TN 9 (07-10)

A. Completing the Disability Report – Field Office (Form SSA-3367) in EDCS

The EDCS 3367 collects information about the:

• Current filing;

• Prior filings; and

• Observations made by the interviewer.

Complete the EDCS 3367 during the initial claims-taking process. The questions on the EDCS pages correspond to those on the paper SSA-3367.

IMPORTANT: When completing the EDCS 3367, follow the policy guidance and detailed instructions in DI 11005.045 Completing the Paper Form SSA-3367-F5 (Disability Report – Field Office) .

1. Onset

The Onset page displays the:

• Claim type;

• Alleged Onset Date (AOD); and

• Potential Onset Date (POD).

On the Potential Onset Reason page, enter the date you are recommending and check the reason. The Potential Onset Date rationale should correspond with the rationale found on the SSA-820-F4 (Work Activity Report - Self Employed Person) or the SSA-821 (Work Activity Report - Employee) in file if work is performed before or after the AOD.

2. Miscellaneous, DWB, and Prior Filing Information

The 3367 Miscellaneous, DWB and Prior Filing Information page documents the:

• Protective filing date;

• Date Last Insured (DLI);

• Prescribed period and controlling date for a Disabled Widow(er) Beneficiary (DWB); and

• Prior filings.

You can key prior filing information for multiple prior filings by selecting the Add Prior Filing feature at the bottom of this page. On the Prior Filing Information Entry page, choose the type of claim and enter the following information:

• Claim Type(s)

• SSN of Prior Claim;

• Date of last decision (MM/DD/YYYY);

• Level of last decision;

• Last decision (allowance or denial);

• Location of prior folder;

• Whether or not the prior folder was requested; and

NOTE: If the prior folder is fully electronic, complete the location of prior folder as “EF”. This will alert the DDS to the presence of a prior electronic folder.

3. Presumptive

Use the 3367 Presumptive page to document the presumptive disability (PD) reason by selecting the radio button next to the short description of the PD/PB allegation, if applicable. The descriptions only display if a Title XVI claim is part of the EDCS case.

NOTE: Presumptive disability must be indicated on the ADIB screen in MSSICS.

4. Observations

Observations are very valuable to the case, as the Disability Determination Services (DDS) examiners often do not have direct contact with the claimants.

The Observations page records the following information:

• Type of interview (telephone, in-office, or Internet);

• Observations about the claimant; and

• Comments about the claimant’s behavior and appearance.

5. Field Office (FO) Medical Development

The FO Medical Development page records information regarding FO requests for evidence from the claimant. When you receive medical evidence from the claimant:

• Annotate the Remarks (Capability/Remark page) section of the EDCS 3367; and

• Show the name of the source for each document.

6. Capability/Remark

Use the Capability/Remark page to document:

• Claimant-supplied medical evidence by checking the box provided and annotating the “Remarks” box that medical evidence was received and the name of each source;

• Miscellaneous remarks that may be relevant to the claim; and

• DDS capability development is needed.

For MCS exclusion cases, correct the data on the MCS Exclusion Information page – Interviewer information.

NOTE: EDCS displays the first initial and last name of the FO employee who completes the EDCS 3367 (based on the PIN of the logged-on individual).

Over key the pre-filled FO telephone number with the claims representative’s (CR) direct extension to facilitate communication during claims processing.

(For detailed information, see DI 11005.045 Completing the Paper Form SSA-3367–F5 (Disability Report–Field Office.)

B. Completing the Adult Disability Report (Form SSA-3368) in EDCS

The EDCS 3368 collects Adult Disability Report information:

• submitted on an Internet Disability Report; or

• completed during the claimant interview.

The questions on the EDCS 3368 pages correspond to those found on the paper SSA-3368. (For detailed information about completing the SSA-3368, see Completing the Disability Report Adult Form SSA-3368 - DI 11005.023).

The EDCS 3368 includes intelligent pathing on selected pages. Intelligent pathing presents additional questions based on the answers to previous questions.

1. About You

The About You page displays the claimant’s name and daytime telephone number, which propagates from the mainframe application. Collect the following information, if applicable:

• Alternate telephone number;

• Language information; and

• Other names used by the claimant.

NOTE: If no MCS or MSSICS claim has been established, the claimant’s name and daytime telephone number propagates from the MCS Exclusion Information Page.

2. Contacts

Use the Contacts page to collect the following:

• Alternate contact information; and

• Information about the person completing the disability report.

