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  • HALLEX I-1-160 - I-1-270 - Severe.net
    of the fee request to the claimant If the representative did not do so return the petition to the representative with a notice that the representative did not follow the procedures in 20 CFR 404 1725 a 7 5 Diary the case for 30 days from the date of the fee petition for receipt of any comments from the claimant unless the claimant s comments have been submitted with the fee petition e g claimant has signed the Form SSA 1560 indicating agreement with the requested fee B After the expiration of the 30 day diary period the fee authorizer with jurisdiction over the fee petition must review the petition pursuant to the regulatory criteria See I 1 240 Evaluating Fee Petitions and make a fee determination subject to the 5 000 limit See I 1 201 A Authority to Approve Fees HALLEX I 1 240 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division I General Subjects Subject Representative Fees Chapter I 1 200 June 30 1994 Current through March 1997 I 1 240 EVALUATING FEE PETITIONS The regulations do not specify maximum fees rather they prescribe criteria for evaluating fee petitions and determining reasonable fees for representatives 20 CFR 404 1725 b and 416 1525 b A Criteria for Evaluating Fee Petitions When evaluating fee petitions the fee authorizer must consider the purpose of the Social Security program namely to provide a measure of economic security for program beneficiaries together with the extent and type of services performed the complexity of the case the level of skill and competence required in providing the services the amount of time spent on the case the results achieved by the representative the level of review to which the claim was taken and the level of review at which the representation began and the amount of the fee requested B Excluded Activities In evaluating the amount of time a representative spent on the case the fee authorizer must exclude any time claimed for 1 Preparing the fee petition or any other activities related to charging or collecting a fee such as status inquiries and 2 Any services the representative performed before a state or federal court EXCEPTION Acquiescence Ruling 87 1 6 Webb v Richardson applies to fee authorizations in the Sixth Circuit Michigan Ohio Tennessee and Kentucky C Expenses The representative s expenses are not considered part of the fee for services The representative must look to the claimant for reimbursement of any expenses 20 CFR 404 1725 b 1 vii and 416 1525 b 1 vii HALLEX I 1 245 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division I General Subjects Subject Representative Fees Chapter I 1 200 June 30 1994 Current through March 1997 I 1 245 AUTHORIZATION TO CHARGE AND RECEIVE A FEE A Form HA L530 Authorization to Charge and Receive a Fee To prepare Form HA L530 1 Fill in the identifying information at the top of the form i e date claimant s name wage earner s name if different from the claimant s name wage earner s Social Security number type of claim name and address of the claimant and the names of auxiliary beneficiaries if the representative has included the names of the claimant s dependents on the fee request 2 Indicate the fee authorized in the section beginning You are hereby authorized 3 In the section beginning NOTE IF EITHER YOU OR THE CLAIMANT DISAGREES fill in the Regional Chief ALJ s RCALJ s name and the Regional Office address if the fee authorizer is an ALJ or the name of the Deputy Chair of the Appeals Council and the AC address if the fee authorizer was the Attorney Fee Branch NOTE Enter the name and address of the RCALJ in the Region where the case was heard 4 Check the appropriate block in the section beginning The paragraph or paragraphs checked below as follows a First block Check the first block if it can be determined that all of the authorized fees will be paid directly to the attorney representative out of funds withheld from the claimant s past due benefits and insert the name and address of the office which processed the award i e Office of Disability and International Operations ODIO or the appropriate Program Service Center PSC in case the attorney wishes to obtain information as to the status of the fee authorization For those cases processed in ODIO by the Office of Disability Operations the staff should type in the following address Office of Disability and International Operations Division of Appealed Claims P O Box 17295 Baltimore Maryland 21235 NOTE If the attorney requests the status of his or her payment after the fee has been authorized tell him or her to write to ODIO or the appropriate PSC at the address provided b Second block Check the second block if it can be determined that the amount withheld is less than the authorized fee c Third block Check the third block if no funds have been withheld i e the claimant is not entitled to any past due benefits the representative is not an attorney or the claim is for Supplemental Security Income d Last block Check the last block if it is necessary to add an additional or special paragraph s to the authorization i e when the authorized fee is less than what was requested NOTE If the additional information that the fee authorizer must add is too lengthy for the available space on the HA L530 use a continuation sheet as an attachment B Sample Paragraphs The following sample paragraphs may be appropriate 1 Auxiliary Beneficiaries The approved fee is for all services performed for the claimant and auxiliary beneficiaries 2 Out of Pocket Expenses We do not consider out of pocket expenses when we authorize a fee therefore you

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  • HALLEX I-1-302 - I-1-404 - Severe.net
    office should maintain and must allow inspection of the following materials Compilation of the Social Security Laws Title 5 United States Code The Public Information Regulation of the Department of Health and Human Services 45 CFR Part 5 Social Security Administration regulations under the retirement survivors disability supplemental security income programs and Part B of title IV Black Lung Benefits i e title 20 Code of Federal Regulations Parts 401 404 410 416 and 422 Medicare program regulations issued by the Health Care Financing Administration 42 CFR Parts 400 498 Social Security Rulings Social Security Acquiescence Rulings Social Security Handbook HALLEX Under the FOIA SSA may charge a fee for search review and duplication efforts expended to provide material in response to an FOIA request as discussed in 45 CFR Part 5 Subpart D Fees 2 Information Field Personnel May Not Disclose Only the SSA Freedom of Information Officer has the authority to determine whether to disclose records under the FOIA other than the publications listed above When a field office receives an FOIA request for documents or records other than these publications the receiving office must acknowledge the request in writing and promptly forward the request together with copies of the requested material to Freedom of Information Officer Social Security Administration 4100 Annex Building 6401 Security Boulevard Baltimore Maryland 21235 If the requested material is partly or wholly unavailable note this on the memorandum to the Freedom of Information Officer The forwarding office should also include a record of the search time which was required to respond to the request and the grade s of the employee s who performed the search C Headquarters Procedures 1 The Division of Litigation Analysis and Implementation DLAI FOIA PA Staff in the Office of Civil Actions handles all requests for records under the FOIA which are received by headquarters components 2 The receiving component must acknowledge any such request in writing and promptly forward the request by route slip to the FOIA PA Staff of DLAI along with a copy of the requested material If the requested material is partly or wholly unavailable note this on the forwarding route slip 3 Include a record of the search time which was required to respond to the request and the grade s of the employee s who performed the search 4 When the FOIA PA Staff does not have the jurisdiction to make the decision on disclosure they will forward the request along with a copy of the requested information to the Freedom of Information Officer in Baltimore for a decision on disclosure HALLEX I 1 403 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division 1 General Subjects Subject Information Disclosure Chapter I 1 400 April 26 1995 Current through March 1997 I 1 403 PRIVACY ACT A General 1 The Privacy Act applies to all records or information about an individual maintained by an agency in a System of Records which is retrievable by the individual s name Social Security number or some other type of personal identifier assigned to that individual The Privacy Act does not require access to records retrieved by some other method 2 Subject to several exemptions the Privacy Act grants an individual the right of access to his or her own records and prohibits disclosure of such records to others without the prior written request or consent of the individual 3 The Privacy Act does not apply to all documents and records pertaining to individuals It applies only to records maintained by an agency in a System of Records from which information is retrieved using the name of the individual or some other type of personal identifier The FOIA by comparison requires an agency to consider any request which reasonably describes the records whether or not such information is maintained in a System of Records B List of OHA s Systems of Records With the Catalog Number of Each System Attorney Fee File 09 60 0003 Working File of the Appeals Council 09 60 0004 Administrative Law Judge Working File on Claimant Cases 09 60 0005 Storage of Hearing Records Tape Cassettes and Audiograph Discs 09 60 0006 Administrative Law Judge Docket of Claimant Cases 09 60 0008 Hearings and Appeals Case Control System 09 60 0009 Listing and Alphabetical Name File Folder of Vocational Experts and Medical Experts 09 60 0012 Records of Usage of Medical Experts and Vocational Experts 09 60 0013 Curricula Vitae and Professional Qualifications of Medical Experts and Resumes of Vocational Experts 09 60 0014 Hearing Office Master Docket of Claimant Cases 09 60 0184 Representative Disqualification Suspension Information System 09 60 0219 NOTE In claims pending before OHA OHA also responds to requests involving the Claims Folder System 09 60 0089 when OHA has the claim file C Individual s Right to Access His or Her Records in a System of Records Pursuant to the Privacy Act see 5 U S C 552a d 1 SSA generally grants individuals the right of access to material about themselves maintained in a System of Records This general principle is subject to exceptions including restrictions on access to certain medical records see I 1 403 G 4 investigatory information compiled for criminal law enforcement records that are maintained in a System of Records for which SSA has published a notice of exemption from access in the Federal Register or records compiled in anticipation of a court action or formal administrative proceeding D Processing an Individual s Request to Access Material in OHA s Systems of Records and the Claims Folder System 1 If access is requested for a program purpose see 20 CFR 422 440 and the request is a claimant s or claimant s representative s first request for access to material in an OHA System of Records or the Claims Folder System the hearing office HO staff will process the request following the procedures in HALLEX I 1 403 G and

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  • HALLEX I-1-501 - I-1-590 - Severe.net
