TN 5 (12-17)

A. Procedure for reconsideration cessation cases

1. Completing and routing non-sample cases

1. Complete, sign, and date the SSA-832 and SSA-833. Refer to Disability Hearing Officer (DHO) signature requirements in DI 28084.050. Do not complete blocks 26–28, 30, 30A, and 32. Sign blocks 25 and 31.

   Complete an SSA-831 when applicable, e.g., reconsideration of adverse revision of initial decisions and escalated claims. For instructions to complete the form, see DI 27015.001 and DI 27530.000. However, do not complete blocks 30 through 32B. Sign the form in block 37, and leave the SSA code block blank.

2. Check the “Recon DHU” (Disability Hearings Unit) block on the pertinent forms.

3. Upload the SSA-831, SSA-832, and SSA-833 to the certified electronic folder (CEF).

   Image the SSA-832 and SSA-833 in Section A, Payment Documents/Decisions. Image the SSA-1207 Disability Hearing Decision in Section B, Jurisdiction Documents and Notices.

4. For paper cases, place the case folder copy and field office (FO) copy of the SSA-831, SSA-832, or SSA-833 on the top of the left side of the folder.

   A paper folder for concurrent Title II/Title XVI cases may have both a paper modular disability folder (MDF) and a brown folder that contains the Title XVI non-medical material (see DI 70005.005A.2). Place the decision form(s) on top of Section A (front yellow) of the folder. File the original hearing decision and the case folder copy of the cover notice of decision in Section B (red). Also, place a copy of the decision form(s) on top of the left side of the brown folder and a copy of the hearing decision and case folder copy of the cover notice of decision on top of the right side of the brown folder.

5. Retain the State Agency copy of the decision form, and send the Vocational Rehabilitation (VR) copy to the servicing VR agency, if applicable.

6. For paper cases, file the original hearing decision and the case folder copy of the notice of decision under the envelope on the top of the right side of the case folder.

7. Forward the original notice and a copy of the DHO's decision to the individual, and a copy of the notice and decision to the individual’s representative, if any. For mailing instructions follow NL 00603.105B.2.

8. Perform required systems inputs. (If using the NDDSS, for specific systems instructions see SM 06001.001. Otherwise, see SM 05901.000.)

9. Route the case folder to the FO under cover of a properly completed SSA-2640 (DIB Hearing Case) unless the conditions noted in Section A apply. For an exhibit of Form SSA-2640, see DI 33095.135.

2. Quality Review (QR) sample cases

1. Process the SSA-831, SSA-832, or SSA-833 as in Section A items a. through e. Leave all paper copies in the paper case folder.

   (The reviewing component, Disability Quality Branch (DQB), returns the DHU copy upon completion of the review.)

2. For the paper folder, make copies of the SSA-831, SSA-832, or SSA- 833 for the DHU's records. Enter “Quality Review Sample Case” in the Remarks section.

3. Place the individual’s (and representative's) copy of the hearing decision and decision notice, the envelope(s) for mailing the notice and decision to the individual (and representative), and a properly completed SSA-2640, in the paper case folder. Make sure the decision and notice are clean without evidence of mutilation (e.g., punched, stapled, or otherwise mutilated).

4. Route the paper case folder to the reviewing component under cover of an SSA-408 (Route Slip). Annotate the form with “Medical Cessation - QR Action Required.” Indicate if the case is Title II, XVI, or concurrent. Staple Form SSA-3031 (Disability Hearing Quality Review Sample Case) under the SSA-408.

5. If the official folder is a CEF, do not send paper copies of the hearing decision and decision notice to the reviewing component. The reviewing component will release notices if there are no deficiencies.

6. In CEFs, the SSA-832 and SSA-833 are accessible in Section A. Do not send a paper copy to the reviewing component.

7. OQR reviews electronic cases only. The system selects a sampling of DHO’s continuance or cessation decisions for part of the reviewing component’s download.  For all cases with deficiencies, DHO returns the case(s) to DDS for corrective action. Please refer to GN 04448.401 which is OQR’s business process.

8. Update the case control system showing folder movement to the reviewing component.

3. Exceptions to reconsideration cessation routing

a. Special review cases

Special review cases include individuals with 301 involvement and Title II individuals who are age 54 or older with a revised cessation date.

NOTE: This procedure does not apply to foreign cases or to cases with railroad involvement.

• Process the SSA-832 and SSA-833 hearing decision, and notice as in Section A. However, do not input decisions for 301 cases. For paper folders with 301 involvement, place the SSA-832 and SSA-833 in the case folder for processing by the program center (PC). For additional information on 301 cases, see DI 33025.025.

• Route the Title II case folder via a properly completed SSA-2640 to the Office of Earnings and International Operations (OEIO) , or to the program center (PC) in these situations:

  1. if age 54 or older, and the cessation date has been revised, or

  2. if there is 301 VR involvement.

b. Foreign claims

Follow Section A, but route non-QR cases to the Social Security Administration, Office of Earnings and International Operations, P.O. Box 17769, Baltimore, MD 21203, Attn: Reconsideration Branch.

c. Concurrent disability insurance benefits and disabled widow (‘ers), including surviving divorced spouse benefits (DIB/DWB) cases

Follow Section A and route the case folders to the FO if the decision is the same on both cases. Route to the appropriate PC if the decisions are different, e.g., DIB continued, DWB ceased.

