TN 25 (12-15)

A. General information about forwarding the HA-501-U5 and folder

Use the instructions in this section to send the Form HA-501-U5 (Request for Hearing by Administrative Law Judge) and folder to the servicing hearing office (HO). Field offices (FO) also use these instructions to forward the HA-501-U5 and folder to the jurisdictional processing center (PC) when the case involves a Title II (TII) only non-medical issue. We use the words hearing request and HA-501-U5 interchangeably throughout these instructions. These instructions presume:

• The claimant received a reconsideration determination; or

• The claimant insists on filing a hearing request before receipt of a reconsideration determination per GN 03103.120; and

• There is a completed HA-501-U5 and when applicable, a completed Electronic Non-disability Summary Sheet (eNDSS). For information on the HA-501-U5 see GN 03103.010 and GN 03103.020. For information on the eNDSS, see GN 03103.130.

Other Program Operations Manual System sections include instructions for processing hearing requests on the following issues.

1. Medicare Part A (Hospital Insurance (HI)), Part B (Supplementary Medical Insurance (SMI)), and Income-Related Monthly Adjustment Amount (IRMAA)

   Process hearing requests for Medicare Part A and Part B per GN 03108.210.

   Process hearing requests for Medicare IRMAA per HI 01140.001.

2. TII exceptions

   The FO does not send TII exceptions to the PC. TII exceptions include:

   • Substantial gainful activity;

   • Res judicata (previously determined claim for disability benefits);

   • Work issue continuing disability review (dispute of earnings and work activity - does not include appeals on overpayments if beneficiary agrees with the work continuing disability review decision); and

   • Benefit Offset National Demonstration (BOND) overpayments.

   For TII exceptions, process the HA-501-U5 per GN 03103.080B.1 in this section and GN 03103.080B.4 in this section; and forward it, additional evidence, and the folder to servicing HO.

3. Title XVI (TXVI) only, TII and TXVI concurrent common issue – non-medical

   Process hearing requests for TXVI only and TII and TXVI concurrent common issues cases per SI 04030.030 and GN 03103.130.

4. TII, TXVI, and TII and TXVI concurrent – disability

   Process hearing requests for disability issues per DI 12010.010, DI 81010.085, and DI 81010.150.

5. Representative Payee (RP) Misuse

   Process hearing requests for RP misuse per the instructions in GN 00604.064G

B. Servicing FO’s procedure for forwarding the HA-501-U5 and folder to the servicing HO and the jurisdictional PC

Within five business days of receipt of the HA-501-U5, take the following actions and suspend all actions not related to the hearing request.

1. Fax the HA-501-U5 to the servicing HO undercover of the 501 Case Flag. For instructions on how to determine the servicing HO, see GN 03103.040.

       

   Exhibit of the HA-501 Case Flag
   

        

        

   (attach this flag to the front of folder)
      
   

      

   NON – DISABILITY
   

     

      

   HEARING
     

     

   REQUEST

   
      

          

           

   Name _______________________________

      
   

       

   SSN ___________ X-Ref ______________

       
   

      

   Date of Hearing request _____________

      
   

       

   Attorney Representative Yes ______ No _______

      
   

   FO Code ____________

         

2. Fax the HA-501-U5 into Paperless using the HA-501-U5 NONDIB-ALJ Hearing Req (NON-DIB) barcode. Fax the HA-501-U5 to the fax number on the barcode coversheet.

3. If you have the paper folder, complete and attach the Form SSA-409 (Post Adjudicative Routing) to the front of the paper folder. Complete the appropriate fields and check Action Required. Check box “27. Other” and write, “non-medical hearing and electronic documents,” and use TOEL Appeal RHEAR. To determine the jurisdictional PC, see GN 01070.245.

4. Fax the HA-501-U5 and additional evidence into the Non-Disability Repository for Evidentiary Documents (NDRed) or eView. See GN 00301.328.

5. To ensure that the HA-501-U5 is legible, review the Claims File Records Management System (CFRMS) and take one of the following actions.

