Disability Process Proposal (Revised Report) June 1994 Disability Process Reengineering Team U.S. Department of Health and Human Services Social Security Administration Date: June 30, 1994 From: Director, Process Reengineering Program Subject: Disability Reengineering Team Recommendations To: Commissioner of Social Security I am pleased to present to you the concluding recommendations of the Disability Process Reengineering Team for your consideration. In this document, you will find that the Team has made changes in response to reactions received during the public comment period, which has now closed. Despite these changes, the Team remained true to its original mandate to provide a high level process proposal in order to improve the disability process. For purposes of this interim step, the Team has revised the original proposal s format by removing much of the background information and description of the current process. Knowing that you will soon be releasing the final disability process redesign for the Agency, they believed it unnecessary to include that original level of detail in this document and are presenting only the new process description. As you will recall, 18 individuals with a variety of SSA and DDS backgrounds came together in October 1993 for the purpose of reengineering "the initial and administrative appeals system for determining an individual's entitlement to Social Security and Supplemental Security Income disability payments." After completing their initial tasks of analyzing the current process, obtaining process improvement recommendations from over 3,600 individuals and groups internal and external to the disability claim process, benchmarking with public and private sector organizations to identify "best practices," and modeling theoretical processes via computer, the Team presented an initial proposal on March 31, 1994. They distributed that proposal as widely as possible throughout SSA, the State DDSs, and to interested public and private individuals and organizations. They asked their audience for reactions to the proposal, for items of concern, and for additional ideas for improvement. During the comment period that began on April 1, 1994 and ended on June 14, 1994, the Team received over 6,000 written responses from SSA and DDS employees, employee unions, professional associations, members of the public, claimant representatives, physicians, State governors, claimant advocate groups, Federal components, and other interested parties. Members of the Team read, analyzed, and collated every one of those 6,000 comments so that no idea, reaction, or nuance would be overlooked. Group employee feedback discussions were held in over 80 sites across the country and facilitated dialogue with almost 2,000 SSA and DDS employees. In addition, team members conducted briefings and spoke with more than 3,000 individuals about their reaction to the proposal during this period. The comments can be categorized as follows: -- SSA received widespread praise for taking on the task of redesigning the disability claim process. The prevalent belief was that dramatic improvements are needed to provide better service and handle workloads more effectively. Whether fully supporting the proposal or not, most commenters expressed concern that the system is broken and that only radical redesign will solve the problems that currently exist. -- There was a very mixed reaction to the proposal. For the commenters who expressed in writing a reaction to the overall proposal, about 48% were favorable to the overall concept, 36% were unfavorable, 9% were neutral, and 7% believed no reengineering was needed. Very few responses were totally favorable or unfavorable toward the proposal--those liking it had concerns about some elements while those generally disliking it found portions which they believed would be improvements over the current process. -- The most popular concepts were: 1. the elimination of the reconsideration step; 2. the disability claim manager as the single point of contact; 3. the formulation of a single policy presentation for all decision makers; 4. the claimant as a partner in claim development; and 5. the elimination of the Appeals Council review as a mandatory step for claimants. -- The greatest concerns centered around: 1. the personal safety of a disability claim manager in the proposed environment; 2. the ability of one person to fulfill the disability claim manager role; 3. the concept of a pre-denial interview to be conducted by the disability claim manager; 4. the general aspects of the new disability methodology; and 5. the ability of the claimant to be a full partner in the new process. -- Many of the responses centered around how the proposal would be implemented and what organizational changes would be needed to make the new process work. -- There were concerns about whether the proposal would meet the objective of not increasing or decreasing program costs with fairly divided opinions about whether the new decisional methodology would allow or deny more claims than the current methodology. Reliance on treating sources as preferred sources of medical evidence and personal bias resulting from disability claim manager face-to-face meetings with claimants were often cited as the reason for the belief that there will be an overall increase in allowed claims. The new four-step evaluation process was cited as the most common reason for the belief that there will be an overall increase in denied claims. After considering all the responses, the Team reviewed the breadth of the initial proposal to determine concepts that needed to be revised, language that needed to be clarified, and detail that needed to be added. The following is a summary of modifications made to the initial proposal: -- Process Intake and Entry o Language was added to further explain the intent that a face-to-face interview is not required in every claim. o In response to the many questions received about the role of the disability claim manager and the ability of one person to perform the duties of the disability claim manager, a section was added that further clarifies the duties and responsibilities of the disability claim manager and the team environment. While the goal remains for the disability claim manager to be an individual employee, the implementation of this key concept may necessitate interim steps, such as developing disability claim management teams, until all process enablers are in place. o In response to expressed concerns, a statement of principles is included that disability claim managers will not discourage claimants from filing applications. o The discussion of SSA s responsibility for assisting claimants who are unable to assist in developing their own claim evidence was expanded to reemphasize the Team's perspective on this. o Commenters were puzzled by third-party certification requirements. To clarify the Team's intention, the proposal now provides SSA the flexibility to establish rules, standards, and procedures to ensure the integrity and effectiveness of these parties in their dealings with SSA. o The concept behind the initial adjudicator s interaction with the claimant after reviewing all available medical evidence was clarified by changing the term "predenial" to "predecision." o The automatic personal interview at the initial level was replaced by the requirement that a predecision notice be issued to the claimant advising of the right to submit additional evidence or request a personal conference within 10 calendar days. Numerous commenters felt that requiring an interview might antagonize the claimant and endanger the safety of the disability claim manager. Although these changes may provide some relief, the Team recognizes that employee safety issues need to be viewed and dealt with in the wider context of changes in society. An enhanced employee safety program will need to be a key feature in the implementation of the disability process redesign. -- Disability Decision Methodology o References to the Americans with Disabilities Act were removed. The Team concluded that the provisions of that statute are not directly related to individual determinations of disability. o One of the basic tenets of reengineering is to look at what the organization does and why it does it. During its analysis of the current process, the Team found that the basic objective of the process is to deliver accurate decisions as quickly as possible, but that unnecessary complexities and an oppressive level of detail in the current disability decision methodology are major factors in preventing SSA from achieving this objective. The Team sought to rectify this matter by proposing a new, streamlined disability decision methodology. However, the new methodology was seen by many commenters as being unnecessary to accomplish the disability process reengineering goal. While additional explanation for developing the new decisional methodology was added to the revised proposal, the underlying framework for the new methodology was not changed. The Team believes that a failure to address the problems found in the current methodology will defeat the entire effort to improve service and productivity. The key elements of a single employee as disability claim manager, defragmentation of the process, dramatically reduced processing times, and enhanced public understanding of the disability process will be difficult, if not impossible, to implement without changes to the disability decision methodology. o A statement was added to Step One of the new methodology to show that SSA will continue to evaluate work activity subsidies and special conditions when determining substantial gainful activity. o Some commenters incorrectly assumed an intent to circumvent the Sullivan vs. Zebley decision, and to minimize the efforts that went into developing the standards that are currently in place. Rather, the proposal acknowledges the need to develop a childhood disability methodology that, to the extent possible, remains consistent with the adult claim process. However, language which could have been construed to be critical of the current childhood methodology was removed. The Team has refined the childhood methodology to: (1) develop a simplified Index of Disabling Impairments, as in the adult process; (2) develop standardized functional assessment instruments for measuring a child s functional ability; and (3) retain the comparability standard, as in the current process, as the final step of the new childhood process. The Team also recommends that the development of functional assessment instruments for childhood be deferred until SSA has gained experience with functional assessment instruments for adults. -- Evidentiary Requirements o The references to the impact of universal health coverage on medical evidence development were removed because of the unknown future of such a program. o Many commenters expressed the belief that the proposal changes the evidentiary requirement of obtaining objective medical evidence from treating sources to that of obtaining only subjective evidence in support of the impairment allegation. The description of the standardized medical evidence request form was expanded to explain the types of information that will be collected and the continuing responsibilities of the treating sources to provide objective, claim-related evidence. o Consideration of evidence quality was added to the description of the national sliding medical evidence fee schedule, as suggested by several commenters. -- Administrative Appeals Process o Clarifying language was added to explain that the adjudication officer will only conduct an informal conference to narrow issues in dispute if the claimant has a representative. o The explanation of the adjudication officer s role in scheduling hearings for the administrative law judge was reworded to eliminate some confusion. -- Quality Assurance o Employee certification requirements were removed as the Team determined these would not reasonably enhance quality decisions. o The quality assurance section was expanded to better explain the review of administrative law judge decisions and to better define the role of a national claim processing system in the quality assurance process. o In response to many concerns, the Team has added additional remarks about fraud prevention points to emphasize that this potential must not be overlooked during the development of implementation plans. Based on changes to the proposal, the Team re-ran the computer model that was developed to predict performance of the new process. The processing time outcomes of the modelling have not changed from the original proposal. The time from a claimant s first contact with SSA until issuance of an initial decision will be reduced from an average of 155 days to less than 40 days. Similarly, the time from a claimant s first contact with SSA until issuance of a hearing decision will be reduced from an average of a year and a half to approximately 5 months. The radical nature of the proposal raised many implementation concerns during the public comment period. A great many issues remain to be addressed before the key elements of this proposal are adopted in a final process redesign. Many implementation comments expressed the belief that SSA needs to actively seek input from "line" workers and interested external parties about ways to best implement the process. The Team agrees that involvement of the wider internal and external communities in the implementation phase will assist in addressing many concerns as well as ensuring that better ways for delivering world-class service are not overlooked. We look forward to the broad implementation planning document that you will be issuing in conjunction with your final disability process redesign for the Agency that will describe how SSA will develop implementation plans. Since the Team was asked to keep to a high level view of process redesign and not address organizational issues, the initial redesign proposal purposefully did not mention specific components or organizations. The Team's