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DI 40525: Other Processing Issues

Effective Dates: 03/29/2013 - Present

BASIC (01-01)

A. Process - general

TII direct release and mailer initiated CDR folders are pulled from the Office of Central Operations (OCO) Megasite in Baltimore and the SSA National Records Center (NRC, commonly referred to as the "Caves") in Independence, Missouri or the PC of jurisdiction. Both the Megasite and NRC will obtain all folders, which are located in their files for the requested record and forward them to the FO.

When the Megasite/Caves does not find the folder, the PC of jurisdiction will be responsible for a special search and, if necessary, preparing a duplicate folder. See DI 40525.075.

NOTE: Even if the FO subsequently determines that the folder they received does not contain the medical evidence used in the most recent prior favorable medical decision, NO REPEAT REQUEST for a folder will be made to the Megasite/CAVES.

B. Process – PC actions based on PCACS and Disability Control File (DCF) reads

  1. Alerts for folders located in operational sites and components are printed in the jurisdictional PC's.

  2. These alerts can include Module/DRS locations and any auxiliary files locations.

  3. OCO and the PSC's are responsible for retrieving Title II folders and the Title II portion of concurrent TII/TXVI folder(s) for these CDR direct release alerts and mailing them to the FOs.

  4. OCO/PSC is responsible for initiating special search activities and preparing a duplicate folder if the folder shown on PCACS is not in file (NIF) in the Megasite/CAVES, cannot be located or has been destroyed.

  5. The OCO/PSC sends any folder belonging to the NH located during the search even if it is not the appropriate folder, i.e., does not contain the needed medical evidence.

    EXCEPTION: If ODO/PSC determines the Title II folder is in a FO, they will forward the alert to the servicing FO to retrieve the Title II folder and conduct the CDR interview.

  6. DO NOT consider a folder "missing" until the Megasite/Caves/PSC complete the Initial Pull Period (not to exceed 90 days) and it yields "NO FOLDER".

  7. AT THIS POINT, OCO/PSC changes PCACS to read "AUXRH QUES QUES", or "AUXRH TEMP QUES" or "CAVES QUES QUES or PC1-6 QUES QUES" for the direct release/mailer alerts.

  8. OCO/PSC updates the FOLDER RECONSTRUCTION field on the DCF to read "Q". See CHART below.

  9. OCO/PSC is still searching (can take up to 120 days from the "AUXRH QUES QUES", "AUXRH TEMP QUES" or "CAVES QUES QUES or PC1-6 QUES QUES" entry date) for the medical CDR folder in other locations.

  10. OCO/PSC still unable to locate the folder, updates the FOLDER RECONSTRUCTION field on the DCF to read "L".

  11. Prepares a duplicate folder, updates the DCF, and forwards the duplicate folder to the FO. The FO will allow 15 working days for receipt of the duplicate folder before contacting OCO/PSC-DRS for status. See DI 40525.100C.

C. Process – chart of PCACS Title II locations for NIF CDR folders and OCO/PSC/FO actions

PCACS LOCATION

OCO/PSC ACTION

FO ACTIONS and REMARKS

1. AUXRH QUES QUES or

AUXRH TEMP QUES (Megasite "questionable"" location)

  • Updates DCF FOLDER RECONSTRUCTION field to "Q".

  • Treats as missing folder and begins searching in other locations.

See DI 40525.070

FO: NO ACTION – IS ON HOLD FOR A MAXIMUM OF 120 DAYS, awaiting the folder or duplicate folder from OCO/PSC.

This read indicates that OCO has searched for the folder and could not locate it in that location.

2. CAVES QUES QUES

(NRC "questionable" location)

  • Updates DCF FOLDER RECONSTRUCTION field to "Q".

  • Treats as missing folder and begins searching in other locations.

See DI 40525.070

FO: NO ACTION - IS ON HOLD FOR A MAXIMUM OF 120 DAYS, awaiting the folder or duplicate folder from OCO/PSC.

This read indicates that Caves has searched for the folder and could not locate it in that location.

3. PC1-6 QUES QUES

(PSC "questionable" location)

  • Updates DCF FOLDER RECONSTRUCTION field to "Q".

  • Treats as missing folder and begins searching in other locations.

See DI 40525.070

FO: NO ACTION - IS ON HOLD FOR A MAXIMUM OF 120 DAYS, awaiting the folder or duplicate folder from OCO/PSC.

This read indicates that PSC has searched for the folder and could not locate it in that location.

