TN 2 (02-13)

This section explains the actions you must take if a claimant fails or refuses to submit evidence needed to adjudicate his or her disability claim.

During the initial disability interview, you must:

• Tell the claimant what evidence we require, why we require it, and where he or she can obtain it.

• Always provide the claimant with a list of required evidence (e.g., attestation cover notice with proof request).

• Tell the claimant the timeframe to submit the evidence.

NOTE: To apply failure to cooperate (FTC) procedures, the claimant must be capable of obtaining the evidence. Some claimants may need assistance. Prior to disallowing or denying the claim, make every reasonable effort to assist the claimant to obtain the necessary evidence.

References:

• GN 01010.410, Failure to Submit Essential Evidence

• GN 00301.180, Identifying Claimants Who May Need Assistance

• SI 00601.100, Information and Evidence – General

• SI 00601.110, Closeout – Failure to Cooperate (N18) – Initial Claims

A. When to develop FTC

Develop FTC issues when:

• the claimant does not respond to your initial request for evidence or contact attempts;

• efforts to obtain evidence from the claimant are unproductive; or

• the disability determination service (DDS) requests FO assistance in contacting the claimant.

It is the claimant’s responsibility to submit evidence to establish eligibility or entitlement for disability benefits. If the claimant does not provide the evidence after a reasonable time (i.e., no more than 15 days from initial request), follow instructions in this subsection.

1. Review file for required evidence

Review the disability claims folder to determine whether:

• Medical evidence of record (MER) is in the file as defined in DI 22505.001.

• Developmental evidence, i.e., completed disability report and completed SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)) is in the file.

• Due to the nature or severity of the claimant’s impairment or condition, he or she needs assistance obtaining the evidence. For details about how to identify claimants who need assistance and how to provide assistance, see GN 00301.180.

• A relative, friend, third party, or medical source named during the interview can provide assistance by either contacting the claimant or obtaining the required evidence.

If you determine that none of the factors above apply, i.e., there is no MER, no developmental evidence, no assistance needed by the claimant, and no third party or medical treating source can assist you in obtaining the required evidence, you may contact the claimant by telephone or send a follow-up request to the claimant’s mailing address. If you are not able to contact the claimant, send a closeout letter.

2. Closeout process

Follow the closeout procedures referenced below:

Title II

• GN 01010.410C.2, Failure to Submit Essential Evidence

Title XVI

• SI 00601.110B.2, Closeout – Failure to Cooperate (N18) – Initial Claims

• SI 00601.120, SSA-L8009-U3 Supplemental Security Income, Important Information (IC) – Notice Instructions

B. Document efforts to resolve FTC

Record all efforts made to resolve FTC situations.

1. SSA mainframe systems (MCS or MSSICS)

Record all efforts on the Report of Contact (RPOC) screen in the Modernized Claims System (MCS) or the Report of Contact (DROC) screen in the Modernized Supplemental Security Income Claims System (MSSICS) including the dates and results of those efforts.

2. Electronic Disability Collect System (EDCS)

a. Claim not transferred to the DDS

Complete form SSA-5002 (Report of Contact) in EDCS and send it to the Certified Electronic Folder (CEF). If the claim is an EDCS exclusion, see DI 81010.030.

NOTE: For a technically denied claim established in EDCS, close the record per, Processing Field Office Determinations, DI 81010.140.

b. Claim transferred to the DDS

Use the EDCS Transfer/Updates feature to create the SSA-5002 per DI 81010.095. Send the SSA-5002 to the CEF.

3. Paper folder (EDCS exclusion)

Complete the SSA-5002. Then, put the paper SSA-5002 in the blue section of the paper modular disability folder (MDF).

C. FTC issues resolved

If the FTC issue is resolved at any point prior to a denial based on FTC, forward the claim to the DDS for a medical determination.

D. FTC issues not resolved

If the claimant does not respond to the initial request for evidence or indicates a lack of interest or unwillingness to cooperate, continue to process the claim following the instructions below.

1. MER or developmental evidence in file

Forward the claim to the DDS for a medical determination if the following is in the file:

• MER as defined in DI 22505.001, or

• completed disability report (e.g., SSA-3368) and a SSA-827.

The MER must be new (i.e., the DDS has not already reviewed it and made a determination on that evidence). Also, developmental evidence is not considered “in the file” if the SSA-827 or the appropriate disability report (SSA-3368 or SSA-3820) is missing or incomplete.

