TN 10 (07-11)

A. Establishing mainframe claim prior to creating EDCS case

Before creating an EDCS case, use the Modernized Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS) to establish:

• an initial claim,

• a reconsideration request, or

• a hearing request.

NOTE: Certain Childhood Disability Beneficiary (CDB) and Disabled Widow Beneficiary (DWB) cases do not require establishment of an MCS claim prior to creating an EDCS case. For more information on conversion cases, see Childhood Disability Benefits (CDB) General RS 00203.080 and DI 81010.020B in this section.

When establishing a case in EDCS:

1. Always establish the case under the claimant’s own SSN.

2. If there is no previously established case in EDCS for an SSN, EDCS displays a dialog box saying “NO EDCS CASE FOUND.”

3. If we previously established one or more cases in EDCS for an SSN, EDCS displays the:

   • claimant’s name,

   • Certified Electronic Folder (CEF) indicator,

   • date of birth,

   • established date,

   • claim or appeal level (initial, reconsideration, or hearing),

   • claim type,

   • office code and type, and

   • status for each prior folder.

4. Select the adjudicative level you want to establish.

NOTE: The EDCS level must match the level established on the mainframe.

The EDCS case is associated with information pending on the mainframe application. If you add new subsequent applications on the mainframe, you must perform an “update after transfer” using the Update-After-Transfer (UAT) utility in EDCS to update the claims in EDCS. For more information regarding the UAT utility, see Using the Update-After-Transfer (UAT) Utility DI 81010.095.

NOTE: If you can establish one claim type in EDCS but another claim type for the same individual at the same time is an EDCS exclusion, you cannot process the case in EDCS. For more information on EDCS exclusions, see Certified Electronic Folder (CEF) Exclusions and Limitations DI 81010.030.

B. Exceptions to establishing a mainframe claim prior to creating an EDCS case

The following conversion claims do not require establishing a new claim in the mainframe (MCS):

• Child benefits to Childhood Disability Beneficiary (CDB) benefits for continuing eligibility. For situations when we require a new application, see Childhood Disability Benefits (CDB) RS 00203.080B.2.b.

• Young parent benefits to Widow(er)’s Insurance Benefits (WIB) or Disabled Widow(er)’s Benefits (DWB). For further instructions, see Conversion from Mother's or Father's Benefits to DWB - DI 11015.005.

• WIB to DWB for Medicare purposes. For more information regarding this conversion, refer to Health Insurance (HI) for DWBs RS 00207.020.

You can establish the following cases in EDCS if a record of the claimant is on an existing Master Beneficiary Record (MBR) with specified Ledger Account File (LAF) codes:

• The CDB and DWB under age 60 situations require a LAF on the MBR of C, E, S6, S7, S8, S9, D (any number), AD, T4, or T6.

• The DWB over age 60 requires a LAF of C, S6, S7, S8, S9, or AD.

NOTE: You can establish appeals for the CDB or DWB claims where an MCS exclusion exists only if EDCS was used for the associated prior level case.

C. Selecting disability reports for creating EDCS cases

After the claims representative (CR) selects the appropriate level (e.g., initial claim, hearing request) for the case, EDCS provides the following options:

• KEY the disability report data; or

• submit PAPER forms.

IMPORTANT: Although the paper feature is currently an option, it is never appropriate to choose “PAPER” when creating a case in EDCS. This option is obsolete and you should disregard it.

EDCS also alerts the user if an Internet Disability Report (IDR) is available. For further information, see Receiving the i3368 (Internet Adult Disability Report) DI 81007.040.

The CR must select the option to KEY the disability report data into EDCS unless one of the exclusions or limitations listed in Certified Electronic Folder (CEF) Exclusions and Limitations DI 81010.030 applies.

