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HALLEX I-3-001

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Office of Appellate Operations and Appeals Council Functions

Chapter: I-3-000

June 30, 1994

Current through June 1997

I-3-001 COMPOSITION OF THE OFFICE OF APPELLATE OPERATIONS

The Office of Appellate Operations (OAO) consists of the Appeals Council and its support staff.


HALLEX I-3-002

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Office of Appellate Operations and Appeals Council Functions

Chapter: I-3-000

June 30, 1994

Current through June 1997

I-3-002 COMPOSITION AND FUNCTION OF THE APPEALS COUNCIL

The Associate Commissioner for Hearings and Appeals is the Chair of the Appeals Council. The Executive Director of OAO is the Deputy Chair of the Appeals Council. The Director of the Office of Civil Actions is an Administrative Appeals Judge of the Appeals Council. The Appeals Council includes other Administrative Appeals Judges and Appeals Officers.

In accordance with a direct delegation of authority from the Secretary of Health and Human Services, the Appeals Council is the final level of administrative review for claims filed under title II, title XVI, and title XVIII of the Social Security Act, and Part B of the Federal Coal Mine Health and Safety Act (Black Lung Benefits).

The Appeals Council impartially considers Administrative Law Judge (ALJ) decisions and orders of dismissal, either at the request of the claimant or on its own motion. When the Appeals Council grants a claimant's request for review or reviews a case on its own motion, the Appeals Council may render the Secretary's final decision, issue an order of dismissal, or remand the case to an ALJ for further proceedings.

Cases are assigned to Administrative Appeals Judges (AAJs) in Jurisdictional Groups according to Circuit Court Jurisdictions.

In addition to the actions by the AAJ(s) on individual cases, the Appeals Council also acts in banc to decide issues raised in cases that come before it for review. Typically, these are issues that arise in a significant number of cases and on which there are no clear precedents in the statute, regulations, or rulings by the Commissioner of Social Security. In order that it may act in a consistent manner in all such cases, the Council, with the Chair presiding, meets in banc to discuss these issues, and, as necessary, enunciates adjudicatory principles and guidelines. These principles are recorded in Appeals Council Interpretations, and are distributed to all OHA adjudicators in an indexed chapter of HALLEX.


HALLEX I-3-003

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Office of Appellate Operations and Appeals Council Functions

Chapter: I-3-000

June 30, 1994

Current through June 1997

I-3-003 COMPOSITION AND FUNCTION OF THE APPEALS COUNCIL SUPPORT STAFF

The Appeals Council support staff includes the Operations Management, Analysis and Coordination Staff (OMACS); the Administrative Support Staff (ADSS); the Retirement and Survivors Insurance, Health Insurance and Supplemental Security Income (RSI, HI & SSI) Staff; and Program Review Branches (PRBs).

The support staff assists the Appeals Council in processing its case workload. In particular, the RSI, HI & SSI Staff and the PRBs analyze the record and any other material submitted, examine hearing decisions, other ALJ final actions and requests for Appeals Council review, and make recommendations to AAJs as to what action should be taken on cases pending before the Council. The staff also initiates implementing action on behalf of the AAJs, including drafting orders and final decisions of the Secretary.

NOTE: For ease of reference, hereafter we will use the term "OAO branch" to refer to the RSI, HI & SSI Staff and the PRBs.


HALLEX I-3-004

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Office of Appellate Operations and Appeals Council Functions

Chapter: I-3-000

June 30, 1994

Current through June 1997

I-3-004 ORGANIZATION CHART

OFFICE OF APPELLATE OPERATIONS

TABLE

TABULAR OR GRAPHIC MATERIAL SET FORTH AT THIS POINT IS NOT DISPLAYABLE



HALLEX I-3-060

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 3: Appeals Council Review

Subject: Office of Appellate Operations and Appeals Council Functions

Chapter: I-3-000

April 26, 1995

Current through June 1997

I-3-060 FILING A REQUEST FOR REVIEW (REVISED 3/95)

Citations: > 20 CFR 404.614, 404.901, 404.911, 404.968, 410.660, 416.325, 416.1411, 416.1468, and 422.205 > 42 CFR 405.724, 473.46 and 498.80

If a claimant is dissatisfied with an Administrative Law Judge's (ALJ's) decision or order of dismissal, the claimant may request the Appeals Council to review the decision or action. The claimant must submit any such request in writing by completing Form HA-520, entitled "Request for Review of Hearing Decision/ Order," or submitting a letter or other written document. The claimant may specifically ask for a review or may imply that he or she is requesting review. Implied request for review occurs when the claimant expresses disagreement or dissatisfaction with the ALJ's action or an intent to pursue appeal rights.

