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DI 70025.001: Paper Modular Disability Folder (MDF) Procedures for the Office of Hearings Operations (OHO)

changes
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  • Effective Dates: 03/24/2017 - Present
  • Effective Dates: 04/05/2018 - Present
  • TN 3 (04-11)
  • DI 70025.001 Paper Modular Disability Folder (MDF) Procedures for the Office of Disability Adjudication and Review (ODAR)
  • DI 70025.001 Paper Modular Disability Folder (MDF) Procedures for the Office of Hearings Operations (OHO)
  • A. Introduction to the Office of Disability Adjudication and Review’s (ODAR’s) paper Modular Disability Folder (MDF) procedures
  • A. Introduction to the Office of Hearings Operations (OHO’s) paper Modular Disability Folder (MDF) procedures
  • The Certified Electronic Folder (CEF) is the Social Security Administration’s preferred method for processing disability claims. However, the field office (FO) must establish a paper folder when the system excludes a disability claim from the Electronic Disability Collect System (EDCS) or when a processing limitation occurs that removes the case from electronic processing. The EDCS is the method field offices use to enter claims into the CEF. For information about CEF exclusions, see DI 81010.030.
  • The Modular Disability Folder (MDF) is the official folder for paper cases. Prior to electronic processing, SSA created the MDF to address the increased complexity of the disability programs. The MDF promotes uniform assembly for all disability claims processing components within SSA and the Disability Determination Services (DDS).
  • These instructions specifically address ODAR’s responsibilities concerning the MDF when a claimant or his or her representative requests a hearing.
  • These instructions specifically address OHO’s responsibilities concerning the MDF when a claimant or his or her representative requests a hearing.
  • B. Hearing office (HO) actions
  • Since implementation of the MDF, HO staff does not need to remove documents from the claim file in order to create a separate exhibit file for the hearing. For additional information on this subject, see DI 70025.001B.2. in this section.
  • 1. Conducting prehearing case analysis
  • HO staff follows the prehearing case analysis instructions in the Hearings, Appeals and Litigation Law Manual (HALLEX) I-2-1-1 through HALLEX I-2-1-10.
  • 2. Preparing the Modular Disability Folder (MDF) for the hearing
  • a. Parts of the MDF
  • The MDF is designed in six color-coded parts or sections to organize related material (e.g., all medical records are filed in the Yellow (back) section) and to encourage discarding extraneous or duplicate material. The CEF has the same color-coded sections, with a few additional sections for queries and multimedia files. For additional information about the CEF and the hearing process, see HALLEX I-2-0-1.
  • HO staffs, who prepare the exhibits list for the hearing, designate each part by letter (A – F), as follows:
  • Part A
  • Payment Documents/Decisions - Yellow (Front)
  • Part B
  • Jurisdictional Documents/Notices - Red
  • Part C*
  • Current Development/Temporary - Green
  • Part D
  • Non-Disability Development - Orange
  • Part E
  • Disability Related Development and Documentation - Blue
  • Part F
  • Medical Records -Yellow (Back)
  • * Since Part C is for temporary working papers only, it does not house exhibits and should be empty when the HO staff receives the file.
  • b. Concurrent Title II/Title XVI or multiple claims housed in two-part brown folders
  • In concurrent Title II/Title XVI claims or multiple claims under Title II, a two-part brown folder, attached to the MDF, houses the additional claims. The Title II claim is the primary claim documentation in the MDF.
  • NOTE: File Supplemental Security Income (SSI), Disabled Widow(er)'s Benefit (DWB) and Childhood Disability Benefit (CDB) claims in two-part brown folders, attached to the MDF, in concurrent or multiple claims situations, or both. We name the two-part brown folders, as follows:
  • Part
  • Description
  • SSI
  • Supplemental Security Income
  • DWB
  • Disabled Widow(er’s) Benefits
  • CDB
  • Child's Disability Benefits
  • FO and DDS employees are responsible for filing documentation relative to their respective levels of claim processing in the designated part of the MDF, as specified in DI 70005.005B., prior to when the MDF arrives in the HO.
  • 3. Identifying the proposed exhibits
  • The HO staff does not remove any documents from the MDF to create an exhibit file. Rather, the HO staff selects and marks documents in the MDF as proposed exhibits, as stated in HALLEX I-2-1-15.
