TN 4 (05-95)

A. Introduction

FOs, DDSs and PCs prepare and/or release the notices required for a broad range of disability determinations. The following subsection outlines the primary areas of responsibility for each component, but is not all inclusive.

B. Policy

1. Field Office (FO)

FOs may be responsible for notices covering:

• Initial/reconsideration denials based on SGA —title II and XVI,

• Title II work continuances,

• Title II SGA cessations (advance and final notice),

• Title II and XVI continuing disability reviews (CDRs) for medical reasons (prereview notices),

• Suspension/reinstatement of benefits under various circumstances including extended period of eligibility (EPE) cases,

• Adverse actions resulting from work activity,

• Disallowances based on lack of insured status and failure to meet prescribed period requirement,

• Vocational Rehabilitation (VR) refusal cases,

• Drug addiction and alcoholism (DAA) cases,

• Failure to cooperate,

• Whereabouts unknown, and

• Workers' Compensation/Public Disability Benefit (WC/PDB).

2. Disability Determination Services (DDS)

DDSs may be responsible for notices covering:

• Initial and reconsideration medical and medical/vocational denials,

• Partially unfavorable allowances - initial and reconsideration,

• Title II and XVI CDR cessations,

• Title II and XVI CDR continuances (medical issues),

• Adverse reopenings of fully or partially unfavorable determinations (medical issues),

• Prisoner/felon cases,

• Title XVI DAA cases,

• Failure to cooperate, and

• Whereabouts unknown.

3. Processing Center (PC)

PCs are responsible for notices covering:

• SGA denials at the request of the FO,

• Title II SGA cessations (advance and final notices),

• Certain disability awards (e.g., childhood disability beneficiary files as disabled wage earner),

• Denials for failure to cooperate, whereabouts unknown, etc.,

• Adverse reopenings,

• Black lung determinations - Office of Disability Operations (ODO),

• End stage renal disease (ESRD) claims - ODO,

• VR section 301 payment decisions (ODO),

• For Foreign claims, the Office of International Operations (OIO) performs the same functions as the DDS, and

• WC/PDB.

NOTE: The Office of Central Operations (OCO) includes ODO and OIO.

C. References

See the following subchapters for specific notice requirements and responsibilities:

1. Specific notice requirements and responsibilities

• Special Notice Options Policy for the Blind or Visually Impaired, NL 01001.010

• Work Issues, DI 13010.090, DI 13010.185, and DI 13095.000.

• CDR Cases, DI 13005.000, DI 13010.090, DI 28095.000,

• Medical Denials/Partially Favorable Allowances, DI 26535.000, DI 27030.000

• Due Process, DI 13010.185, DI 27525.000, DI 28080.000, DI 40515.015

• DAA Cases, DI 90070.900

• Prisoner Cases, DI 28065.000

• Technical Denials/Withdrawals, DI 40105.000

• Adverse Reopenings, DI 27540.000

• ESRD Cases, DI 45001.000

• WC/PDB,NL 00720.395

For information on processing a trial work period (TWP) determination, please refer to DI 13010.090. For information on processing a TWP when a fraud conviction is involved, please see DI 13010.037.

2. Paragraphs to be requested

For lists of paragraphs to be requested, see NL 00720.001 (MADCAP Paragraphs and Notices).