efforts resulted in considerable public and employee concern about the future role of the State DDSs. I would like to take this opportunity to clarify that the Team's silence on the role of the DDSs was not meant to be a de facto recommendation for the elimination of the Federal/State partnership in the disability process. Nor is their silence regarding the role of the SSA field offices meant to be an implicit recommendation that the primary disability claim manager activity be concentrated at these sites. Considering the current and projected workloads of the disability programs it would be difficult to foresee a time when there would not be a continued role for the DDSs in a redesigned disability determination process. The expertise and skill of the DDS employees remain vital to our goal of providing world class service to customers. With the submittal of this final document, the commissioned work of the Disability Process Reengineering Team is complete. As with any effort of this magnitude, the Team views its proposal as a blueprint to guide the Agency toward its goal of providing world-class services and anticipates that modifications of the blueprint are inevitable. Realities pertaining to the changing nature of medical and information technology, program funding, and legislation will impact the ways in which the disability programs are administered over time. However, the 18 individuals who comprised the Team offer their continued support and assistance in any further development, refinement, and implementation of a reengineered disability process. It is difficult to put into words the sense of wonderment felt as we look back over the past year and see the tremendous accomplishments made by SSA and the entire disability community in developing this proposed vision of a new disability process--the beneficial dialogue that has developed among all the interested parties in the disability process; the heightened spirit of cooperation between individuals and groups that are committed to improving service to our customers; the knowledge we have gained as an Agency in standing back and looking anew at our basic business concepts; and the realization that we are standing at the threshold of a new beginning. There are many people who deserve thanks for helping us get to this point. Every person who provided his/her time and energy to support this effort, every person who got involved in the discussions or made the effort to send in a comment, and every person who set aside other priorities to take an active role in reengineering added to our inspiration and motivation. Finally, you and Principal Deputy Commissioner Larry Thompson have our gratitude and respect for the extraordinary leadership you have shown in initiating and guiding this effort. Rhoda M. G. Davis Attachment NEW PROCESS Overview Claimants for disability benefits under the new process will be provided a full explanation of SSA s programs and processes at the initial contact with SSA. Claimants will be offered a range of options for filing a claim and conferring with decisionmakers, using various modes of technology to interact with SSA. Claimants, who are able to do so, along with third parties and representatives who act on their behalf, will assist in the development of their claims, deal with a single contact point in the Agency, and have the right to a personal interview with decisionmakers at each level of the process. The number of steps will be consolidated and the issues on appeal will be focused. If the claim is approved, the effectuation of payment to the claimant, eligible dependents and the representative will be streamlined. The new process will result in correct decisions at the earliest possible point in the process. A correct disability decision is one that appropriately considers whether an individual does or does not meet the factors of entitlement for disability as defined by SSA s statute, regulations, rulings and policies. Correct decisions in the new process depend on: a simplified decision methodology that provides a common frame of reference for deciding disability at all levels of the process; consistent direction and training to all adjudicators; enhanced and targeted collection and development of medical evidence; an automated and integrated claims processing system that will assist adjudicators in evidence gathering, analysis and decisionmaking; and a single, comprehensive quality review process across all levels. The goal of the new process is to guide all adjudicators at all levels of the process, who will be using the same standards for decisionmaking, to making correct decisions in an easier, faster, and more cost-effective manner. A disability claim manager will handle most aspects of the disability claim at the initial level, thus eliminating many steps caused by numerous employees handling discrete parts of the claim (handoffs) and the time lost as the claim waits at each employee s workstation to be handled (queues). This will reduce the time needed to rework files and redevelop information from the same evidentiary sources. Levels of appeal will be combined and improved, reducing the need to redevelop nonmedical eligibility factors after a favorable decision because less time will have elapsed since initial filing. The new process will enable the current work force to handle an increased number of claims, freeing the most highly specialized staff (physicians and Administrative Law Judges (ALJs)) to work on those cases and tasks that make the best use of their talents, and targeting expenditures for medical evidence to those areas most useful in determining disability. Employees will perform a wider range of functions, using their skills to their full potential, enabling them to meet the needs of claimants and minimize unnecessary rework. The new process will facilitate employees ability to do the total job by providing technology and the training and support to use that technology. [For ease of reference, references in this proposal to SSA or employees include both Federal and State employees who participate in the disability process.] DETAILED DESCRIPTION OF NEW PROCESS Process Entry and Intake SSA Will Customize Its Disability Claims Entry and Intake Processes to Maximize Access, Efficiency, Accuracy, and Personal Service The disability claims entry and intake processes will reflect the SSA commitment to providing world-class service to the public. The hallmarks of the process will be accessible, personal service that ensures timely and accurate decisions. SSA will work to make potential claimants better informed about the disability process and fully prepare them to participate in it. SSA will also be flexible in providing modes of access to the claims process that best meet the needs of claimants and the third parties and representatives who act on their behalf. SSA will provide claimants with a single point of contact for all disability claims-related business. Finally, SSA will ensure that the disability decisionmaking process promotes timely and accurate decisions. SSA Will Make Information About Its Disability Programs Available to Potential Claimants Prior to Entry Into the Process SSA will make available to the general public comprehensive information packets about the Disability Insurance (DI) and Supplemental Security Income (SSI) disability programs. [For ease of reference, references in this proposal to the SSI Disability Program include the Program for those who are blind.] The packets will include information about the purpose of the disability programs; the definition of disability; the basic requirements of the programs; a description of the adjudication process; the types of evidence needed to establish disability; and the claimant s role in pursuing a claim. The packets may be customized locally to include referral information about other programs and resources for legal representation. The goal is to target the information to likely beneficiaries and to ensure that potential claimants and other groups involved in the disability process have a better understanding of SSA disability programs, their medical and nonmedical requirements, and the nature of the decisionmaking process. This should result in reduction of general inquiries from members of the public unfamiliar with SSA disability programs and increase the number of claimants who enter the disability process knowledgeable and prepared to assume responsibility for pursuing their claims. SSA will make disability information packets commonly available in the community, both at facilities frequented by the general public (libraries, neighborhood resource centers, post offices, the Department of Veterans Affairs offices, and other Federal government installations) and at facilities frequented by potential claimants (hospitals, clinics, other health care providers, schools, employer personnel offices, State public assistance offices, insurance companies, and advocacy groups or third-party organizations that assist individuals in pursuing disability claims). SSA studies have shown that claimants frequently rely on advice from their physicians and from State public assistance personnel in deciding whether to file a claim for disability benefits. Therefore, SSA will make a special effort to target its public information activities at these and other known sources of referrals for claims. SSA will also make the disability information packets available electronically. In addition to comprehensive program information, the packets will describe the types of information that a claimant will need to have readily available when the individual files a claim. It will also contain two basic forms: the first, designed for completion by the claimant, will include general identifying information and will serve as the claimant s starter application for benefits; the second, designed for completion by the treating source(s), will request specific medical information about a claimant s alleged impairments. SSA will encourage claimants who are able to do so to review the information in the packet and have the basic forms completed prior to telephoning or visiting an SSA office to apply for disability benefits. Claimants will be encouraged to immediately submit starter applications to protect the filing dates for benefits. The starter application will serve as a claim for both programs, but it will include a disclaimer should the claimant want to preclude filing for benefits based on need (i.e., SSI). SSA Will Permit Claimants to Choose the Mode of Entry Into the Process That Best Meets Their Individual Needs The disability claims entry process will be multi-faceted, allowing claimants and third parties and representatives who assist them the maximum flexibility in deciding how they will participate in the process. Claimants may choose to enter the disability claims process by telephoning the SSA toll-free number, electronically, by mail, or by telephoning or visiting a local office. Claimants may also rely on third parties to provide them assistance in dealing with SSA. Finally, claimants may formally appoint representatives to act on their behalf in dealing with SSA. SSA field managers will also have the flexibility to tailor the various service options to their local conditions, considering the needs of client populations, individual claimants, and the availability of third parties who are capable of contributing to the application process. If an individual submits a starter application by mail or electronically, SSA will contact the claimant to schedule an appointment for a claims intake interview or, at the claimant s option, conduct an immediate intake interview by telephone. If an individual telephones SSA to inquire about disability benefits, the SSA contact will explain the requirements of the disability program, including the SSA definition of disability, and provide a general explanation of evidence requirements. The SSA contact will determine whether the individual has the disability information packet, and mail it or advise the claimant regarding possible means of electronic access. If an individual indicates a desire to file a claim at that time, the SSA contact will complete the starter application available on-line as part of the automated claims processing system to protect the claimant s filing date and schedule an appointment for a claims intake interview. The interview may be in person or by telephone at the claimant s option. If the individual has no medical treating sources, the SSA contact will annotate this information within the on-line claim record. If a claimant visits an SSA office, the SSA contact will refer the claimant for an immediate claims intake interview or, at the claimant s option, complete the starter application and schedule a future appointment for an intake interview. In all cases, appointments for claims intake interviews will be made available within a reasonable time period, generally 3 to 5 working days, but no later than two weeks. Local management will determine how to best accommodate claimants needs in learning about the disability process and completing a claims intake interview. Depending on an individual s circumstances, such accommodation may involve: referral to the nearest location for obtaining an information packet which can then be mailed in; an immediate telephone or in-person interview; arranging for an on-site visit from an SSA representative; or referral to appropriate third parties who can provide assistance. Additionally, depending on the nature of the individual s disability, SSA may encourage the individual to file in person when it appears that a face-to-face interview will assist in the proper claims intake and development; however, face-to-face interviews will not be required in every claim. Face-to-face interviews, when considered necessary by either the claimant or SSA, can also be accomplished via videoconferencing. In any case, SSA will make every reasonable effort to meet the needs of the claimant in completing the application process. Every effort will be made to provide services to members of the