    Director at the telephone number in I 1 502 Regardless of whether the caller expresses an intent to submit a written inquiry or is referred to the DLAI Director DCR will make a written report of contact containing the information listed in I 1 502 C and immediately hand carry the written report of contact to the DLAI Director B Oral or Written Inquiries Concerning Pending Cases When DCR receives an oral or written litigation related inquiry that relates to a pending case DCR will 1 when the case is pending in OHA Headquarters immediately hand deliver the written report of contact or written inquiry to either the Executive Director Office of Appellate Operations OAO or the Director OCA as appropriate or 2 when the case is pending in a hearing office HO immediately telephone the HO litigation coordinator to advise him or her of the inquiry and telefax a copy of the written report of contact or written inquiry to the HO litigation coordinator s attention and 3 hand deliver to the DLAI Director an informational copy of all litigation related inquiries referred to OAO OCA or an HO HALLEX I 1 504 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division I General Subjects Subject Litigation related Inquiries Chapter I 1 500 June 30 1994 Current through March 1997 I 1 504 HEARING OFFICE PROCESSING A Oral Inquiries Generally When the HO directly receives an oral litigation related inquiry the HO will ask the caller to submit a written inquiry and send it to the HO litigation coordinator unless the inquiry relates to a pending case If the caller objects to submitting a written inquiry the HO may if necessary refer the caller to the DLAI Director at the telephone number in I 1 502 Regardless of whether the caller expresses an intent to submit a written inquiry or is referred to the DLAI Director the HO will make a written report of contact containing the information listed in I 1 502 C for each litigation related inquiry and immediately furnish the written report of contact to the HO litigation coordinator The HO litigation coordinator will 1 send a copy of each written report of contact and the original of any subsequent written inquiry if any to the DLAI Director 2 send a copy of each written report of contact and subsequent written inquiry if any to the OHA Regional Office RO for its information and 3 send a copy of each written report of contact and subsequent written inquiry if any to the Office of the Chief Administrative Law Judge OCALJ for its information to Director Division of Field Practices and Procedures Office of the Chief Administrative Law Judge P O Box 1237 Arlington VA 22210 B Oral or Written Inquiries Concerning Pending Cases When the HO receives an oral or written litigation related inquiry that relates to a pending case the HO will involve the HO litigation coordinator as outlined in A above and the HO litigation coordinator will 1 complete steps 1 and 2 as outlined in A above except only send a copy of any original written inquiry 2 if circumstances warrant telephone the OHA RO OCALJ and DLAI Director to discuss the inquiry 3 coordinate any action that the HO must take as a result of the inquiry and 4 provide the OHA RO OCALJ and DLAI Director with a copy of any written response NOTE There should be few instances in which the HO will need to suspend action on a pending case because of an inquiry C Written Referrals from DCR When the HO receives from DCR a written report of contact of an oral litigation related inquiry as described in I 1 503 B the HO litigation coordinator will 1 if circumstances warrant provide a copy of the written report of contact to the OHA RO and OCALJ for their information 2 telephone the DLAI Director to ensure his knowledge of the DCR referral and if necessary discuss the HO s proposed response if any 3 ensure that the HO takes timely and appropriate action as a result of the inquiry and 4 provide the OHA RO OCALJ and DLAI Director with a copy of any written response HALLEX I 1 505 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division I General Subjects Subject Litigation related Inquiries Chapter I 1 500 June 30 1994 Current through March 1997 I 1 505 OFFICE OF APPELLATE OPERATIONS PROCESSING A Oral Inquiries Generally When OAO directly receives an oral litigation related inquiry OAO will ask the caller to submit a written inquiry and send it to the Executive Director OAO If the caller objects to submitting a written inquiry OAO may if necessary refer the caller to the DLAI Director at the telephone number in I 1 502 Regardless of whether the caller expresses an intent to submit a written inquiry or is referred to the DLAI Director OAO will make a written report of contact containing the information listed in I 1 502 C for each litigation related inquiry and immediately furnish the written report of contact to the Executive Director s office The Executive Director s office will hand carry a copy of each written report of contact and the original of any subsequent written inquiry if any to the DLAI Director B Oral and Written Inquiries Concerning Pending Cases When OAO receives an oral or written litigation related inquiry that relates to a pending case OAO will involve the Executive Director The Executive Director s office will follow the steps as outlined in A above for oral inquiries and will 1 provide a copy of each written report of contact and the subsequent written correspondence if any or original written inquiry to the DLAI Director 2 if circumstances warrant contact the DLAI Director to discuss the inquiry

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  • HALLEX I-1-601 - I-1-690 - Severe.net
    for further responses including a written final reply 14 The Specialist annotates the RC with the information provided to the congressional staff member and updates the IRIS and ADCAR forms with the response code and the date 15 An IA inputs the IRIS and ADCAR systems information and diaries the case for 30 to 60 days as directed by the Specialist 16 For cases pending in an OAO PRB the Specialist continues to provide monthly or bimonthly telephone status responses until the TIB receives the CF en route to an AAJ The Specialist then prepares a written response based on the OAO Analyst s recommendation to the AAJ The final response will be released by the AAJ s Assistant or the PRB s Release Clerk when the final action order or decision is released 17 The Specialist places the written response in a red congressional inquiry folder and reattaches the yellow flag to the front of the red folder The flag is annotated to request the AAJ s Assistant or the PRB s Release Clerk to date stamp and return the flag to DCPI when the congressional response has been released The Specialist annotates the ADCAR and IRIS forms with the AAJ s code and routes the CF to the AAJ 18 When the Specialist receives the congressional flag showing that the response has been released he or she annotates the IRIS and ADCAR systems sheets to show that a final letter has been released An IA updates the IRIS and ADCAR systems C Written Inquiries from Members of Congress The Division of Congressional and Public Inquiries has three Written Inquiries Branches WIBs that handle written congressional inquiries about pending appeals cases These branches also refer as necessary inquiries about cases pending at the hearing level at another SSA component or at another Government agency to the appropriate office NOTE Forward all written congressional inquiries to DCPI unless they are received in ES and ES determines that it should handle Guidelines for processing written congressional inquiries are as follows 1 The DCPI mail clerk opens the mail date stamps all congressional inquiries and obtains CICS summary queries 2 A Typing and Control Clerk TCC obtains an IRIS pre update search to determine if any DCPI employee has an open or closed inquiry on the case 3 An Operations Analyst OA reviews the congressional inquiries and places an ADCAR subject matter coding sheet which indicates the level of adjudication and subject of the inquiry on the control folders An OA also screens the inquiries and determines which should be referred to ES because of policy questions processing time questions personnel matters etc These inquiries also have an ADCAR coding sheet attached to the control folder They are then assigned to ES on the ADCAR system and routed to that office for a response or for assignment to another component Invitations and thank you letters to the Associate Commissioner are forwarded directly to the Associate Commissioner s office and are not controlled on the ADCAR and IRIS systems 4 Inquiries are assigned to Congressional and Public Inquiries CPI Analysts on a rotating basis However if a DCPI employee whether in a WIB or in the TIB has an open or closed inquiry on the case the inquiry is assigned to that employee 5 A TCC inputs on the IRIS and ADCAR systems the name of the person to whom the case is assigned and annotates the CPI Analyst s code and the date of assignment on the hard copies of these systems forms 6 After an inquiry is assigned the CPI Analyst contacts the appropriate OHA SSA or other office to obtain status on the case The CPI Analyst carefully documents on a RC the office contacted its telephone number the name of the person providing the information and all status information obtained 7 If the case is pending in an OAO PRB the CPI Analyst Advises the PRB contact person that there is congressional interest and requests that the contact attach a yellow DCPI Case Flag Form HA 282 to the front of the CF at the lower right hand corner Advises the PRB contact if there is additional medical or other information attached to the congressional and if so that it will be forwarded for association NOTE The PRB staffs are responsible for routing congressional interest CFs through DCPI when the CFs are sent to an AAJ with a grant review notice final action or final reply 8 If the case is pending in an OCA Division the CPI Analyst Advises the OCA contact person that there is congressional interest and obtains status on the case Checks monthly to obtain updated status reports until the OCA Division completes its action on the case 9 If the case is pending in an HO the CPI Analyst Advises the HO that there is congressional interest in the case and requests that the congressional interest be noted on HOTS and that the CF be flagged Advises the HO that DCPI will send an interim response and forward the congressional inquiry and a copy of the response to the HO for further responses and a final reply 10 If the case is pending with another SSA component the CPI Analyst Advises the component of congressional interest and requests that the interest be noted in the CF Advises the component that DCPI will prepare an interim response and forward the congressional inquiry and a copy of the response for association with the CF 11 If the inquiry concerns a non SSA case or issue the CPI Analyst refers it to the appropriate Government or non Government office 12 An initial response to the congressional inquiry should be released within 7 days from the date the inquiry was assigned to the CPI Analyst When the status of the case has been obtained the CPI Analyst Prepares a response in WordPerfect using either language from DCPI s Macro Text or when necessary original language The Macro Text

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  • HALLEX I-1-701 - I-1-713 - Severe.net