A claimant must file the request for review at a Social Security field office (FO), at a hearing office, directly with the Appeals Council, or at one of the following locations:

A claimant residing in the Philippines may file the request at the Department of Veterans Affairs Regional Office (RO) in the Philippines.

A claimant with ten or more years of service in the railroad industry may file a request for review at a Railroad Retirement Board (RRB) office.

A claimant residing in a foreign country may file a request with an office maintained by the Foreign Service of the United States, Department of State.

The claimant or his or her representative must file the request for review within 60 days after the date of receipt of the ALJ's decision or dismissal. We presume that the claimant receives the notice of the ALJ's decision or dismissal five (5) days after the date of the notice, unless there is a reasonable showing to the contrary.

EXCEPTION: The Appeals Council will extend the time period for filing if the Council finds that the claimant had good cause for late filing of the request for review.

When a claimant requests review in a letter or other written communication and files it directly with the Appeals Council, the Docket and Files Branch completes Form HA-520 and distributes the copies to the proper parties.

The claimant must submit any document(s) or other evidence the claimant wishes the Appeals Council to consider with the request for review. > 20 CFR 404.975 and 416.1475 state that the Appeals Council shall give claimants a reasonable opportunity to file briefs or other written statements about the facts and law relevant to the case.

The request for review form (HA-520) notifies the claimant that if the claimant:

has additional evidence, he or she must submit it with the request for review unless he or she requests an extension of time to submit it (see below);

needs additional time to submit evidence or legal argument, he or she must request an extension of time in writing, explaining the reason(s) he or she is unable to submit the evidence or legal argument with the request for review; and

neither submits evidence or legal argument with the request for review nor within any extension of time the Appeals Council grants, the Council will take its action based on the evidence of record.

A. Who May Request Review

Any party to an ALJ's decision or dismissal or the party's qualified representative may request review. Any other individual may request review if that individual's rights with respect to monthly benefits, a lump sum payment, a period of disability, or entitlement to health insurance benefits may be adversely affected by the decision or dismissal. Certain individuals may file a request for review on behalf of a minor, a mentally incompetent claimant, or a claimant physically unable to file (404.612 and 416.315).

Refer to chapter > I-3-400 for further discussion on who may request review.

B. Date of Filing Request for Review

Ordinarily, we consider a request for review filed as of the date it is received in any Social Security Administration (SSA) office, including OHA hearing offices and Headquarters, or the date it is received by an employee of SSA authorized to receive a request for review at a place other than an SSA office. We also accept as the date of filing:

the date the request is received at the Department of Veterans Affairs RO in the Philippines or by an employee of that Department in the Philippines authorized to receive such request at a place other than the RO;


the date the RRB receives the request, if an individual having 10 or more years of service in the railroad industry files the request; or

the U.S. Postal Service stamp cancellation or "postmark" date on the envelope in which the request is mailed to us, if using the date we receive it would result in the loss of the claimant's rights. If the postmark is unreadable or there is no postmark, we consider the request timely filed if we receive it by the 70th day after the date on the notice of the ALJ's decision or dismissal. We will also consider other evidence of when the individual mailed the request for review to us.

If the period for filing a request for review; i.e., 60 days after the receipt of the ALJ's notice, ends on a Saturday, Sunday, Federal legal holiday, or on any other day all or part of which is a nonwork day for Federal employees by statute or Executive Order, we extend the time for filing to the next full workday.

C. Extension of Time to Request Review

If a claimant or other individual specified in section > I-3-405 does not file the request for review within the 60-day period, the individual must explain why in writing. If the Appeals Council concludes that good cause was shown, it will extend the time period.

In deciding whether good cause exists for a late filing, the Appeals Council will consider any information an FO or HO provides and any explanation for the delay the individual submits. The analyst must address good cause in the recommendation to the Appeals Council whenever the request for review is untimely. The Council must rule on whether the individual's explanation establishes good cause for the late filing of the request for review. If the Council finds good cause, it will include the following language as either the opening or second paragraph of remand orders, decisions and denial letters:

The request for review was not filed within the prescribed time limit (> 20 CFR 404.968 and 416.1468), but the Appeals Council finds that good cause is shown for the late filing (> 20 CFR 404.911 and 416.1411).

No further detail regarding the Council's good cause finding is required.