1. Initial disability claims

When creating an initial claim:

• Select the appropriate initial claim disability report. EDCS defaults to the report it determines is appropriate (SSA-3368 - Adult Disability Report or SSA-3820 - Child Disability Report), but you can change the selection if a different report is appropriate (e.g., when an SSI claimant files in the month of attainment of age 18 and we require the SSA-3368 instead of the SSA-3820).

• If you elect to complete an EDCS disability report that is different from the available Internet disability report, refer to Receiving the i3368 (Internet Adult Disability Report) DI 81007.040.

• If you are keying a subsequent initial case into EDCS and a prior closed electronic folder exists, see DI 81010.020E in this section.

In order to establish a CEF, you must establish all claims associated with the case in EDCS. If one or more claims are EDCS exclusions, the official file must be paper. Although the official file is paper, we can use EDCS/eView to create an electronic record that Disability Determination Services (DDS), Office of Disability Adjudication and Review (ODAR), and other components can use for case development.

2. Disability appeals

If the initial case is a CEF and DDS medically denied the case level being appealed, you must:

• KEY the EDCS 3441 (Disability Report – Appeal) data into EDCS; and

• process using CEF procedures.

NOTE: Exclude appeals from certified electronic folder processing if one of the exclusions in Certified Electronic Folder (CEF) Exclusions DI 81010.030 applies.

If i3441s are involved, see Receiving the i3441 (Internet Disability Report – Appeal) DI 81007.050

D. Creating EDCS cases for appeals of less than fully favorable (LTFF) determinations or decisions

EDCS allows for the creation of an appeal for a claim that contains a less than fully favorable allowance. LTFF appeals occur when the claimant files an appeal based on one or more of the following:

• closed period (CP),

• adverse onset date, or

• medical diagnosis.

You cannot create the LTFF appeal in EDCS when the case is pending due to medical reactivation or reopening. If the claim is pending due to a medical reactivation or reopening the FO:

• notifies the office of jurisdiction by uploading an SSA-5002 (Report of Contact), stating “Request for appeal received. Return claim to FO”; and

• contacts the office of jurisdiction by telephone.

After notifying the office of jurisdiction of the request for appeal, the FO:

• checks Claim Status in eView;

• verifies the case is no longer pending;

• inputs the appeal; and

• transfers the appeal in EDCS.

E. Creating an EDCS case when a prior EDCS case exists

1. Using the “Copy from Prior” button in EDCS

The “Copy from Prior” button appears when you create a new EDCS case and a closed electronic case exists. Once you select the “Copy from Prior” button, the “Copy Prior Folder Information” page appears. This page contains two summary boxes:

1. The top summary box displays information available for copying.

2. The bottom summary box displays information already collected.

After selecting information from the “Available for Copying” summary box, the information:

• propagates into the new EDCS case,

• displays in the “Already Collected” summary box, and

• can be changed, updated, or deleted in EDCS.

The original information still exists in the prior claim, remains available for copying, and is not deleted from the “Available for Copying” summary box.

2. Prior case closed correctly or transferred

If a prior EDCS case exists and was correctly closed or transferred, create a new case and either enter all new disability report information or:

• Use the “Copy from Prior” utility to copy relevant information from the most recently closed prior case into the new subsequent initial EDCS case. (For more information on creating an EDCS case, see Creating Electronic Disability Collect System (EDCS) Cases DI 81010.020D.1.); and

• Review and update any information propagated from a prior EDCS case (e.g., verify the address and telephone number for each source copied from a prior case or update information such as the date the claimant last saw the source, the next appointment, and the reason for seeing the source).

3. Prior case closed incorrectly and never transferred

If a prior EDCS case exists, is erroneously pending because it was not properly closed, AND it was never transferred to DDS for a medical determination or to ODAR for a decision:

• Verify the status of the case via the DDS Query (DDSQ) or Case Processing and Management System (CPMS); and

• Close the old EDCS case using the Manual Clearance option. For details on manual clearance, see Deleting and Manually Clearing Electronic Disability Collect System (EDCS) Cases DI 81010.105.

