I-2-1-15.Exhibits

1. Part A – Payment Documents/Decisions

HO staff will generally exhibit:

• SSA-831 (Disability Determination and Transmittal);

• Disability Determination Explanation (DDE);

• SSA-832 and SSA-833 (title II and XVI Cease/Continue Disability Determination and Transmittal);

• Previous decisions, dismissals, and revised determinations (including Appeals Council action documents);

• The ALJ or senior attorney decision in the pending case; and

• Representative fee authorization(s).

2. Part B — Jurisdictional Documents/Notices

HO staff will generally exhibit:

• Initial determination form and notice;

• Request for reconsideration and notice;

• Request for hearing;

• A cessation notice of planned action;

• An initial notice of overpayment;

• Representative appointment and fee agreement;

• Notice of withdrawal of representative (submitted prior to finalized exhibit list);

• Waiver of right to appear;

• Substitute party form; and

• Withdrawal of a request for hearing.

If received, the HO will also add the following documents to the B section but will generally not exhibit the documents:

• Representative fee petition request;

• Notice of withdrawal of representative received after ALJ issues decision;

• Acknowledgement of request for hearing and any attachments;

• Continuance of hearing;

• Notice of hearing;

• Professional Qualification Statements sent with notice of hearing; and

• Request for Appeals Council review. (For instructions on referring the request to the Office of Appellate Operations, see the hearing office Standard Hearings Operations Procedure section 1.3.5.8.2.)

3. Part C — Current Development/Temporary

This section is reserved for working papers only. HO staff will not add material identified as an exhibit in this section.

HO staff will commonly file requests for medical evidence in this section, or other printouts, queries, or systems screens that were not necessary for adjudication purposes.

4. Part D — Non-Disability Development

HO staff will generally exhibit:

• The application;

• A written statement or record of oral inquiry indicating an intent to claim benefits (for protective filing purposes);

• Birth certificate or other proof of age;

• Earnings records and proof of any non-posted wages or self-employment income;

• Workers' Compensation, Department of Veterans Affairs, or other relevant federal agency award information (with any medical records from these sources filed in Part F).

• Evidence of death and relationship in auxiliary and survivor cases (for purposes of non-disability development);

• Verification of any work activity engaged in by the claimant after the alleged onset date;

• Pertinent statements or reports of contact (not disability related); and

• Congressional inquiries and responses

5. Part E — Disability Related Development and Documentation

HO staff will generally exhibit:

• SSA-3368 (Disability Report - Adult);

• SSA-3369 (Work History Report);

• SSA-3441 (Disability Report-Appeal);

• SSA-3820 (Disability Report-Child);

• SSA-454 (Report of Continuing Disability);

• SSA-455 (Disability Update Report);

• SSA-821 (Work Activity Report- Employee);

• SSA-820 (Work Activity Report-Self Employed);

• School records (including teacher evaluations);

• Supplemental requests for more information about activities of daily living, pain, seizures, medication, recent medical treatment, or work history;

• Letters from employers, family members, or other individuals describing the claimant's impairments and limitations;

• Vocational expert interrogatories and the received response;

• A written summary of the case, or written statements about the facts and law material to the case, submitted by the claimant or the claimant's representative;

• Pertinent reports of contact related to disability development;

• Unsuccessful attempts to obtain necessary disability documentation;

• Any other documentation relating to development of disability;

• State vocational reports;

• Disability Determination Services worksheet(s); and

• Electronic Disability Collect System (EDCS) routing form.

6. Part F — Medical Records

HOs will generally exhibit:

• A Cooperative Disability Investigations Unit Report of Investigation (filed on top in a paper claim(s) file);

• Treatment records (with cover letter if not otherwise identified);

• Hospital records;

• Laboratory/imaging reports and findings;

• Outpatient notes;

• Consultative examination reports;

• Medical opinions, analyses, and residual functional capacity assessments;

• School records of multi-discipline evaluations and/or psychologist evaluations;

• Letters of unsuccessful attempts to obtain medical evidence;

• SSA-4734 (Residual Functional Capacity Assessment);

• SSA-2506 (Psychiatric Review Technique - PRT Form);

• Death certificate (for the purposes of assessing disability);

• Medical expert interrogatories and received responses; and

• Professional Qualification Statements attached to medical evidence, SSA-831 or SSA-833.

1. Numbering the Exhibits

HO staff will sequentially number documents identified as exhibits in each part of the claim(s) file. Documents are exhibited beginning with the number 1 and followed by the letter applicable to each part (e.g., the first exhibit of part A would be 1A, the second exhibit 2A, etc.).

Exhibiting a paper claim(s) file can present some unique circumstances. HO staff will also consider the following when preparing and numbering proposed exhibits in a paper claim(s) file:

• If the exhibit has only one page, HO staff will place an exhibit number in the lower right hand corner of the page. If the exhibit has more than one page, HO staff places an exhibit number in the lower right hand corner of the first page and, on each subsequent page, adds the exhibit number, page number, and total number of pages in the exhibit. To illustrate, for exhibit 15 in part F, page 2 of 5 pages, the exhibit would read “Ex. 15F, page 2 of 5” or “Ex. 15F, 2/5.”

• HO staff will tape any exhibit smaller than average letter size to a sheet of 8 1/2 x 11 inch paper (copying back of page if necessary).

• HO staff will combine all initial, reconsidered and revised determinations into one multi-page exhibit. If there are other documents in the same section/part of the file, the HO staff will make the other documents a separate exhibit.

• Medical records are organized by source according to the dates of treatment, with the record of oldest treatment on the bottom and the most recent record of treatment on top. After the records are organized chronologically (with most recent treatment on top), HO staff will exhibit together the records from the source. For example, all records pertaining to one period of hospitalization, including an admission summary, laboratory reports, progress notes, surgical procedures and a discharge summary would be included in one exhibit. Likewise, HO staff will combine in one exhibit any medical records that include laboratory reports or x-rays, or multiple records from one medical source that cover a period of time, in chronological order with the most recent treatment on the top.

• HO staff will not write on, highlight or otherwise markup exhibits, except for stamping and numbering them.

2. Prepare the Exhibit List

HO staff will follow the instruction in HALLEX I-2-1-20.