In determining whether an individual has shown good cause for missing the deadline to request review, the Appeals Council will consider whether the failure was the result of:

circumstances which impeded the individual's efforts to pursue the claim;

an action by SSA which misled the claimant; or

misunderstanding as to the requirements of the Act resulting from amendments to the Act, other legislation, or court decisions.

For example, in accordance with the Regulations at 404.911 and 416.1411, the Appeals Council may find good cause for failure to file a timely request when the failure resulted from one of the following circumstances:

1. The individual was seriously ill or had a physical or mental impairment, and the illness or impairment prevented the individual from contacting SSA in person, in writing, or through a friend, relative, or other person.

2. There was a death or serious illness in the individual's immediate family.

3. A fire or other accidental cause destroyed or damaged pertinent records.

4. The individual was actively seeking evidence to perfect the claim and did not complete the search before the time period expired.

5. The individual requested an additional explanation concerning the ALJ's action within the time limit, provided that within 30 days after receipt of the explanation the individual requested review.

6. SSA furnished the individual incorrect or incomplete information about the right to request review.

7. The individual did not receive notice of the ALJ's action.

8. The individual transmitted the request for review to another Government agency in good faith and within the time limit, but the request did not reach SSA until after the time period had expired.

9. The Appeals Council concludes that there were unusual or unavoidable circumstances which demonstrated that the individual was not aware of the need to file timely, or that circumstances prevented the individual from filing timely.

If the Appeals Council finds that the individual did not have good cause for the late filing, the Council will dismiss the request for review. Refer to chapter > I-3-400.



HALLEX I-3-070

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-070 RECEIPT OF REQUEST FOR REVIEW

Mailroom personnel will date-stamp the request for review on the day of receipt and forward the request with the envelope to the Docket and Files Branch (DFB). The envelope must remain with the file because, when material, the postmark establishes the filing date of the request for review. When the request is in the form of a letter, DFB will complete and distribute Form HA-520.



HALLEX I-3-071

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-071 DOCKET AND FILES PROCEDURES (REVISED 02/92)

A. Claim File Located in Docket and Files

Docket and Files Branch will:

1. associate the request for review with the claim file,

2. prepare the appeals file (AF),

3. forward the request for review, claim file and AF to the appropriate OAO branch, and

4. enter into the Case Control System the request for review filing date, the date sent to the OAO branch, and the code of the OAO branch (see > I-3-090, Exhibit 1).

NOTE: Cases in which the claimant may have a terminal illness ("TERI" cases) and other critical cases require special handling. These cases are identified by either a TERI or CRITICAL CASE flag (see > I-3-090 Exhibits 3 and 4) on the front of the claims file, or the remark "Critical Case" or "TERI case" on the request for review. Upon receipt of a request for review on a TERI or other critical case, Docket and Files will hand-carry the request for review, claims file and appeals file to the appropriate Program Review Branch Chief.

B. Claims File Not Located in Docket and Files

When an ALJ issues a partially favorable decision, the hearing office sends the claims file to the effectuating component. Therefore, the file may not be in DFB when OHA receives a request for review. When DFB receives a request for review in such a case, it institutes the file retrieval process by contacting the effectuating component, requesting the file and following up at 30-day intervals (10 days for critical cases, which include TERI cases) until it receives the file. The effectuating component normally will not release the file to OHA until it completes the effectuation process; we do not ask them to delay payment actions to send us the file. All contacts should be documented for the file and this record can be made available to the OAO branch as necessary to answer any status inquiries.

In any other type of case when the file is not in DFB when it receives a request for review, DFB will:

make appropriate systems queries, e.g., BDIQ, SSI file-locator queries, etc., and follow up on any leads obtained from the queries;

make and document contacts with other possible file locations including the servicing OAO branch, HO, FO, PSC/ODIO and, as indicated based on the leads developed, with the servicing DDS and other non-servicing offices to which the file may have been sent in error; and

follow up on all leads until it locates the file, exhausts all leads, or begins the reconstruction process after a 60-day (20-day for critical cases) search period.

After DFB exhausts all claims file location leads or after a 60-day (20-day for critical cases) search period, whichever comes first, DFB will initiate the reconstruction process by:

obtaining a copy of the ALJ's decision and exhibit list if not already available;

notifying the claimant, representative, servicing FO and DDS that the original file cannot be located and must be reconstructed, and simultaneously providing the claimant, representative, servicing FO and DDS with a copy of the exhibit list and asking each to furnish copies of any listed documents in their possession;

following up on all requests for documentation at 20-day (7-day for critical cases) intervals;

if necessary, requesting the cassette from the Computer Cassette Library; and

reviewing case locator queries at 30-day (10-day for critical cases) intervals and following up on all new leads to the location of the original file.

