When to return cases:

DDS should return initial claims to an FO only if:

• A disability determination has been made, and the case is not part of the Disability Quality Branch’s (DQB) review component sample, or

• DDS does not need to make a disability determination on the case,

• The SSA-827 is not in the file, and

• The FO requests the claim be returned.

When not to return cases:

DDS should not return cases to an FO if a disability determination is needed. DDS should request FO assistance, evidence, claimant contact, etc., by the most expeditious method available (e.g., EDCS Assistance Request (AR)), keeping jurisdiction in the DDS.

Exception: See “SGA issues” in Table 2, Examples, in this section.

The DDS should return the case when it: (no FO contact required)

• Receives an F-9 alert (Title XVI file only, SM 05905.204).

• Receives a direct written request to withdraw the claim (DI 11010.075).

• Receives notification that the Title II claimant died within five months of Alleged Onset Date (AOD) (DI 11010.075).

• Recognizes the case is under SSA jurisdiction:

  • Career railroad or RR annuitant (DI 11010.262).

  • Prisoner case when the FO fails to respond to an AR (DI 23501.005).

  • Foreign claim (DI 11010.275).

  • Emergency clause (DI 11055.110 and DI 11010.290).

  • Collateral estoppel case (DI 11011.001).

  • SGA case (DI 10501.001).

  • Changed identity claim (DI 11010.270).

  • Res judicata case (DI 11010.075; DI 27516.001).

The FO should request that the DDS return the case when it:

• Discovers a technical or non-medical denial is applicable (DI 11010.040 and DI 13010.105E.). See also DI 81010.140.

• Receives notice of the SSI claimant’s death; the FO determines disability decision is not needed (DI 11055.050).

• Receives notice that the Title II claimant died within five months of AOD (DI 11010.075.)

• Receives a request for withdrawal (DI 11010.075).

• Discovers the case is under SSA jurisdiction (DI 11010.075).

The DDS should not return the case to the FO when:

• Failure to pursue or whereabouts unknown is an issue (DDS makes a determination), DI 11010.045.

• The claimant moves to another state (send folder directly to other DDS after notifying the FO). See DI 11010.255.

• Additional information is needed from the claimant (DDS contacts claimant).

• An SSI claimant attains age 65 (DDS tells the FO; DDS still makes determination).

• The case is part of a DQB review component sample.

DDS should contact the FO for assistance (DDS keeps jurisdiction) when it:

• Learns a claimant has died (DI 11010.630C.; DI 11055.050B.).

• Receives a withdrawal request from the claimant via telephone (DI 11010.075).

• Is unable to secure form SSA-3369 from claimant (DI 10005.010).

• Needs to contact claimant's employer (DI 11010.145).

• Needs proof of age (DI 11010.640).

• Learns of a change of address, change of name, or representative payee issue (DI 11010.630 through DI 11010.635).

• Needs assistance developing medical evidence (DI 11010.645).

• Needs assistance following up on medical evidence (DI 11010.520).

• Needs additional information from the claimant but has been unable to obtain it (DI 11010.485).

Title II insured status alerts

If DDS receives a systems-generated alert regarding Title II insured status, telephone the FO to verify status before returning the folder.

SGA issues

• FOs should resolve SGA issues prior to sending folders to DDS.

• If DDS receives a case with an unresolved SGA issue or discovers an SGA issue during case development, the DDS should send an electronic assistance request (AR) in eView to the FO requesting SGA development.