public who have limited knowledge of English. Similarly, local managers will modify the claims entry and intake process to provide maximum flexibility for representatives who act on behalf of claimants or third parties who can assist claimants in completing the application process. Such accommodations may include, but are not limited to: 1) using automated means to interact with SSA to protect a claimant s date of filing (e.g., telephone, fax, or E-mail); 2) providing appointment slots for third parties to accompany claimants to interviews or to provide assistance during telephone claims on a claimant s behalf; 3) out-stationing SSA personnel at a third-party location to obtain applications and/or medical evidence, when appropriate; and 4) providing open appointment scheduling to permit claimants to contact SSA within a flexible band of time. Interested third parties will be encouraged to participate in the development of claims. Local managers will also conduct outreach efforts that are designed to meet the needs of hard-to-reach populations or assist those individuals unable to access the SSA claims process without considerable intervention. As appropriate, outreach efforts may be facilitated through videoconferencing, teleconferencing or other electronic methods of obtaining and processing claims information to provide timely service despite claimants geographic or social isolation. A Disability Claim Manager Will Be Responsible for a Disability Claim from Intake Through Payment A disability claim manager will have responsibility for the complete processing of an initial disability claim. The disability claim manager will be a highly-trained individual who is well-versed in both the medical and nonmedical aspects of the disability programs and has the necessary knowledge, skills, and abilities to conduct personal interviews, develop evidentiary records, and adjudicate disability claims to payment. However, the disability claim manager will also be able to call on other SSA resources, including medical and technical support personnel, to provide advice and assistance in the claims process. The disability claim manager will rely on an automated claims processing system that will permit the disability claim manager to: gather and store claims information; develop both medical and nonmedical evidence; share necessary facts in a claim with medical consultants and specialists in nonmedical or technical issues; analyze evidence and prepare well-rationalized decisions on both medical and nonmedical issues; and produce clear and understandable notices that accurately convey all necessary information to claimants. In making decisions, disability claim managers will use a simplified decision methodology that effectively streamlines evidence collection, and will rely on standards for decisionmaking that are used at all levels of the process. The disability claim manager will be the focal point for claimant contacts throughout the claims intake and adjudication process. The disability claim manager will explain the disability programs to the claimant, including the definition of disability and how SSA determines if a claimant meets the disability requirements. The disability claim manager will also convey what the claimant will be asked to do throughout the process; what the claimant may expect from SSA during this process, including anticipated timeframes for decision; and how the claimant can interact with the disability claim manager to obtain more information or assistance. The disability claim manager will advise the claimant regarding the right to representation and provide the appropriate referral sources for representation. The disability claim manager will also advise the claimant regarding community resources, including the names of organizations that could help the claimant pursue the claim. The goal will be to give the claimant access to the decisionmaker and allow for ongoing, meaningful dialogue between the claimant and the disability claim manager. The Scope of the Disability Claim Manager s Duties and Responsibilities The broad scope of the disability claim manager s duties and responsibilities, as outlined above and discussed in more detail in the following sections, presupposes a well-trained, skilled, and highly motivated workforce that has the program tools and technological support to issue quality decisions. Although disability claim managers will work exclusively with the disability programs, they will perform multiple tasks instead of singular activities, enabling them to experience the direct relationship between their actions and the final product. Varying levels of job complexity provide the opportunity for personal development, growth, and learning. In carrying out their duties and responsibilities, disability claim managers will work in a team environment with internal medical and nonmedical experts, who provide advice and assistance with complex case adjudication, as well as technical and other clerical personnel who may handle more routine aspects of case development and payment effectuation. Where disability team members cannot be physically co-located, they can share information via the automated claims processing system and remain in communication using telephone or videoconferencing. Each disability team member will have at least a basic familiarity with all the steps in the process and an understanding of how he or she complements another s efforts; team members will be able to draw upon each other s expertise on complex issues. In this team environment, and with the proper training, program tools (a simplified decision methodology and one set of standards for decisionmaking) and technological support, one individual should be able to handle the duties and responsibilities of the disability claim manager. An individual employee as the disability claim manager is basic to the objective of a single point of Agency contact for claimants. However, in the near term, it may be necessary to consider whether the duties of a disability claim manager may be more appropriately carried out by more than one individual and, therefore, whether it is necessary to expand the disability team described above to include additional employees. Claim complexity, customer service needs, and service area location may dictate a need for flexibility in delineating the specific duties of the individuals who comprise the members of the disability team. In the near term, entry level positions will be developed in which employees perform one or more duties of the disability claim manager while gaining experience and qualifying for greater responsibility. As the program tools and technological support, which are the underpinnings of the new process, are fully implemented, it is envisioned that team duties and positions will be modified and consolidated as necessary to fully realize the goal of an individual employee as disability claim manager. Claims Intake and Development Will Be Directed at Reaching a Decision in the Most Timely and Accurate Manner The disability claim manager will conduct a thorough screening of the claimant s medical and nonmedical eligibility factors. If the claimant appears ineligible for either disability program based on the claimant s allegations and evidence presented or available at the time of the claim intake interview, the disability claim manager will explain this to the claimant. However, the decision regarding whether to file an application will be the claimant s alone and the disability claim manager will not discourage a claimant from filing an application. If the claimant decides not to file a claim, the disability claim manager will follow existing procedures for closing out an oral inquiry. If the claimant decides to file, the disability claim manager will complete appropriate application screens from the automated and fully integrated (DI and SSI) claims processing and decision support system. Impairment-specific questions will assist the disability claim manager in obtaining information that is relevant and necessary to a disability decision. Based on the claimant s statements and the evidence that is available at the interview, the disability claim manager will determine the most effective way to process the claim. If the evidence is sufficient to decide the claim, the disability claim manager will take necessary action to issue a decision and, if necessary, effectuate payment. The disability claim manager will determine what additional evidence is required to adjudicate the claim and will take steps to obtain that evidence. Such steps may include asking the claimant to obtain further medical or nonmedical evidence if the claimant is able to do so, requesting medical evidence directly from treating sources, or ordering further medical evaluations. As in the current process, SSA will pay for the reasonable cost of providing existing medical evidence. If the claimant has a representative, the representative will have the responsibility to develop medical and nonmedical evidence. The disability claim manager will decide whether to defer nonmedical development (e.g., requesting SSI income and resource information, or developing DI dependents claims) or do it simultaneously with development of the disability aspects of the claim. In making this decision, the disability claim manager will take into account the type of disability alleged, evidence and other information presented by the claimant, and other relevant circumstances, e.g., terminal illness, homelessness or difficulty in recontacting the claimant. Because the disability claim manager maintains ownership of the claim throughout the initial decision-making process, the disability claim manager will be in the best position to choose the most efficient and effective manner of providing claimants with timely and accurate decisions while meeting claimants individual service needs. Although the disability claim manager will be responsible for the adjudication of an initial claim, the disability claim manager will call in other staff resources, as necessary. With respect to disability decisionmaking, the disability claim manager will, in appropriate circumstances, refer claims to medical consultants to obtain expert advice and opinion. SSA will develop guidelines to assist the disability claim manager in determining when expert medical advice is appropriate. Similarly, other staff resources will be called upon for technical support in terms of certain claimant contacts and status reports; development of nondisability issues including auxiliary claims or representative payee issues; and payment effectuation. However, the disability claim manager will make final decisions on both the medical and nonmedical aspects of the disability claim. Claimants Will Be Partners in the Processing of Their Disability Claims Throughout the disability claims process, SSA will encourage claimants to be full partners in the processing of their claims. Many claimants are able to obtain the documentation necessary to develop their record, either on their own or with the assistance of a third party. Others have substantial difficulty doing so, and may have no third party to assist them. Given the range of claimant capabilities, SSA will retain ultimate responsibility for development of claims when claimants are not formally represented. To the extent that they are able, claimants and their families and other personal support networks will actively participate in the development of evidence to substantiate their claim for disability benefits. SSA will provide assistance and/or engage third-party resources, when necessary and appropriate. SSA will keep claimants informed of the status of their claims, advise claimants regarding what additional evidence may be necessary, and inform claimants what, if anything, they can do to facilitate the process. At the completion of the claims intake interview, the disability claim manager will issue a receipt to the claimant that will identify what to expect from SSA and the anticipated timeframes. It will also identify what further evidence or information the claimant has agreed to obtain. Finally, it will provide the name and telephone number of the disability claim manager for any questions or comments which the claimant may have, including any difficulty in obtaining the information the claimant agreed to obtain. SSA Will Recognize That Some Third Parties Can Develop Complete Application Packages Certain third-party organizations may be willing to provide a complete disability application package to SSA. Based on local management s assessment of service area needs and the availability of qualified organizations, SSA will recognize third-party organizations who are capable of providing a complete application package, including appropriate application forms and medical evidence necessary to adjudicate a disability claim. In such claims, SSA will permit the third party to identify potential claimants, screen for medical and nonmedical criteria, and contact SSA to protect the filing date. The third party will interview the claimant; complete all applications and related forms; obtain completed treating source statements; and obtain additional medical evaluations, when appropriate. Using procedures agreed on with local management, the third party will submit claims for adjudication by a disability claim manager. SSA will monitor such third parties to ensure that quality service is provided to claimants and to prevent fraud. SSA may establish rules, standards, and procedures for third-party interaction with claimants and SSA. Third parties may be required to undergo periodic program, procedural or software training, and may be required to meet standards for staffing and automation support. In individual cases, disability claim managers may elect to contact the claimant for the purpose of verifying identity or other claims-related issues, as appropriate. SSA will also perform ongoing document verification on a sample basis to assure the integrity of claims submitted by third parties. The automated claims processing system will facilitate