    will control and account for OHA s class membership screening actions Responsibility in OCA for screening region wide class actions that may involve overlapping division responsibilities is determined on a class action by class action basis OAO or an HO will screen any alerted unscreened claims when it is necessary to consider consolidation with a pending claim see HALLEX I 1 708 below DLAI develops instructions for screening including a screening sheet if not already developed by Litigation Staff in connection with its preparation of the required TI DLAI also provides any necessary training on the screening process as well as guidance on any questions arising from that process B Screening Procedures The OCA operating division will screen all inactive potential class member claims under OHA jurisdiction unless a subsequent current claim is pending in OHA or the potential class member claim file is attached to a pending claim file The OCA operating division will forward alerts and any associated claim files to an HO or OAO as necessary 1 Pre Screening Actions Prior to screening an individual case the screening component will obtain appropriate systems information to determine whether ä there is a subsequent claim pending at any administrative level or in court ä there are additional claims within the class dates which have not been associated ä the claimant has received a determination decision on a subsequent claim which is fully favorable with respect to the time period at issue in the potential class member claim and thus provides a basis for determining that the claimant is not a class member eligible for class relief or ä the claimant has received a determination decision on a subsequent claim which may provide a basis for determining that the claimant is not a class member eligible for class relief on the basis of res judicata The screening component will also ä obtain the files for all unassociated claims that fall within the class dates as well as any inactive claims that postdate the class period which potentially provide a basis for screen out or for limiting class relief and ä if necessary request reconstruction of any potential class member files for claims that cannot be located unless as indicated in HALLEX I 1 705 C available systems data or other information provides satisfactory proof that the particular claim would not confer class membership 2 General Screening Principles Absent a specific provision in the court order or settlement agreement the following screening principles apply ä a claimant who received a partially favorable decision will not be screened out as a class member if all other class membership criteria are met ä if the determination decision on a claim filed subsequent to the claim being screened applied the standard or criteria mandated by the court order or settlement agreement and adjudicated the entire time period at issue in the claim being screened the claimant will be screened out as a class member not entitled to relief the screener must carefully review the required standard or criteria and compare the evidence and determination decision on the subsequent claim with the evidence in the class member claim ä whether the term final decision of the Secretary if not otherwise defined also includes ALJ or Appeals Council dismissals or Appeals Council denials of review will be determined individually for each class action and ä the receipt of a determination decision on a subsequent claim which is fully favorable with respect to the time period at issue in the potential class member claim is a basis for a determination that the claimant is not a class member eligible for class relief only if the individual has received all benefits to which he or she could be entitled based on the potential class member claim 3 Post Screening Actions ä The screener whether in OCA OAO or an HO will place the original screening sheet in the claim file and forward one copy for reporting purposes to Attn insert name of class action Class Action Coordinator Division of Litigation Analysis and Implementation Suite 702 One Skyline Tower 5107 Leesburg Pike Falls Church VA 22041 3200 HO personnel may also forward material to DLAI by telefax using telephone number 703 305 0655 The need for additional copies will be determined by the requirements of the particular class action ä If the OCA operating division determines for an OHA jurisdiction class member case that a subsequent claim is pending at the initial or reconsideration level it will annotate this information on the covering route slip transmitting the case to the adjudicating component for the component s use in considering consolidation see HALLEX I 1 708 concerning consolidation and will expedite the case Additionally if the OCA operating division determines that a subsequent claim is pending in OAO or an HO the OCA operating division will notify the OAO branch chief or HO manager as appropriate by telephone that it is transmitting a class member case for consolidation consideration and will expedite the case ä If the OCA operating division determines on screening of an OHA jurisdiction class member case that a non OHA component has jurisdiction for readjudication the operating division will after sending any required notice forward the case to the non OHA component The operating division will also notify DLAI of the change in jurisdiction for DLAI s coordination with Litigation Staff 4 Special Post Screening Actions If a claimant is a class member and ä a favorable or partially favorable determination decision on a subsequent claim establishing an onset date within the time period covered by the class member claim has been effectuated and ä at the time of effectuation the claim now identified as a class member claim could not be reopened for payment purposes under the normal rules of administrative finality the screener will forward the class member claim to the effectuating component for further effectuation i e further payment based on the date of the class member claim This is because the fact of class membership has in effect reopened the claim regardless of the rules of administrative finality The screener will instruct the effectuating component to return the claim file to the screening component on completion of its effectuation action so that the screening component can send any required notice with respect to class membership and determine whether there are any remaining issues raised by the class member claim If after further effectuation the class member has received all benefits payable based on the class member claim the screening component will modify any class member notice to advise the claimant that he or she is entitled to no additional relief If there is no notice of class membership the screening component will forward the claim to the adjudicating component under cover of a route slip indicating the case circumstances If during the screening process it becomes apparent that a favorable determination decision on a subsequent claim was improperly effectuated e g the effectuating component used an incorrect onset date the screening component will prior to sending any required notice with respect to class membership ä associate all claim files ä screen claim files if necessary ä forward claim files for proper effectuation as well as for any additional effectuation action based on the fact of class membership and ä instruct the effectuating component to return the claim files to the screening component on completion of its effectuation action for the screening component to send any required notice with respect to class membership and determine whether there are any remaining issues raised by the class member claim C Notices 1 Notice of Class Membership Many DDS jurisdiction cases provide no separate notice of a favorable class membership determination However occasionally an OHA component may screen a DDS jurisdiction case for the purpose of consolidating at the OHA level e g OHA plans to issue a favorable decision that is also fully favorable with respect to the class member case In this situation OHA will give notice in the body of the decision that all class relief has been provided For OHA jurisdiction cases there may be a time lag between the date of screening for eligibility for class relief and the date that OHA processes the case e g the date that a claim is scheduled for hearing Therefore at the OHA level the screening component will normally give notice of eligibility for class relief at the time of screening such notice may sometimes be given in connection with notice of action on a current claim 2 Notice of Non Class Membership or Notice That Individual Is not Eligible for Class Relief All cases denied class membership or denied class relief will receive notice of same and of any ensuing appeal rights in a notice tailored to the particulars of the class action and the individual claim 3 General Notice Guidelines The OHA screening component will ä use OHA letterhead paper ä send the original to the claimant send a copy to the representative if any and place a copy in the claim file and ä if the claimant is deceased send the notice to the potential substitute party or eligible individual if known otherwise send the notice in the claimant s name in care of the Next of Kin On release of the notice the screening component will forward the file s to the designated location for class member cases usually an HO or to the designated location for non class member cases location will be identified in the TI tailored to the particular case The screening component will forward to the claim file location for action all notices that are returned to the screening component as undeliverable HALLEX I 1 707 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division I General Subjects Subject Class Action Implementation Chapter I 1 700 June 30 1994 Current through March 1997 I 1 707 PROCESSING AND ADJUDICATION The DDS or OHA will follow the requirements of the court order or settlement agreement as explained in the Program Operations Manual System or TI developed for implementation If not specifically addressed by the court order or settlement agreement or the implementing instructions OHA adjudicators will follow all current practices with respect to scheduling routing developing evidence coding etc HALLEX I 1 708 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division I General Subjects Subject Class Action Implementation Chapter I 1 700 June 30 1994 Current through March 1997 I 1 708 CASE CONSOLIDATION PROCEDURES A General When a claimant has an inactive claim s to be reopened or redetermined under a class action court order or settlement agreement and also has a subsequent claim pending at any administrative level SSA may consider consolidating the claims Claims may be consolidated only when they have common issues If the claims are disability claims and involve disability issues they will be considered to have common issues regardless of the period at issue or the title s under which the claims were filed Claims with common issues may be consolidated when it is reasonable to do so NOTE For any case involving terminal illness TERI consolidation action where jurisdiction rests with different levels will depend entirely on the exigencies of the particular case i e TERI procedures will always take precedence Absent a specific provision in the court order or settlement agreement the following principles apply when SSA s policy is to consolidate B Both Claims under DDS Jurisdiction Resident DDS or Non resident DDS The DDS will usually consolidate the claims and issue one determination If the class member claim is under the jurisdiction of a non resident DDS i e the DDS in the State where the prior claim was adjudicated in which the claimant no longer resides the non resident DDS will have jurisdiction for consolidation A DDS jurisdiction class member claim is generally under the jurisdiction of the DDS which made the determination to be reviewed even if the claimant has moved out of the DDS s usual area of jurisdiction EXCEPTIONS The resident DDS will have jurisdiction for a class action claim if 1 the court order or settlement agreement is also applicable in the state of the claimant s current residence e g a nationwide region wide or circuit wide class action 2 a face to face review is appropriate cessation