4.

WITHIN 120 DAYS AFTER THESE “PCACS READS” ARE UPDATED:

AUXRH QUES QUES -

AUXRH TEMP QUES

CAVES QUES QUES

OR

PC1-6 QUES QUES

  • OCO/PSC updates DCF FOLDER RECONSTRUCTION field to "L".

  • OCO/PSC prepares a "DUPLICATE" folder.

See DI 40525.070

FO: TICKLE(S) for 15 WORKING DAYS from date when Title II and/or duplicate folder has been updated to the FO on PCACS.

IF FOLDER NOT RECEIVED, FO Contacts OCO/PSC-DRS for current status and tickles file for receipt per DI 13015.060.

When folder is received FO proceeds with CDR per DI 13015.070.

5. DESTR DEST DEST

(Destroyed)

The PC of jurisdiction gets alert and is responsible for preparing a duplicate folder.

FO: NO ACTION NECESSARY. The folder has been destroyed.

6. INTRN FOUT PTRN

(In transit, files out, permanent transfer)

For example, death cases, Age 54 transfers, folder misroute (i.e., wrong PC).

The PC of jurisdiction will:

  • Send the folder to the FO when it arrives in the PC.

  • If the folder has not arrived after 60 days, search for it, and

  • Prepare a duplicate folder if not found.

  • Updates the DCF with an "L" in the FOLDER RECONSTRUCTION field.

IN TRANSIT:

0-75 DAYS:

  • If PCACS date (LOCDT) is less then 75 days –TICKLE the case for 15 days and recheck to see if folder has been received and read in by the new PC.

  • If not received in the PC, diary for another 15 working days, recheck status, if no movement, repeat tickle till folder is receipted in or LOCDT date is more than 75 days.

  • If folder is received in PC and PCACS changed accordingly, REQUEST the folder from the PC through PCACS.

  • If PCACS, not updated, proceed to 75 - 119 days.

MORE THAN 75 DAYS – UP TO and including the 119th DAY:

If the TO LOCATION has not changed to the current PC, CALL the PC shown in the TO LOCATION to see if they have the folder.

If YES, have them send the folder to your FO.

If NO, it is their responsibility to start the OCO/PSC lost folder process in accordance with DI 40525.070 - DI 40525.075.

At this point -- FO has no further action until a Title II or duplicate folder is received.

MORE THAN 119 DAYS:
   

EXCEPTION: If the folder location shows it to be in transit for more than 119 days, ignore the above steps. Phone the PC shown in the “TO LOCATION” and request the folder. Tickle for 15 working days for receipt of the folder. If the folder has not been received, FO contacts the DRS/Module Manager to start the OCO/PSC lost folder process in accordance with DI 40525.070 - DI 40525.075.

7. INTRN FOUT TTRN

(In transit, files out, temporary transfer)

[THIS MEANS THE FOLDER IS BEING SENT TO A LOCATION OTHER THAN A PC, e.g., FO, DDS, ODAR, etc.]

Follow the procedure in DI 40525.070E.

FO: ACTIONS as follows:

  • Check the office shown in the TO LOCATION, if the office shown is YOUR OFFICE, tickle file for 15 working days for receipt of the folder and wait.

  • At the end of the 15 working days, the FO contacts the PC (if folder not received) to determine status. Depending on response the FO will be setting another tickle date for receipt of the file or contacting OCO/PSC for implementation of lost folder process per DI 40525.070 - DI 40525.075.

  • If the office shown is NOT YOUR OFFICE, FO phones the office in the TO LOCATION (see FO exceptions in DI 13015.040D., DI 13015.040E., and DI 13015.040F.) and asks them to forward the folder to you.

  • If they do not have the folder yet, ask them to forward it when they receive it.

  • In "INTRN FOUT TTRN" situations – It is the FO"s responsibility to make sure a title II folder is received in order to conduct the CDR interview, etc. If necessary the FO will contact OCO/PSC and have them start the lost folder procedures in DI 40525.070 - DI 40525.075.

  • If the date shown in LOCDT is more than a year prior to the current date – contact OCO/PSC and have them start the lost folder procedures in DI 40525.070 - DI 40525.075.

8. MOD XX

PC of jurisdiction responsible for sending the folder to the FO.

FO: NO ACTION
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DI 40515: Due Process/Statutory Benefit Continuation
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DI 405: Processing Continuing Disability Review Cases
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DI 40540: Section 1619 Medical CDRs
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