TN 13 (12-10)

A. Decision basis code changes on the following forms are substantive changes that you must correct by preparing an amended determination:

• SSA-831-C3/U3 (Disability Determination and Transmittal);

• SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI); or

• SSA-833-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II).

See Definitions and General Processing Instructions in DI 40115.005A.1. and DI 40115.005A.3.

The decision basis code includes the “reason for continuance” and the “reason for cessation” in a continuing disability review case.

EXCEPTION: If the incorrect decision basis code is due to an obvious typographical error, the review component may correct the decision basis code entry on the determination form. For an explanation of how to correct determination forms, see GN 04440.237.

1. Fully favorable and unfavorable determinations

If the decision basis code TCA occurs in a fully favorable or unfavorable determination case, the review component must assume jurisdiction and prepare an amended determination. The one exception is when a fully unfavorable determination also has a 12-month MER TCA that you would have to return to the adjudicating component for correction.

2. Less than fully favorable determinations

If the decision basis code TCA occurs in a less than fully favorable determination case that is:

• an adverse reopening,

• a cessation, or

• a reconsideration of an adverse reopening or cessation,

the review component must return the case to the adjudicating component to prepare an amended determination. For an explanation of why the review component should not prepare an amended determination, see GN 04440.244.

In all other less than fully favorable determination cases, the review component must assume jurisdiction and prepare an amended determination, unless returning the case to the adjudicating component for another corrective action (e.g., group II documentation deficiency).

B. Procedure for a decision basis code TCA

1. Returning a case for corrective action

If returning the case to the adjudicating component for corrective action:

• Prepare an SSA-847-U3 (SSA Request for Case Action);

• Ask the adjudicating component to prepare an amended determination and, if necessary, a new notice and to release the case; and

• Do not control the return.

2. Correcting a case in the review component

If correcting the case in the review component:

• Assume jurisdiction and prepare an amended determination;

• Prepare a new notice and rationale, if necessary; and

• Prepare an SSA-847-U3 explaining why you changed the decision basis code.

See Details:

• For procedures on assuming jurisdiction, see GN 04440.244 - GN 04440.245.

• For an explanation of necessary action when an amended determination is prepared, see GN 04440.244.

• For routing of the amended SSA-831-C3/U3 to the Wilkes-Barre Data Operations Center, see GN 04440.150.