  • C. Examples of documents
  • The following are examples of documents (not an exhaustive list) that we usually identify as proposed exhibits. The MDF already contains the documents mentioned in this section when the Hearing Office (HO) receives it.
  • * Example 1. Part A -- Payment Documents/Decisions - Yellow (Front) section.
  • (Filed in chronological order with the most recent document on top)
  • * SSA-831 (Disability Determination and Transmittal).
  • * SSA-832 and SSA-833 (Cessation or Continuance of Disability/Blindness Determination for Title XVI and Title II).
  • * Example 2. Part B -- Jurisdictional Documents/Notices – Red section.
  • (Filed in chronological order with the most recent document on top)
  • * SSA/SSI Notice of Disability/Blindness (Denial/Award).
  • * SSA-561 (Request for Reconsideration).
  • * Notice of Reconsideration (Denial/Award).
  • * HA-501 (Request for Hearing by ALJ).
  • * SSA-1696 (Appointment of Representative)
  • * Attorney fee agreements and any other documents relating to the fees to be charged for representation before SSA
  • * Revocation or withdrawal of a representative
  • * Example 3. Part C -- Current Development/Temporary – Green section.
  • We reserve this section for working papers only. Each SSA component involved in processing disability claims is responsible for purging this section when an action is completed, filing essential material in the appropriate module and discarding non-essential materials. There should be no documents in this section.
  • * Example 4. Part D -- Non-Disability Development – Orange section.
  • (Filed according to guidelines.in DI 70005.005B.4. and GN 01050.190)
  • * The application (paper or computer printouts), and any written statement or record of oral inquiry indicating an intent to claim benefits which serves as a protective filing.
  • * Birth Certificate or other proof of age.
  • * Earnings records and proof of any non-posted wages or self-employment income.
  • * Workers' Compensation and Department of Veterans Affairs award information.
  • * Evidence of death and relationship (in auxiliary and survivor cases).
  • * Pertinent statements or reports of contact (not disability related).
  • * Example 5. Part E -- Disability Related Development and Documentation – Blue section.
  • (Filed in chronological order with the most recent document on top).
  • * SSA-3368 (Disability Report - Adult).
  • * SSA-3369 (Work History Report).
  • * SSA-3441 (Disability Report - Appeal).
  • * SSA-3820 (Disability Report - Child).
  • * SSA-454 (Continuing Disability Review Report).
  • * SSA-455 (Disability Update Report).
  • * School records (Teacher Evaluations Only).
  • * Supplemental questionnaires (Function Report forms).
  • * Unsuccessful attempts to obtain necessary non-medical disability documentation.
  • * Any other documentation relating to development of disability.
  • * State vocational reports.
  • * SSA-821 (Work Activity Report - Employee).
  • * SSA-820 (Work Activity Report - (Self Employed Persons).
  • * SSA-5002 (Disability-related non-medical contact)
  • * Electronic Disability Collect System (EDCS) routing form
  • * Example 6. Part F -- Medical Records – Yellow (Back) section.
  • (Filed in treatment-date order - the earliest date on top).
  • * CDI Report of Investigation (When in file)-must be filed on top of all documents, including the DDS Worksheet.
  • * DDS Worksheet
  • * Treatment records.
  • * Hospital records.
  • * Laboratory reports.
  • * Outpatient notes.
  • * Clinic notes.
  • * Physician's records and reports.
  • * Cover letters from treatment sources if medical evidence is not otherwise identified.
  • * X-ray findings.
  • * Examination reports.
  • * Medical opinions.
  • * School records (Multi-Discipline evaluations and/or Psychologist evaluations).
  • * Professional Qualifications (PQs) of all physicians and mental health professionals whose reports, analyses, assessments, or judgments are entered into the record of exhibits.
  • * SSA-5002 (Report of Contact) - Disability related.
  • * Letters of unsuccessful attempts to obtain medical evidence.
  • * SSA-4734 (Physical Residual Functional Capacity Assessment) (DDS Medical Consultant (MC)/Single Decision Maker (SDM)).
  • * SSA-2506 (Psychiatric Review Technique Form (PRTF)) (DDS MC/Psychological Consultant (PC)).
  • * Capability opinions - DDS MC/PC completes.
