POMS Reference

DI 30005: Adjudicating Component Actions on Deficient Cases

TN 8 (04-04)

A. Policy - corrective action

This deficiency requires FO development of the unresolved work issue. If there is no other deficiency, the review component will send the case folder directly to the FO and notify the adjudicating component of the deficiency by an SSA-1774-U5 with a copy of the SSA-5524-U3 attached. If there is another returnable deficiency, the review component will send the case folder and an SSA-1774-U5 to the adjudicating component.

See GN 04440.228 for a further explanation of corrective action in group II work activity documentation deficiencies.

B. Procedure - DDS

1. SSA-1774-U5 and folder received in DDS

The review component will send the folder to you when there is another returnable deficiency other than the work activity deficiency. See GN 04440.228C.1. Upon receipt of the SSA-1774-U5 and folder, contact the FO and ask them to develop the work activity issue. Correct all deficiencies in the case.

Upon FO completion of the work activity development, route the folder as follows:

a. SGA denial or cessation appropriate

If an SGA denial or cessation is appropriate:

  • Send the folder to the FO to process the case.

  • Ask the FO to send a copy of the SSA-5524-U3 and SGA denial or cessation determination to the review component unless the review component has established other follow-up procedures (e.g., fax, e-mail etc.).

  • Ask the FO to contact the review component if the FO cannot comply with the request for any reason.

b. SGA denial or cessation not appropriate

If upon completion of the work activity development, an SGA denial or cessation is not appropriate, return the case folder with the corrected deficiencies to the review component.

2. SSA-1774-U5 without folder received in DDS

The review component will send the case folder directly to the FO when there is no other returnable deficiency and send an SSA-1774-U5 with a copy of the SSA-5524-U3 attached and supporting documentation to the adjudicating component. See GN 04440.228C.2. for an explanation of review component action when there is no other returnable deficiency.

If the adjudicating component agrees with the deficiency, no further action is necessary unless the review component sends you the case folder. The review component will send the case folder to you when an SGA denial is not appropriate, there is a possibility of an earlier onset date as a result of the work activity development and medical development of the earlier onset date appears necessary. See GN 04440.228D.1.c. Upon receipt of the folder from the review component:

  • Develop for an earlier onset date if appropriate.

  • Prepare a new determination if necessary.

  • Return the case file to the review component.