempts to locate the Grant folder(s) (Folder Retrieval Worksheet, DI 52530.095, Exhibit 4).

   • Annotate the alert “UTL Prior Folder(s) - FO (enter FO code) Requested to Reconstruct.”

   • Photocopy the annotated alert and send a copy to the Grant coordinator in ODARA (see DI 52530.005B.7. for the address).

   • Complete and attach the “Presumed Class Membership Flag” in DI 52530.095E. Exhibit 5.

   • Send the manila folder via SSA-559 to the servicing FO.

   • Annotate the SSA-559, “Grant Lost Folder Case - Please Reconstruct.” Forward reconstructed folders to ODAR (See DI 52530.005B.7. for the address).” Provide the FO with specific information regarding the types of applications and dates needed for reconstruction.