  • D. Concurrent and multiple filing cases
  • 1. Identification of proposed exhibits
  • In concurrent Title II/Title XVI claims, the MDF houses all medical material and all Title II non-medical material. In multiple Title II claims, the MDF houses the primary Title II claim with the medical evidence. We file any other claim in the two-part brown folder and staple it to the back of the MDF.
  • All material in the two-part brown folders remains in these folders, and HO staff does not reassemble it. Identify the material as exhibits, as described in DI 70025.001D.3 in this section.
  • 2. Documents not normally made exhibits
  • The HO staff does not identify every document in each part of the MDF as an exhibit.
  • HO staff follows the procedures in HALLEX I-2-1-15B to determine which documents in the MDF they do not need to identify as an exhibit.
  • 3. Marking and numbering exhibits
  • a. Documents identified as exhibits
  • The HO staff numbers the documents identified as proposed exhibits within each section of the claim file, sequentially.
  • The HO staff also numbers exhibits in each part, beginning with the number 1.
  • The alpha letter applicable to each part (e.g., Part A) must also be included when numbering the exhibits.
  • EXAMPLES:
  • * 1A = 1st hearing, Exhibit 1, part A
  • * 2A = 1st hearing, Exhibit 2, part A
  • * 3A = 1st hearing, Exhibit 3, part A
  • * 1B = 1st hearing, Exhibit 1, part B
  • * 1D = 1st hearing, Exhibit 1, part D
  • * 1E = 1st hearing, Exhibit 1, part E
  • * 1F = 1st hearing, Exhibit 1, part F
  • * 1SSI = 1st hearing, Exhibit 1, SSI File
  • b. Prior and subsequent hearings
  • HO staff does not renumber the exhibits from a prior decision. Prior hearing documentation remains intact in the existing folder. HO staff does not incorporate these documents into the MDF. The HO staff attaches a copy of the exhibit list from the prior hearing to the exhibit list for the MDF.
  • If there is a prior claim that the beneficiary (or his or her rep payee) did not appeal to the hearing level, that prior file will remain in its folder, attached to the back of the current claim MDF.
  • HO staff prefaces exhibits relating to second or third final hearing, for example, with the letters "B," "C," etc.
  • EXAMPLES:
  • * B-1A = 2nd hearing, Exhibit 1, part A
  • * C-1DWB = 3rd hearing, Exhibit 1, DWB File
  • 4. Preparing the exhibit list
  • After the HO staff marks and identifies the proposed exhibits, the staff prepares an exhibit list. For examples of exhibit lists, see DI 70025.001E. in this section. For additional information about preparing the exhibit list in various situations, see HALLEX I-2-1-20. If additional evidence arrives at or after the hearing, HOs mark the item(s) with the next exhibit number(s) and add the exhibit(s) to the exhibit list under the heading "RECEIVED DURING HEARING" or "RECEIVED SUBSEQUENT TO HEARING," as appropriate.
  • 5. Decisions - content, distribution, and routing
  • a. Content
  • All references to specific exhibits include the alpha codes to indicate the specific MDF section that housed the exhibit and the preceding alpha code for subsequent filings.
  • b. Distribution and routing
  • HOs file the ALJ decision/dismissal, including attachments (e.g., order of approval/disapproval of the fee agreement), CPMS Case History, CD envelope, and CD (unfavorable decisions) in Part A of the MDF.
  • Case routing is determined based on the information in CPMS and the answers to the routing-related prompts.
  • E. Exhibits
  • Exhibit 1-- First request for hearing
  • Claimant: John Doe SSN: 000-00-0000
  • Exhibit No.
  • Part No.