   • If the folder is in the office, place the HA-501-U5 and additional evidence into the original paper folder. Mail the folder to the jurisdictional PC.

   • If the folder is not in the office and the HA-501-U5 is legible, shred it. Handle other evidence per GN 00301.275 and GN 00301.322.

C. Jurisdictional PC’s procedure for forwarding the folder to the servicing HO

For TII only non-medical hearings, the PC completes the eNDSS and sends it along with the folder to the servicing HO within 30 business days of receiving the hearing request. Contact the servicing HO if you are not able to forward the folder and eNDSS within 30 days. Suspend actions not related to the hearing request. For information on completing the eNDSS, see GN 03103.130.

1. Add the eNDSS, documentation (worksheet(s) for overpayments and waivers), and evidence to the folder.

2. Complete and attach the SSA-636 (Transmittal Notice Hearing Case) and Non-medical Folder Flag to the folder.

          

   Exhibit of the Non-medical Folder Flag Document

       

         

   SSN: ________________________
   

     

   NAME: ________________________
   

      

   DATE: __________________________
   

       

        

   ODAR
   Non-Medical
   Case

        

       

   Paper file to follow within 30 days from the date the hearing is filed

       

        

   ODAR OFFICE CODE: ____________
   FO OFFICE CODE: _______________
   PSC CODE: __________________

       

   Complete Part A of the Form SSA-492 (PSC Case Folder) and attach it to the folder under the Form SSA-559 (Transmittal Slip for Claims Folder). This form alerts the servicing HO to return the folder to the PC when they complete their action. The Office of Earnings and International Operations (OEIO) uses the SSA-385 (OIO Case Folder) for this purpose.

3. For some Retirement Survivor Insurance claims and non-claim earnings discrepancy cases, the PC may see that a fully favorable determination is possible or that the reconsideration determination is incorrect. However, prepare and send the case to the servicing HO for processing. Add a remark to the file that states the PC could make a fully favorable determination.

4. Mail the folder to the servicing HO and set a diary to control the folder as follows:

   1. Prepare a 180-day diary from the date of sending the folder to the servicing HO, 165 days for the hearing and ALJ decision and 15 mail days.

   2. After 180 days, the PC obtains the location and status of the case and sets diary. In general, set a 60-day diary. Increase or decrease the number of diary days depending on the status inquiry.

D. Servicing FO’s and jurisdictional PC’s procedure when the documents are stored electronically or the paper folder is destroyed or lost

If the servicing FO (TXVI only and TII and TXVI concurrent common issue cases – non-medical) or the jurisdictional PC (TII only – non-medical) is unable to obtain a paper folder because the documents are stored electronically or the paper folder is lost or destroyed, create or reconstruct a paper folder.

1. Electronically stored documents

   In non-medical situations, when there is no folder because we store the documents electronically, create a paper folder. Include the following documents in the paper folder when applicable:

   • Completed eNDSS (non-medical cases);

   • Copy of the award notice(s);

   • Copies of letters and notices pertaining to the issue before the administrative law judge (ALJ);

   • Evidence used to make the initial and reconsideration determinations; and

   • Additional evidence submitted with the hearing request.

2. Destroyed or lost folder

   Before you reconstruct a destroyed or lost folder (disability or non-medical), see GN 03105.010 and GN 03105.040.

E. Procedure for requesting the folder from an FO

1. Initial folder request

   Call the FO that has the folder within one business day of receiving the hearing request. Ask the FO to send the folder as appropriate, to the servicing FO, jurisdictional PC (TII non-medical), or the servicing HO within five business days.

2. Folder request follow-up procedures

   If you do not receive the folder within:

   1. 15 business days of the initial request, call the FO for a status;

   2. 10 business days of the follow-up request, transfer responsibility for obtaining the folder to the Office of the Regional Commissioner (ORC) per GN 03103.080J.

F. Procedure for requesting a folder from the PC, Office of Central Operations (OCO), Federal Records Center (FRC), or Disability Determination Services (DDS)

1. Initial folder request

   The servicing FO or jurisdictional PC requests the folder through Processing Center Action Control System (PCACS) within one business day of receiving the hearing request. If you are unable to obtain the folder through PCACS, send an email message using the message format in GN 03103.080F.3.