effective monitoring of the claims-taking and evidence submission practices of third parties by permitting random and/or targeted selection of claim files involving specific third parties or specific types of evidence. Claimants Will Have the Opportunity for a Personal Interview Before SSA Makes an Initial Disability Denial Decision When the evidence does not support an allowance, the disability claim manager will issue a predecision notice advising the claimant of what evidence has been considered and providing the opportunity to submit further evidence, if any, and/or the opportunity for a personal interview within 10 calendar days. The predecision notice will further advise the claimant that if he or she does not submit evidence or request a personal interview within the 10 days, the claim will be decided based on the evidence of record. If the claimant requests a personal interview, the disability claim manager will conduct the interview in person, by videoconference, or by telephone, as the disability claim manager determines is appropriate under the circumstances. In appropriate circumstances, this predecision interview may be held concurrently with the initial intake interview. If the claimant identifies further available evidence, the disability claim manager will advise the claimant to obtain the evidence if the claimant is able to do so or, as necessary, assist the claimant in obtaining it. The claimant will be advised of the specified timeframes for submitting additional evidence. In preparing the predecision notice, the disability claim manager will rely on existing information available on-line as part of the automated claims processing and decision support system. As part of the evidence gathering process, the disability claim manager will have previously analyzed all the medical and non-medical information gathered, and entered the pertinent data into the electronic claim record. The decision support system will use the accumulated data in the electronic record to assist the disability claim manager in producing the predecisional notice. Initial Disability Decisions Will Use a Statement of the Claim Approach The initial disability determination will use a statement of the claim approach. The statement of the claim will set forth the issues in the claim, the relevant facts, the evidence considered, including any evidence or information obtained as a result of the predecisional notice, and the rationale in support of the determination. The statement of the claim not only reflects the SSA commitment to fully explaining the basis for its action but also recognizes that claimants need clear information about the basis for the determination to make an informed decision regarding further appeal. As with the predecisional notice, much of the information that will provide the basis for the statement of the claim will be available on-line as part of the automated claims processing and decision support system. Adjudicators will create the statement of the claim and whatever supplementary information is necessary for a legally sufficient notice to the claimant based on the information in the decision support system. For allowance decisions, the statement of the claim will be more abbreviated than for denial decisions; however, it will contain sufficient information to facilitate quality assurance reviews and/or continuing disability reviews. The statement of the claim will be part of the on-line claim record and will be available to other adjudicators as the basis and rationale for the Agency action, if the claimant seeks further administrative review. In making initial disability determinations, disability claim managers will rely on standards for decisionmaking that are used at all levels of the process. SSA will develop a single presentation of all substantive policies used in the determination of eligibility for benefits and all decisionmakers will be bound by these same policies. These policies will be published in accordance with the Administrative Procedure Act. Expert systems will be developed to facilitate the development and delivery of disability policy as an integrated part of the automated claims processing system. Disability Decision Methodology The Methodology for Deciding Disability Claims Will Promote Consistent, Equitable, and Timely Disability Decisions SSA must have a structured approach to disability decisionmaking that takes into consideration the large number of claims (2.7 million initial disability decisions in Fiscal Year 1994) and still provides a basis for consistent, equitable decisionmaking by adjudicators at each level. The approach must be simple to administer, facilitate consistent application of the rules at each level, and provide accurate results. It must also be perceived by the public as straightforward, understandable and fair. Finally, the approach must facilitate the issuance of timely decisions. As described further below, the goal of the new decisionmaking approach is to focus decisionmaking on the functional consequences of an individual s medically determinable impairment(s). The new process will assess an individual s functional ability, assess it once in the process, do it directly rather than indirectly, and rely on standardized functional assessment instruments to do so. By focusing on function, the new approach will permit both providers of medical evidence and adjudicators at all levels of the process to use a consistent frame of reference for deciding disability, regardless of the diagnosis. It will also facilitate evidence collection by lessening the need for voluminous medical records and, instead, look at the consequences of medical findings, i.e., function. Ultimately, adjudicators will make correct decisions in an easier, faster, and more cost-effective manner. The cornerstone of the new approach is, of course, the statutory definition of disability. Under the statute, disability (for adults) means the: ...inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months...An individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy... ( 223(d) of the Social Security Act) Disability Decisionmaking for Adult Claims Will Be a Four-Step Evaluation Process The new decision-making approach is the foundation on which SSA will base the claim intake process and evidence collection. The focus will be, first, to document the medical basis for concluding that an individual has a medically determinable physical or mental impairment. Second, once the evidence establishes a medically determinable impairment(s), decisionmakers will, in most cases, use additional medical findings to determine the link between the disease or impairment and the loss of function. The disability decision methodology will consist of four steps that flow from the statutory definition of disability. They are: Step 1 Is the individual engaging in substantial gainful activity? If yes, deny. If no, continue to Step 2. Step 2 Does the individual have a medically determinable physical or mental impairment? If no, deny. If yes, continue to Step 3*. Step 3 Does the individual have an impairment included in the Index of Disabling Impairments i.e., an impairment that clearly restricts functional ability to a degree that the individual is unable to engage in substantial gainful activity without measuring the individual s functional ability? If yes, allow*. If no, continue to Step 4. Step 4 Does the individual have the functional ability to perform substantial gainful activity? If yes, deny. If no, allow*. *An impairment must meet the duration requirement of the statute; a denial is appropriate for any impairment that will not be disabling for 12 months. Step 1 Engaging in Substantial Gainful Activity Any individual who is engaging in substantial gainful activity will not be found disabled regardless of the severity of the individual s physical or mental impairments. Under the new approach, SSA will simplify the monetary guidelines for determining whether an individual who is an employee (except those filing for benefits based on blindness) is engaging in substantial gainful activity. In making this determination, SSA will evaluate the work activity based on the earnings level that is comparable to the upper earnings limit in the current process (i.e., $500). A single earnings level will simplify the evidentiary development necessary to evaluate work activity and establish the appropriate onset date of disability. Additionally, SSA will continue to exclude impairment-related work expenses in evaluating whether an individual s earnings constitute substantial gainful activity. SSA will continue to evaluate whether work activity is done under special conditions and/or is subsidized. Finally, SSA will continue to use separate earnings criteria to evaluate the work activity of blind individuals in the DI program as in the current process. Step 2 Medically Determinable Impairment Because the statute requires that disability be the result of a medically determinable physical or mental impairment, the absence of a medically determinable impairment will justify a finding that the individual is not disabled. Under the new approach, decisionmakers will consider whether an individual has a medically determinable impairment or combination of impairments, but will no longer impose a threshold severity requirement. Rather, the threshold inquiry will be whether the individual has a medically determinable physical or mental impairment or combination of impairments. To establish the presence of a medically determinable impairment, evidence must show an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. Decisionmakers will continue to evaluate the existence of a medically determinable impairment based on a weighing of all evidence that is collected, recognizing that neither symptoms nor opinions of treating physicians alone will support a finding that the individual has a medically determinable impairment or combination of impairments. There must be medical signs and findings established by medically acceptable clinical or laboratory diagnostic techniques which show the existence of a physical or mental impairment or combination of impairments. Depending on the nature of an individual s alleged impairment(s), SSA will consider the extent to which medical personnel other than physicians can provide evidence of a medically determinable impairment. There will be an exception to the requirement that evidence include medically acceptable clinical and/or laboratory diagnostic techniques. This will occur when, even if SSA accepted all of the individual s allegations as true, SSA still could not establish a period of disability; under these circumstances, SSA will not require evidence to establish the existence of a medically determinable impairment. For instance, if an individual describes a condition as one that will clearly not meet the 12-month duration requirement, (e.g., a simple fracture), SSA will deny the claim on the basis that even if the allegations were medically documented, SSA could not establish a period of disability. Step 3 Index of Disabling Impairments If an individual has a medically determinable physical or mental impairment documented by medically acceptable clinical and laboratory techniques, and the impairment will meet the duration requirement, the decisionmaker will compare the individual s impairment(s) against an index of severely disabling impairments. The index will describe impairments so severely debilitating that, when documented, can be presumed to equal a loss of functional ability to perform substantial gainful activity without assessing the individual s functional ability. The index will be consistent with the statutory definition of disability by limiting the presumption of inability to perform substantial gainful activity, without considering age, education and previous work, to a relatively small number of claims with the most severe disabilities. Individual functional ability will be assessed in all other cases in a consistent manner at Step 4 in the process. Because the index will permit severely disabling impairments to be identified quickly and easily, it will only consist of descriptions of specific impairments and the medical findings that are used to substantiate the existence and severity of the particular disease entity. The medical findings in the index will be as nontechnical as possible and will exclude such things as calibration or standardization requirements for specific tests and/or detailed test results (e.g., pulmonary function studies or electrocardiogram tracings). The index will be easy to understand and simple enough so that laypersons will be able to understand what is required to demonstrate a disabling impairment in the index. Additionally, SSA will draw no conclusions about the effect of an individual s impairments on his or her ability to function merely because an individual s impairment(s) does not meet the criteria in the index. Finally, SSA will no longer need the concept of medical equivalence in relation to the index. Because impairments included in the index are presumed to limit functional ability so as to preclude substantial gainful activity without reference to an individual s age, education and previous work, a combination of impairments, or an impairment closely related to one that is in the index, would be found disabling when an individual s functional ability is assessed. Therefore, rules for determining equivalence for impairments in the index will not be necessary. Step 4 Ability to Engage in Any Substantial Gainful Activity The majority of disability claims will be evaluated using a standardized approach to measuring functional ability to perform substantial gainful activity. This standardized approach will realistically measure an individual s functional ability to do the principal dimensions of work and task performance. The approach will be known and accepted in the medical community. It will be universally used by public and private disability programs in which benefits are based on the ability to perform work-related duties. Standardizing the