GN 01010.410: Failure to Submit Essential Evidence

changes
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~~Effective Dates: 03/16/2015 - Present~~
Effective Dates: 05/29/2018 - Present
TN 15 (06-13)
GN 01010.410 Failure to Submit Essential Evidence
A. Failure to submit essential evidence
It is the claimant’s responsibility to submit evidence to establish eligibility and entitlement for benefits. Some claimants may need assistance obtaining evidence; for instructions on how to provide assistance, refer to GN 00301.180. Prior to disallowing or denying the claim, make every reasonable effort to assist the claimant to obtain the necessary evidence.
B. Special considerations
1. Identity discrepancies
The purpose of the identifying the claimant is to establish that he or she is the person alleged. The SSN card by itself is not sufficient evidence to establish the applicant’s identity, see GN 00203.020.
2. Evidence of age
Always make reasonable efforts to resolve material discrepancies. You must consider the proof of age tolerance policy before disallowing the claim. For additional information, see GN 00302.030.
3. Evidence of relationship
Marital and child relationship requirements often involve complex issues. Always consider State and Federal law prior to disallowing the claim. For more instructions, see GN 00305.005 and GN 00306.001.
4. Independently entitled divorced spouse (IEDS)
Unique issues arise with independently entitled divorced spouse claims since the number holder (NH) is eligible but has not filed for benefits. For development when attempting to obtain proofs from the non-filing NH, see RS 00202.100.
5. Failure to cooperate versus unavailability of evidence
You must distinguish between the uncooperative claimant who fails to submit available evidence and the cooperative claimant who submitted all available evidence but such evidence has very low probative value.
a. Failure to cooperate
If the claimant does not cooperate, document the file and process a disallowance or denial.
b. Unavailability of evidence
If the cooperative claimant cannot furnish any evidence of high probative value because it is not obtainable, make a determination based on the evidence submitted and award or disallow benefits accordingly.
C. Claims processing
Always provide the claimant with a complete written list of required evidence at the time of the initial interview. Make sure to add a pending issue in the claim development worksheet (DW01/DW02) in Modernized Claims System (MCS) to indicate the type of evidence requested and a tickle date. If after a reasonable time (e.g., 15 days), the claimant does not provide the evidence, follow the instructions in GN 01010.410C.2. in this section.
NOTE: To determine whether a “reasonable time” has passed to receive evidence from the claimant, we should consider the type of evidence requested and other important factors such as where the evidence is coming from (e.g., requests to the Department of Homeland Security (DHS) and requests for foreign documents often take longer to receive). Take into consideration the types of documents requested and from where they are requested when determining if we should extend the deadline for receipt of evidence. Do not deny the claim if the claimant needs additional time and we determine he or she is actively trying to obtain applicable evidence.
1. Initial request
* For in-office or teleclaim interviews, an initial request constitutes the initial “written” request (e.g., attestation cover notice with proof request) provided to the claimant after his or her initial claim interview. Tell the applicant that we may have to deny the claim if we do not receive the requested evidence within 30 days from the date of the interview.
* Internet applications (iClaim)--For Internet applications (first-party applicants using iClaim), the iClaim utility determines what proofs are necessary during the claims taking process and checks to see if the proof already exists in our records. If we need proofs, iClaim generates a list of only the documents required and displays them on the Evidence and Receipt screen.
* If a third-party files the Internet claim, we include the list of documents required with the paper Internet Application Summary mailed to the claimant for review and signature.
* If we do not receive the information or evidence after 15 days, send a notice with a 30-day closeout date as discussed in GN 01010.410C.2. in this section.
IMPORTANT: The 30-day closeout date starts with the date of the initial written request
NOTE: If you later determine that you need an additional piece of evidence that was not included in the original request, mail a separate “initial request” (e.g., SSA-L1043, Social Security Request for Information) for the specific item and provide additional time for the claimant to respond.
2. Closeout letter
If the claimant does not respond to the initial request, or indicates a lack of interest or unwillingness to cooperate, send an SSA-L1045-U2 (Letter Requesting Proof from Claimant) via the Document Processing System (DPS) with a 30-day closeout date.
