1. |
Evidence Sources |
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a. Allowances |
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b. Denials |
Medical evidence
Personalized notice
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2. |
Allegations |
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a. Allowances |
SSA-3368-F8 (Disability Report of Medical Evidence)
Report of Contact (SSA-5002)
SSA-795 (Statement of Claimant or Other Person)
Personalized notice (partially unfavorable decisions)
|
|
|
b. Denials |
SSA-3368-F8 (Disability Report of Medical Evidence)
Report of Contact (SSA-5002)
SSA-795 (Statement of Claimant or Other Person)
Personalized notice
|
|
3. |
Evidence of SGA/SGA Findings |
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|
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a. Allowances |
SSA-820-F4 (Work Activity Report - SE)
SSA-821-F4 (Work Activity Report - EE)
Report of contact or SSA-553 (Special Determination)
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|
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b. Denials |
SSA-820-F4 (Work Activity Report - SE)
SSA-821-F4 (Work Activity Report - EE)
Report of contact or SSA-553 (Special Determination)
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4. |
Medical Facts |
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|
|
a. Allowances |
Medical evidence
Reports of contact
|
|
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b. Denials |
Medical evidence
Reports of contact
|
|
5. |
Interpretation of Medical Findings |
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|
|
a. Allowances |
Regulation basis code (SSA-831-U5)
In some cases, the Psychiatric Review Technique Form (PRTF - SSA-2506-BK) and Residual Functional Capacity (RFC - SSA-4734-F4 and Supplement)
Personalized notice (partially unfavorable decisions - later onset date and closed period cases)
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b. Denials |
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6. |
Pain-Related Issues |
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a. Allowances |
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b. Denials |
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7. |
Resolution of Conflicting Medical Opinions |
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a. Allowances |
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|
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b. Denials |
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8. |
Resolution of Inconsistencies Material to Decision |
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a. Allowances |
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b. Denials |
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9. |
Vocational Rule Used for Medical/Vocational Decisions |
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|
|
a. Allowances |
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|
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b. Denials |
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10. |
Citation of Jobs and Incidence |
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|
a. Allowances |
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b. Denials |
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11. |
Duration of Impairment |
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a. Allowances |
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b. Denials |
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12. |
Assessment of Functional Abilities |
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|
|
a. Allowances |
RFC form
Medical evidence
|
|
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b. Denials |
RFC form
Medical evidence
|
|
13. |
Basis for Decision |
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a. Allowances |
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b. Denials |
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