2. No MER or developmental evidence in file

• Deny the claim based on FTC only if the claimant does not respond or submit the required evidence after sending the closeout letter or does not ask for more time to submit the evidence.

• Close the EDCS record, if applicable. Process an FO “No Determination” (ND) per DI 81010.140.

IMPORTANT: Do not process an FTC denial if you can deny the claim based on the claimant not meeting other non-disability factors of entitlement or eligibility (e.g., insured status not met or excess income). In addition, if an EDCS record was established for any type of technically denied claim, close the record per DI 81010.140.

a. Title II claims

Deny the claim for “Insufficient evidence furnished.”

• Use code 000M5 if the claimant does not respond or submit the required evidence within the closeout period or does not ask for more time to submit the evidence.

• Use code 000M6 if the DLI is in the past.

Prepare a manual denial letter and mail it to the last known address (for detailed instructions, see NL 00601.020E.2).

b. Title XVI claims

Follow instructions in Closeout Failure to Cooperate (N18) Initial Claims SI 00601.110.

3. FTC issue arises after a favorable medical determination

When an FTC issue exists after the DDS returns a favorable determination to the FO, follow the instructions below:

• Title II claims
  GN 01010.410, Failure to Submit Essential Evidence

• Title XVI claims
  SI 00601.110, Closeout Failure to Cooperate (N18) Initial Claims

E. Claimant submits requested evidence after being denied for FTC

Follow the instructions in this subsection for:

• implied request for reconsideration;

• good cause determinations;

• processing reconsideration requests; and

• reopenings.

1. Evidence submitted within the appeal period

If a claimant submits the requested information within the appeal period, treat the submission as a request for reconsideration.

References:

• DI 81010.110, Processing Field Office (FO) Technical Reactivations

• DI 12005.010, Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial

• DI 81010.145, Processing Reconsideration Requests of Field Office (FO) Determinations

• GN 03102.100, The Reconsideration Process

• SI 04020.020, Requests for SSI Reconsideration

• MSOM MSSICS 020.001, Appeals - Overview

2. Evidence submitted after the appeal period

If a claimant submits the requested information after the appeal period, treat the submission as an untimely filed implied request for reconsideration. We can extend the period for requesting a reconsideration if the claimant submits a written request for an extension and if the claimant can show good cause for failing to submit the request for reconsideration within the time limit.

a. Good cause determination

Develop and document the file with a “good cause” determination. Follow the procedures in Good Cause for Extending the Time Limit to File an Appeal GN 03101.020.

See Also:

• VB 02501.010, Good Cause for Extending Time Limit

• GN 03101.020, Good Cause for Extending the Time Limit to File an Appeal

• SI 04020.020, Requests for SSI Reconsideration

• DI 12005.015, Late Filing of a Request for Reconsideration

b. Good cause established

Process the request for reconsideration as though the claimant filed it timely.

See Also:

• DI 12005.015, Late Filing of a Request for Reconsideration

• DI 81010.145, Processing Reconsideration Requests of Field Office Determinations

c. Good cause not established

If you determine the claimant did not have “good cause” for late filing, follow the procedures in DI 12005.015C.

If the claimant wishes to re-file, follow the instructions in DI 12005.015D.

If the claimant does not wish to re-file, see DI 12005.015E.

3. Processing reconsideration requests of FO determinations

For instructions on how to process requests for reconsideration on technically denied claims, see details in:

• DI 12005.010, Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial

• DI 81010.145, Processing Reconsideration Requests of Field Office (FO) Determinations

4. Reopening FTC denial

Generally, you cannot reopen or revise a correct determination. Use the reopening procedures only if the FTC denial was incorrectly processed, and:

• The claimant contacts us after the appeal period ended; or

• You cannot establish good cause for filing reconsideration late.

EXAMPLE: A claimant denied for FTC recontacts the FO after the appeal period is over. The FO cannot find good cause for late filing of an appeal. However, the FO discovers that the FTC denial was incorrect because the requested evidence had in fact been submitted timely. The FO can reopen the incorrect FTC denial in this situation.

Follow instructions:

• Title II claims

  GN 04001.070, Do Not Reopen Correct Determinations – Operating Policy

• Title XVI claims
  SI 04070.010, Title XVI Administrative Finality – General Reopening Policies

See exceptions to the general reopening procedures:

• DI 27505.001A, Rules for Reopening

• SI 04070.010C, Policy – Only Incorrect Determinations Can Be Reopened and Revised