TN 9 (07-11)

Citations:

20 CFR 404.1512 through 404.1519t , and 416.912 through 416.919t

NOTE: These procedures are not required for CE appointments scheduled 10 days or less before the date of the appointment, see DI 22510.016G.

A. Special CE appointment communication procedures

• If the claimant has an appointed representative, see DI 22510.016C.

• If the claimant is not the applicant, see DI 22510.016D.

• For guidelines on communication with third parties, see DI 22510.016B.

B. Claimant confirms the CE appointment

If the claimant confirms he or she will attend the CE appointment scheduled for a specific location, date, and time:

• Document the CE appointment confirmation, and

• Make the required CE appointment reminder per DI 22510.019E in this section.

C. Claimant states he or she will not attend the CE appointment

If the claimant tells you that he or she will not attend the CE appointment, consider whether he or she has a good reason. For examples of good reasons, see DI 23007.009C.

• If the claimant provides a good reason why he or she cannot attend the CE appointment, reschedule it.

  See details:

  DI 22510.016, Consultative Examination (CE) Appointment Special Scheduling Procedures, and

  DI 22510.017, Consultative Examination (CE) Appointment Notice.

• If the claimant does not provide a good reason, adjudicate the claim under refusal to cooperate procedures in DI 23007.009.

D. Claimant does not respond to CE appointment notice

If the claimant does not confirm or refuse the CE appointment, you must follow up to determine whether the claimant will attend the CE appointment.

NOTE: Allow 10 days from the date of the notice for the claimant to respond. Local procedures may allow additional time to account for mail delivery and processing.

1. If the claimant is homeless, alleges a mental impairment, or the evidence suggests a mental impairment, contact a designated third party, to assist the claimant.

• Attempt to reach a designated third-party contact at the same time you follow up with the claimant.

• Make two telephone contact attempts then send a call-in letter to the third party if you do not reach him or her by telephone.

If you have already completed required development and evaluation of every mental impairment as explained in DI 24505.025 and DI 24505.030, consider the claimant’s substantiated severe mental impairment(s) rather than alleged mental impairment(s) when determining whether we require third-party contact.

REMINDER: If your efforts to reach the third party are not successful, the third party is unable or unwilling to assist the claimant, or the claimant did not designate a third party, you are not required to search for another third party; see DI 22510.016B.

EXCEPTION: If the case involves an authorized representative or an applicant other than the claimant, third-party contact is not required. Follow the special procedures in DI 22510.016C and DI 22510.016D.

2. Telephone follow up to confirm the claimant will attend the CE appointment

1. If the claimant provided a telephone number, attempt to reach the claimant by telephone.

2. If you reach the claimant:

   1. Ask the claimant if he or she will attend the CE appointment.

   2. Remind the claimant that if he or she does not attend the CE appointment, we may make a determination based on the evidence in file.

   3. Explain that this means we may find that he or she is not disabled.

   4. If the claimant tells you he or she will not attend the CE appointment, consider whether he or she has a good reason. For examples of good reasons, see DI 23007.009C.

      • If the claimant provides a good reason why he or she cannot attend the CE appointment, reschedule it.

      • If the claimant does not provide a good reason, adjudicate the claim under refusal to attend a CE procedure in DI 23007.009.

3. If you do not reach the claimant because call is unanswered, you reach a busy signal, a recorded message, voice mail, an answering machine, or another person:

   • If possible, leave a message for the claimant to call you. When leaving a message, disclose only information necessary for the claimant to return the call. See minimization policy in GN 03316.005D.

   • Make a second attempt to reach the claimant on a different day and at a different time.

4. If the telephone number is not in service or if you do not reach the claimant on the second attempt, send a call-in letter per DI 22510.019D.3. in this section.

5. Document the case development summary worksheet with the details of the development per DI 20503.001.

NOTE: If you do not reach the claimant on the first attempt, you may send the call-in letter before making your second attempt. If you reach the claimant before he or she receives the call-in letter, ask him or her to disregard the call-in letter.

3. Call-in letter follow up to confirm the claimant will attend the CE appointment

1. If the claimant does not have a telephone or you did not reach the claimant by telephone, send a call-in letter. Indicate in the letter that if the claimant does not respond within 10 calendar days of the letter, we may make a determination based on the evidence in file. Explain that this means we may find that he or she is not disabled. For sample call-in letter, see NL 00705.735.

2. Allow 10 days from the date of the call-in letter for the claimant to respond.

   NOTE: Local procedures may allow additional time to account for mail delivery and processing.

3. If the claimant calls before the CE appointment, ask if he or she will attend. Remind the claimant that if he or she does not attend the CE appointment, we may make a determination based on the evidence in file. Explain that this means we may find that he or she is not disabled.

4. If the claimant tells you he or she will not attend the CE appointment, consider whether he or she has a good reason. For examples of good reasons, see DI 23007.009C.

   • If the claimant provides a good reason why he or she cannot attend the CE appointment, reschedule it.

   • If the claimant does not provide a good reason, adjudicate the claim under refusal to attend a CE procedure in DI 23007.009.

5. If the claimant does not respond within the time allowed, you may cancel the CE appointment and process the determination per DI 23007.005H.

   EXCEPTION: If you did not send the call-in letter more than 10 calendar days before the CE appointment:

   1. Do not cancel the CE appointment.

   2. If the claimant does not attend the CE appointment and does not respond before expiration of the call-in letter, process the determination under failure to attend a CE appointment procedure in DI 23007.010G. You are not required to do additional follow up under DI 23007.010D.

   3. If the claimant does not attend the CE, but responds before expiration of the call-in letter, consider whether he or she has a good reason for missing the appointment. For examples of good reasons, see DI 23007.010E.

      • If the claimant provides a good reason why he or she cannot attend the CE appointment, reschedule it.

      • If the claimant does not provide a good reason, adjudicate the claim under failure to attend a CE procedure in DI 23007.010G.

6. Document the case development summary worksheet with the details of the development undertaken per DI 20503.001.

E. Reminding the claimant of the CE appointment

The CE appointment reminder procedures here are separate from the CE appointment notice follow-up requirements explained in DI 22510.019D in this section.

1. If a claimant confirms that he or she will attend a scheduled CE appointment, you must attempt to remind the claimant of the appointment, unless:

   • You reached the claimant during a follow up to the CE appointment notice performed within 10 calendar days of the CE appointment, or

   • The scheduled CE appointment was for a date 10 days or less in the future, see DI 22510.016G.

2. Make the CE appointment reminder 10 calendar days prior to the date of the CE appointment. If the reminder date falls on a non-business day, make the reminder on the next business day.

3. You may make the CE appointment reminder by telephone or by mail.

4. If you reach the claimant by telephone or choose to send the CE appointment reminder by mail, provide:

   • The CE appointment information,

   • A reminder that if he or she does not attend the CE appointment we may make a determination based on the evidence already in file, and

   • An explanation that this means we may find that he or she is not disabled.

5. If you reach an answering machine or a person other than the claimant, or if an automated system performs the CE appointment reminder by telephone, include only the information in the following script:

   Script: “Hello, This is an important reminder from the State of _____ on behalf of the Social Security Administration. We are calling because First Name Last Name has an appointment on Date and Time. To cancel or reschedule this appointment or if you need additional information, please call our office at Phone Number.”

6. Document the case development summary worksheet with the details of the development undertaken per DI 20503.001.

   NOTE: Make a third-party appointment reminder, if applicable; see DI 22510.016B.