cases or 3 the court order requires review by the resident DDS If two DDSs are involved and at the point consolidation becomes an issue the current claim is ready for favorable adjudication that adjudication will proceed without consolidation The determination issuing DDS will notify the other DDS of the action taken on the current claim C Prior Inactive Claim under DDS Jurisdiction Subsequent Current Claim Pending in HO Consolidation between adjudicative levels becomes an issue for the HO when it has a subsequent current claim pending and 1 receives an alerted unscreened potential class member claim 2 receives a class member claim 3 becomes aware of a class member claim pending DDS review or 4 receives an alert for a DDS jurisdiction claim 1 HO Receives Alerted Unscreened Potential Class Member Claim Ordinarily the HO will receive potential class member cases unscreened Accordingly HO personnel must first screen for eligibility for class relief and send any required notice see HALLEX I 1 706 B and C If the claimant is not a class member eligible for relief HO personnel will forward the claim file s to the designated location for such cases unless it is otherwise needed for adjudication If the claimant is a class member eligible for relief HO personnel must determine if there is an issue common to both the subsequent current and class member claims If there is no common issue e g the current claim involves waiver of overpayment and the prior claim involves entitlement issues the ALJ will notify the claimant of the reason s for not consolidating see HALLEX I 1 790 Exhibit 2 for sample language the notice may be mailed along with any required notice of class membership HO personnel will place a copy of the notice in each claim file and will forward the prior inactive claim file to the appropriate DDS using HALLEX I 1 790 Exhibit 3 If there is a common issue the ALJ s consolidation action will depend on whether the hearing has already been scheduled or held a Hearing Scheduled or Held The ALJ will ä retain jurisdiction of the subsequent current claim ä consolidate the prior inactive class member claim with the subsequent current claim ä prepare and mail the customary notice of intent to consider a new issue 20 CFR 404 946 b 416 1446 b this notice may be mailed along with any required notice of class membership ä if the hearing has been held and the prior inactive claim raises an additional issue offer a supplemental hearing unless the ALJ is prepared to issue a favorable decision that is fully favorable with respect to the class member claim ä issue one decision that covers the issues raised by all consolidated claims and ä notify DLAI at the address in HALLEX I 1 706 B 3 of the disposition of the class member claim by forwarding a copy of the decision EXCEPTION The ALJ will not consolidate if the subsequent claim involves a remand with a court ordered time limit and consolidation would prevent compliance with the time limit b Hearing not Scheduled The ALJ will ä dismiss the request for hearing on the subsequent current claim without prejudice see HALLEX I 1 790 Exhibit 4 for sample language the notice of dismissal may be mailed along with any required notice of class membership and ä forward all claims to the DDS for consolidation and readjudication EXCEPTIONS The ALJ will not dismiss the request for hearing when a hearing has not been scheduled if 1 the claimant has waived his or her right to an in person hearing and the case is ready for an on the record decision 2 the ALJ is prepared to issue a fully favorable decision on the subsequent claim 3 the subsequent claim is on remand from the Appeals Council or 4 the subsequent claim is a TERI case Once the DDS has issued a determination covering the issues raised by all claims the claimant will have the right to file a new request for hearing if the determination is unfavorable either in whole or in part c ALJ Unable to Consolidate or Dismiss Because Exception Applies Claimant Previously Notified of Case Transfer to OHA The ALJ will ä advise the claimant by appropriate modification of HALLEX I 1 790 Exhibit 2 of the action taken in the case ä place a copy of the notice in the class member claim file and ä forward or return the class member claim file to the appropriate DDS for separate review see HALLEX I 1 790 Exhibit 3 d ALJ Unable to Consolidate or Dismiss Because Exception Applies Claimant Not Previously Notified of Case Transfer to OHA HO personnel will ä document the class member claim file with the reason for not consolidating or dismissing ä retain the class member claim file with the subsequent current claim and ä flag the class member claim file for DDS review after completion of all OHA actions either favorable or unfavorable on the subsequent current claim see flag at HALLEX I 1 790 Exhibit 5 Although OHA action may in effect render moot either through res judicata or through reversal the issues raised by the class member claim the DDS must still review the class member claim for input to CATS and notice to the claimant 2 HO Receives Class Member Claim HO personnel will proceed in accordance with HALLEX I 1 708 B 1 above 3 HO Becomes Aware of Class Member Claim Pending DDS Review At any point during the hearing proceedings HO personnel may become aware usually based on information furnished by a claimant or representative that a class member case is undergoing or awaiting review in a DDS In this situation HO personnel must consult directly with the DDS orr followestablished coordination procedures for a particular region to determine if there is a common issue If HO personnel and DDS agree that there is no common issue both components may proceed with their actions independently If HO personnel and DDS agree that there is a common issue or if there is any doubt as to whether there is a common issue HO personnel will request the DDS to forward the class member claim file for consolidation consideration unless the DDS is ready to issue a determination Every attempt should be made to resolve the question without forwarding the file If HO personnel review the class member claim file and determine that there is no common issue HO personnel will prepare appropriate notice to the claimant see HALLEX I 1 790 Exhibit 2 and return the claim file to the DDS If HO personnel review the class member claim file and determine that there is a common issue HO personnel will proceed in accordance with HALLEX I 1 708 C 1 above 4 HO Receives an Alert for a DDS Jurisdiction Claim If the HO receives an alert without a claim file HO personnel will determine whether the alerted case is located in the HO The case that was alerted may have proceeded on appeal to OHA or may be attached to a subsequent current claim that proceeded on appeal to OHA If the alerted case is attached to a claim pending a hearing HO personnel will proceed in accordance with HALLEX I 1 708 C 1 above If the alerted case is the case on appeal HO personnel will screen for eligibility for class relief and send appropriate notice to class members not eligible for relief If the claimant is a class member and a hearing has not been scheduled or held the ALJ will subject to the exceptions and guidance for excepted cases in HALLEX I 1 708 C 1 b and d above dismiss the request for hearing and forward the case to the DDS for reopening If a hearing has been scheduled or held the ALJ will continue with normal processing If the ALJ issues a fully favorable decision the ALJ will notify the claimant and representative if any in the decision that the decision resolves the class member claim The ALJ will also notify DLAI at the address in HALLEX I 1 706 B 3 of the disposition of the class member claim by forwarding a copy of the decision If the ALJ issues other than a fully favorable decision or dismisses the request for hearing HO personnel will flag the class member claim see HALLEX I 1 790 Exhibit 5 for forwarding to the DDS on completion of all OHA actions and expiration of any appeal period The DDS may take any further action warranted to effect class relief If the HO does not have the alerted case HO personnel will forward the alert to the OCA operating division responsible for screening along with information about the status of the subsequent current claim for OCA s further handling The HO will continue with processing of the subsequent current claim and will consider consolidation if the alerted case is later received in the HO during the pendency of the subsequent current claim If the HO no longer has a pending claim when the alert is received HO personnel will forward or return the alert to the OCA operating division for their further handling D Prior Inactive Claim under HO Jurisdiction Subsequent Current Claim Received in FO or Pending in DDS When an FO or DDS receives a subsequent current claim and a prior claim s is pending readjudication in an HO the FO or DDS will forward the subsequent current claim to the HO for consolidation consideration The FO or DDS will notify the claimant of this action When the ALJ determines that the subsequent current claim does not have an issue in common with the class member claim pending readjudication he or she will forward or return the subsequent current claim to the DDS for adjudication use HALLEX I 1 790 Exhibit 3 appropriately modified and will notify the claimant of the transfer see HALLEX I 1 790 Exhibit 6 When the ALJ determines that the claims have common issues he or she will proceed with consolidation consideration pursuant to HALLEX I 1 708 C 1 above If based on the principles and exceptions in HALLEX I 1 708 C 1 above the ALJ is unable to consolidate or dismiss the class member claim he or she will return or forward the subsequent current claim to the DDS use HALLEX I 1 790 Exhibit 3 appropriately modified and will so notify the claimant by appropriate modification of HALLEX I 1 790 Exhibit 6 E Prior Inactive Claim under HO Jurisdiction Subsequent Current Claim Pending in HO In the HO jurisdiction situation see HALLEX I 1 703 the ALJ may consolidate common issue claims even if at the point consolidation becomes an issue one claim is ready for decision If necessary the ALJ will offer a supplemental hearing However if the subsequent current claim is a TERI case or a time limited remand the ALJ will consolidate only if appropriate depending on the exigencies of the case When the OCA operating division coordinating the screening of potential class member cases determines that a class member has a subsequent current claim pending in an HO the OCA operating division will notify the HO manager that it is transmitting a class member case and the OCA operating division will expedite the case see HALLEX I 1 706 B 3 When the HO receives an alert for an HO jurisdiction case without a claim file HO personnel will determine whether the alerted case is located in the HO The case that was alerted may have proceeded on appeal to OHA or may be attached to a subsequent current claim that proceeded on appeal to OHA If the alerted case is attached to a claim pending a hearing HO personnel will screen for class membership and send any required notice If the claimant is a class member the ALJ will consolidate pursuant to HALLEX I 1 708 E above If the alerted case is the case on appeal consolidation is not an issue HO personnel will follow instructions for screening and notice and if appropriate for processing and adjudication of class member claims If the HO does not have a claim that falls within the dates for class membership HO personnel will forward the alert to the OCA operating division responsible for screening along with information about the status of the subsequent current claim for OCA s further handling The ALJ will continue with processing of the subsequent current claim and will consider consolidation if the alerted case is later received in