I-2-1-10.Claim(s) File

Last Update: 6/9/14 (Transmittal I-2-110)

A. General

The claim(s) file is the official Social Security Administration record of a case. It includes any supporting material, documents, or records that are pertinent to a person's claim for Social Security benefits.

The format of a claim(s) file may be electronic or paper. See Hearings, Appeals and Litigation Law (HALLEX) manual I-2-0-1 for an overview of the electronic disability process. For an overview of the certified electronic folder, see Program Operations Manual System (POMS) DI 81001.005. For more information about the paper modular disability folder, see POMS DI 70005.005 and DI 70010.001.

When a hearing office (HO) receives a request for hearing (RH), the HO staff will also ensure receipt of the current claim(s) file. HO staff will usually not have to take any action to obtain the claim(s) file. New electronic cases will appear in daily Case Processing and Management System (CPMS) reports and HO staff can access electronic claim(s) files after the servicing field office (FO) transfers jurisdiction to the HO. If the claim(s) file is paper, the FO will generally forward the claim(s) file to the HO with the RH; or, when the claim(s) file is paper and the Appeals Council remands the case, the Appeals Council will send the claim(s) file with the remand. When an HO does not receive a paper claim(s) file with a request for hearing or remand order, it will follow the instructions in HALLEX I-2-1-11.

B. Organization of Claim(s) File

A claim(s) folder, whether electronic or paper, contains six sections. Generally, claim(s) files are organized as follows:

  • Part A (Yellow Tab- front)- Payment Documents/Decision

  • Part B (Red Tab)- Jurisdictional Documents/Notices

  • Part C (Green Tab)- Current Development/Temporary

  • Part D (Orange Tab)- Non-Disability Development

  • Part E (Blue Tab)- Disability Related Development and Documentation

  • Part F (Yellow Tab- back)- Medical Records

For detailed information about two-part paper folders, a description of how to organize each part, procedures for when a paper folder is full, and other related information, see POMS DI 70005.005.

C. Routing of Paper Claim(s) File

The usual routing of a claim(s) file for an HO is as follows:

  • If an administrative law judge (ALJ) issues an unfavorable decision or dismissal, the HO sends the claim(s) file to the Office of Disability Adjudication and Review (ODAR) Mega-site in case the claimant appeals the claim(s). The ODAR Mega-site retains the claim(s) file until the retention time to hold the file expires. (See HALLEX I-2-1-10 D for retention periods for claim(s) files.) When a retention period expires, the ODAR Mega-site sends the claim(s) file to the folder servicing operation, which sends the claim(s) file to the Federal Records Center.

  • If an ALJ issues a favorable decision, the HO sends the claim(s) file to the effectuating component (processing service center (PSC) for title II claims and FO for title XVI claims). After taking all necessary actions, the effectuating component sends the claim(s) file to the folder servicing operation, which sends it to the Federal Records Center.

NOTE:

In title II claims, PSC 7 handles effectuation issues for claimants under the age of 53. The other PSCs handle effectuation issues for claimants age 53 or older, and their respective jurisdictions are based on the claimant's Social Security number (SSN). When a claimant attains age 53 and PSC 7 previously housed a paper claim(s) file, it will send the claim(s) file to the PSC with jurisdiction over the claimant's SSN.

D. Retention Periods For Claim(s) File

It is important to be familiar with the retention periods for claim(s) files because a prior claim(s) file may not always be available. For additional information on prior claim(s) files, see HALLEX I-2-1-13.

The retention periods for all claim(s) files are noted in the Table of Contents in the Privacy Act Notices Systems of Records. For purposes of this provision, the more common claim(s) file retention periods are:

  • 60-0089: Paper claim(s) files in which the claim was disallowed or unfavorably decided are generally retained for 10 years (title II) or for 6 years, 6 months (title XVI). As a general rule, paper claim(s) files in which the claim was favorably decided are retained for approximately 5 years (non-disability) or 10 years (disability) after the last payment is made.

  • 60-0320: Electronic claim(s) files in which the claim was disallowed or unfavorably decided for medical reasons are generally retained for 5 years after the agency's final denial or termination decision, and for 2 years if the claim was disallowed or unfavorably decided for nonmedical reasons. Electronic claim(s) files in which the claim was favorably decided are destroyed after 7 years of the most recently awarded claim if the person has attained full retirement age or a medical reexamination date is scheduled to occur after attainment of full retirement age.

NOTE:

Generally, there are longer retention periods for foreign claims, claims with outstanding overpayments, and claims involving fraud issues. Additionally, claim(s) files can be held beyond the normal retention period(s) if needed to resolve pending litigation.