NOTE: It is never appropriate to use the Update-After-Transfer (UAT) utility to add a new claim to a case when we require new Modernized Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS) applications for subsequent filings. See the UAT procedures in Using the Update-After-Transfer (UAT) Utility DI 81010.095.

F. Curtailing completion of the EDCS 3368 or EDCS 3820

EDCS allows curtailing disability data collection for some cases (i.e., Terminal Illness (TERI), Presumptive Disability (PD), and Compassionate Allowance (CAL) cases). For details, see Curtailing Completion of the SSA-3368 or the SSA-3820 DI 11005.020.

1. Choosing the curtailment option on the form(s) selection page

If you choose the curtailment option on the Form(s) Selection page:

• Information pertaining to the EDCS 3369 (Work History Report) is grayed out;

• EDCS does not allow you to select one of the associated radio buttons; and

• EDCS does not allow you to collect information about work history, education, or training.

2. Changing from curtailed to full development

To change from curtailed to full development:

• return to the Form (s) Selection page, and

• change the answer to the Curtail Forms Completion question to “No.”

3. When you cannot curtail EDCS 3368 or EDCS 3820

You cannot curtail development of an EDCS 3368 or EDCS 3820 if:

• you have already answered “No” to the curtailment question, or

• an Internet Disability Report has propagated into EDCS for the case.

4. Curtailing the EDCS 3368 and i3368 for CAL cases

When the claimant alleges a CAL condition, the i3368 and EDCS automatically curtails the form by not presenting the claimant or claims representative (CR) with the job history and education or training questions.

a. Claimant submits an i3368

When the claimant completes the Conditions screen on the i3368, the CAL Predictive Model (PM) runs to determine if one or more of the allegations entered are CAL conditions. If the CAL PM determines there is a CAL condition, the i3368 curtails the job and education history sections.

When the curtailed i3368 propagates to EDCS, EDCS automatically curtails the 3368, and the Curtail Form Completion field on the Select Form(s) page defaults to yes. You cannot un-curtail a curtailed i3368 in EDCS. If the i3368 is curtailed due to CAL, it remains curtailed in EDCS.

EDCS runs the predictive model and CAL PM at transfer to DDS to determine whether Quick Disability Determination (QDD) applies. If the CAL determination changes from yes to no, EDCS sends the proper CAL indicator to the DDS. However, the 3368 does not change; the DDS receives the curtailed 3368.

NOTE: The ‘Calculate CAL’ button no longer displays on the EDCS 3368.

b. Curtailing the EDCS 3368

The condition(s) propagated from MCS and MSSICS or entered by the CR on the Medical Conditions screen are sent to the CAL PM when you establish the case in EDCS. If one or more of the conditions are CAL conditions, EDCS automatically curtails the form and the Curtail Form Completion field on the Select Form(s) page defaults to yes.

You have the ability to change curtailment at any point by changing the Curtail Form Completion answer on the Select Form(s) page. If you modify any of the condition(s) on the Medical Conditions screen, the CAL PM runs again when you leave the screen. EDCS displays an alert about the potential impact to curtailment.

EDCS runs the predictive model and CAL PM at transfer to DDS to determine whether QDD applies. EDCS sends the most recent CAL determination to the DDS.

NOTE: The CAL PM runs every time you leave the 3368 Medial Condition page, therefore the ‘Calculate CAL’ button no longer displays on EDCS 3368.

c. Curtailing the EDCS 3820

The CAL PM does not run automatically when completing the EDCS 3820. However, you still have the ability to change curtailment at any point by changing the Curtail Form Completion answer on the Select Form(s) page.

NOTE: The EDCS 3820 does not automatically calculate CAL, therefore, the “Calculate CAL” button remains on the 3820.

EDCS runs the predictive model and CAL PM at transfer to DDS to determine whether QDD applies. EDCS sends the most recent CAL determination to the DDS.