TN 27 (04-15)

A. Background for assuming jurisdiction

The Social Security Administration (SSA) uses regulations and subregulatory guidelines to implement disability programs established by Congress in the Social Security Act (Act). The Act also provides State agencies the authority to make disability determinations following SSA’s regulations and the Commissioner the authority to review these determinations. It is with this reviewing authority that the Office of Quality Review (OQR) evaluates the correctness of claims processed by a State agency disability determination service (DDS) on SSA’s behalf. When OQR conducts a quality review of a claim and finds a deficiency (for more information, see GN 04440.003C), the reviewer has the option of returning the case to the DDS for correction or assuming jurisdiction of the claim. When an OQR reviewer assumes jurisdiction of a claim, he or she assumes responsibility of the determination in addition to performing the role of quality reviewer.

IMPORTANT: Once OQR assumes jurisdiction, the determination becomes Federal and affects the handling of subsequent appeals.

B. When assuming jurisdiction is mandatory

Generally, OQR assumes jurisdiction if a regulation basis code technical corrective action (TCA) occurs in fully favorable or unfavorable determination cases. However, there are exceptions. (See GN 04440.232 for further explanation.)

1. Exceptions to assuming jurisdiction

Quality reviewers cannot assume jurisdiction for a regulation basis code TCA if:

• The regulation basis code TCA occurs in a fully favorable determination case that is an adverse reopening, cessation, or a reconsideration of an adverse reopening or cessation. In these instances, the reviewer must return the case to the adjudicating component and request that they correct the TCA.

• The incorrect regulation basis code is due to an obvious typographical error.

C. When assuming jurisdiction is optional

• OQR may assume jurisdiction if a group I or other returnable deficiency does not exist and one or more of the medical assessments and disability determination forms noted in DI 26510.090 C are missing or does not have the required signature(s) per DI 26510.090 C.

NOTE: If the necessary signature is missing from the SSA-832-C3/U3 or SSA-833-C3/U3, reviewers may only assume jurisdiction if the case is a continuing disability review (CDR).

• OQR may assume jurisdiction if OQR returns the case to the DDS twice for deficiencies and the adjudicating component does not make the proper corrections after the second return. (For more information on second returns, see GN 04440.203.)

D. When OQR will not assume jurisdiction

• OQR will not assume jurisdiction if it is only changing the impairment code, onset date, or cessation date.

• OQR will not assume jurisdiction if there is a group I or other returnable deficiency as defined in GN 04440.003. See additional guidance per GN 04440.244D on how to decide whether to assume jurisdiction.

E. Procedures for assuming jurisdiction

Quality reviewers can assume jurisdiction in initial level claims, reconsiderations, and CDRs. OQR only reviews certified electronic folder (CEF) initial and reconsideration level claims, but will review both CEF and paper CDRs. The following are variations on how to process different types of claims when assuming jurisdiction.

1. Processing an amended determination for CEF initial and reconsideration claims

When assuming jurisdiction, the quality reviewer must prepare the SSA-831-C3/U3 (Disability Transmittal) according to the following instructions:

• Code the “831/832/833 approved” field as “M” in the legacy system;

• Code the “Assume Jurisdiction (Y/N)” field as “Y” in the legacy system;

• Create an SSA-831-C3/U3; manually enter changes to fields when necessary, if they have not propagated from the legacy system;

• Item 30 - The quality reviewer’s signature propagates;

• Item 32 - Complete with the appropriate statement (e. g., See RFC dated ___, See SSA-416 dated____);

• Item 32A - Enter the name of the regional medical contractor (MC) or psychological contractor (PC);

• Item 32B - Enter the MC or PC Specialty Code;

• Item 34 - Manually enter: SSA jurisdiction exercised. This amends unapproved DDS determination of MM/DD/YY in item 34 of the SSA-831-C3/U3 and identify the specific review component;

• Item 37 - The branch chief or field director signature propagates;

• Add a note in eView alerting the field office (FO) to not process the adjudicating component’s incorrect SSA-831-C3/U3. See GN 04440.237F for instructions;

• Upload the corrected SSA-831-C3/U3 image to the CEF;

• Alert the adjudicating component of your actions in the CEF via an SSA-847-U5 (SSA Request for Action);

• Prepare a new personalized decision notice (PDN) and release the date-stamped notice to the claimant and representative, if necessary. Annotate in the Jurisdictional Documents/Notices (Red) section of the CEF that the PDN was sent to the representative; and

• Move the DDS notice, if incorrect, to the “C. Current Development/Temporary (Green)” section of the CEF while the review component has jurisdiction of the case.

2. Processing the amended determination for CEF CDRs

When assuming jurisdiction in a CDR CEF case, prepare the SSA-832-C3/U3 or SSA-833-C3/U3 per instructions in DI 28084.000 and DI 28084.000, and:

• Code the “831/832/833 approved?” field as “M” in the legacy system;

• Code the “Assume Jurisdiction? (Y/N)” field as “Y” in the legacy system;

• Create an SSA-832/833 (manually enter changes to fields when necessary) or print the DDS SSA-832/833, make pen-and ink corrections, and fax into the EF. It is important that the current version of the SSA-832/833 be in file;

• Items 1 to 6 - Copy from the original form. If the original form is missing or incomplete, complete these items using the evidence in file;

• Item 7 - Enter the FO code. Leave the DDS code blank;

• Item 24 - Enter: SSA jurisdiction exercised. This amends the adjudicating component determination of MM/DD/YY and identify the specific review component;

• Items 25 and 26 - Sign and date the determination;

• Item 27- Complete with the appropriate statement (e.g., See RFC dated ___, See SSA-416 dated___);

• Item 30 - Enter the name of the regional medical contractor (MC) or psychological contractor (PC);

• Item 30A - Enter the MC or PC Specialty Code;

• Item 31 and 33 - The quality representative must sign and date the amended SSA-832-C3/U3 or SSA-833-C3/U3;

• Add the SSA-832-C3/U3 or SSA-833-C3/U3 to the CEF using DocSend or fax. See DI 81030.055B.1. for adding documents to the CEF;

• When faxing the form, create a barcode in eView. Refer to instructions in DI 81030.055D;

• Fax the SSA-832/833-C3/U3 to the CEF. Refer to instructions in DI 81030.055C;

• Add a note in eView alerting the FO to not process the adjudicating component’s incorrect disability transmittal. See GN 04440.237F for instructions;

• Alert the adjudicating component of your actions in the electronic file via an SSA-847-U3; and

• Follow the same PDN procedures as noted in GN 04440.245E.1.

3. Processing an amended determination in paper cases (CDR only)

Quality reviewers must prepare the SSA-832-C3/U3 or SSA-833-C3/U3 per instructions in DI 28084.000 and DI 28084.000 with the same exceptions listed in GN 04440.245E.2. (excluding faxing and eView instructions). In addition, the following instructions apply:

• Place a large “X” across the adjudicating component’s original Disability Transmittal;

• File the adjudicating component’s Disability Transmittal in the yellow front- Payment Documents/Decision section of the modular disability folder (MDF);

• File and route the corrected determination form in accordance with GN 04440.150B.5.;

• Prepare a new PDN and release the date-stamped notice to the claimant and representative, if necessary; and

• If the adjudicating component’s notice is incorrect, reviewers will leave it in the red section - Jurisdictional Documents/Notices - of the folder, and place, an “X” through the incorrect notice.