GN 04440: Federal Quality Review of Disability Determinations
TN 13 (12-10)
A. Policy for TCA on determination forms
A TCA on the determination form exists when the determination contains a non-substantive missing, incomplete, or incorrect entry. Typically, the review component can make a correction to the SSA-831-C3/U3 (Disability Determination and Transmittal), SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI), and SSA-833-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II). With a certified electronic folder (CEF), the review component receives the electronic SSA-831-C3/U3 in a format that can be changed.
B. Procedure for changes to paper determination forms
If the determination form contains a TCA, correct the entry(ies), initial, date the change, and enter an explanatory remark in block 34, Remarks. For a further explanation of non-substantive changes made to the SSA-831-C3/U3, see DI 40115.005C.
EXAMPLE: Established Onset Date (EOD) is prior to Date First Insured (DFI)
In situations in which the adjudicating component’s EOD is prior to the DFI, but the time period before EOD was used to determine whether the 12-month duration requirement was met, correct the SSA-831-C3/U3 as follows:
Block No. 15A or 28, or both
Line-out the incorrect entries.
Enter the correct EOD for entitlement purposes.
Initial the changes.
Block No. 34 (Remarks)
Enter “Change in Onset - EOD cannot be set prior to DFI. Item 15 is based on DFI, but the impairment(s) was of disabling severity, for purposes of the duration requirement, as of [date].”
Identify your specific review component.
C. Procedure for changes to determination forms
If the determination form contains a TCA, take the following actions, as appropriate:
1. 831-enabled and non 831-enabled cases
Make applicable changes to the Office of Quality Review (OQR) legacy system coding.
Code 831 approved “M” for modified.
Create an 831 eForm.
Manually enter changes to the 831 eForm for certain fields, when necessary.
Manually enter a remark in item 34 of the 831 eForm indicating what fields the review component modified.
Manually complete the adjudicating component and review component signature blocks, when necessary.
Send the 831 eForm to the CEF during the clearance process.
NOTE: For 831-enabled cases, send corrected data and a new, corrected 831 image to the CEF. For non 831-enabled cases, send only a new, corrected 831 image to the CEF.
For non 831-enabled cases, two additional options are available to make corrections, see GN 04440.237C.2. and GN 04440.237C.3.
For procedures regarding the “Do Not Process” note that you should add to the adjudicating component’s incorrect determination in eView, see GN 04440.237F.
2. Non-831 enabled, all SSA-832-C3/U3, and all SSA-833-C3/U3 cases – DocSend
Make applicable changes to OQR’s legacy system coding.
Code 831/832/833 approved “M” for modified.
Make applicable changes to the adjudicating component’s 831, 832, or 833 image in the Document Management Architecture (DMA) viewer using annotations.
Correct item 34 remarks and item 37 adjudicating component’s signature on the 831; or item 24 remarks and item 31 adjudicating component’s signature on the 832 or 833.
Download the modified 831, 832, or 833 image to a local drive.
Upload the modified 831, 832, or 833 image to the CEF using DocSend. Refer to instructions in DI 81030.055B.
3. Non-831 enabled, all SSA-832-C3/U3, and all SSA-833-C3/U3 cases – Fax
Make applicable changes to OQR’s legacy system coding.
Code 831/832/833 approved “M” for modified.
Print the 831, 832, or 833 image from the DMA viewer.
Make applicable changes to the printed hardcopy 831, 832, or 833.
Correct item 34 remarks and sign in item 37 of the 831; or correct item 24 remarks and sign in item 31 of the 832 or 833.
Create a barcode in eView. Refer to instructions in DI 81030.055D.
Fax the modified 831, 832, or 833 to the CEF. Refer to instructions in DI 81030.055C.
For procedures regarding the “Do Not Process” note that you should add to the adjudicating component incorrect determination in eView, see GN 04440.237F.
D. Policy for unsigned or improperly signed determination forms
An unsigned or improperly signed determination form TCA exists in any of the following situations:
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The adjudicating component’s medical consultant (MC) or psychological consultant (PC) has not signed the determination form when required and:
An appropriate medical evaluation document (see DI 24501.002C.1.), including the Disability Determination Evaluation in eCAT, is not signed by the adjudicating component MC or PC;
The medical evaluation document does not contain the statement "These findings complete the medical evaluation portion of the disability determination" with a check in the check block; or
The adjudicating component disability examiner (DE) fails to complete the MC/PC signature block of the disability determination form and enter the appropriate statement; i.e., "See form ____ dated ____."
The adjudicating component's determination form is unsigned or improperly signed by the DE.
A reconsideration determination form is signed or adjudicated by the same DE or MC/PC who signed the initial determination form.
See “Correcting Unsigned or Improperly Signed Determination Forms” DI 30005.234.
E. Procedure for correcting unsigned or improperly signed determination forms
If the determination form is unsigned or improperly signed as per
GN 04440.237D in this section, and is otherwise correct, either:
correct the TCA in the review component, or
return the case to the adjudicating component for correction.
NOTE: If the DE failed to enter the name of the MC/PC who prepared the Residual Functional Capacity determination or the Psychiatric Review Technique Form in the appropriate signature block of the determination form or the respective specialty code, the quality reviewer enters the correct information on the determination form.
1. Case corrected in the review component
If the review component corrects the case:
Assume jurisdiction and prepare an amended determination.
Ensure that the same quality reviewers and medical reviewers prepare all necessary forms, notices, and rationales.
Notify the adjudicating component of the TCA and, if applicable, include pertinent copies of documents prepared in the review component.
For procedures on assuming jurisdiction, see GN 04440.244 – GN 04440.245.
NOTE: If the unsigned or improperly signed determination form is a cessation, return the case to the adjudicating component for correction. See GN 04440.244.
2. Case corrected by adjudicating component
If you return the case to the adjudicating component for correction:
Prepare an SSA-847-U3 (SSA Request for Case Action) to return the case.
Annotate the return to indicate that you are not charging a deficiency.
Advise the adjudicating component of the TCA and ask them to correct the TCA.
Instruct the adjudicating component not to return the case to the review component, since follow-up review is not necessary.
Advise the adjudicating component to forward the case to the appropriate component to effectuate the determination.
F. CEF procedure for ensuring incorrect determination forms are not effectuated
Once you have either assumed jurisdiction or made corrections to the adjudicating component's determination form (per GN 04440.237C), ensure that the adjudicating component’s incorrect determination form is not effectuated, as follows:
Select the “Edit (Lock Case)” link in the top frame of eView to access Edit Mode;
Select the “Case Documents” tab;
Expand Section A – Payment Documents/Decisions (Yellow Front);
Locate the adjudicating component’s determination form to annotate and select the “Details” link. The Edit Document Information screen appears;
Select the “Do Not Process” checkbox and select “OK”; the “Do Not Process” text then appears in the Note field;
Select the “Unlock Case” link in the top frame to exit Edit Mode.
NOTE: Do NOT move the adjudicating component's uneffectuated “Do Not Process” determination form to Section C – Current Development/Temporary (Green).