When DFB has reconstructed the claims file to the extent possible, or after DFB has actively pursued reconstruction for 90 days (30 days for critical cases), DFB will hand-carry the case to the appropriate OAO Branch Chief. The Branch Chief will review the reconstruction material and will either assign the case to an analyst for action or, after considering input from the AAJ as necessary, may ask DFB to attempt further reconstruction.



HALLEX I-3-075

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-075 OAO BRANCH RESPONSIBILITIES WHEN CLAIM FILE IS UNAVAILABLE (REVISED 02/92)

When DFB begins searching for or reconstructing a claims file on a request for review case, it will send a copy of the HA-520 and any related correspondence to the appropriate OAO branch.

The OAO branch will establish and maintain controls and respond promptly to all incoming correspondence on cases undergoing search and/or reconstruction. Although an analyst may be unable to give substantive responses to some questions, the analyst must provide, at a minimum, a status report on the search or reconstruction efforts. The OAO branch will diary the case for follow-up with DFB every 30 days (15 days for critical cases) concerning the status of the search/reconstruction efforts.



HALLEX I-3-080

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-080 OAO BRANCH SCREENING--GENERAL (REVISED 02/92)

When the OAO branch receives the request for review and the claims file, branch staff will promptly screen the case as discussed below.

NOTE: Cases in which the claimant may have a terminal illness ("TERI" cases) and other critical cases require special handling. These cases are identified by either a TERI or CRITICAL CASE flag (see > I-3-090 Exhibits 3 and 4) on the front of the claims file, or the remark "Critical Case" or "TERI case" on the request for review.

NOTE: Upon receipt of a request for review on a TERI or Critical case, Docket and Files will hand-carry the request for review, claims file and appeals file to the appropriate Program Review Branch Chief (see > I-3-151).



HALLEX I-3-081

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-081 OAO BRANCH SCREENING OF CASE FOR JURISDICTION

Branch staff will verify that a case is in the proper branch, i.e., that the branch handles the claim type and issue involved, and that the claimant resides within the geographic area or circuit court jurisdiction assigned to the branch. The branch will hand-carry any misrouted files to the proper branch and, if necessary, update the Case Control System.

If the case is in the proper branch, the branch staff must complete a Case Control System coding sheet to show receipt of the file in the branch.

In addition to the entries in the Case Control System, the branch staff must also make the following entries in OAO's Case Tracking System:

1. name, social security number, claim type and state of claimant's residence,

2. the request for review filing date, and

3. the date the branch received the request for review and claim file.



HALLEX I-3-082

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-082 OAO BRANCH SCREENING OF CASE FOR CASSETTES

Branch staff must check the file for the cassette of the hearing. The file should contain a hearing cassette unless the Administrative Law Judge issued a dismissal, an on-the-record decision, or a partially favorable decision.

Since November 1988, hearing offices have been responsible for removing cassettes from claim files of those cases in which a fully or partially favorable decision is issued and sending cassettes daily to OHA Headquarters for storage in the Cassette Computer Library. Branch staff will, therefore, reassociate the cassette(s) in partially favorable decision cases by requesting the cassette from the Cassette Computer Library using the form shown in > I-3-090, Exhibit 2.

Send the request by interoffice mail to the Cassette Computer Library. Allow five working days for the Cassette Computer Library to respond. If necessary, follow up by telephone after the fifth workday.



HALLEX I-3-083

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-083 OAO BRANCH SCREENING OF CASE FOR TIMELINESS

Branch staff will determine whether the request for review is timely filed. If the claimant did not file the request for review timely and did not furnish an explanation for the late filing, an analyst must request an explanation. See section > I-3-402.

If the late request was filed by mail, the analyst will prepare letter 6-90-27 in the Appeals Text Guide. If the request was filed in person (i.e., at an FO), and the claimant is represented, telephone the representative to elicit the necessary information. If the request was filed in person, and the claimant is not represented, telephone the servicing FO, prepare letter 6-90-25 to the claimant, or prepare memorandum 6-90-26 to the FO, whichever the analyst believes would best expedite matters considering the circumstances in the case. See section > I-3-155, items 25 and 26, for the policy on signature requirements.



