I-2-1-10.Claim Files

Last Update: 9/28/05 (Transmittal I-2-67)

A. The Claim File (CF) — General

The CF is the official Social Security Administration (SSA) record of a case. When the request for hearing (RH) is received in the HO, the HO staff should immediately obtain the current CF and any prior CF(s) that is required.

B. Obtaining the Current Claim File(s)

When a claimant files an RH in his or her servicing field office (FO), the HO staff usually does not have to take any action to obtain the current CF. If the servicing FO has the current CF, it generally forwards it to the HO along with the RH. If the servicing FO does not have the current CF, it will determine its location, contact the component that has the CF and request that they forward it to the HO, and send to the HO documentation of their request (either a copy of their written request, email, or a report of their telephone contact), along with the RH. If the servicing FO does not do this, the HO staff must contact the servicing FO and request that they take appropriate action and forward to the HO either: (1) the CF or (2) information about the location of the CF and the action(s) they have taken to have it forwarded to the HO.

When an HO receives information from an FO about the location of a CF and action(s) they have taken to have it forwarded to the HO, the HO staff should take the following actions:

  1. Diary the case for a period of 10 days.

  2. First HO Follow-up:

    If the HO does not receive the CF within the 10 day period, contact the component that has the CF by telephone or email and request that they send it to the HO, and then diary the case again for 5 days.

  3. Second HO Follow-up:

    If the HO does not receive the CF from the component that has it within the 5-day extended period, contact them again by telephone and send them a memorandum or an email to confirm the telephone request. Diary the case again for 5 days.

  4. If the component that has the CF does not respond, contact the Regional Office (RO) for assistance. (See E., below.)

NOTE:

For specific directions on how to establish and diary a case in the Case Processing and Management System, consult the CPMS website training resources and desk guides found in OHA's Case Processing and Management System (CPMS) website.

C. Obtaining the Prior Claim File(s)

The HO staff should consider whether the evidence in any prior CF(s) is material to the current claim before initiating action to obtain it.

  1. If it appears that the evidence in the prior CF is not material to the current claim, the HO staff should recommend to the ALJ that no action be taken to obtain the prior CF. (See D. below.)

  2. If the evidence in the prior CF is material to the current claim, and the servicing FO has not sent either the prior CF or information identifying the component that has it and showing that they have asked such component to send the CF to the HO, the HO staff should recommend to the ALJ that the HO request the prior CF through the Customer Information Control System (CICS). If the ALJ agrees, and the HO requests the CF in this manner, diary the request for 10 days and follow-up as in I-2-1-10 B.

D. Examples of Situations When an ALJ May Not Need the Prior Claim File

  1. The claimant performed substantial gainful activity after any prior claims were adjudicated.

  2. A prior period of disability was terminated because of substantial gainful activity.

  3. At least four years have elapsed between the date of the prior notice of initial determination and the date of the new application.

  4. The pending request for hearing only concerns an impairment, which began after any prior claims were adjudicated.

  5. The current evidence indicates that any onset of disability, which might be established, occurred after the date the claimant last met the disability earnings requirements.

E. Formal Search Procedures and Reconstruction

The Office of the Regional Commissioner (ORC) is responsible for coordinating efforts to locate and obtain CFs and for determining when folder reconstruction is necessary.

If the HO staff has been unable to obtain a CF, particularly where CPMS shows that a RH had been filed but no CF has been received, they will notify the OHA RO of the situation immediately. The OHA RO will refer the case to ORC for search or reconstruction.

  1. For all cases referred to ORC, the HO will maintain a record of the claimant's name and Social Security number, the claim type and the date the RH was filed. This record will assist the HO staff in making periodic follow-up contacts through the RO to determine the status of the request. Such follow-ups shall occur at least every 20 days or in accordance with the agreement established between the RO and the ORC.

  2. If the HO still does not receive the prior or reconstructed CF, or the CF it receives is incomplete, HO staff will notify the RO and request their assistance in obtaining the missing evidence. The RO will contact ORC again and request that they expedite their action to obtain the missing evidence.

    1. If a signed authorization will not be needed to obtain the missing evidence, HO staff will notify the RO and request their assistance by telephone and send them a memorandum or email to confirm the telephone request. (See I-2-1-90, Sample 1, Memorandum for Requesting Missing Medical Evidence.)

    2. If a signed authorization will be needed, HO staff will notify the RO and request their assistance by memorandum. Attach a copy of the signed authorization to the memorandum. The preliminary telephone call will not be necessary. The memorandum may be sent regular United States Mail or via fax.

    3. Include in the memorandum or email a description of the missing evidence and any available information which may assist them in obtaining it. If the memorandum is sent regular by United States Mail or via fax include:

      • In Title II and Title XVI disabled worker or individual cases, photocopies of Forms SSA-3368 (Disability Report - Adult) and SSA-3369 (Work History Report); and

      • In Title II disabled widow/widower or title XVI disabled child cases, photocopies of Form SSA-3820 (Disability Report - Child).