3. Medical Conditions

The Medical Conditions page displays the alleged onset date and medical conditions on line 1. This information propagates from the mainframe application. Collect the following information:

• Additional medical conditions not listed on line 1;

  NOTE: If the claimant alleges cancer, enter the type and stage when prompted. A “Check Spelling” button is placed below the conditions field of the EDCS 3368. Run the spell-check feature on each initial claim.

• The answer to the question, “Do your conditions cause you pain or other symptoms?”; and

• The claimant’s height and weight.

The Calculate CAL button in no longer available in EDCS for the SSA-3368. EDCS automatically runs the CAL selection software and checks the conditions entered on the medical conditions page. If one or more of the conditions entered are a CAL condition EDCS automatically curtails the 3368.

4. Work and Onset

Use the Work and Onset page to document the claimant’s alleged:

• Current work status; and

• Ability to work due to his or her condition.

The AOD propagates from the mainframe or the MCS Exclusion Information page. Data propagated from the mainframe cannot be over keyed. If a change in the AOD is needed:

• Access the mainframe claim;

• Revise the alleged date of onset; and

• Repropagate the data into EDCS.

For EDCS cases consisting of only an MCS exclusion claim, correct the data on the MCS Exclusion Information page.

An amended application is produced if the AOD is changed on the mainframe. For information on handling amended applications, see Alternative Signature Methods – GN 00201.015I.

5. Job History

Use the Job History page to document the claimant’s alleged:

• Number of jobs in the 15 years before becoming unable to work because of physical or mental condition(s); and

• Job titles of the most recent job(s) (up to 5);

If the claimant alleges one job in the 15 years before becoming unable to work, obtain details pertaining to that job (e.g., specific job duties, heaviest weight lifted, hours spent standing, sitting).

When the claimant alleges more than one job in the 15 years before becoming unable to work, obtain the following for up to the five most recent jobs:

• Occupation or job title;

• Type of business;

• Dates worked; and

• Most recent hours and pay.

6. Medical Sources

Use the Medical Sources page to:

• Enter information about the claimant’s alleged medical sources;

• Enter tests and medicines associated with the medical source; and

• View a summary of the Doctor/Therapist/Hospital/Clinic and “Other” sources of medical information that have been recorded in EDCS.

You can add, modify, or delete sources from the Source Reference File (SRF) on this page. Always check the SRF before adding a medical source. For details, see Source Reference File (SRF) - DI 81010.040.

NOTE: You can edit medical sources that propagate from the Internet 3368 (i3368) without deleting other information for that source (e.g., date(s) seen, testing, and medication). Use the EDCS Replace Source function to replace a claimant-supplied source on an i3368 with a source from the SRF.

7. Tests Summary

The Tests Summary page:

• Collects any medical tests the claimant alleges he or she has had, or is scheduled to have, and the source who ordered the tests;

• Provides a drop-down box of common tests to assist in completing this section; and

• Allows you to add, modify, copy, or delete tests.

8. Medicines Summary

The Medicines Summary page:

• Collects names of the medicines the claimant alleges to be currently taking;

• Provides a drop-down box of common medicines to assist in completing this section; and

• Allows you to add, modify, or delete medications.

9. Other Medical Information

Use the Other Medical Information page to collect information about other sources (e.g., worker’s compensation, vocational rehabilitation, insurance companies, prisons, attorneys) that can provide information about the claimant’s alleged medical conditions.

NOTE: Vocational Rehabilitation questions were removed for initial claims.

10. Education and Training

Use the Education and Training page to record, update, view, and delete information about the claimant’s alleged educational history, including special education, job training, or vocational school.

NOTE: If the claim is marked with a limited educational profile (e.g., 7^th-

11^th grade education), EDCS prompts the Claims Representative (CR) to obtain the claimant’s full work history. See Completing the SSA-3369 - DI 11005.025.

11. Remarks

Use the Remarks page to display:

• Additional information provided by the claimant or interviewer for which there is not a corresponding question in EDCS;

• Additional information provided by the claimant or interviewer for which space was not sufficient in a previous section; and

• Data imported from the i3368 or Internet 3441 (i3441), when there is no corresponding field in EDCS.

C. Completing the Work History Report (Form SSA-3369) in EDCS

The EDCS 3369 collects detailed information and remarks about the types of work that the claimant alleges having performed in the 15 years prior to becoming unable to work.

