I-3-0-71.OAO Branch Procedures

Last Update: 12/16/08 (Transmittal I-3-39)

A. Claim File Located in the Mega-site

The OAO Branch will:

  1. Prepare the appeals file.

  2. Establish the case in the Appeals Review Processing System (ARPS) (see ARPS Training Module # 3 – Establish a Case).

  3. Store the appeals file in the branch. The branch will request the claim file from the mega-site when it needs to respond to a request for copies of material and/or an extension of time request, or when the request for review is ready to be assigned to an analyst to work.

NOTE:

Cases in which the claimant may have a terminal illness (“TERI” cases) or other critical cases requiring special handling (e.g., Military Service Casualty Case (MSCC) or Compassionate Allowance (CAL) cases) are identified by either a TERI flag (SSA-2200), MSCC flag, or CRITICAL CASE flag (see exhibits in I-3-0-92, POMS DI 11005.003H, and I-3-0-93) on the front of the claim file, the remark “TERI/MSCC/CAL Case” or “Critical Case” on the request for review and/or a critical case characteristic designation in ARPS. Upon receipt of a request for review on a TERI/MSCC/CAL or other critical case, the OAO Branch will request the file from the mega-site via the Mega-site Information Management System (MIMS) or E-mail.

B. Claims File Not Located in the Mega-site

1. General

There are situations in which the claim file may not be located in the Mega-site when the OAO Branch begins to work on the request for review (e.g., an ALJ issued a partially favorable decision and the hearing office sent the claim file to the effectuating component or the request for review was not established in ARPS and the Mega-site released the claim file(s) for permanent storage). When the OAO Branch is ready to work a request for review in such a case, it institutes the file retrieval process by contacting the component to which the file was sent (by the HO or Mega-site) and requesting the file. If, after 30 days (10 days for critical cases, which include TERI/MSCC/CAL cases), the Branch staff has not received the claims folder, they will forward the appeals file to a member of the Folder Finding Team in their Branch (see I-3-0-95).

The Folder Finding Team will initiate completion of the Claims File Search Checklist (see I-3-0-96). The Team will ensure that all appropriate initial requests and timely follow-ups are completed and annotated on the checklist.

2. Initial Folder Reconstruction Procedures for Request for Review by OAO

If, upon completion of all the checklist items, the Team is unable to locate the claims file, they will certify that they are unable to locate the claim file(s) by signing the last item on the checklist. The existing material (e.g., appeals file, request for review, copy of the Administrative Law Judge's decision, recording of the hearing, and Claims File Search Checklist, etc.) will be routed to a hearings and appeals analyst or technical assistant on the Folder Finding Team in their Branch. This individual will review the checklist, and if appropriate, immediately prepare a remand order (modeled after the template REM-55 remand order — see I-3-0-97). The analyst or technical assistant will attach the Claims File Search Checklist to the remand order in each case. This document details OAO's efforts in attempting to secure the claims folder. The remarks section of the transmittal sheet, routing the existing materials and remand to the hearing office, will contain the following remarks: “Appeals Council Lost Folder Remand — Please Initiate Folder Reconstruction Process.”