TN 6 (03-09)

A. Overview

The FO No Determination and FO Denial process allows the FO to record non-medical determination information on a claim entered into the Electronic Disability Collect System (EDCS) that does not require a medical determination by Disability Determination Services (DDS). If the claim was not entered into EDCS (e.g. an Abbreviated Application was completed), then no EDCS record is created for the denial.

Use the FO Determination function to process:

• technical denials (e.g., insured status or excess resources),

• substantial Gainful Activity (SGA) denials, and

• withdrawals after case transfer.

NOTE: Use the Manual Clearance option to close out a case that was never transferred to the DDS or Office of Disability Adjudication and Review (ODAR) for a determination or decision AND was never properly closed out in EDCS. For details on the Manual Clearance function, see Deleting and Manually Clearing Electronic Disability Collect System (EDCS) Cases - DI 81010.105.

B. Using the “No Determination” function

It is not necessary to complete a disability report, i.e. SSA-3368 (Disability Report – Adult) or SSA-3820 (Disability Report – Child) in EDCS for “No Determination” cases. However, if an EDCS record has been created an FO No Determination must be completed in EDCS to close out the case. FO No Determinations may be made on cases pending in the FO or in the DDS.

1. “No Determinations” on cases pending in the FO

To process a claim using the “No Determination” functionality for cases pending in the FO:

• Select “Claims Action” on the EDCS tool bar at the top of the screen and select “No Determination”;

• Select the reason for a Technical Denial;

• Add any appropriate remarks;

• Ensure the Paper Folder Indicators are correct (for more information on paper folder indicators, see Paper Folder Indicators (PFIs) - DI 81001.020); and

• Select “OK” at the bottom of the screen.

After completing the FO Determination page:

• EDCS closes the claim as a “No Determination”; and

• the Claims Actions screen displays the Determination or Disposition of the case along with the date of the last action taken on the claim.

NOTE: If a case contains multiple claims and one of the claims requires a “No Determination”, the FO must, whenever possible, process the “No Determination” before transferring the EDCS case to the DDS. If not possible, add a message in eView or EDCS to alert the DDS of the reason for the delayed claim.

2. FO “No Determinations” on cases pending in the DDS

The FO can perform an FO Determination on a claim(s) when the case is:

• pending at the DDS,

• medically reactivated and not pending in OQR, or

• a hearing level case when the case is still in the jurisdiction of the FO and has not been transferred to ODAR.

NOTE: The FO cannot perform an FO Determination on Informal Remand (IR) claims.

If an FO Determination is made on one claim prior to case transfer, and the other title of the concurrent claim is transferred to DDS, do not make an FO Determination on the claim pending at DDS if the original FO Determination needs to be reactivated. Convert the case to a paper folder and process per Certified Electronic Folder (CEF) Exclusions and Limitations - DI 81010.030C. For example:

• A Number Holder (NH) files a concurrent claim and the FO makes an FO Determination on the Title II because the claimant is uninsured.

• The FO transfers the Title XVI to DDS, but later finds LAG earnings which makes the NH insured.

• The FO must not make an FO Determination on the Title XVI claim pending at DDS to allow for technical reactivation of the Title II claim.

C. Processing SGA denials using the FO denial function

Always process SGA denials electronically unless an EDCS exclusion applies. For more information on exclusions see Certified Electronic Folder (CEF) Exclusions and Limitations - DI 81010.030. SGA denials may be recognized before or after case transfer to the DDS.

To process an SGA Denial:

• Complete the SSA-821 or SSA-820 (Work Activity Report – Employee/Self Employed Person) using signature proxy procedures per Using Form Attestation for Work Activity Reports - DI 81010.120;

• Select “Key” to enter the disability report and key the SSA-3367 - Disability Report - Field Office) when SGA Denial is made prior to case transfer; and

• Select “Claims Action” on the EDCS tool bar at the top of the screen and select “Denial”.

• Select “Denial” on the Select Determination Type page,

• Complete the “Field Office Determination – Denial” screen including the fields for Reg Basis, Prior Action, Work and Education, and a Rationale NOTES:

  1. These fields are necessary for completion of the SSA-831 (Disability Determination and Transmittal);

  2. Users must select the appropriate Title II SGA denial Reg Basis Codes (N1, N2) from the drop down box on the FO SGA Denial Page. A pop-up displays to assist users in differentiating between the Title II choices. For concurrent claims, the Title II claim displays first. For Title XVI claims, N33 is the only choice.

• Ensure the PFIs are correct (For more information on the paper folder indicator see Paper Folder Indicators (PFIs) - DI 81001.020.);

• Select “OK” at the bottom of the screen; and

• Create the SGA denial notice per Preparing Notices in Disability Claims - DI 11010.345.

NOTE: If the notice is not stored in the Online Retrieval System (ORS), then fax a copy into the CEF per Faxing Documents into the Certified Electronic Folder (CEF) - DI 81010.090.

After completing the “Field Office Determination – Denial” page:

• EDCS closes the claim as an SGA denial;

• The Claims Action screen displays the Determination/Disposition of the claim along with the date of the last action taken on the claim; and

• The SSA-831 created by EDCS saves to the Certified Electronic Folder (CEF).

D. Processing withdrawals of applications

If the claimant submits a request for withdrawal of the application to the FO after the case has been transferred to DDS:

• Process the withdrawal request per Processing Withdrawal Request - DI 23015.001; and

• Close the case using the “No Determination” feature per Processing Field Office (FO) Determinations - DI 81010.140B.

If the case is transferred fax the SSA-521 (Request for Withdrawal) into the CEF. The office of jurisdiction:

• receives an alert of a new document in DMA; and

• closes out the case following proper procedures.

E. Recalling claims transferred to DDS

Very rarely is it necessary to recall claims transferred to DDS. For example, if a claim was routed to the wrong DDS, it may have to be recalled. To recall a transferred claim:

• Contact the office with jurisdiction using local procedures; and

• Ask them to return jurisdiction.

For information regarding jurisdiction of cases, see Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS) - DI 11010.255.