Justification for the Non-Substantive Changes to 0960-0622

Justification for Non-Substantive Changes for Form SSA‑561-U2

Request for Reconsideration

20 CFR 404.907-404.921, 416.1407-416.1421, 418.1009, and 418.1325

OMB No. 0960-0622

Background

The agency is currently experiencing record-high average processing times for initial and reconsideration level claims. We note that the greatest portion of the time it takes to adjudicate a claim is in development of the medical evidence once the claimant applies for Disability Insurance Benefits (DIB) or Supplemental Security Income (SSI). While the agency has the duty to assist the claimants in the development of their claim, a claimant, or their representative, who is interested in reducing the time it takes for development should have the right to do so by fully completing the development of their record on their own. In doing so, they potentially reduce the adjudicative time for their claim in the development stage. Therefore, claimants who elects to fully develop their also deserves the benefit of an expedited process for their claims.

To this end, SSA is piloting a new process, the “Disability Determination Ready Claim” (DDRC) process, which will allow claimants applying for disability benefits under Titles II and XVI of the Act, or their representatives, to file a certified, completed application under the new DDRC process which will allow the agency to advance the claim without further development and proceed directly to adjudication.

Under the DDRC process, the claimants will: (1) submit a completed application (including all forms); (2) submit all the evidence, including the medical evidence; and (3) certify that they have provided the agency with all evidence and information that is required and available for their claims. Based on the certification, the agency will process the claim for adjudication without additional development in-line in accordance with policy for other expedited claims.

However, if at any time during processing, the claimant submits new evidence or the agency determines more information is required, the claim will lose DDRC status, and the agency will process it under the current non-expedited rules and processes.

DDRC will affect the priority processing of a disability claim by allowing claimants who submit their medical evidence and then use the DDRC Certification Statement to certify they submitted a claim with a fully developed medical record to bypass the development stage. While the Certification Statement will not change the application for filing for disability benefits or requesting reconsideration, we will ask claimants who opt to submit DDRC claims to append the Certification Statement to forms associated with their applications so that the Agency has notice that the claimant is opting into the DDRC process and certifies that they satisfied the conditions for a DDRC claim. The DDRC status and Certification Statement will not affect the submitted application.

While the agency’s long-term goal will be to allow such a process at all levels of adjudication, the pilot will begin with claims at the reconsideration level, localized to one, or a few, Disability Determination Service offices.

We are submitting this Change Request to append the DDRC Certification Statement to this information collection in anticipation of respondents using it for the DDRC pilot.

As we hope to begin implementation of this pilot by November 18, 2024, we are asking for OMB approval by November 15, 2024.

Revisions to the Information Collection

• Change #1: We will apply existing priority case processing procedures to initial disability claims in which the claimant certifies that they have submitted all required medical evidence at the time the application is filed. Upon certification, and confirmation by the agency that the evidentiary record is complete, the agency will expedite processing of these claims without further development and proceed directly to adjudication.

Justification #1: The Social Security Administration currently has a significant backlog of pending claims at the initial level. Much of the time and resources spent processing claims at the initial level results from the agency assisting in the development of the medical record. In addition, the agency develops every claim irrespective of the completeness of the medical record. Thus, the processing of a claim in which the full medical record is submitted with the application is delayed because it must wait in line at the development stage with all claims. The ability for the agency to expedite claims that are submitted with a full medical record past the development stage and proceed directly to adjudication will avoid such delays and free up resources for claims that require development assistance. We anticipate this will improve case processing times and reduce the backlog of cases at the initial level.

• Change #2: We will apply existing priority case processing procedures to requests for reconsideration of initial disability claim determinations in which the claimant certifies that they have submitted all new required medical evidence with the request. Upon certification, and confirmation by the agency that the evidentiary record is complete, the agency will expedite processing of those claims without further development and proceed directly to adjudication.

Justification #2: The Social Security Administration currently has a significant backlog of pending cases at the reconsideration level. Like the initial level, the agency also assists in development of every reconsideration claim irrespective of the completeness of the medical record. Notably, many claims at the reconsideration level are fully developed at the time of appeal since the agency already assisted in the development of the record at the initial level. As stated above, placing a claim in a development queue when the record is already fully developed results in unnecessary delays and contributes to the backlog. The ability to expedite such claims without development and proceed directly to adjudication will avoid delays and free up resources for claims in which development is needed. We anticipate this will improve case processing times and reduce the backlog at the reconsideration level.

• Change #3: We are including a new Certification Statement which certifies that the claimant requests SSA to consider the claim as DDRC. The Certification Statement certifies that the claimant: submitted all known evidence which relates to whether the claimant is blind or disabled; is not aware of additional evidence which relates to whether the claimant is blind or disabled; will inform the agency about or submit any additional evidence the claimant becomes aware of; and will attend any consultative evaluation which SSA requires. We are appending the Certification Statement to disability forms used in conjunction with the DDRC program for respondents to use to opt into the DDRC process.

• Justification #3: The Agency will use the Certification to notify DDS and agency employees to expedite the claim to adjudication without development, unless review of the case indicates that further development is needed. Consistent with existing priority processing case types, Agency employees require some mechanism to distinguish which claims need to be prioritized. In addition, many priority case types are initiated by a claimant’s statements. The Certification Statement will provide notice to Agency employees that the claimant is opting into the DDRC program, and the claim potentially meets the conditions for priority processing.

These revisions will not affect the current burden for this form. We will implement the new certification statement upon OMB’s approval.

As we hope to begin implementation of this pilot by November 18, 2024, we are asking for OMB approval by November 15, 2024.