approach to assessing individual functional ability will facilitate consistent decisions regardless of the professional training of the decisionmakers in the disability process. In using a standardized approach to measuring functional ability, SSA will be assessing the individual s physical and mental abilities to perform work-related activities. Individualized assessments of functional ability will also consider the effects of the individual s education. Once the individualized assessment of functional ability is made, the individual s age will determine whether his or her functional ability is compared against the demands of the individual s previous work or against a baseline of occupational demands. The baseline will describe a range of work-related functions that represent work that exists in significant numbers in the national economy that does not require prior skills or formal job training. SSA Will Develop Instruments That Provide A Standardized Measure of Functional Ability SSA will develop, with the assistance of the medical and advocacy community and other outside experts from public and private disability programs, standardized instruments or protocols which can be used to measure an individual s functional ability. These standardized measures of functional ability will be linked to clinical and laboratory findings to the extent that SSA needs to document the existence of a medically determinable impairment or combination of impairments. However, extensive development of all available clinical and laboratory findings will not always be necessary in evaluating an individual s functional ability to perform basic work activities. Functional assessment instruments will be designed to measure, as objectively as possible, an individual s abilities to perform a baseline of occupational demands that includes the principal dimensions of work and task performance, including primary physical, psychological, and cognitive processes. Examples of task performance include, but are not limited to: physical capabilities, such as sitting, standing, walking, lifting, pushing, pulling; mental capabilities, such as understanding, carrying out, and remembering simple instructions; using judgment; responding appropriately to supervisors and co-workers in usual work situations; and responding appropriately to changes in the routine work setting; and postural and environmental limitations. To the extent that current regulations already set forth guidelines for evaluating an individual s ability to perform certain of these tasks, they will be utilized in the new process. Functional assessment instruments will be designed to realistically assess an individual s abilities to perform a baseline of occupational demands. To the extent possible, objective measures of function will be developed. However, a realistic and individualized assessment of function may require, in addition to objective measures of function, a standardized means or standardized tools for collecting information regarding an individual s perceptions of his or her functioning, the effect of symptoms, including pain, and the individual s activities of daily living. Functional assessment instruments may also require impairment-specific measures to account for the episodic nature of certain impairments or to meet a more general need for longitudinal information. SSA will be primarily responsible for documenting functional ability using the standardized functional assessments. In the near term, SSA will solicit information on which to base a functional assessment from treating medical sources, other nonmedical sources, and from claimants in a manner that is similar to the current process. In the future, the standardized functional assessments will be widely available and accepted so that functional assessments may be performed by a variety of medical sources, including treating sources. The SSA goal will be to develop functional assessment instruments that are standardized, that accurately measure an individual s functional abilities and that are universally accepted by the public, the advocacy community, and health care professionals. Ultimately, documenting functional ability will become the routine practice of physicians and other health care professionals, such that a functional assessment with history and descriptive medical findings will become an accepted component of a standard medical report. Disability insurance payers have incentives to participate in the research necessary to develop standardized functional assessments and some private insurers have already expressed interest in working with SSA in this effort. Standardized functional assessments will not only provide SSA with the functional information necessary to make disability decisions; functional measurements will also assist insurance payers in developing provider reimbursement levels relating to rehabilitation and in assuring quality in rehabilitation programs by permitting assessment of the relationship between rehabilitative interventions and outcomes. Ultimately, the use of the same functional assessment measurements by both SSA and medical insurance payers will facilitate the cooperation and participation of the medical community in developing, refining, and implementing them. SSA Will Identify Baseline Occupational Demands That Represent Substantial Gainful Activity SSA will use the results of the standardized functional assessment in conjunction with a new standard that SSA will develop to describe basic physical and mental demands of a baseline of work that represents substantial gainful activity and that exists in significant numbers in the national economy. To develop the new approach, SSA will conduct research and, working in conjunction with outside experts, will specifically identify the activities that comprise a baseline of occupational demands needed to perform substantial gainful activity. The baseline will describe a range of work-related functions that represent work that exists in significant numbers in the national economy. In establishing the work-related functions that comprise an appropriate baseline of occupational demands, SSA will ensure that: 1) the functional activities are a realistic reflection of the demands of occupations that exist in significant numbers in the national economy; and 2) the occupations are those that can be performed in the absence of prior skills or formal job training. The Department of Labor s Advisory Panel for the Dictionary of Occupational Titles (DOT) has made recommendations for developing a new DOT by 1996 which will be a data base system that collects, produces, and maintains accurate, reliable, and valid information on all occupations in the national economy. This new system will provide comprehensive occupational data that includes, but is not limited to: physical demands of work; sensory/perceptual requirements; cognitive job demands; physical working conditions; and job characteristics such as pace or intensity of work, and the scope of interactions with others. The development of a national data base with detailed occupational information should assist SSA in conducting the initial research necessary to identify a baseline of occupational demands that represents work existing in significant numbers in the national economy. It should also provide a mechanism to ensure that the baseline of occupational demands remains current and reflects changes in the national economy over time. The Effect of Education on Ability to Perform Substantial Gainful Activity The statute recognizes that education may play a role in an individual s ability to perform substantial gainful activity. Experience demonstrates that educational level alone, i.e., the numerical grade level that an individual has attained, may not be a good indicator of ability to function. For example, completion of a certain educational level in the remote past, without any practical application of that education in recent work activity, has no positive effect on an individual s ability to perform substantial gainful activity. Similarly, completion of a certain grade level does not necessarily represent mastery of the subject matter. In relying on standardized functional assessments, SSA will be measuring an individual s ability to perform the principal dimensions of work and task performance, including primary physical, psychological, and cognitive processes, and the positive effects of education will be appropriately reflected in the assessment of an individual s cognitive abilities. Thus, evaluation of a claimant s educational level will be done as an integral part of establishing the functional ability of that individual. The baseline of occupational demands will not reference prior skills or significant formal job training. The issue of whether literacy and/or specific communication or language skills will be a factor in disability evaluation depends on the extent to which such skills are occupational demands of work existing in significant numbers in the national economy. In conducting the necessary research to identify the occupational demands of baseline work that represents work existing in significant numbers in the national economy, SSA will need to consider whether literacy or specific communication and language skills are required as occupational demands. The Effect of Age on Ability to Perform Substantial Gainful Activity The effect of aging on the ability to perform substantial gainful work is very difficult to measure, especially in the context of today s world when individuals are living longer than preceding generations. Despite this change, the demographic characteristics of those preceding generations continue to provide the framework for disability decisionmaking because SSA s approach for deciding disability has changed little since the inception of the DI program. The statute recognizes that age should be considered in assessing disability on the assumption that the ability to make a vocational adjustment to work other than work an individual has previously done may become more difficult with age. In determining the impact of age, recognition should be given to the changes that occur with each succeeding generation. Accordingly, in the new process, SSA will establish an age criterion in relation to the full retirement age. The full retirement age will gradually increase over time, based on the recognition that succeeding generations can expect to remain in the workforce for longer periods than the preceding generation. In applying age criterion under the new process, an individual who falls within the prescribed number of years preceding the full retirement age will be considered as nearing full retirement age. In establishing what the prescribed number of years should be, SSA will conduct research and consult with outside experts on the relationship between age and an individual s ability to make vocational adjustments to work other than work the individual has done in the recent past. SSA will rely on the age of the individual in relation to the full retirement age to decide which of two decision paths to follow as described in the next two sections. Individuals Who Are Not Nearing Full Retirement Age For an individual who is not nearing full retirement age, SSA will compare the individual s functional abilities against the functional demands of the baseline work. The ability to perform the baseline work will represent a realistic opportunity to perform substantial gainful activity that exists in significant numbers in the national economy and a finding of disability will not be appropriate. However, anyone who cannot perform the baseline work will be considered unable to engage in substantial gainful activity, and a finding of disability will be justified. The range of work represented by less than the baseline will be considered so narrow that despite any other favorable factors, such as young age or higher education or training, an individual would not be expected to have a realistic opportunity to perform substantial gainful work in the national economy. For individuals who are not nearing full retirement age, the ability or inability to perform previous work is not a significant factor. These individuals should be capable of making a vocational adjustment to other work, as long as they are functionally capable of performing the baseline work. Individuals Who Are Nearing Full Retirement Age For individuals who are nearing full retirement age, SSA will compare the individual s functional abilities against the functional demands of the individual s previous work. Individuals nearing full retirement age can not be expected to make a vocational adjustment to work other than work they have performed in the recent past. However, consistent with the statute, if an individual, even one nearing full retirement age, is capable of performing his or her previous work, SSA will find that the individual is not disabled. For those individuals who have no previous work, SSA will compare the individual s functional ability to the range of work-related functions that represent work that exists in significant numbers in the national economy, i.e., baseline work, and a finding of not disabled will be appropriate if the individual is capable of performing the baseline work. In such claims, when the individual has no previous work related to the existence of his or her impairment(s) or lack of education, a finding of disability will not be appropriate because the individual retains the functional ability to perform a range of work-related functions that represent work that exists in significant numbers in the national economy. In contrast, those individuals who have significant functional limitations caused by a medically determinable impairment and lack of education would not be able to perform a range of work-related functions that represent work existing in significant numbers in the economy. Such individuals would be found disabled, as they are today. SSA Will Rely on Medical Consultants to Provide Necessary Expertise in the Decisionmaking Process SSA will continue to rely on medical consultants to provide expert advice and opinion regarding medical questions and issues that will arise in deciding disability claims. Disability adjudicators at all levels of the administrative review process will call on the services of medical consultants to interpret medical evidence, analyze specific medical questions, and provide expert opinions on existence, severity and functional consequences of medically determinable impairments. Additionally, on a national basis, SSA may identify specific types of issues that may require a medical opinion. If a medical consultant is called on to offer expert advice and opinion, the medical consultant will provide a written analysis of the issues and rationale in support of his or her opinion. The written analysis will be included in the record and will be considered with the other medical evidence of record by disability adjudicators at all levels of administrative review. Additionally, medical consultants will assist in the training of other consultants and disability adjudicators; contact other health care professionals to resolve medical questions on specific claims; carry out public relations and training with the medical community; and participate in the quality assurance program. Childhood Disability Methodology As with adults, SSA must have a structured approach to disability decisionmaking in childhood claims that takes into consideration the relatively large number of claims and still provides a basis for consistent, equitable decisionmaking by adjudicators at all levels of administrative review. The approach for childhood claims must also derive from the statute. Under the statute, An individual will be considered to be disabled for purposes of this title if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months (or in the case of a child under the age of 18, if he suffers from any medically determinable physical or mental impairment of comparable severity).  