   If the folder is in the Disability Quality Branch (DQB), request it by telephone. Consider the following situations when you request a folder.

   • If you need multiple or related folders and the folders are in different jurisdictions, prepare a separate email for each folder;

   • If the folder is at DDS or if the FO sends the folder to DDS under informal remand criteria, see DI 12010.015 and DI 12010.020.

2. Folder request follow-up procedures

   If you do not receive the folder within 15 business days of the initial folder request, take the following actions. Allow 21 business days if folder is in FRC.

   1. Send a follow-up email and on the subject line, add “Priority Follow-up” and the date of the first request.

   2. You should receive the folder or an email stating the reason for delay and the expected release date within 10 calendar days after the follow-up request.

   3. If you do not receive the folder within 10 days after the follow-up, request, or the expected release date, transfer responsibility for obtaining the folder to the ORC per GN 03103.080J in this section.

3. Exhibit email message requests for claim folder(s)

   Find the email address of the PC by using the Detailed Office Organization Resource System (DOORS).

   Include the following information in the email.

   1. Email to PC

      • Requesting Office’s: Office Code, Address, City, State, Name of office contact

        • Claimant Name, Social Security number (SSN), filed a hearing on day/month/year

        • Send the claim type (disabled wage earner (HA), disabled adult child (DAC) claim folder(s)) to: office code, address, city, state, zip code.

        If the folder(s) is not in the reconsideration or Disability Processing Branch, check all other PC sections housing inactive folders - Dormant, FRC.

   2. Email request to Office of Disability Operations (ODO)

      • Requesting Office’s: Office Code, City, State, Name of office contact

        • Claimant name, SSN, filed a hearing on day/month/year.

        • Send the claim type (HA, DAC) claim folder(s) to: office code, address, city, state, zip code.

        Verify location through off-line query. If off-line query location for prior folder is ODO FRC, request the folder.

G. Procedure for requesting informal remand case folders

If DDS keeps a folder longer than seven business days after they receive it from the FO, follow-up 15 business days from the date the FO sent the folder to DDS. For information about informal remands, see DI 12010.015.

H. Procedure for forwarding the HA-501-U5 in foreign claim and non-claim earnings discrepancy cases

Do not request the folder for foreign claim and non-claim earnings discrepancy cases. In block 17 of the HA-501-U5 check “Other Attached,” and add a remark: “folder is not attached because the case involves a foreign claim or non-claim earnings discrepancy.” Mail the HO copy of the HA-501-U5 along with any additional evidence to the servicing HO within five business days.

1. Foreign claims

   In foreign claim situations, mail a copy of the HA-501-U5 to:

   Foreign Claims
   Social Security Administration
   Office of International Operations
   P.O. Box 17769
   Baltimore, MD 21235

2. Non-claim earnings discrepancy cases

   For non-claim earnings discrepancy cases, mail a copy of the HA-501-U5 to:

   Social Security Administration
   Office of Earnings and International Operations
   6100 Wabash Ave
   Baltimore, MD 21215

I. Procedure for processing hearing requests when the folder is at the HO

If you obtain a query that shows that the folder is at the servicing HO or the Appeals Council (AC), contact the office indicated on the query to determine if the current HA-501-U5 is a duplicate or if the folder shown on the query is a prior claims file.

1. Prepare a Form SSA-5002 (Report of Contact (ROC) if applicable, indicate that the hearing request is a “possible duplicate;” and add the address and contact information for the office that has the folder.

2. Send the ROC and a copy of the HA-501-U5 to the servicing HO.

J. Procedure for referring folder request responsibility to the ORC when there is no folder or no response to the folder request

1. If the office from which you requested the folder advises you that there is no record of the folder or is unable to locate the folder, search your office’s files and the systems records to determine if there are other possible locations for the folder.

2. If you do not find a folder or lead and there is no change in the folder location, transfer responsibility for obtaining the folder to the ORC.

