TN 21 (02-14)

A. Introduction to correcting other TCAs

The formal defined group I and group II deficiencies cover most deficient actions. You can find definitions of the deficiencies in DI 30005.121 through DI 30005.126. However, it is possible to find disability determinations with other incorrect actions that the group I or group II deficiencies or TCA definitions do not cover, but the cases still require corrective action. In addition, incorrect actions may occur in non-sample claims that require corrective action (e.g., the non-sample claim in a concurrent title II/title XVI claim selected for the quality assurance sample). For a further explanation of non-recorded TCAs, see GN 04440.003.

B. Policy for correcting other TCAs

Take corrective action without recording a deficiency to the Office of Quality Review’s (OQR’s) legacy system in the situations described in GN 04440.235A. To determine when to record a deficiency in the OQR legacy system, refer to “Recording Deficiencies” GN 04440.125.

1. Non-sample claim

If the incorrect action occurs in a non-sample claim and the group I or group II deficiency or TCA definitions cover the incorrect action, the review component follows the corrective action procedures indicated for that deficiency or TCA. For specific instructions on deficiencies, refer to GN 04440.204 through GN 04440.234.

If the group I deficiency, group II deficiency, or TCA definitions do not cover the incorrect action the review component follows GN 04440.235B.2.

2. If the group I deficiency, group II deficiency, or TCA definitions do not cover an incorrect action

The incorrect action in the sample or non-sample claim may be substantive or non-substantive.

a. Substantive change

A substantive change is one that affects the:

• basis for a determination (even when there is no change that affects benefits), or

• basic decision to allow/deny, cease/continue, or

• onset, ending, or cessation date.

For the definition of a substantive change in initial and reconsideration claims, see DI 40115.005A.1.

If the group I deficiency, group II deficiency, or TCA definitions do not cover the incorrect action, and the incorrect action is substantive in nature, return the case to the adjudicating component for corrective action in most cases. However, in some instances, you must send the case to the field office (FO). Send the case to the FO if additional development is necessary to properly document the disability determination; e.g., to document or verify the date last insured (DLI) for a title II adult disability claimant, the prescribed period for a disabled widow/widower claimant, or age 22 for a childhood disability claimant.

For procedure on returning cases to the FO, see GN 04440.235C.3. and GN 04440.234C.4.

b. Non-substantive change

For incorrect actions that are non-substantive in nature but require corrective action, the review component either returns the case to the adjudicating component or corrects it (e.g., incorrect notices).

The review component may decide to correct the case based on the ability to assume jurisdiction and prepare forms (i.e., whether workload considerations preclude the review component from taking on the additional work necessitated by assuming jurisdiction of a case).

In addition, return cases for correction if, in the judgment of the Office of Quality Review Field Management, the adjudicating component is frequently adjudicating cases with the same incorrect action.

For explanation of specific corrective action procedures, see GN 04440.236 through GN 04440.243.

C. Procedure for correcting substantive deficiencies

1. You must return the case to the adjudicating component

If the adjudicating component must take the corrective action, return the case by an informational SSA-1774-U5 (Request for Corrective Action) or SSA-847-U3 (SSA Request for Case Action) and:

• Notify the adjudicating component of the appropriate TCA;

• Request the appropriate corrective action;

• Inform the adjudicating component that you are not citing a deficiency;

• Tell the adjudicating component not to return the case to the review component, since follow-up review is not necessary; and

• Do not control the return.

2. Case corrected in the review component

When the review component assumes jurisdiction and prepares an amended determination on a decision basis code TCA in a fully favorable or unfavorable determination case:

• Prepare an SSA-847-U3;

• Notify the adjudicating component of the appropriate TCA;

• Inform the adjudicating component that you are not citing a deficiency; and

• Explain that the review component assumed jurisdiction and no further action is necessary.

3. When the review component must return a paper folder case to the FO

When the FO must take the corrective action, return the case by SSA-5524-U3 (Request for Assistance) and request the necessary action. Tell the FO to prepare a technical denial, if appropriate.

If you need documentation or verification of the DLI for a title II adult disability claimant, the prescribed period (PP) for a disabled widow(er) claimant, or age 22 for a childhood disability claimant, send the case to the FO with an SSA-5524-U3.

NOTE: If the missing or inadequate documentation involves a relatively simple question, the review component has the option to telephone, email or fax the request to the FO rather than preparing an SSA-5524-U3. When using this expedited process, the review component must document the conversation and outcome on a SSA-5002 (Report of Contact) and add it to the folder.

Ask the FO to document or verify the DLI, the PP, or the childhood disability claimant's age and either:

• Prepare a technical denial if necessary, effectuate the denial, and notify the review component of the final outcome of the case;

• Effectuate the allowance, if a technical denial is not appropriate and the onset date stays the same. Notify the review component of the final outcome of the case; or

• Return the case to the review component if a technical denial is not appropriate and the onset date changes.

4. When the review component must return the certified electronic folder (CEF) case to the FO

When the case contains a substantive deficiency and the FO must take corrective action because the DLI, PP, or attainment of age 22 is at issue, take the following additional actions:

• Code the review screens prior to creating the eForms, so the information propagates into the eForm;

• Prepare an eForm SSA-5524-U3 and ask the FO to verify the DLI, PP, or attainment of age 22 (whichever is an issue) and document the CEF;

  NOTE: If the missing or inadequate documentation involves a relatively simple question, e.g., “When did the claimant actually stop work”?, the review component has the option to telephone, email or fax the request to the FO rather than preparing an SSA-5524-U3. When using this expedited process, the review component must document the conversation and outcome on an SSA-5002 and add it to the folder.

• Prepare an informational SSA-1774-U5 using eForms and notify the adjudicating component of the TCA;

• Control the return;

• Clear the case to the FO; and

• Send the SSA-5524-U3, if applicable, and SSA-1774-U5 to the CEF during the clearance process.

NOTE: The review component retains jurisdiction of the CEF in pending status. The review component clearance stops processing time from accruing on the case while the FO completes the requested development.

For the review component action after receiving the FO completed development, follow DI 81030.021E.3. or DI 81030.021E.4.

D. Procedure for correcting non-substantive deficiencies

Follow the corrective action instructions for specific non-substantive deficiencies in GN 04440.236 through GN 04440.243.