  • Description
  • No. of Pages
  •  
  •  
  • PAYMENT DOCUMENTS/DECISIONS
  •  
  • 1
  • A
  • Initial Disability Determination by State Agency, Title II, dated May 25, 2008 (with attached rationale)
  • 4
  • 2
  • A
  • Reconsideration Disability Determination by State Agency, Title II, dated November 22, 2008 (with attached rationale)
  • 4
  •  
  •  
  • JURISDICTIONAL DOCUMENTS/NOTICES
  •  
  • 1
  • B
  • Social Security Notice, dated May 25, 2008
  • 3
  • 2
  • B
  • Request for Reconsideration filed July 26, 2008
  • 4
  • 3
  • B
  • SSA-1696 (Appointment of Representative) filed July 26, 2008
  • 1
  • 4
  • B
  • Fee Agreement signed July 23, 2008
  • 2
  • 5
  • B
  • Social Security Notice of Reconsideration, dated November 22, 2008
  • 4
  • 6
  • B
  • Request for Hearing filed December 20, 2008
  • 2
  • 7
  • B
  • Acknowledgement of Request for Hearing, dated January 6, 2009
  • 6
  • 8
  • B
  • Notice of Hearing, dated March 3, 2009
  • 10
  • A
  •  
  • NON-DISABILITY DEVELOPMENT
  •  
  • 1
  • D
  • Leads/Protective Filing Worksheet, dated January 2, 2008
  • 2
  • 2
  • D
  • Application for Disability Insurance Benefits filed January 31, 2008
  • 4
  • 3
  • D
  • Earnings record (dated/certified), February 5, 2009
  • 4
  •  
  •  
  • DISABILITY RELATED DEVELOPMENT AND DOCUMENTATION
  •  
  • 1
  • E
  • Vocational Report, dated February 8, 2008
  • 6
  • 2
  • E
  • Supplemental Questionnaire, dated March 16, 2008
  • 6
  • 3
  • E
  • Reconsideration Disability Report, dated August 30, 2008
  • 5
  • 4
  • E
  • Claimant's Statement When Request for Hearing is Filed and the Issue is Disability, dated December 20, 2008
  • 3
  •  
  •  
  • RECEIVED DURING HEARING
  •  
  • 5
  • E
  • List of Claimant's Medications, dated January 15, 2009
  • 2
  •  
  •  
  • MEDICAL RECORDS
  •  
  • 1
  • F
  • Hospital Records for admission on March 17, 2008 through discharge on March 24, 2008, from General Hospital
  •  
  • 2
  • F
  • Psychiatric Review Technique Form by State Agency, dated May 21, 2008
  •  
  • 3
  • F
  • Medical records covering period from January 15, 2004 to June 30, 2008, from J. Kildare, MD
  • 56
  • 4
  • F
  • Medical Report, dated July 30, 2008, by Dr. C. M. Bones
  • 3
  • 5
  • F
  • Professional Qualifications, Dr. C. M. Bones
  • 1
  •  
  •  
  • SUPPLEMENTAL SECURITY INCOME (SSI)
  •  
  • 1
  • SSI
  • Record of SSI Inquiry, dated January 2, 2008
  • 1
  • 2
  • SSI
  • Application for Supplemental Security Income Benefits filed January 31, 2008
  • 6
  • 3
  • SSI
  • Initial Disability Determination by State Agency, Title XVI, dated May 25, 2008 (with attached rationale)
  • 4
  • 4
  • SSI
  • Supplemental Security Income Notice, dated May 25, 2008 (with attached rationale)
  • 3
  • 5
  • SSI
  • Reconsideration Disability Determination by State Agency, Title XVI, dated November 22, 2008 (with attached rationale)
  • 4
  • 6
  • SSI
  • Supplemental Security Income Notice of Reconsideration – Disability, dated November 22, 2008
  • 3
  • Exhibit 2 — Subsequent Request for Hearing
  • Claimant: John Doe SSN: 000-00-0000
  • Exhibit No.
  • Part No.
  • Description
  • No. of Pages
  •  
  •  
  • PAYMENT DOCUMENTS/DECISIONS
  •  
  • B-1
  • A
  • ALJ's decision, dated January 6, 2010, Notice of Decision, and list of exhibits marked 1A-3A, 1B-8B, 1D-3D, 1E-5E, 1F-8F, AC-1-AC-3, 1SSI-6SSI.