NOTE: Handle OQR cases as in Section A whether or not the decisions are the same on the two cases.

d. Drug Addiction and Alcoholism (DA/A) cases

Follow Section A, but remove any DA/A Routing Flag before releasing the case folder to the FO.

e. Railroad cases

Follow Section A, but route non-QR cases to the Great Lakes Program Service Center (GLPSC), Disability Review Section (DRS), P.O. Box 8470-A, Chicago, IL 60680.

B. Procedure for reconsideration continuance cases

1. Completing and routing non-sample cases

1. Complete, sign, and date the SSA-831, SSA-832, and SSA-833. See Section A for instructions to separate and distribute the copies.

2. For electronic cases, upload the SSA-831, SSA-832, and SSA-833 to the CEF.

3. Follow Section A for filing and releasing the DHO's decision and notice of decision.

4. Perform required systems inputs; see references in Section A.1.h. for instructions.

5. For CEFs, route all final decisions, both favorable and unfavorable, to the FO. If necessary, the FO will forward the CEF to the program center (PC). For more information on DDS Responsibilities for eCDR Reconsideration Appeals, see DI 81020.255B.

6. For a paper folder, route the Title II case folder and the Title II portion of a concurrent Title II/Title XVI to the appropriate PC. Send the Title II folder under cover of a properly completed SSA-2640. For an exhibit of this form, see DI 33095.135. Annotate the Remarks section of the SSA-2640 to show any action required, e.g., to update the Master Beneficiary Record (MBR) with diary information, to reinstate benefits, or to return the folder to files.

7. Route Title XVI only paper cases to the servicing FO. Annotate the SSA-2640 to show any FO required action.

8. If the DHU has a separate Title XVI paper folder, route the Title XVI case in concurrent Title II/XVI cases (if DHU has it) to the servicing FO. Send under cover of a properly completed SSA-2640. If the Title XVI folder is not in the DHU, route only the SSA-832 to the FO. Add to the SSA-2640 “FO Action Necessary.” Also, include a copy of the SSA-833 and annotate the SSA-2640 to show that we forwarded the SSA-833 for informational purposes.

2. Quality Review sample cases

1. Process the SSA-831, SSA-833, or SSA-832 as in SectionA.1, items a through e. Leave all paper copies in the case folder. The reviewing component will return the DHU copy upon completion of the review.

2. For paper cases, make a copy of the SSA-831, SSA-832, and SSA- 833 for DHU records and enter “Quality Review Sample Case” in the Remarks section of the form. For paper cases, place the individual’s (and representative’s) copy of the hearing decision, decision notice, the envelope(s) for mailing the notice and decision to the individual (and representative), and a properly completed SSA-2640 in the case folder. Make sure the decision and notice have not been punched, stapled, or otherwise mutilated.

3. Route the paper case folder to the reviewing component via an SSA-408 annotated, “Recon Medical Continuance - QR Action Required”. On the SSA-408 show if the case is Title II, Title XVI, or concurrent. Be sure to staple an SSA-3031 (Disability Hearing Quality Review Sample Case) under the SSA-408.

4. OQR reviews electronic cases only. The system selects a sampling of DHO’s continuance or cessation decisions for part of the reviewing component’s download.  For all cases with deficiencies, DHO returns the case(s) to DDS for corrective action. Please refer to GN 04448.401 which is OQR’s business process.

5. In CEFs, the SSA-832 and SSA-833 will be accessible in Section A. The reviewing component does not need a paper copy.

6. Update the case control system showing folder movement only to the reviewing component.

3. Exceptions to reconsideration continuance routing

a. Concurrent DIB/DWB claims

• Prepare the forms and notices as in Section A.1.

• Route cases to the program center (PC) with jurisdiction.

b. Medicare for Qualified Government Employment (MQGE) cases

Follow Section A.2. Include “MQGE Recon Case” in the Remarks section of the SSA-833.

c. Railroad cases

Follow Section A and forward the case folder to Great Lakes Process Service Center – Disability Review Section (GLPSC-DRS), P.O. Box 87755, Chicago, IL 60680-8115.

d. DA/A cases

• Show in the Remarks section of the SSA-832 “DA/A Case” if DA/A is material to the hearing decision. Otherwise, except as noted in this section, process the case as in Section A.

• During the reconsideration process, copy any received material that would be helpful to a treatment referral agency. Fasten the copies to the inside back cover of the paper case folder.

• Route the case folder to the FO via a properly completed SSA-2640. Check “DA/A no longer involved in disability”. Remove DA/A indicator” block of the SSA-2640 if we determine that the individual is disabled independent of DA/A. This action is necessary because if an individual is disabled independent of DA/A, he or she is no longer subject to the representative payee and treatment requirements. Also, he or she is not subject to an automatic 12-month diary.

• See detailed information regarding DA/A in DI 90070.000.

e. Foreign cases

• Route non-QR cases to the Office of Earnings and International Operations (OEIO) after completing the actions in B.1.

• Forward the case folder via a properly completed SSA-2640 to the address shown in Section A.3.b.

NOTE: For CEFs, route all final decisions, both favorable and unfavorable, to the FO. If necessary, the FO will forward the CEF to the program center (PC). For more information see DI 81020.255B.