GN 01010.032:
Records and Information Available to the Field Office (Fo) for Adjudicative Purposes
Effective Dates: 01/28/2015 - Present- Effective Dates: 12/27/2017 - Present
- TN 13 (11-11)
- GN 01010.032 Records and Information Available to the Field Office (Fo) for Adjudicative Purposes
- A. Policy on considering Social Security Administration (SSA) records
- Before establishing the current claim in the Modernized Claims System (MCS), the adjudicator must examine the available SSA records (Master Beneficiary Record (MBR), Supplemental Security Record (SSR), the Inquiry Request (I/R) screens, or the archived MCS screens) to detect any prior claim filed and decide if prior established evidence can be used (see GN 01010.030). This review is necessary whenever either there is a prior claim on the same Social Security number (SSN) or on another SSN (e.g., auxiliary or survivor claim).
- 1. Policy on reviewing SSA Records
- a. Information about the MBR
- The full MBR (full account (FACT)) record has the available information; however, the following fields have limited information due system implementation dates.
- * Monthly benefit claims since approximately 01/62;
- * Denials and disallowances since 01/78;
- * Some one-check-only actions since 1975; and
- * Lump Sum Death Payment (LSDP) claims since 1977.
- See SM 00510.002 for a full discussion of the data contents of the MBR.
- b. An MBR with a not in file (NIF) reply to an MBR query indicates
- * There was no prior claim on the Number Holder (NH)’s SSN; or
- * The prior claim was a monthly benefit claim not active after the dates listed in GN 01010.032A.1.a.
- c. Policy when the MBR data is suspect or discrepant
- The following policies apply to adjudication when MBR data is discrepant with the earning record (E/R) or otherwise questionable.
- 2. Exclusions to adjudication of a current claim
- An adjudicator should not adjudicate a current claim based on the MBR information in the following situations:
- * There is a need for the prior claims material and you must request the folder from the Federal Archives and Records Center (FARC);
- * The MBR appears unreliable or raises an issue that requires examination of the prior claims material (e.g., all benefits terminated prior to 1970);
- * The prior claim file is likely to have evidence needed to adjudicate the current claim; or
- * The adjudicator believes review of prior claims material is necessary for some other reason.
- a. Railroad retirement board (RRB) claims
- Data on the MBR is not acceptable as an RRB jurisdiction determination for survivors, see RS 01602.200B.
- EXCEPTION: If the MBR indicates the entitlement of another survivor, at least four months prior to the date of the current claim, assume SSA jurisdiction and prepare an award, see RS 01602.200.
- b. Primary insurance amounts (PIAs) on the MBR and E/R differ
- If the PIA on the MBR differs from the PIA on the E/R, follow the procedures in GN 01010.100.
- c. MBR is unavailable or unacceptable
- If the MBR is not available or it is not acceptable, request the prior claims file from the processing center (PC) or FARC to review the material.
- B. Procedures for requesting a prior claims folder
- 1. Paper claims folder
- * If the prior claims material is located in the PC or the FARC and it requires review, use the Processing Center Action Control System (PCACS) to request the folder (see MSOM PCACS 009.011).
- * If the claims file is not readily available or the PC cannot find it, follow the instructions in GN 01070.222.
- 2. Electronic folder (EF)
* If the Retirement (RIB), survivor and Medicare claims are stored in the Non-Disability Repository (NDR), use the Claims File Records Management System (CFRMS) to review the claims information (see SM 08001.001).- * If the Retirement (RIB), survivor and Medicare claims are stored in the Non-Disability Repository (NDR), use the Claims File User Interface (CFUI) to review the claims information (see SM 08001.001).
- * If the Disability (DIB) claims are stored in eDIB also known as the Certified Electronic Folder (CEF), use the eView web-based application linked to the Electronic Disability Collect System (EDCS) to review the claims information (see DI 81005.005).
- 3. Multiple prior claims
- * RSI - Request only the most recently stored paper folder from the PC.
- * DIB - If the Res Judicata rule was the basis for the most recent denial (e.g., technical denial code of 0S1 on the MBR per GN 03101.160 and GN 04040.010), request additional prior claims folders. If you need claims material from the most recent substantive medical decision, request the claims folder identified as being forwarded to the FARC within two years after the Date Last Insured (DLI) for DIB.
- 4. Cleared or archived MCS claims
- Use cleared or archived MCS screens to adjudicate the current claim if the information displayed confirms a factor of entitlement. For more information, see GN 01010.038.
- 5. Query entitlement status (QENT)
- In lieu of an MBR, use QENT to identify a prior filing and to obtain information on PIAs, family maximums, and monthly benefit amounts, (see MSOM QUERIES 006.018).
- CAUTION: Since QENT displays only the PIA and maximum (MAX) entries for the latest cost-of-living allowance (COLA) and these fields update even after the NH terminates, it may be necessary to de-convert them to the actual termination effective date. Obtain a FACT MBR if this is the case.
- 6. Disability, railroad, alien and military service (DRAMS) query
- * Use DRAMS to verify:
- * Prior periods of disability;
- * Railroad Retirement Board (RRB) data;
- * Military service (MS) data; and
- * Japanese internment data.
- * Use DRAMS only as a lead for Non-citizen (alien) deportation dates
- Note: If these dates look inaccurate or irrelevant, override the DRAMS data on MCS (see MSOM MCSEC 001.005 MREQ and RS 02635.001). For more information about DRAMS, refer to MSOM QUERIES 005.003
- C. References
- * GN 01010.030 Identifying Prior Claims Filing Situations in the FO
- * GN 01010.038 Using Information on SSA Systems as Acceptable Proof
- * GN 01070.000 Intercomponent Communications
- * GN 03101.160 Res Judicata
- * RS 01602.200 Field Office Processing of Survivor Claims
- * RS 01602.200 When Jurisdiction Determination Need Not be Requested by FO in Subsequent Survivor Claims - Operating Procedure
- * RS 02635.001 Effects of Removal (Deportation) on Retirement or Disability Beneficiaries
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