1614(a)(3)(A) of the Social Security Act) Of course, any decision approach for childhood claims must be consistent with the Supreme Court s interpretation of this statutory language in Sullivan v. Zebley, 493 U.S. 521 (1990). Disability Decisionmaking For Childhood Claims Will Be a Four-Step Evaluation Process The disability decision methodology for childhood claims will consist of four steps that are based on the statutory definition of disability. As with adults, the approach is one that provides accurate decisions that can be achieved efficiently and cost-effectively, primarily by ensuring that documentation requirements are directed toward the ultimate finding of disability. To the extent possible, the approach for childhood claims should mirror the adult approach. The four steps are: Step 1 Is the child engaging in substantial gainful activity? If yes, deny. If no, continue to Step 2. Step 2 Does the child have a medically determinable physical or mental impairment? If no, deny. If yes, continue to Step 3*. Step 3 Does the child have an impairment that is included in the Index of Disabling Impairments? If yes, allow*. If no, continue to Step 4. Step 4 Does the child have an impairment(s) of comparable severity to an impairment(s) that would prevent an adult from engaging in substantial gainful activity? If yes, deny. If no, allow*. *An impairment must meet the duration requirement of the statute; a denial is appropriate for any impairment that will not be disabling for 12 months. Step 1 Engaging in Substantial Gainful Activity Any child who is engaging in substantial gainful activity will not be found disabled regardless of the severity of his or her physical or mental impairments. The guidelines for determining whether a child is engaging in substantial gainful activity will be identical to the guidelines for adults. Although the issue of work activity will arise infrequently in childhood claims, the step is warranted for two reasons: 1) the approach for adults and children should be as similar as possible; and 2) as a child approaches age 18, it is increasingly likely that work activity may be an issue. Step 2 Medically Determinable Impairment Because the statute requires that disability be the result of a medically determinable physical or mental impairment or combination of impairments, the absence of a medically determinable impairment will justify a finding that a child is not disabled. To establish the presence of a medically determinable impairment or combination of impairments, evidence must show an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. The same guidelines and rules that apply for adults will apply equally for children. SSA will continue to evaluate the existence of a medically determinable impairment based on a weighing of all evidence that is collected, recognizing that neither symptoms nor opinions of treating physicians alone will support a finding of disability. SSA will use the same exception for evidence collection in childhood claims that will be applied in adult claims. If a child has a medically determinable physical or mental impairment that is not an exception to further development, SSA will then evaluate whether the impairment(s) is included in the index of disabling impairments. Step 3 Index of Disabling Impairments If a child has a medically determinable physical or mental impairment or combination of impairments documented by medically acceptable clinical and laboratory techniques and the impairment(s) will meet the duration requirement, SSA will compare the child s impairment(s) against an index of disabling impairments. As with adults, the index for childhood claims will function to quickly identify severely disabling impairments. The index will describe impairments so severely debilitating that the impairment is of comparable severity to an impairment that would prevent an adult from engaging in substantial gainful activity without assessing the child s functional ability. As with adults, individual functional ability in childhood claims will be assessed in a consistent manner at Step 4 in the process. The index for childhood claims will consist of descriptions of specific impairments and the medical findings that are used to substantiate the existence and severity of the particular disease entity. The medical findings in the index will be as nontechnical as possible and will be simple enough so that laypersons will be able to understand what is required to substantiate a disabling impairment in the index. As with adults, SSA will draw no conclusions about the effect of a child s impairments on his or her ability to function merely because a child s impairment(s) is not included in the index. Additionally, SSA will no longer use the concept of medical equivalence or functional equivalence in relation to the childhood Index. Step 4 Comparable Severity to an Impairment(s) That Would Prevent an Adult From Engaging in Substantial Gainful Activity Consistent with the approach for adult claims, SSA will develop, with the assistance of the medical community and educational experts, standardized instruments which can be used to measure a child s functional ability. These standardized measures of functional ability will be linked to clinical and laboratory findings to the extent that SSA needs to document the existence of a medically determinable impairment or combination of impairments. The functional assessment instruments will be designed to measure, as objectively as possible, a child s ability to function independently, appropriately, and effectively in an age-appropriate manner. Ultimately, the course of documenting and developing for functional abilities in childhood claims will, to the extent possible, mirror the adult approach. However, SSA will consider whether it is appropriate to defer the development of standardized functional assessment instruments for use in childhood claims until it gains experience in the development, refinement and use of such instruments for adults. SSA will use the results of the standardized functional assessments to determine whether a child has impairment(s) of comparable severity to an impairment(s) that would prevent an adult from engaging in substantial gainful activity, as in the current process.Medical Evidence Development SSA s Ability to Issue Timely and Accurate Disability Decisions Depends on the Efficient Collection of Quality Medical Evidence SSA s ability to provide timely and accurate disability decisions depends to a significant degree on the quality of medical evidence it can obtain and the speed with which it can obtain it. The medical evidence collection process accounts for a considerable portion of the total time involved in processing disability claims. The new process will eliminate multiple, repetitive requests for information from health care providers. Health care providers will be relieved of requests for information that burden them with far too much paperwork and will be compensated for the time invested in providing information. Evidence Collection Will Focus on Core Diagnostic and Functional Information Necessary to a Disability Decision The goals of the evidence collection process will be to focus requests for evidence on the critical diagnostic and functional assessment information necessary for a disability decision and to form a new partnership with the sources of this information so that it can be obtained in the most efficient, cost-effective manner. Medical evidence development will be driven by the four-step approach used to decide disability. Two of the core elements of that approach are: 1) identifying an individual s medically determinable impairments (including those that meet the Index of Disabling Impairments criteria); and 2) assessing the functional consequences of those impairments. The decisionmaker will develop medical evidence that is sufficient to satisfy the core elements but target evidentiary development to obtain only the evidence necessary to reach an accurate decision on the ultimate question of disability. Treating Sources Will Be the Preferred Sources for Medical Evidence SSA will give primary emphasis to obtaining medical information from treating sources that provides brief, but specific, diagnostic information regarding an individual s medically determinable impairments and the functional consequences of those impairments. Treating source statements will include diagnostic information about a claimant s impairments, the clinical and laboratory findings which provide the basis for the diagnosis, onset and duration, response to treatment, and the functional limitations that can reasonably be linked to the clinical and laboratory findings. Depending on the nature and extent of an individual s impairments and treating sources, statements from multiple medical sources may be appropriate. Once the standardized measurement criteria described earlier are widely available, a standardized functional assessment available from a treating source will be accepted as probative evidence. Treating sources or another examining source may perform the standardized functional assessment at SSA expense. A Standardized Form Will Request Medical Evidence From Treating Sources SSA will develop a standardized form which effectively tailors a request for evidence to the specific diagnostic and functional assessment information necessary to make a disability decision. Such information includes but is not limited to diagnostic information about a claimant s impairments, the clinical and laboratory findings which provide the basis for the diagnosis, onset and duration, response to treatment, and the functional limitations that can reasonably be linked to the clinical and laboratory findings. Treating sources will be encouraged to submit such information electronically. Standardizing requests for evidence in this manner will facilitate the participation of claimants, representatives and third parties in the evidence collection process. The form will permit treating sources to provide necessary diagnostic and functional assessment information in summary form on a single document. In appropriate circumstances, SSA will accept a treating source s statements on the standardized form as to history and diagnosis, the clinical and laboratory findings which provide the basis for the diagnosis, onset and duration, response to treatment, and the functional limitations that can reasonably be linked to the clinical and laboratory findings, without resorting to the traditional, wholesale procurement of actual medical records. In completing standard forms, treating sources will certify that they have in their possession the medical documentation referred to in the statement and that said documentation will be promptly submitted at the request of SSA. The certification approach does not relieve treating sources from providing objective evidence in support of their diagnoses and opinions; rather it is designed to streamline the collection of necessary evidence. The approach is also consistent with evidence collection methods used by private disability insurance carriers, which request specific medical records in individual claims, when necessary and appropriate to the individual circumstances, or at random as part of a quality assurance program. Treating source completion of the standardized forms will be monitored to prevent fraud. Decisionmakers will verify treating source statements by obtaining underlying medical records when appropriate. The automated claims processing system will facilitate effective monitoring of the evidence submission practices of individual treating sources by permitting random and/or targeted selection of claim files involving that treating source for quality assurance and program integrity reviews. SSA Will Provide Incentives for Treating Sources to Cooperate in the Development of Medical Evidence As in the current process, SSA will pay for the reasonable cost of providing existing medical evidence. SSA will acknowledge the value of treating source information by establishing a national fee reimbursement schedule for medical evidence. The fee reimbursement schedule will utilize a