the HO during the pendency of the subsequent current claim If the HO no longer has a pending claim when the alert is received HO personnel will forward or return the alert to the OCA operating division for their further handling F Prior Inactive Claim under DDS or HO Jurisdiction Appeal on Subsequent Current Claim Pending at Appeals Council Consolidation becomes an issue at the Appeals Council level when the Council receives an alerted claim s screened or unscreened or receives an alert for a claim already in its possession The Appeals Council may consolidate a class member claim with a subsequent current claim pending before it on a request for review when the Appeals Council proposes to issue a favorable decision on the subsequent current claim and that decision is also fully favorable with respect to the issues raised by the class member claim The Council may also direct an ALJ to consolidate a prior inactive class member claim and a subsequent current claim when the Appeals Council proposes to remand and a common issue prior inactive class member claim has been associated with the subsequent current claim Accordingly the Council s disposition of the subsequent current claim will determine the disposition of the prior inactive claim as follows 1 Appeals Council Decides to Issue a Favorable Decision Decision is Fully Favorable with Respect to Prior Inactive Claim OAO personnel will a screen all alerted claims in OAO s possession if unscreened see HALLEX I 1 706 B and NOTE If on screening OAO personnel determine that an additional potential class member claim file must be retrieved the Appeals Council will not delay action on the subsequent current claim unless the additional claim file is material to the Council s consideration of the subsequent current claim In this situation OAO personnel will forward the prior inactive alerted class member claim to the OCA operating division having jurisdiction with a copy of the Appeals Council s action on the subsequent current claim b if the alerted claim s is a class member claim s and has issues in common with the claim pending review 1 consolidate 2 notify the claimant in the decision on the subsequent current claim that the decision also resolves the class member claim and 3 notify DLAI at the address in HALLEX I 1 706 B 3 of the disposition of the class member claim by forwarding a copy of the decision or c if the alerted claim s is not a class member claim s send the notice of non class membership see HALLEX I 1 706 C 3 return the claim files to the designated location if not needed for adjudication purposes and proceed with action on the subsequent current claim or d if an HO jurisdiction class member claim does not have an issue in common with the subsequent current claim ä forward the class member claim to the HO modify HALLEX I 1 790 Exhibit 3 as appropriate for the Appeals Council ä advise the claimant of the transfer and the reason therefor either in any required notice of class membership or in the notice of the Council s action on the subsequent current claim and ä notify the OCA operating division of the transfer or e if a DDS jurisdiction class member claim does not have an issue in common with the subsequent current claim ä forward the class member claim to the DDS modify HALLEX I 1 790 Exhibit 3 as appropriate for the Appeals Council and ä advise the claimant of the transfer either in the notice of the Council s action on the subsequent current claim or in a separate notice based on appropriate modification of HALLEX I 1 790 Exhibit 2 2 Appeals Council Decides to Issue a Favorable Decision Decision not Fully Favorable with Respect to Prior Inactive Claim OAO personnel will a screen all alerted claims in OAO s possession if unscreened see HALLEX I 1 706 B and NOTE If on screening OAO personnel determine that an additional potential class member claim file must be retrieved the Appeals Council will not delay action on the subsequent current claim unless the additional claim file is material to the Council s consideration of the subsequent current claim In this situation OAO personnel will forward the prior inactive alerted class member claim to the OCA operating division having jurisdiction with a copy of the Appeals Council s action on the subsequent current claim b send any required notice to the claimant see HALLEX I 1 706 C and c if the alerted claim s is a class member claim s and has issues in common with the claim pending review request the effectuating component to forward the claim files to the component having jurisdiction for readjudication after the Appeals Council s decision is effectuated using the following language on the transmittal sheet insert name of class action court case review needed following effectuation forward the attached combined files to the DDS or HO as appropriate the DDS or HO will determine whether the Appeals Council s action has resolved all class member relief issues and will take any necessary action or d if the alerted claim s is not a class member claim s return the claim file s to the designated location if not needed for adjudication purposes and proceed with action on the subsequent current claim or e if the alerted class member claim s does not have an issue in common with the subsequent current claim follow the instructions in HALLEX I 1 708 F 1 d and e above 3 Appeals Council Decides to Remand OAO personnel will a screen all alerted claims in OAO s possession if unscreened see HALLEX I 1 706 B and NOTE If on screening OAO personnel determine that an additional potential class member claim file must be retrieved the Appeals Council will not delay action on the subsequent current claim unless the additional claim file is material to the Council s consideration of the subsequent current claim In this situation OAO personnel will forward the prior inactive alerted class member claim to the OCA operating division having jurisdiction with a copy of the Appeals Council s action on the subsequent current claim b send any required notice to the claimant see HALLEX I 1 706 C and c if the alerted claim s is a class member claim s and has issues in common with the claim pending review direct the ALJ in the remand order to consolidate the class member claim s with action on the subsequent current claim or EXCEPTION The Appeals Council will not direct the ALJ to consolidate the claims if a court remand contains a court ordered time limit and it will not be possible to meet the time limit if the claims are consolidated d if the alerted claim s is not a class member claim s return the claim files to the designated location if not needed for adjudication purposes ad proceed with the action on the subsequent current claim or e if the alerted class member claim s does not have an issue in common with the subsequent current claim follow the instructions in HALLEX I 1 708 F 1 d and e above If as noted in the above exception a court ordered time limit precludes consolidation OAO personnel will ä forward or return the class member claim s to the component having readjudication jurisdiction using HALLEX I 1 791 Exhibit 3 modified appropriately ä notify the claimant in the remand order of the action on the class member claim s and ä place a copy of the remand order in the class member claim file s 4 Appeals Council Proposes to Dismiss or Deny the Request for Review or to Issue an Unfavorable Decision OAO personnel will a screen all alerted claims in OAO s possession if unscreened see HALLEX I 1 706 B and NOTE If on screening OAO personnel determine that an additional potential class member claim file must be retrieved the Appeals Council will not delay action on the subsequent current claim unless the additional claim file is material to the Council s consideration of the subsequent current claim In this situation OAO personnel will forward the prior inactive alerted class member claim to the OCA operating division having jurisdiction with a copy of the Appeals Council s action on the subsequent current claim b send any required notice to the claimant see HALLEX I 1706 C and c if the alerted claim s is a class member claim s and has issues in common with the claim pending review remand the claims to the component having jurisdiction for readjudication see sample language for remand to DDS at HALLEX I 1 790 Exhibit 7 d if the alerted claim s is not a class member claim s return the claim files to the designated location if not needed for adjudication purposes and proceed with action on the subsequent current claim or e if the alerted class member claim s does not have an issue in common with the subsequent current claim follow the instructions in HALLEX I 1 708 F 1 d and e above G Alerted Claim under DDS or HO Jurisdiction Is Pending at Appeals Council Level If the Appeals Council receives an alert for a case that is pending appeal OAO personnel will screen for class membership regardless of jurisdiction If the claimant is not a class member OAO personnel will enclose the non class member notice with the notice of the Appeals Council s action If the claimant is a class member the Appeals Council s action will depend on the Council s consideration of the merits of the request for review as follows 1 Appeals Council Decides to Issue a Fully Favorable Decision OAO personnel will notify the claimant and representative if any in the decision that the decision resolves the class member claim 2 Appeals Council Decides to Issue a Partially Favorable Decision OAO personnel will request the effectuating component to forward the claim file s to the component having jurisdiction for readjudication after the Appeals Council s decision is effectuated using the following language on the transmittal sheet insert name of class action court case review needed following effectuation forward the attached file s to the DDS or HO as appropriate The DDS or HO will determine whether the council s action has resolved all class member issues and will take any necessary action 3 Appeals Council Finds a Basis for Remand Unrelated to the Fact of Class Membership The Council will proceed with the remand If the DDS has jurisdiction for the class member claim the Council will remand directly to the DDS for reopening see sample language for remand to DDS

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  • HALLEX I-1- 790 - Severe.net
    the claimant of the right to file a new request for hearing Exhibit 5 Case Flag DDS Readjudication Necessary on Expiration of OHA Retention Period Class Action Case READJUDICATION NECESSARY Claimant s name SSN This claimant is a class member After expiration of the retention period forward claim file s to the DDS for readjudication Send folders to the appropriate DDS NOTE If the claimant has filed a civil action and elected to remain in court for review of the current claim forward the prior inactive claim file s without delay to the DDS for readjudication Exhibit 6 Sample Notice to Claimant Subsequent Current Claim and Class Member Claim Have No Issues in Common On you filed a claim for benefits under title II title XVI or titles II and XVI of the Social Security Act That claim was forwarded to the Disability Determination Service for adjudication On we notified you that you are also a class member under the class action and indicated that we would readjudicate your claim filed on That claim has been assigned to me for a hearing To process your claims more expeditiously the name of state e g Tennessee Disability Determination Service forwarded your insert date of subsequent current claim claim to this office to consider combining it with your claim of I have reviewed both or all claims and have determined that the claims do not have issues in common which would permit them to be combined Therefore I am returning your insert date of subsequent current claim claim to the Disability Determination Service The Disability Determination Service will complete its adjudication of your insert date of subsequent current claim claim and notify you of the results I will separately review your claim of and notify you of the results Modify the following sentence as necessary My office will communicate with you at a later date concerning the scheduling of a hearing If you have any questions concerning your new claim please contact your Social Security Office Exhibit 7 Text for Appeals Council Remand to DDS Class Member Claim s Associated with Current Claim on Which Appeals Council Would Take Unfavorable Action On the claimant filed a request for review by the Appeals Council on the issues raised by his her application dated OR the Administrative Law Judge s dismissal action The claimant has also been identified as a member of the name of class action class action and is entitled to have the final administrative denial of his her application s dated readjudicated by the name of state e g Tennessee Disability Determination Service under the terms of the enter date order of the U S District Court for the District of OR stipulation and order for settlement approved by the U S District Court for the District of OR other entry as appropriate The Appeals Council has determined that the current and class member claim s have issues in common Accordingly the Appeals Council grants the claimant s request for review

