POMS Reference

GN 04440: Federal Quality Review of Disability Determinations

TN 13 (12-10)

A. Overview of the CEF

All States are certified to process disability cases in a fully electronic environment. After completion of the electronic certification process, in most cases, the CEF became SSA's official folder.

The CEF is SSA's electronic disability repository of data used to store the claimant's disability file information. The CEF is created when a disability case is entered in the Electronic Disability Collect System (EDCS), which electronically collects disability report information (e.g., SSA-3367-F5 (Disability Report – Field Office), SSA-3368-BK (Disability Report - Adult), SSA-3369-BK (Work History Report), SSA-3820-BK (Disability Report – Child), and SSA-3441-BK (Disability Report - Appeal)) and establishes the electronic record. This information may include the claimant's own data entries via the Internet disability report forms (e.g., i3368/i3369). All documentation is stored in the CEF (i.e., SSA is no longer required to simultaneously maintain a paper modular disability folder (MDF) for CEF cases).

The review component receives a National Disability Determination Services System download and an electronic folder (EF) interface download when a case is selected for quality review. To perform quality reviews, review components access the CEF via eView, which is available through interfaces from the quality review case processing system, i.e., the Office of Quality Review’s legacy system.

B. Types of cases in electronic case processing

1. CEF

A CEF is created if all claims associated with the case are established in the EDCS.

2. EF

If all claims associated with the case are not established in EDCS (e.g., one or more claims are established in EDCS, but one or more are EDCS exclusions), an electronic folder (EF) exists – this is not a CEF. Although there is an EF, the agency's official folder must be paper. For further details regarding this type of case, refer to DI 81001.005A.2.

NOTE: For a list of EDCS exclusions and limitations, refer to Certified Electronic Folder (CEF) Exclusions and Limitations DI 81010.030. Process EDCS exclusions and limitations using current Program Operations Manual System procedures for paper folders.

3. Paper cases

The paper MDF is the agency's official folder in the following situations:

  • The case is an EDCS exclusion or limitation;

  • A processing limitation occurs on a CEF case that removes the CEF case from electronic processing (creating an EF); or

  • A case reopening requires a modular folder.

NOTE: You may be required subsequently to convert to paper cases for cases that originate as CEF cases at prior levels.

C. Accessing the CEF

The Personal Identification Number (PIN) of the employee logged onto the workstation determines a user's access. For more information, refer to Authorized Access to the Certified Electronic Folder (CEF) DI 81001.025.

Review components access the CEF via eView through interfaces from OQR’s legacy system, the eView desktop icon, or the eView website at http://eview.ba.ssa.gov/ . eView is a web-based software application, which the review component uses to perform quality review and to take action on the disability information contained in the CEF. For further details regarding eView, refer to DI 81005.005.

D. Contents of the CEF

The CEF is comprised of the following:

  • An electronic storage system housing disability information, consisting of keyed data entry fields and images of documents scanned, faxed, added through DocSend, or uploaded to the CEF.

  • Information from various case processing systems used by SSA and adjudicating components to process disability cases.

  • Information from external sources, such as medical providers, claimants, representatives, etc.

  • Information that allows various disability processing components to virtually share disability case information (i.e., without having to mail or move a paper MDF between case processing components).

E. Organization of the CEF

The documents in the CEF are organized in the same format as the paper MDF, with additional sections for Queries and Multimedia files.

The CEF sections include the following:

  • Section A – Payment Documents/Decisions (Yellow Front)

  • Section B – Jurisdictional Documents/Notices (Red)

  • Section C – Current Development/Temporary (Green)

  • Section D – Non-Disability Development (Orange)

  • Section E – Disability Related Development (Blue)

  • Section F – Medical Records (Yellow Back)

  • Queries – Stores scanned queries

  • Multimedia Files – Stores audio files

F. Verification of images

Review components must ensure that documents added to the CEF by fax or DocSend are:

  • successfully uploaded to the CEF;

  • accessible via eView (i.e., review the image in eView); and

  • legible and usable on screen.

NOTE: You do not have to take these verification steps if you use OQR’s legacy system to add a document to the CEF.

When the quality of the image is unacceptable, the quality reviewer re-images the document to improve the on-screen image.

G. Disposition of documents

Retain documents added to the CEF until you verify that the imaged version is acceptable for CEF case processing (i.e., all pages are completely imaged and legible). If the image is acceptable, shred the document. For detailed instructions regarding source document retention, refer to DI 81020.055C.