sliding-scale mechanism to reward the early submission of medical information; additionally, the sliding scale will be adjusted to reflect the quality of the evidence received. A national, sliding-scale fee schedule will provide incentives for treating sources to cooperate in the evidentiary development process and invest quality time to provide medical certifications on behalf of their patients. SSA will provide resources to focus professional educational efforts and medical relations outreach at the local and/or regional level to ensure that treating sources are given up-to-date information on program requirements and made aware of specific evidentiary needs or problems as they arise in the adjudication process. SSA will conduct educational outreach on the national level on an ongoing basis with the medical community to provide a better understanding of the SSA disability programs, the medical and functional requirements for eligibility, and the best ways to provide medical information needed for decisionmaking. Consultative Examinations Will Be Used When There is No Treating Source Able or Willing to Provide Necessary Evidence or There Are Unresolved Conflicts in the Record If a claimant has no treating source, or a treating source is unable or unwilling to provide the necessary evidence, or there is conflict in the evidence that can not be resolved through evidence from treating sources, the decisionmaker will refer the claimant for an appropriate consultative examination. Because the standardized measurement criteria for assessing function will be widely available, consulting sources will be able to perform functional assessments that, in the absence of adequate treating source information or where there are unresolved conflicts in the evidence, will be considered probative evidence. Depending on the service area, SSA will consider contracting with large health care providers to furnish consultative examinations for a specified geographic location. As part of an ongoing training and medical relations program, SSA will ensure that providers of consultative examinations are provided adequate training on disability requirements. Those medical providers who conduct consultative examinations for SSA will also need ongoing training regarding changes in the disability program. SSA will prepare training programs for this audience which will utilize written, audiotape, videotape, and computerized training methods. Administrative Appeals Process The Administrative Appeals Process Will Be Simple and Accessible and Maintain Public Confidence in the Integrity of the Process To eliminate the public perception that multiple, mandatory appeal steps are obstacles to receiving timely, fair, and accurate decisions, SSA will reduce the number of mandatory appeals steps in the administrative process. Streamlining the appeals process will not only promote more timely decisions but also ensure that claimants do not inappropriately withdraw from the claims process based on a perception that it is too difficult or time-consuming to pursue their appeal rights. Claimants will be able to fully participate in the administrative appeals process with or without a representative. SSA will ensure that claimants are fully advised of their right to representation and SSA will routinely provide the appropriate referral sources for representation. SSA will also encourage the early participation of a representative when the claimant has appointed one and will give the representative responsibility for developing evidence necessary to decide a claim. However, the decision whether to appoint a representative must remain with the claimant and SSA will neither encourage nor discourage claimants in seeking representation. The administrative appeals process will instill public confidence in the integrity of the system. To instill such confidence, SSA will provide an initial decisionmaking process that is thorough and results in fully developed records with fair and accurate decisions. Additionally, the claimant will be given the basis of a decision in clear and understandable language. Finally, SSA will ensure that its policies have been consistently applied at all levels of administrative review. As noted previously, the initial disability determination will use a statement of the claim approach which will set forth the issues in the claim, the relevant facts, the evidence considered, including any evidence or information obtained as a result of the predecision notice, and the rationale in support of the determination. The statement of the claim will be part of the on-line claim record and will stand as the basis and rationale for the Agency action, if the claimant seeks further administrative review. SSA will standardize claim file preparation and assembly, including the use of appropriate electronic records, at all levels of administrative process until such time as the claims record is fully electronic. The First Level of Administrative Appeal Will Be An Administrative Law Judge Hearing Because the initial determination will be the result of a process that ensures fully developed evidentiary records and ample opportunity for the claimant to personally present additional evidence prior to an adverse determination, there will be no need for any intermediate appeal (e.g., reconsideration) prior to the ALJ hearing. If the claimant disagrees with the initial determination, the claimant may, within 60 days of receiving notice, request an ALJ hearing. An Adjudication Officer Will Conduct All Prehearing Proceedings When a claimant requests an ALJ hearing, an adjudication officer will conduct an interview in person, by telephone, or by videoconference, and become the primary point of contact for the claimant. The adjudication officer will have the same knowledge, skills and abilities as the adjudicators who decide claims initially. The adjudication officer will also have specialized knowledge regarding hearings procedures. The adjudication officer will be the focal point for all prehearing activities but will work closely with the ALJ, medical consultants and the disability claim manager, when appropriate. The adjudication officer will provide an in-depth understanding of the hearing process, with particular focus on the right to representation. To prevent delays caused by a lack of understanding of this right, the adjudication officer will again provide the appropriate referral sources for representation; give the claimant, where appropriate, copies of necessary claim file documents to facilitate the appointment of a representative; and encourage the claimant to decide about the need for and choice of a representative as soon as is practical. The adjudication officer will be available to answer the claimant s questions and concerns regarding the hearing process. The adjudication officer will also identify the issues in dispute and whether there is a need for additional evidence. If the claimant has a representative, the representative will have the responsibility to develop evidence. If the claimant has a representative, the adjudication officer will also conduct informal conferences with the representative, in person or by telephone, to identify the issues in dispute and prepare written stipulations as to those issues not in dispute. If the claimant submits additional evidence, the adjudication officer may refer the claim for further medical consultation and opinion, as appropriate. The adjudication officer will have full authority to issue a revised favorable decision if the evidence so warrants. This will ensure that allowance decisions are expedited and not delayed until a formal hearing before an ALJ. If the adjudication officer issues a favorable decision, the adjudication officer will refer the claim to a disability claim manager to effectuate payment. The adjudication officer will consult with the ALJ during the course of prehearing activities, as necessary and appropriate to the circumstances in the claim. As a preliminary matter, the adjudication officer will also routinely schedule a date for the hearing that is a standard number of days after the hearing request. Standardizing the hearing date process will facilitate claimant understanding and reduce the possibility of non-appearance at the hearing. It will also enable representatives to plan their schedules when taking on a case. The adjudication officer may exercise discretion in establishing an earlier or later hearing date depending on the individual circumstances and the ALJ s calendar. Electronic access to ALJs calendars, as established by individual ALJs, will facilitate timely and appropriate scheduling of hearings. The adjudication officer will refer the prepared record to an ALJ only after all evidentiary development is complete and the claimant or a representative agrees that the claim is ready to be heard. The ALJ will retain the authority and ability to develop the record. However, use of an adjudication officer realigns most, if not all, prehearing activities so that the burden of ensuring their completion rests with other members of the adjudicative team. With completely developed claims before them, ALJs will be able to concentrate their efforts on conducting more hearings and rendering decisions faster. The Administrative Law Judge Hearing Will Be a De Novo, Nonadversarial Proceeding The ALJ hearing will be a de novo proceeding in which the ALJ considers and weighs the evidence and reaches a new decision. A de novo hearing is consistent with the role of an ALJ envisioned under the Administrative Procedure Act. Under that scheme, the ALJ is an independent decisionmaker who must apply an agency s governing statute, regulations and policies, but who is not subject to advance direction and control by the agency with respect to the decisional outcome in any individual claim. ALJs are independent triers of fact who perform their evidentiary factfinding function free from agency influence. At the same time, the Administrative Procedure Act ensures that an ALJ s decision is subject to later review by the agency, thus giving the agency full authority over policy. Policy responsibility remains exclusively with the agency while the public has assurance that the facts are found by an official who is not subject to agency influence. A hearing before an ALJ will remain an informal adjudicatory proceeding as it is under the current process. The claimant will have the right to be represented by an attorney or a non-attorney with the decision regarding representation made by the claimant alone. An informal, nonadversarial proceeding is consistent with the public s strong preference for a simple, accessible hearing process that permits, but does not require, a representative. An informal process facilitates the earlier and faster resolution of the issues in dispute, thus promoting more timely decisions. As an independent factfinder in a nonadversarial proceeding, the ALJ will still have a role in protecting both SSA interests and the claimant s interests, particularly when the claimant is unrepresented. However, an improved initial determination process with its focus on early and comprehensive evidentiary development, predecision notices and opportunity for personal interviews, fully rationalized initial decisions, and prehearing analysis of contested issues should ensure that the Agency position is fully explored and presented to the ALJ. Moreover, the primary burden of compiling an evidentiary record will be shifted to the representative if one is appointed or to the claimant (when able to do so), with assistance (when necessary) from SSA personnel. This will permit the ALJ, in most circumstances, to close the record at the conclusion of the oral hearing, deliberate on the issues, and render prompt decisions. In making disability decisions, ALJs will rely on the same standards for decisionmaking that are used by the disability claim managers and adjudication officers. Adjudication officers and other decision writers will assist ALJs in preparing hearing decisions, using the same decision support system that supports the preparation of initial disability determinations. A simplified disability decisional methodology, in conjunction with the use of prehearing stipulations that frame the issues in dispute, will result in shorter, more focused hearing decisions. If the ALJ issues a favorable decision, he or she will refer the claim to a disability claim manager to effectuate payment. The Administrative Law Judge Decision Will be the Final Decision of the Secretary Subject to Judicial Review Unless the Appeals Council Reviews the Administrative Law Judge Decision On Its Own Motion Under the new process, if a claimant is dissatisfied with the ALJ s decision, the claimant s next level of appeal will be to Federal district court. A claimant s request for Appeals Council review will no longer be a prerequisite to seeking judicial review. As under the current process, the Appeals Council will continue to have a role in ensuring that claims subject to judicial review have properly prepared records and that the Federal courts only consider claims where appellate review is warranted. Accordingly, the Appeals Council, working with Agency counsel, will evaluate all claims in which a civil action has been filed and decide, within a fixed time limit whether it wishes to defend the ALJ s decision as the final decision of the Secretary. If the Appeals Council reviews a claim on its own motion, it will seek voluntary remand from the court for the purpose of affirming, reversing or remanding the ALJ s decision. The Secretary s authority for seeking voluntary remand prior to the Secretary s filing of an answer to the civil action is currently provided for in  205(g) of the Act. Favorable Appeals Council decisions will be returned to the disability claim manager to effectuate payment. The number of civil actions requiring substantive action by the Appeals Council will be relatively small because, in the new process, ALJ decisions will be the result of a fully developed evidentiary record where the factual and legal issues