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  • HALLEX I-2-000 - I-2-090 - Severe.net
    Congressional Letter Does Not Request Hearing If the HO receives a letter from a Member of Congress which cites a claimant s dissatisfaction with a reconsideration or revised determination and expressly states or implies that the claimant intends to request a hearing accept the congressional letter as a protective filing and take the following actions Prepare a written response to acknowledge receipt of the congressional letter In this response inform the Member of Congress that the letter will serve as a protective filing if the claimant files an RH See 20 CFR 404 630 and 416 340 for requirements on use of a written statement as an application filing date Also request that the Member advise the claimant to contact the appropriate FO if the claimant wishes to file an RH Ensure that the congressional letter is date stamped and that the postmarked envelope in which the letter was mailed is not destroyed for purposes of establishing the protective filing date Make a copy of the congressional letter and envelope for the HO files and send the originals to the appropriate FO along with a copy of the HO s acknowledgement of the congressional letter for action following their usual procedures 3 Congressional Phone Inquiry If the HO receives a congressional telephone inquiry prepare and date a report of contact RC to document the inquiry inform the person making the inquiry that the inquiry will serve as a protective filing if the claimant files an RH and forward the RC to the appropriate FO for action Also request that the person making the inquiry advise the claimant to contact the appropriate FO if he or she wishes to file an RH See 20 CFR 404 630 and 416 340 for requirements for use of a written statement as an application filing date HALLEX I 2 050 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division II Administrative Law Judge Hearings Subject Initial Processing of a Request for Hearing Chapter I 2 000 June 30 1994 Current through March 1997 I 2 050 TIMELY REQUEST FOR HEARING FILING REQUIREMENTS A When the Request for Hearing RH Must be Filed 1 The claimant or representative on the claimant s behalf must file an RH within 60 days unless the time for filing is extended from the date of receipt by the claimant of a The notice of a reconsideration or a revised reconsideration determination b The notice of revised initial determination in a non disability case or c The ALJ s notice of proposed revised decision based on new evidence 404 992 c and 416 1492 e 2 When the last day for filing an RH falls on a Saturday Sunday legal holiday or any other day which is not a full work day for Federal employees by statute or Executive Order the time period for filing the RH is extended to include the next full work day B Date of the RH Ordinarily we consider an RH filed as of the date it is received in any Social Security Administration office or the date it is received by an employee of SSA authorized to receive an RH at a place other than an SSA office We also accept as the date of filing the date an RH is received at the Veterans Administration Regional Office in the Philippines or an office of the Railroad Retirement Board for persons having 10 or more years of service in the railroad industry However if an RH is mailed to us and using the date we receive it would result in the loss or lessening of the claimant s rights we accept the U S Postal Service stamp cancellation or postmark date on the envelope in which it is mailed to us If the postmark is unreadable or there is no postmark we consider the RH timely filed if we receive it by the 70th day after the date on the notice of the determination or decision being appealed See I 2 050 C below If a claimant files Form HA 501 or HA 5011 at the HO stamp the date of receipt in the upper right hand corner of the form If a claimant submits an RH to the HO in the form of a letter stamp the date of receipt in the upper right hand corner of the letter and staple the mailing envelope to the letter If an RH was filed in an FO or other office within the Social Security Administration and the date the RH was received is unclear contact the appropriate office by telephone to determine if they have any evidence of the date of receipt If a copy of the notice of the determination is not in the file to establish its date review the actual determination e g Form SSA 831 in disability cases and any computer printouts in the file to determine if they show the date of the determination or contact the appropriate FO by telephone and request that they obtain and forward a copy of the notice of the determination C Presumed Date of Receipt of Notice of Determination We presume that a claimant received notice of a determination or decision within 5 days after the date of such notice unless there is a reasonable showing to the contrary If an RH is mailed to us and the U S Postal Service stamp cancellation or postmark is unreadable or there is no postmark we presume that the claimant mailed it to us no more than 5 days before we received it unless there is evidence to the contrary If an RH is received within 65 days of the date of the determination or decision consider the RH timely filed If an RH was not received within the 65 day period but the U S Postal Service stamp cancellation or postmark shows that it was mailed within that period use the postmark and consider the RH timely filed If an RH is received by mail within 70 days of the date of the determination or decision and the postmark is unreadable or there is no postmark consider the RH timely filed D RH not Filed Within the Prescribed Time Period 1 Any claimant who has a right to a hearing but does not file a timely request may ask for an extension of time to make the request The request for an extension must be in writing and must give the reasons why the request was not filed within the required time period Most requests for an extension are in the form of an explanation for untimely filing written on or attached to the RH form 2 The ALJ must grant an extension for filing the RH if he or she determines that the claimant has established good cause for missing the filing deadline See I 2 060 Good Cause for Late Filing 3 The ALJ must deny the request for an extension for filing the RH and dismiss the RH if the claimant does not show good cause for missing the deadline See I 2 415 Hearing Request Not Timely Filed HALLEX I 2 060 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division 2 Administrative Law Judge Hearings Subject Initial Processing of a Request for Hearing Chapter I 2 000 February 21 1997 Current through March 1997 I 2 060 GOOD CAUSE FOR LATE FILING Citations 20 CFR 404 911 and 416 1411 A Determining Good Cause When determining whether a claimant had good cause for missing the deadline to request a hearing consider the following 1 What circumstances kept the claimant from making the request on time 2 Whether our action misled the claimant 3 Whether the claimant did not understand the requirements of the Act as a result of amendments to the Act other legislation or court decisions B Examples of Good Cause Examples of circumstances when good cause may exist include but are not limited to the following 1 The claimant was seriously ill and was prevented by the illness from contacting us in person in writing or through a friend relative or other person 2 There was a death or serious illness in the claimant s family 3 Important records were destroyed by fire or other uncontrollable event 4 The claimant was trying to find necessary information to support the claim and did not find the information within the stated time period 5 Within the time limit for requesting a hearing the claimant requested an explanation or other information from the Social Security Administration regarding the determination being appealed and within 60 days of receiving the information or explanation the claimant filed an RH 6 SSA gave the claimant incorrect or incomplete information about when and how to request administrative review 7 The claimant did not receive notice of the determination or decision 8 Within the time limit for requesting a hearing the claimant submitted an RH to another Government agency in good faith and the RH did not reach us until after the time period had expired 9 Unusual or unavoidable circumstances prevented the claimant from filing timely 10 Evidence exists which shows that the claimant did not know of the need to file timely C Development Procedures for Determining Good Cause If nothing in the file exists to indicate the reason for the late filing contact the claimant and request an explanation Also ask the servicing FO to forward any pertinent information in its files e g any letter or communication from the claimant representative or the claimant s family a copy of any records containing information regarding pertinent contacts etc The ALJ may also elect to obtain the needed information at a hearing on the issue of good cause for untimely filing HALLEX I 2 070 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division 2 Administrative Law Judge Hearings Subject Initial Processing of a Request for Hearing Chapter I 2 000 February 21 1997 Current through March 1997 I 2 070 HEARING OFFICE SERVICE AREA REVISED 02 97 A General Each hearing office HO has jurisdiction over a designated geographic area referred to as the HO s service area The HO will generally process all requests for hearing RHs of claimants residing in that area In general hearings will be held within 75 miles of the claimant s home SSA may only reimburse the claimant the representative and unsubpoenaed witnesses for travel expenses if the distance between the HO and the person s residence or office whichever he or she travels from is more than 75 miles See I 2 072 G Reimbursement of Travel Expenses of Foreign Claimants I 2 090 Samples Sample 4 ENCLOSURE REIMBURSEMENT OF TRAVEL EXPENSES and I 2 310 H Reimbursement of Travel Expenses B Screening RH to Determine Venue When an HO receives an RH the HO staff will screen the RH to determine if the HO has venue i e whether the resident address of the claimant is in the geographic area the HO serves If the HO does not have venue the HO staff will forward the RH to the HO that does C Changing Venue Although a claimant may request a change of venue i e request to have the case transferred to another