   Use the exhibit email message in GN 03103.080J.4. in this section. Attach copies of the initial email request, follow-up email, responses (ODO, PC, DDS, or other office), system’s record of the folder’s location, and the HA-501-U5;

3. Notify the servicing HO of the transfer. Send any evidence to the servicing HO for association with the HA-501-U5. Add the remark: “The office has not obtained the folder and the RO is now responsible for obtaining the folder.”

   • Complete block 17 on the FO copy of HA-501-U5 to show that a copy was sent to the ORC. Check and complete the “Other Attached       ” block; and

   • Retain the FO copy of HA-501-U5 for control purposes.

4. Exhibit email message for the transfer of jurisdiction from servicing FO or jurisdictional PC to the ORC.

   Include the requesting Office’s: Office Code, Address, City, State, Name of office contact.

   “We are sending the following information and attached material for your action in obtaining the claims folder(s) needed by an ALJ at office code, city, state, and zip code.”

   Claimant name, SSN, date of birth (DOB)

   Number holder’s (NH): name, DOB, SSN, and date of death

   SSI case: Spouse’s name, SSN, DOB

   The request for hearing was filed day/month/year. See the attached HA-501-U5.

   Appeal issue: claim denial, medical cessation, or other

   Hearing request is for: TII only, TXVI only, or concurrent TII or TXVI, or Other

   Current folder(s) needed: HA, DAC, DWB, SSI, or Other

   Prior folder(s) needed: HA, DAC, DWB, SSI, Other, or None

   See the attached queries, folder requests, report of contacts, and responses.

5. If you receive the folder after transferring responsibility, immediately call the ORC and send the folder to the servicing HO.

K. Procedure for responding to a folder request from another office

Send the folder(s) to the FO, PC, or the servicing HO within five business days of the folder request and control the folder per the current folder control instructions.

If the folder is not in the office or the folder cannot be sent within 25 days of receipt of the folder request, send an email to the requestor within one business day of when you receipt the folder request. If the folder is in another office or another office has jurisdiction of it, provide the office’s contact information and a contact person.

L. Reference list

• DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing

• DI 12010.015 Informal Remand of Medical/Vocation Determinations

• DI 60099.075 Appeal Process for BOND Overpayments

• DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)

• DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)

• GN 00301.275 Retention or Return of Documents

• GN 00301.310 The Non Disability Repository for Evidentiary Documents (NDRed) Application – Overview

• GN 00301.322 Retention of Paper Material After Faxing into Either the eDIB Folder or Claims Folder using NDRed

• GN 00301.328 Related Business Process Information

• GN 01070.209 FO/PC Telephone Numbers/Paperless Fax Numbers

• GN 01070.245 Processing center SSN jurisdiction

• GN 03103.010 The Hearing Process

• GN 03103.020 HA-501-U5 (Request for Hearing by Administrative Law Judge)

• GN 03103.040 Determining Servicing Hearing Office (HO)

• GN 03103.110 SSA-636-U3 (Transmittal Notice – Hearing Case)

• GN 03103.120 Hearing Filed Before Receipt of Reconsideration Determination

• GN 03103.130 Development in Hearing Cases

• GN 03105.010 Reconstruction of Destroyed or Missing Paper Claims Folders

• GN 03105.040 Locating and Reconstructing Paper Claims Folders for Hearings

• GN 03108.210 Title XVIII Entitlement Appeals Procedures

• HI 01140.001 Overview of the Appeals Process for the Income-Related Monthly Adjustment Amount

• MS PCACS 009.011 Diary Folder Request (DIFR)

• OS 15010.150 SSA-492, PSC Case Folder

• SI 04030.030 Title XVI Instructions for Forwarding the Form HA-501-U5 (Request for Hearing by Administrative Law Judge) and Folder to the Servicing Hearing Office

• SM 01201.215 Recall from NRC/FRC/FSO by Administrative Message (NRC/FRC/FSO), E-mail (FSO), Fax (NRC/FRC)

• SM 01201.225 How to Recall SSI Folders from Offices Other than NRC/FSO/FRC