  • 11
  • B-2
  • A
  • Initial Disability Determination by State Agency, Title II, dated May 15, 2010 (with attached rationale)
  • 4
  • B-3
  • A
  • Reconsideration Disability Determination by State Agency, Title II, dated August 20, 2010 (with attached rationale)
  • 4
  •  
  •  
  • JURISDICTIONAL DOCUMENTS/NOTICES
  •  
  • B-1
  • B
  • Social Security Notice, dated May 15, 2010
  • 3
  • B-2
  • B
  • Request for Reconsideration filed June 30, 2010
  • 4
  • B-3
  • B
  • Social Security Notice of Reconsideration, dated August 20, 2010
  • 4
  • B-4
  • B
  • Request for Hearing filed October 1, 2010
  • 2
  •  
  •  
  • NON-DISABILITY DEVELOPMENT
  •  
  • B-1
  • D
  • Application for Disability Insurance Benefits filed March 15, 2010
  •  
  • B-2
  • D
  • Earnings record (dated/certified) December 1, 2010
  •  
  •  
  •  
  • NON-DISABILITY DEVELOPMENT
  •  
  • B-1
  • E
  • Disability Report, dated May 1, 2010
  • 8
  • B-2
  • E
  • Work History Report, dated May 5, 2010
  • 6
  • B-3
  • E
  • Supplemental questionnaire dated August 5, 2010
  • 6
  • B-4
  • E
  • Reconsideration (Disability Report – Appeal), dated July 5, 2010
  • 5
  •  
  •  
  • MEDICAL RECORDS
  •  
  • B-1
  • F
  • Hospital records for admission on March 1, 2010, through discharge on March 15, 2010, from General Hospital
  • 7
  • Exhibit 3-- Appeals Council or Court Remand Cases
  • Claimant: John Doe SSN: 000-00-0000
  • Exhibits admitted in connection with Appeals Council Remand
  • Exhibit No.
  • Part. No.
  • Description
  • No. of Pages
  •  
  •  
  • PAYMENT DOCUMENTS/DECISIONS
  •  
  • 3
  • A
  • Decision by ALJ issued on May 27, 2009
  • 8
  •  
  •  
  • JURISDICTIONAL DOCUMENTS/NOTICES
  •  
  • 5
  • B
  • Request for Review of Hearing Decision/Order filed June 10, 2009
  • 2
  • 6
  • A
  • Action of Appeals Council on Request for Review dated September 5, 2009
  • 4
  •  
  •  
  • NON-DISABILITY DEVELOPMENT
  •  
  • 9
  • B
  • Notice of Hearing, dated October 5, 2009
  • ?
  • 10
  • B
  • Notice of Continued Hearing, dated February 22, 2010
  • ?
  • DISABILITY RELATED DEVELOPMENT AND DOCUMENTATION
  •  
  •  
  • MEDICAL RECORDS
  •  
  • 7
  • B
  • Hospital Records for admission on June 1, 2009, and discharge on June 14, 2009, from General Hospital
  • 29
  • 9
  • F
  • Medical records covering period from June 19, 2009 to July 30, 2009, from J. Kildare, MD
  • 36
  • 1
  • F
  • Appeals Council Exhibit -- Medical Report, dated November 30, 2008, from Dr. C. M. Bones
  • 2
  • 2
  • F
  • Appeals Council Exhibit -- Medical Report, dated July 5, 2009, from DR. C. M. Bones
  • 2
  • 3
  • F
  • Appeals Council Exhibit -- Professional Qualifications of Dr. C. M. Bones
  • 1
  • Exhibits admitted at the Supplemental Hearing held on March 18, 2010 following Remand
  • 7
  • F
  • Outpatient Medical Records covering period from November 3, 2009 to February11, 2010, from General Hospital
  • 8
  • Additional claim file (two-part brown folder), if applicable:
  • Part (SSI) - Supplemental Security Income
  • Part (DWB) - Disabled Widow(er)
  • Part (CDB) - Child's Disability Benefits
  • F. List of documents the HO receives or generates
  • The following is an alphabetical list of documents that the HO receives or generates subsequent to a request for hearing and the MDF section in which the appropriate offices filed each.