When creating an EDCS case for an initial claim, determine whether it is necessary to complete an SSA-3369, per Completing the SSA-3369 - DI 11005.025. For information regarding data propagation of the Internet Work History Report (i3369), see Data Propagation - DI 81010.035D.

NOTE: If the claimant has a limited education, EDCS prompts the CR to obtain a complete work history in accordance with DI 11005.025C.2.b.

If an SSA-3369 is necessary, complete the EDCS 3369. The job title and job information on the longest-held job from the Adult Disability Report (SSA-3368) display in the SSA-3369 if:

• The disability report is completed prior to the SSA-3369; or

• An Internet disability report is completed.

1. ID/Work History

This page displays basic information such as:

• The claimant’s name and telephone number; and

• Job titles for jobs held.

To complete the EDCS 3369:

• Add job titles that were not recorded on the SSA-3368 Work History page;

• Select any job title to bring up the Job Information page; and

• Complete the Job Information page for each job listed on the ID/Work History Page.

NOTE: Changes made to the EDCS 3369 Job Information page automatically update corresponding fields in the EDCS 3368 Work History page, and vice-versa.

2. Remarks

Use this page to enter additional information that the claimant wishes to provide for which there is no corresponding question in EDCS.

3. Deleting the EDCS 3369

To delete the EDCS 3369, change the radio button on the Form Selection page. An alert message appears:

• To confirm deletion of the form; and

• To indicate that no “longest job” was selected on the EDCS 3368 form.

CAUTION: Use caution when choosing the delete function. Once deletion is confirmed, all additional information collected in the SSA-3369 for a job entry that is not part of the standard work information collected on the SSA-3368 is lost.

D. Completing the Child Disability Report (Form SSA-3820) in EDCS

The EDCS-3820 collects child disability report information:

• Submitted on the Internet Disability Report; or

• Entered during the applicant interview.

The questions on the EDCS pages correspond to those found on the paper SSA-3820. A spell-check button is placed below each Allegations field of the SSA-3820. Run the spell-check feature on each initial claim. Spell check is in place to assist in recognizing key words to identify Quick Disability Determination (QDD) and Compassionate Allowance (CAL) cases. EDCS contains the following pages:

1. About the Child

The About the Child page displays:

• The child’s name, date of birth, language preference, and age, which propagate from the mainframe and cannot be changed in EDCS; and

• The child’s height, weight, Medical Assistance number (if the child is receiving Medical Assistance), and spoken language.

2. About You

The About You page displays:

• General information about the person or agency applying on behalf of the child; and

• The applicant identification information, including name, address, daytime telephone number, and relationship to the child, all of which propagate from MSSICS and cannot be changed in EDCS.

3. Other Contacts

Use the Other Contacts page to:

• Establish a summary list of all potential contacts who can assist with the child’s case; and

• Add, update, or delete individuals or organizations from the list of contacts.

4. Illness and Onset

Use the Illness and Onset page to enter:

• Allegations about illnesses, injuries, or conditions and how they limit the child’s daily activities;

• The child pain questionnaire; and

• The child’s disabling condition and AOD.

NOTE: The child’s disabling condition and AOD propagate from the mainframe. You cannot over key the AOD.

To change the AOD, correct it in MSSICS and re-propagate EDCS.

If the claimant alleges cancer, enter the type and stage, when prompted.

5. School History

Use this page to record, update, view, and delete information about the child’s school history. The SRF includes a list of schools to use when developing school history (see Source Reference File (SRF) - DI 81010.040.).

6. Med Sources

Use the Med Sources page to record, update, view, and delete information about the source(s) and treatment for the child. The SRF includes a list of medical providers, hospitals, and clinics to search when developing medical history, which can be added, modified, or deleted (see Source Reference File (SRF) - DI 81010.040.)

7. Medications

Use the Medications page to record, update, view, and delete information about medications that the child is taking.

8. Tests

Use the Tests page to record, update, view, and delete information about tests the child has had, or is scheduled to have, for his or her condition.

9. Vocational Rehabilitation

Use the Vocational Rehabilitation page to record, update, view, and delete information about the child’s experience and interest in vocational rehabilitation.

10. Work Activity

Use the Work Activity page to record, update, and view any of the child’s work experience.

11. Remarks

Use the Remarks page to enter additional information provided about the case that could not fit in the allotted space in prior sections.