If the claimant does not respond to the initial request, or indicates a lack of interest or unwillingness to cooperate, send an SSA-L1045-U2 (Letter Requesting Proof from Claimant) with a 30-day closeout date.
Be sure to include the following information in the notice:
* The specific items we need as evidence.
* A statement advising the claimant to contact the field office (FO) if he or she has not received the evidence and needs more time.
* A statement informing the claimant that we will disallow or deny the application if we do not receive a response by the date indicated on the letter (i.e. 30 days from the original written request).
3. Documenting the claim file
You must document all contacts with the claimant via a Report of Contact (RPOC) in the MCS to include follow-up dates and the outcome of the contact. Document the development worksheets (DW03) in MCS to describe your efforts to obtain the required evidence and indicate if the claimant requested assistance. For information on identifying claimants who may need assistance, see GN 00301.180.
Prepare a special determination via an RPOC describing what the claimant said or did that led to the conclusion to disallow the claim. You must also document if the claimant did not make a reasonable effort to furnish the necessary evidence.
4. Denial of the claim for failure to provide essential evidence
You must deny the claim if the claimant does not present the evidence needed for entitlement, and:
* the claimant received assistance to the fullest extent possible in accordance with GN 00301.180; and
* the claimant has not responded to the closeout letter discussed in GN 01010.410C.2. in this section; or
* the claimant clearly indicated a lack of interest or failure to cooperate; or
* we cannot locate the claimant.
Use the factor of entitlement not established as the reason for the disallowance or denial even when the claimant fails to pursue the claim. To include information in a disallowance or denial notice due to failure to submit essential evidence, see NL 00601.020E.2.
If you cannot locate the claimant, send the notice to the claimant's last known address.
5. New evidence after disallowance or denial of the claim
If the claimant presents new evidence to establish eligibility or entitlement and it is within the reconsideration period, treat the new evidence as a reconsideration request, and fax it to the paperless unit of the processing center (PC) of jurisdiction for non-disability claims.
For component responsibility, see GN 03102.175.
For disability claims, please refer to DI 81010.145.
If the claimant provides the new evidence to establish eligibility or entitlement but is not within the reconsideration period, consider reopening the claim if appropriate.
To determine when not to reopen correct determinations, see GN 04001.070. To consider reopening under new and material evidence, see GN 04010.030.
6. Additional development and PC requests
In some situations, if the PC discovers issues that were clearly overlooked or erroneously applied, the PC can request further development of the issues. The FO must document all the development done to avoid additional PC requests. The PC should not question the FO's judgment on the amount of help a claimant needs. A claimant’s ability to pursue a claim and the degree of help he or she needs is largely a matter of judgment. The FO adjudicator is usually in the best position to make this judgment.
NOTE: For claims involving identity requirements, refer to GN 00203.020. If we denied the application for lack of identity evidence, refer to Claim Denials in GN 01010.400.
D. Failure to submit evidence chart
Step
T2 Initial Claims Disposition Process – Failure to Submit Essential Evidence
1
At the initial interview, if needed, we provide a notice and request that the claimant return the information or evidence to us within 30-days.
The initial notice provides for a 15-day return period to indicate the sense of urgency.
We will deny the claim at 30 days.
2
If we do not receive the information or evidence within 15 days, we send a notice with the 30-day closeout date explaining that we will deny the claim 30 days from the date of the original request.
3
If after the closeout date, we do not receive the requested information or evidence, we make a determination on the initial claim. Technically deny the initial claim the day after the 30th day.
E. References
* GN 00301.180, Identifying Claimants Who May Need Assistance
* GN 00301.225, Follow up and Closeout Precautions
* GN 00305.005, Determining Marital Status
* GN 00306.001, Determining Status as Child
* GN 01010.360, Special Determinations for Claims Adjudication
* GN 03102.175, Component Responsibility in the Reconsideration Process
* GN 04010.030, Reopenings – New and Material Evidence
* GN 04001.070, Do Not Reopen Correct Determinations – Operating Policy
* RS 00202.100, Independently Entitled Divorce Spouse

POMS Reference

GN 01010.410: Failure to Submit Essential Evidence