HALLEX I-3-084

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 3: Appeals Council Review

Subject: Office of Appellate Operations and Appeals Council Functions

Chapter: I-3-000

April 26, 1995

Current through June 1997

I-3-084 OAO BRANCH SCREENING FOR REQUESTS FOR COPIES OF MATERIAL (REVISED 04/95)

A. General

A claimant or the claimant's authorized representative, hereafter "claimant," in accordance with section > I-1-403, Privacy Act, has the right to examine the contents of the claim file and request copies of the exhibits or other claim file material. The claimant also may request duplicate hearing cassettes and a transcript of the hearing cassette.

B. Requests for Materials For a Non-Program Purpose

When the claimant, a Member of Congress or a third-party (a party other than the claimant or a Member of Congress) requests, for a non-program purpose, copies of claim file material or a typed transcript of the hearing, forward the claim file and the request to the Freedom of Information Act/Privacy Act (FOIA/PA) Staff in Suite 702. The waiver of charges provisions contained in C. 2. below do not apply to these requests.

C. Requests for Materials for a Program Purpose

1. Appeals Council Does Not Charge For Materials

When the claimant requests, for program purposes, a duplicate hearing cassette, or makes an initial request for a photocopy of claim file material, we will fill the request at no charge. When a third-party submits the request, forward the claim file and the request to the FOIA/PA Staff.

2. Appeals Council Charges For Materials, But May Waive Charges

a. General

When the claimant requests a typed transcript of the hearing or requests additional copies of claim file material (i.e., when the claimant requests copies in addition to those SSA provided at no charge), the hearings and appeals assistant will estimate the cost of providing those materials, as shown in 2. b. below, and then proceed as shown in either 2. c. or 2. d., and D. below.

b. Estimating Cost of Materials

We charge a fee of $2.50 per page to prepare a typed transcript. To estimate the number of pages to be typed, divide by 2 the number of minutes the hearing lasted, and add 1. (Example: a 34-minute hearing/2 = 17; 17 + 1 = 18 pages, estimated.) In addition to transcript typing charges, we charge $0.10 per page to provide additional copies of claim file material.

c. Cost Does Not Exceed $50

When a claimant requests additional copies of claim file material and/or a transcript for program purposes, and the total cost of requested materials would not exceed $50, all charges are waived in accordance with Appeals Council policy (see 6-90-15 of the Appeals Text Guide).

d. Cost Exceeds $50

When a claimant requests additional copies of claim file material and/or a transcript for program purposes, and the total cost of requested materials would exceed $50, the claimant must send payment before we release the requested materials. The hearings and appeals assistant will enter both the estimated transcription charge and the charge for copying claim file material on the form letter 6-90-13, if the form letter is required under the conditions below.

1. If the cost exceeds $50 because the claimant requested a typed transcript of the hearing but the cost of any copies requested and a duplicate cassette would not exceed $50, we will send the claimant the copies, a duplicate cassette, and letter 6-90-13. Send a copy of that letter, with the branch number shown clearly at the top, to Travel and Payroll Services Staff.

2. If the claimant pays for a transcript after receiving a duplicate cassette, Travel and Payroll Services Staff will return a copy of 6-90-13 to the branch with a notation that payment has been received. The OAO branch will forward the hearing tapes to Contracts Staff, Office of Civil Actions, through the Office of the Deputy Director for Operations, using a Transcript Request Routing Slip. The branch hearings and appeals assistant will diary the file for 30 days. When the transcript is returned, retain a copy for the claim file and transmit the claimant's copy by an appropriately modified 6-90-15 unless a refund is needed. If the typed transcript is shorter than estimated, use letter 6-90-14. Send a copy of 6-90-14 to Travel and Payroll Services Staff requesting them to prepare a refund to the claimant.

D. Hearings and Appeals Assistant Responsibilities

To obtain copies of exhibits or other material, the hearings and appeals assistant will submit the material with a Reproduction Service Request, Form SSA-615, to the Administrative Support Staff (ADSS). To obtain a duplicate hearing cassette, send the cassette via route slip to ADSS.



HALLEX I-3-085

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 3: Appeals Council Review

Subject: Office of Appellate Operations and Appeals Council Functions

Chapter: I-3-000

April 26, 1995

Current through June 1997

I-3-085 OAO BRANCH SCREENING FOR REQUESTS FOR EXTENSIONS OF TIME (REVISED 04/95)

A. General

A claimant or the claimant's authorized representative (hereinafter "claimant") may request an extension of time to submit evidence or arguments. The Appeals Council routinely allows 30 days for submission of evidence and arguments. For second requests or initial requests for more than 30 days, the Council will consider the particular set of circumstances in each case. The Council does not grant extensions automatically and will grant additional time only if there are extenuating circumstances present in the case.