HO it is OHA s policy not to routinely grant such requests Because of the large volume of cases in HOs routine changes of venue would be disruptive and could adversely affect service to other claimants An ALJ may change venue upon a claimant s written or oral request if the claimant has good cause for making the request or on the ALJ s own initiative if the change would promote the efficient administration of the hearing process and ensure the claimant a full and fair hearing Examples of circumstance that could warrant a change of venue include but are not limited to the following A witness who will testify to facts which are material to the claimant s case and which cannot be otherwise obtained would be unable to travel to the place set for the hearing but would be able to travel to another place if the hearing were held there Transportation is not readily available for the claimant to travel to the place set for the hearing The claimant lives closer to another hearing office The claimant is confined in a prison or other institution and reasonable arrangements cannot be made to transport the claimant to the place set for the hearing Under these circumstances hearings may be held at the place of confinement NOTE 1 An ALJ may change venue only after contact has been made with the receiving HO to determine the impact the change would have on the efficient administration of the hearing process in that office NOTE 2 If an ALJ changes venue he or she must notify all parties and the receiving HO of the change and the reasons for it HALLEX I 2 072 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division 2 Administrative Law Judge Hearings Subject Initial Processing of a Request for Hearing Chapter I 2 000 February 21 1997 Current through March 1997 I 2 072 ASSIGNING AND PROCESSING REQUESTS FOR HEARING FILED BY CLAIMANTS WHO DO NOT RESIDE IN THE UNITED STATES REVISED 02 97 A General A claimant has the right to appear before the ALJ either personally or through a designated representative 20 CFR 404 950 a and 416 1450 a If a claimant lives outside the United States and does not inform the ALJ assigned to conduct the hearing that he or she wishes to appear and there are no other parties to the hearing who wish to appear the ALJ may decide the case on the record and not conduct a hearing 20 CFR 404 948 b 1 ii and 416 1448 b 1 ii Sections 201 j 1631 h and 1817 i of the Social Security Act state the authority for the payment of certain travel expenses to claimants representatives and all reasonably necessary witnesses who attend ALJ hearings This reimbursement is statutorily limited to travel within the United States 20 CFR 404 999a ff and 416 1495 ff implement these statutory authorities Individuals who reside in the States the District of Columbia the Commonwealth of Puerto Rico the Virgin Islands Guam and American Samoa are residents of the United States for the purposes of titles II and XVIII see 210 i In addition residents of the Northern Mariana Islands are residents of the United States if the individual is applying for special age 72 benefits under section 228 of title II Individuals who live in the 50 States the District of Columbia and the Northern Mariana Islands are residents of the United States for the purposes of title XVI however an individual shall not be considered an eligible individual for any month during which such individual is outside the United States 20 CFR 416 1603 c NOTE Foreign claimant as defined herein refers to residence not citizenship See Temporary Instruction 5 110 for a discussion of the limitation on the amount available to reimburse a representative for travel to attend a hearing effective for representative travel expenses incurred on or after April 1 1991 B Foreign Claimant Title II or Title XVIII Claim A claimant for title II or title XVIII benefits is a foreign claimant if he or she has requested a hearing and does not reside in the 50 States the District of Columbia American Samoa Guam Puerto Rico or the Virgin Islands A resident of the Northern Mariana Islands is a foreign claimant unless he or she is filing for special age 72 benefits under section 228 of title II of the Act or for title XVI benefits C Foreign Claimant Title XVI Claim A title XVI claimant is a foreign claimant if he or she has requested a hearing and does not reside in the 50 States the District of Columbia or the Northern Mariana Islands Therefore title XVI requests for hearing from foreign claimants are ordinarily limited to cases in which SSA issued the initial and reconsideration determinations on an individual s SSI application while the claimant was a United States resident and Thereafter the claimant moved out of the country The ALJ may find such claimant disabled or eligible for SSI benefits for the time the claimant resided in the United States during the pendency of the application D Requirements for Filing a Request for Hearing A claimant including a foreign claimant must request a hearing in writing 20 CFR 404 933 a and 416 1433 a The claimant may file the request at any SSA office or any United States Foreign Service Office 20 CFR 404 614 b 1 Foreign claimants may also file hearing requests on title II claims at the Veterans Administration Regional Office in the Philippines or with the Railroad Retirement Board 20 CFR 404 933 b 2 E Foreign Claimant Travel Residence and Reimbursement of Travel Expenses The Social Security Act 201 j 1631 h and 1817 i authorizes expenditure of funds to pay travel expenses to claimants for travel within the United States to attend proceedings before ALJs The implementing regulations 404 999c d and 416 1495 state that SSA will reimburse a claimant who travels more than 75 miles to a hearing site OHA selects If a claimant travels to the United States from a foreign country for a hearing SSA considers the point of entry i e the location at which the claimant first enters the United States to be his or her residence or office for the purpose of computing the 75 miles Therefore a foreign claimant is eligible for reimbursement of travel

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  • HALLEX I-2-101 - I-2-140 - Severe.net
    C Order of Exhibits Arrange exhibits in a logical order according to the sequence in which the ALJ will discuss them in the hearing decision The usual order from bottom to top is as follows 1 Jurisdictional documents a The application and any protective filing statement s b The State agency s initial reconsidered and or revised determinations arranged in chronological order with the most recent on top along with the professional qualification statements for all State agency physicians involved in the determinations See I 2 130 Professional Qualifications of Physicians and Mental Health Professionals 2 Nonmedical documents a The earnings record b The report of the disability interview c The report of the vocational history 3 Medical documents Arrange the medical documents in chronological order from the oldest on the bottom to the most recent on top based on the date of the examination or hospitalization rather than the date on which the report was prepared or received 4 Professional Qualifications The professional qualifications of physicians mental health professionals and Vocational Experts involved in the case are placed on the top See I 2 130 Professional Qualifications of Physicians and Mental Health Professionals D Prior Hearing Exhibits When a prior hearing decision and the exhibits on which that decision was based are relevant to the current claim obtain the prior decision exhibits and exhibit list and include them as proposed exhibits for the current case along with the following 1 The certified transcript if one was prepared 2 The claimant s request for Appeals Council review of the hearing decision if one was filed 3 A copy of the Appeals Council s final action on the prior claim if any 4 A copy of any documents related to a civil action if any including the final action of the court NOTE Do not renumber the exhibits on which the prior decision was based but rather number the exhibits on the current claim as Exhibit B 1 B 2 etc E Preparing the Exhibits 1 Prepare and number the exhibits as follows a If the exhibit has only one page place an exhibit number in the lower right hand corner of the page If the exhibit has more than one page place an exhibit number in the lower right hand corner of the first page and on each subsequent page place the exhibit number page number and total number of pages in the exhibit For example Exhibit No 15 Page 2 of 5 b Tape all exhibits smaller than letter size to a sheet of 8 1 2 x 11 inch paper c Combine all initial reconsidered and revised determinations SSA 831s and SSA 833s into one multipage exhibit 2 Prepare the exhibit list See I 2 120 Preparation of Exhibit List NOTE Do not write on highlight or otherwise mark up exhibits except for stamping and numbering them HALLEX I 2 120 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division II Administrative Law Judge Hearings Subject Prehearing Analysis and Case Workup Chapter I 2 100 June 30 1994 Current through March 1997 I 2 120 PREPARATION OF EXHIBIT LIST When the proposed exhibits have been selected arranged in proper order and marked prepare an exhibit list following the format of I 2 190 Sample 4 Exhibit List Final If additional evidence is received at or after the hearing mark the item s with the next exhibit number s Add the exhibit s to the exhibit list under the heading RECEIVED DURING HEARING or RECEIVED SUBSEQUENT TO HEARING as appropriate If the ALJ issues a fully favorable decision a draft exhibit list may be used in the claim file However if the ALJ issues a partially favorable or unfavorable decision the exhibit list must be prepared in final on Form HA 540 Exhibits List and placed in the claim file Many HOs prepare the exhibit list only in final form to avoid duplication of effort HALLEX I 2 125 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division II Administrative Law Judge Hearings Subject Prehearing Analysis and Case Workup Chapter I 2 100 June 30 1994 Current through March 1997 I 2 125 PREPARATION OF SUMMARIES OF THE EVIDENCE The hearing office staff should prepare a summary of the issues and evidence before the hearing for the Administrative Law Judge ALJ to use as a working paper before and at the hearing A Purpose of the Summary The summary enhances the decision making process and the quality of the ultimate written decision by facilitating prehearing recognition of 1 the issues which must be addressed 2 the need to further develop the record and 3 the testimony which needs to be elicited at the hearing B Content of the Summary The summary should include the following 1 A procedural history of the case 2 A profile of the claimant including the claimant s age education and work history 3 In disability cases a summary of the medical evidence including relevant allegations clinical findings treatment and opinions expressed by treating and examining sources regarding the claimant s limitations and residual functional capacity to perform various work functions 4 In non disability cases a summary of the allegations and evidence supporting the position taken by each party 5 A description of any conflicts in the evidence 6 Recommendations on 1 the need for further development or 2 the presence of witnesses at the hearing NOTE When there is a written statement or record of oral inquiry which may protect the claimant s filing date the HO staff must refer to it in the summary of the evidence to ensure that the ALJ is aware of the protective filing material HALLEX I 2 130 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division 2 Administrative Law Judge Hearings Subject Prehearing Analysis and Case Workup Chapter I 2 100 April 26 1995 Current through March 1997 I 2 130 PROFESSIONAL