have been focused for final resolution. Additionally, the Appeals Council will have a role in a comprehensive quality assurance system. As part of the in-line review component of this system, which is described in greater detail below, the Appeals Council will conduct own motion reviews of ALJ decisions (both allowances and denials) and dismissals prior to effectuation. If the Appeals Council decides to review a claim on its own motion, the Appeals Council may affirm, reverse or remand the ALJ s decision, or vacate the dismissal. The Appeals Council s review will be limited to the record that was before the ALJ.The Agency will establish appropriate mechanisms to respond to claimant allegations of ALJ misconduct or bias. To the extent that the allegations of ALJ misconduct may affect the final decision in a claim, the Agency will consider whether an appropriate mechanism includes some form of final Agency review at the claimant s request. Quality Assurance Quality Assurance Will be a System of Agency Accountability SSA will be accountable to the public, the ultimate judge of the quality of SSA service, and will strive to consistently meet or exceed the public s expectations. SSA will have a comprehensive quality assurance program that defines its quality standards, continually communicates them to employees in a clear and consistent manner, and provides employees with the means to achieve them. The quality assurance program will have three primary components: 1) substantial resources to ensure that the right decision is made the first time; 2) comprehensive and systematic reviews of the quality of the decisionmaking process at all levels; and 3) measures of customer satisfaction against the SSA standards for service. Ensuring That The Right Decision Is Made The First Time Requires An Investment in Employees SSA s ability to ensure that the right decision is made the first time depends on a well-trained, skilled, and highly motivated workforce that has the program tools and technological support to issue quality decisions. SSA will make an investment in comprehensive employee training to ensure that all employees have the necessary knowledge and skills to perform the duties of their positions. SSA will develop national training programs for initial job training and orientation as well as continuing education to maintain job knowledge and skills. Such training will include general communication skills and how to deal effectively with the public generally, and disability claimants in particular. National training programs will also address changes to program policy. Consistent program policy training will be provided to disability decisionmakers at all levels of the process. In addition to initial program training, continuing education opportunities will be made available to employees to enhance current performance or career development. These opportunities may be in the form of self-help instruction packages, videotapes, satellite broadcasts, or non-SSA training or educational opportunities. SSA will ensure that employees are given sufficient time and opportunity to complete the required continuing education. Employee feedback on the value of these continuing education opportunities, including the quality of training materials, methods, and instructors, will be used to continually improve training programs. In addition to formal program training, SSA will rely on a targeted system of in-line quality reviews and monitoring of adjudicative practices for all employees. The elements include a mentoring process for new employees, peer review for experienced employees and management oversight at key points in the adjudicative process. SSA will create mechanisms that facilitate peer discussions of difficult claims or issues. Quality reviewers and policy makers will participate in these types of discussions. Peer reviews and mentoring will not only promote timely and accurate development of disability claims, but will also foster a spirit of teamwork. They will also promote earlier identification and resolution of problems with policy or procedures. Managers will be expected to oversee the adjudication process. They will conduct spot checks at key points in the adjudication process or perform special reviews based on profiles of error-prone claims. The goal of these reviews is to provide immediate, constructive feedback on identified errors to reduce or eliminate their possible recurrence. Payment errors on claims detected during in-line reviews will be corrected before a claimant is notified of the decision. As noted previously, under the Administrative Procedure Act, the ALJ is an independent decisionmaker who must apply an agency s governing statute, regulations and policies, but who is not subject to advance direction and control by the agency with respect to the decisional outcome in any individual claim. Accordingly, a system of peer review, mentoring and management oversight in advance of the ALJ s decisionmaking is inappropriate. However, the ALJ decision may be subject to final agency review. Therefore, as part of the in-line quality assurance process, ALJ decisions (both allowances and denials) and dismissals will be subject to review by the Appeals Council on its own motion prior to effectuation of the ALJ decision or dismissal. Several key features previously described in this proposal are critical to ensuring that adjudicators have the necessary program tools to issue accurate decisions. A single presentation of all substantive policies used in determining eligibility for benefits must be in place. Additionally, an automated and integrated claims processing system will provide the necessary technological support for adjudicators at all levels of the administrative process. Expert systems will be developed to integrate disability policy into the claims processing system. Among other things, the claim processing system will facilitate claims taking, evidence development, and the preparation of accurate notices and decisions by providing on-line editing capacity to identify errors in advance and decision support software to assist in analysis and decisionmaking. The processing system will help to identify errors of both procedure and substance, and also support routine analysis to aid in avoiding future similar errors. An on-line technical review will occur each time information is added to the electronic record. Comprehensive employee education and an in-line review system will build quality into the system of adjudication with the goal of error prevention. SSA must monitor that quality on a systematic, national basis. Accordingly, all employees (including ALJs) will be subject to and receive continuous feedback from comprehensive end-of-line reviews as described in the following section. Quality Measurement Will Focus On Comprehensive End-of-Line Reviews A second necessary component of quality assurance is an integrated system of national postadjudicative monitoring to ensure the integrity of the administrative process and to promote national uniformity in the adjudication of disability claims at all levels of the process. This system of quality measurement will include comprehensive reviews of the whole adjudicatory process. At a minimum, a comprehensive end-of-line quality measurement system must: be statistically valid; review both allowances and denials in equal proportion; review the entire disability claims process, both the medical and nonmedical aspects; and review claims decided at all levels of the adjudicatory process. These end-of-line reviews will focus on whether correct decisions were made at the earliest possible point in the process. This type of review will not be aimed at correcting errors in individual claims but, rather, will be the means to oversee, monitor and provide feedback on the application of Agency policies at all levels of decisionmaking. However, erroneous decisions detected during end-of-line reviews will be subject to existing reopening regulations. Reliance on an integrated claims processing system will facilitate the selection of a statistically valid sample of claims at all levels of the process for this review. An integrated claims processing system will permit the selection of other postadjudicative samples of claims as SSA deems necessary to effectively test new operational procedures or monitor specific procedures in the administrative process; oversee the implementation of new program policy regulations and initiatives; and monitor both internal and external claims development practices to prevent fraud. SSA will use the results from these end-of-line reviews to identify areas for improvement in policies, processes or employee education and training. SSA will also use the results to profile error-prone claims with the goal of preventing errors at the front end. SSA Will Conduct Surveys to Measure Customer Satisfaction A final component of quality assurance is measuring customer satisfaction. To measure whether SSA has met or exceeded the public s service expectations, SSA must measure the public s level of satisfaction with the level of service SSA provides. Customer surveys (including feedback cards) and periodic focus groups will be the most frequently used methods of determining the public s views on the quality of SSA service. SSA will also survey representatives and third parties who provide assistance or act on claimants behalf in dealing with SSA. Survey results will be communicated to staff on a timely basis, both as Agency feedback and individual feedback, along with any plans to address identified problems. SSA will also seek employee feedback on how well SSA has met their expectations. Employee feedback will be sought on a wide array of issues including Agency goals and performance indicators, training and mentoring needs, and the quality of operating instructions. Although formal mechanisms will be used to obtain feedback periodically, each employee will be encouraged to provide continuous feedback on how to make improvements in the process.Measur ements and Management Information SSA Will Measure Disability Service From the Perspective of the Claimant SSA s measures of performances will be revised to assess the performance of the Agency as a whole in providing service to claimants for disability benefits. Management information regarding the contributions at each step in the process to the final product, as well as to the work product passed on to other steps will be available. For example, current component processing time measures will be replaced by a measure of time from the first point of contact with SSA until final claimant notification. Meaningful, timely management information will be facilitated by a seamless claim processing system with a common database that is used by all individuals who contribute to each step in the process. Other measures, such as cost, productivity, pending workload, and accuracy will be developed or revised to assess the performance of the Agency as a whole and the participants in the process who contribute to this performance. Measurements for public awareness, as well as claimant and employee satisfaction, will add to this assessment. Management information will be current and accessible from an intelligent workstation. In addition to routine, published national reports generated from the management information system, other reports needed by national or local entities, or individual employees will be preformatted and system-generated on demand. Managers and employees will have the flexibility to change parameters and to access the full data base, permitting comparisons of performance and trends analysis. The management information system will also permit customized, ad hoc reports for special studies or immediate special purpose activities with access to the full data base. Tools including user-friendly report generator software and statistical forecasting and modeling applications will be available on the intelligent workstation to assist users in the data analysis. Representatives: New Rules and Standards of Conduct The Social Security Act and regulations have long recognized the representational rights of claimants and have provided an administrative framework designed to ensure that claimants will have access to the legal community and others in the pursuit of their claims. In the new process, SSA will continue to have a responsibility for monitoring representational activity and for safeguarding the interests of claimants. The new process will establish rules of representation and standards of conduct to ensure that representatives fulfill their responsibilities and serve the needs of the claimants they represent. These new rules will, among other things, ensure that claimants receive competent representation; establish a code of professional conduct for representatives in all matters before SSA; and provide sanctions against representatives, including suspension and disqualification from appearing before the Agency in a representative capacity, for violating the rules of representation and standards of conduct. Without disturbing the statutory intent of facilitating claimant access to representatives, the simplified and user-friendly new process may well result in more claimants pursuing their claims without representation. However, the issue of representation will remain a matter of a claimant s personal choice. The new rules and standards of conduct provide the framework for assuring that representatives they retain will be qualified, will have the obligation to fully develop the record on their behalf, will adequately represent their interests, and will be accountable for misconduct or dereliction of duty. SSA will also conduct outreach efforts with the legal community, to ensure that information about the disability programs is widely available to the organized bar and the Federal judiciary. Policy documents, regularly updated electronically, and rules of representation will be available at forums sponsored by the organized bar and in initial orientation and continuing legal education programs designed for Federal judges.