B. Claimant Does Not Provide Submittal Date for Additional Evidence.

If a claimant indicates that he or she has additional evidence, but does not explicitly state when it will be submitted, the analyst must prepare a letter informing the claimant that the Appeals Council will defer its action for 30 days to allow the claimant the opportunity to submit the evidence.

C. Claimant Requests That the Appeals Council Obtain Evidence From Claimant's Medical Source

If a claimant asks the Appeals Council to obtain additional evidence from the claimant's medical source, the analyst must prepare a letter advising that the claimant bears the responsibility to obtain such evidence, referring the claimant to the servicing field office for assistance, and stating that the Appeals Council will defer its action for 30 days to allow the claimant the opportunity to send in the evidence.



HALLEX I-3-090

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division III: Appeals Court Review

Subject: Initial Processing of Request for Review

Chapter: I-3-060

June 30, 1994

Current through June 1997

I-3-090 EXHIBITS (REVISED 02/92)

1. Instructions Case Control System Data Input

2. Form Request for Cassette Tape

3. Flag Terminal Illness (TERI) Flag

4. Flag Critical Case Flag

EXHIBIT 1

CASE CONTROL SYSTEM DATA INPUT

Case Control System entries will be limited to:

1. The date of receipt of the claim file (400 action).

2. The request for review date (405 action).

3. Designation of the appropriate OAO branch and the date DFB sends the case to the OAO branch (440 action).

4. Date of receipt of the case in the OAO branch and receipt of the case for refile in DFB (445 action).

5. The final disposition by the Appeals Council (425 action).

6. The date OHA releases the claim file and the destination of the claim file (430 action).

OAO component responsibility for Case Control System entries is as follows:

Docket and Files Branch personnel are responsible for direct entry of the date of receipt of all claim files received in OHA (400 action). DFB personnel will also enter the request for review date (405 action), the date the case is sent and the code for the OAO branch to which it is sent (440 action), and receipt date of any cases to be refiled in DFB (445 action). In addition, when DFB personnel send an appealed case to an SSA component outside OHA, they enter the date of transfer (430 action) and the destination of the claim file.

The OAO branch completes a coding sheet (Form HA-673) only to show receipt of files properly assigned to the branch. The OAO branch sends misrouted files to the appropriate branch and that branch will complete a coding sheet to show receipt of the case (445 action).

The appeals technician or the branch release clerk will complete a coding sheet to show the final Appeals Council disposition (425 action) and either the forwarding of the file to the branch mini-docket (440 action) or the release of the claim file from OHA Headquarters (430 action).

When the holding period for post-AC actions ends and no civil action has been filed, OAO branches or DFB personnel update the Case Control System to show the date OHA releases the claim file and its destination.

DFB personnel release claim files going to ODIO.

OAO branches release claim files going to other components (i.e., Program Service Centers or FOs).

DFB's Case Control Section keys all coding sheet entries into the Case Control System.

EXHIBIT 2

REQUEST FOR CASSETTE TAPE

DATE OF REQUEST: ______

REQUESTED BY: ______

OFFICE/COMPONENT: ______

ROOM #: ______

BLDG: ______

TELEPHONE NUMBER: ______

SSN: _____ - ___ - ______

XREF: _____ - ___ - ______

CLAIMANT'S NAME: ______

HEARING HELD DATE: ______

DECISION DATE: ______

NUMBER OF CASSETTES: ______

REMARKS: ______

> (FNa1) PROGRAM SERVICE CENTER INVOLVED: ______

THE CASSETTE COMPUTER LIBRARY CERTIFIES THAT THIS TAPE IS LOST.

______

(SIGNATURE)

______

(TITLE)

______

(DATE)

EXHIBIT 3

TERI Flag

TABLE

TABULAR OR GRAPHIC MATERIAL SET FORTH AT THIS POINT IS NOT DISPLAYABLE

EXHIBIT 4

Critical Case Flag

TABLE

TABULAR OR GRAPHIC MATERIAL SET FORTH AT THIS POINT IS NOT DISPLAYABLE

FNa1. IF MAMPSC IS INVOLVED, THE CONTAINER AND ACCESSION NUMBERS ARE NEEDED.



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