QUALIFICATIONS OF PHYSICIANS AND MENTAL HEALTH PROFESSIONALS REVISED 11 94 A Professional Qualifications General When an ALJ admits a medical report analysis assessment or judgment by a physician or mental health professional including a Medical Expert ME into the record of a case as an exhibit or obtains a physician s or mental health professional s testimony at a hearing the ALJ will also admit into the record a statement of the physician s or mental health professional s qualifications i e a completed Form HA 526 Professional Qualifications of physician or Form HA 4390 Professional Qualifications of Psychologist unless the qualifications are adequately documented on the report analysis assessment or judgment or on another document which is being admitted into the record as an exhibit Generally a physician s qualifications are adequately documented when stationery letterhead or other document identifies his or her medical degree specialty and Board certification A mental health professional s qualifications are generally adequately documented when stationery letterhead or other document identifies his or her mental health degree licence and type of practice The hearing office HO staff must ensure that the proposed exhibits include all necessary professional qualifications statements and reports At the hearing the ALJ will ask any physician or mental health professional who plans to testify to confirm the accuracy of the statement or report of his or her professional qualifications which will be entered into the record as an exhibit If there is no statement or report of professional qualifications or the individual indicates that the statement or report contains an error the ALJ will qualify the physician or mental health professional before he or she testifies by asking questions on the record which will elicit the necessary information about his or her qualifications See I 2 670 Testimony of a Medical Expert and I 2 674 Testimony of a Vocational Expert For additional information regarding the professional qualifications requirements for MEs and VEs refer to the Vocational and Medical Expert Programs Operational Manual See also I 2 538 Obtaining Medical Expert Testimony I 2 539 The Medical Expert s Testimony I 2 542 Obtaining Medical Expert Opinion Through Interrogatories I 2 554 Obtaining Vocational Expert Testimony I 2 555 The Vocational Expert s Testimony and I 2 557 Obtaining Vocational Expert Opinion Through Interrogatories B HO Master File of Completed Professional Qualifications Forms Each HO maintains a master file of completed professional qualifications forms for physicians and mental health professionals in the HO s service area who regularly submit reports or testify at hearings If the physician s or mental health professional s qualifications are not adequately documented on the report analysis assessment judgment or other document being admitted into the record or the ALJ decides a professional qualifications form also should be admitted the HO staff should check the HO s master file of completed professional qualifications forms to determine whether it contains a completed professional qualifications form for the individual If the HO s master file contains a completed professional qualifications form for the individual the HO staff should photocopy the form and make it a proposed exhibit If the HO s master file does not contain a completed professional qualifications form the HO staff should obtain the professional qualifications and complete a Form HA 526 or HA 4390 as appropriate C Obtaining Professional Qualifications and Completing a Form HA 526 or HA 4390 The HO staff first will try to obtain the physician s or mental health professional s qualifications by consulting the American Medical Association Directory the Osteopathic Physicians Handbook and other appropriate directories and handbooks If this is unsuccessful the HO staff should contact the physician or mental health professional directly by telephone and request the information needed to complete a Form HA 526 or HA 4390 1 Form HA 526 Professional Qualifications of physician Insert the following information a name and current address b medical specialty c type of practice d membership in American Specialty Board if any e year of license f educational background and g any other pertinent information 2 Form HA 4390 Professional Qualifications of Psychologist Insert the following information a name and current address b educational background c date of license d type of practice e number of years of practice and f any other pertinent information D HO Staff Is Unable to Obtain a Physician s or Mental Health Professional s Qualifications If the HO staff is unable to obtain a physician s or mental health professional s qualifications the HO staff will 1 Type the claimant s name and Social Security number on a Form HA 526 or HA 4390 as appropriate 2 Type the following in the upper right hand corner of the Form HA 526 or HA 4390 The professional qualifications of insert the name of the physician or mental health professional are not listed in insert the name year and edition of each directory or handbook searched 3 Attach the annotated Form HA 526 or Form HA 4390 to the last page of the medical document HALLEX I 2 135 Office of Hearings and Appeals Social Security Administration S S A Department of Health and Human Services Volume I Division 2 Administrative Law Judge Hearings Subject Prehearing Analysis and Case Workup Chapter I 2 100 April 26 1995 Current through March 1997 I 2 135 EXAMINATION OF PROPOSED EXHIBITS AND OTHER CLAIM FILE MATERIAL REVISED 04 95 A General The ALJ or the HO staff must provide the claimant or representative if any an opportunity before the hearing to examine the CF material which constitutes or will constitute the evidence of record for decision The claimant or representative have the right to examine all material in the CF not just the material the HO staff has selected as proposed exhibits See I 2 115 Exhibits Whenever possible the ALJ or the HO staff will make the CF material available for examination in the HO or an FO to avoid unnecessary photocopying of the material NOTE If the CF contains sensitive or confidential material the ALJ or HO staff must take appropriate measures to protect the claimant s or other individual s privacy See D below B Providing the Opportunity to Examine the Proposed Exhibits and Other CLaim File Material 1 If a claimant or representative requests to examine the CF or proposed exhibits before the date of the hearing inform the requester that he or she can examine the CF and proposed exhibits in the HO 2 If the requester indicates that he or she will not be able to examine the CF or proposed exhibits in the HO before the hearing inform the requester that he or she can examine the CF or proposed exhibits in an FO If the requester agrees to this procedure send the CF and proposed exhibits to the FO closest to the claimant s residence or the representative s place of business following the general procedures set forth in I 2 730 G Proffer Through the FO EXCEPTION For certain representative firms located in the Kansas City Region which employ individuals who represent claimants nationwide send the record to the HO closest to the representative s place of business See I 2 195 Exhibit 1 for a list of these representative firms and the HOs that service them 3 The HO staff must send photocopies of proposed exhibits and other CF material to the requester if the requester is unable to examine the proposed exhibits and CF material in the HO or FO NOTE Although an ALJ may suggest that a claimant or representative come to an HO or FO to review proposed exhibits and CF material the ALJ cannot require the claimant or representative to do so NOTE An ALJ may request that a claimant or representative clarify whether he or she wants a copy of all CF material including route slips file copies of correspondence etc or only a copy of all proposed exhibits Once the claimant clarifies the request the ALJ must provide the material requested C Charging Fees for Photocopies SSA complies with the access provision of the Privacy Act by providing one free copy of CF material to the claimant or the representative when access is for program purposes such as pursuing a benefit under the Social Security Act Once SSA has provided a free copy of CF materials see I 1 403 Privacy Act for a discussion of SSA s policy regarding charging fees for copies of CF materials Unless the HO maintains a record i e a list and or description of the copies provided the HO on receiving another request for a copy of the same material cannot determine whether the HO already provided a copy of that material Therefore the HO staff should document the CF when providing photocopies of CF materials to a claimant or representative However because preparing lists or descriptions of released materials and subsequently separating such materials from materials not yet released may outweigh the cost of simply copying all of the materials the HO may waive fees for subsequent copies If there is any question whether the HO should charge a fee for a subsequent copy contact the Regional Office for guidance D Action When the CF Contains Sensitive Material 1 If the CF contains material which may be harmful to the claimant or another person follow the procedures in I 2 730 F Evidence Contains Information Which May Be Detrimental to the Claimant s Health 2 If the CF contains material which was identified by the source as sensitive or confidential and efforts to obtain release of the restriction have been unsuccessful the ALJ may not admit the material into the record as evidence for decision or disclose the material to any other person See I 2 115 B Documents Not Normally Made Exhibits If possible the OHA employee who receives a threatening phone call must obtain information to aid personnel in locating the claim file identifying the individual understanding the specific nature of his or her complaint etc C Notification of Potential Suicidal Homicidal Behavior No Immediate Threat 1 The gravity and sensitivity of the issue are such that each case must be carefully handled on an individual basis Critical judgment must be emphasized in these cases including consideration of the referral of such individuals to community agencies which are available to assist in such situations a If the folder is located in the servicing HO or OHA Headquarters all details must be recorded on a Report of Contact RC and placed in the file to alert future handlers of the case to the potential suicidal homicidal threat b If the folder is located outside OHA telephone the component holding the folder confirm the telephone contact with a written RC which will be forwarded to the component for placement in the folder and retain a copy of the report for OHA records D Program Responsibilities 1 Expediting claims processing Regardless of OHA s disposition of such claims prompt processing of the claim of a person who is threatening violence must be made a top priority A specific person such as the hearing office manager regional management officer or division director must be designated as the person responsible for coordinating timely processing of such cases If the ALJ or the Appeals Council AC renders a favorable decision the claimant will be promptly informed by telephone See I 2 140 for additional information about processing cases involving potential suicide or homicide 2 Alerting future case handlers The circumstances of the threat and the action by OHA in response to the threat must be documented by completing a RC which fully explains such circumstances A copy of the RC should be prong filed in the manner of a diary slip to remain readily visible on top of the right side of the folder Also an alert must

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