  • Document
  • MDF Section
  • Briefs
  • Part E
  • Case History, CPMS
  • Part A
  • CD (Hearing) & CD Envelope
  • Part A
  • Certificates
  •  
  • Birth
  • Part D
  • Death
  • Part D
  • Congressional Inquiries and Responses
  • Part D
  • Correspondence
  •  
  • Disability Related
  • Part E
  • Non-Disability Related
  • Part D
  • Decision or Dismissal
  •  
  • ALJ
  • Part A
  • Senior Attorney
  • Part A
  • Earnings, Proof of
  • (Certified Earnings Record, Employer Statement, W2, tax return, DEQY/SEQY)
  • Part D
  • Evidence
  •  
  • *Request for
  • Part C
  • Additional Medical
  • Part F
  • Fees
  •  
  • Agreement or Contract
  • Part B
  • Order or Authorization
  • Part A
  • Petition, Form SSA-1560
  • Part B
  • Hearing
  •  
  • Acknowledgement of Request/Attachments
  • Part B
  • Continuance of Hearing
  • Part B
  • Notice of Hearing
  • (Claimant, Rep., ME, VE)
  • Part B
  • Waiver of Right to Appear
  • Part B
  • Information
  •  
  • Release Form SSA-827
  • Part E
  • Interrogatories
  •  
  • Medical Expert (ME)
  • Part F
  • Vocational Expert (VE)
  • Part E
  • Printouts, Systems Screen (Not Pertinent)
  • Part C
  • Proffer
  •  
  • ME, request and response
  • Part F
  • VE, request and response
  • Part E
  • Professional Qualification Statements (PQs)
  •  
  • Attached to Notice of Hearing (ME/VE)
  • Part B
  • Attached to Medical Evidence
  • Part F
  • Attached to SSA-831-833
  • Part F
  • Psychiatric Review Technique Form (PRTF)
  •  
  • Completed by DDS Physician
  • Part F
  • Completed by Claimant’s Medical Source(s)
  • Part F
  • Queries
  • Part C
  • Questionnaires, Disability
  •  
  • Activities of Daily Living (ADL)
  • Part E
  • Claimant's Medication
  • Part E
  • Recent Medical Treatment
  • Part E
  • Work History
  • Part E
  • Reports of Contact
  •  
  • Disability Related
  • Part F
  • Non-Disability Related
  • Part D
  • Representative
  •  
  • Appointment of Representative - SSA-1696
  • Part B
  • Withdrawal or Dismissal of a Representative
  • Part B
  • Resume (see Professional Qualifications Statement)
  •  
  • Substitute Party Form
  • Part B
  • Workers' Compensation Information
  • Part D
  • * HO staff places “Requests” in Part C -- Current Development/Temporary -- Green section, pending receipt of evidence. If the HO staff does not receive the evidence, the staff transfers the original request and documentation regarding follow-up attempts to Part E -- Disability Related Development and Documentation -- Blue section, prior to release of the file, unless the request and documentation are for medical evidence. If the request and documentation concern medical evidence, place them in Part F – Medical Evidence -- Yellow (Back) section.
  • In addition, HO staff places locally developed forms in the folder, according to the procedure in DI 70005.005B.
  • G. List of documents the Appeals Council receives or generates
  • NOTE: The Appeals Council houses its working papers in an Appeals File (AF).
  • Additional Evidence
  • Briefs
  •  
  • Non-medical
  • Part D
  • Medical
  • Part E
  • CD
  •  
  • CDs
  • Part A
  • CD Envelopes
  • Part A
  • Search Requests
  • AF
  • Certifications
  • Part A
  • Congressional Correspondence
  •  
  • Inquiries
  • Part D
  • Interim Responses
  • AF
  • Final Responses
  • Part D
  • (Other) Correspondence
  •  
  • Disability Related
  • Part E
  • Non-Disability Related
  • Part D
  • Interim Correspondence
  • AF
  • Dispositions
  •  
  • Decision by AC
  • Part A
  • Dismissal by AC
  • Part A
  • Notice Denying R/R
  • Part A
  • Remand by AC
  • Part A
  • Fees
  •  
  • Agreement or Contract
  • Part B
  • Order or Authorization
  • Part A
  • Petition
  • Part B
  • MSS Comments
  •  
  • Made AC Exhibit
  • Part F
  • Not Made AC Exhibit
  • AF
  • Order Entering Exhibits
  • Part D
  • PRTF
  •  
  • (Part of AC Decision – in older files only)
  • Part A
  • Representative
  •  
  • Notice of Appointment
  • Part B
  • Withdrawal or Dismissal
  • Part B
  • Request for Review
  • Part B
  • Substitute Party Form
  • Part B
  • Appeals Council Notice(s) – Own Motion, Reopening and Proposed to Find
  • Part B
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