V. THE DATA COLLECTION ELEMENTS

The following twenty-seven elements comprise the DCI. Criteria and instructions are provided below for recording the outcome for each element reviewed for each case selected in the sample.

Please note that each of the five "skeleton" fields is identified. Because the "skeleton" fields will be pre-filled in order to determine the validity of the sample prior to assigning the cases to the review team, the reviewer cannot change the data in the fields. If the data are found to be incorrect, the reviewer will record the element number and the correct data in the comments section of the DCI, and these will be entered into the automated system.

ELEMENT 1 - IDENTIFICATION # (Skeleton field)

Enter the five (5) digit number that uniquely identifies the case by its sequence in the sample selected for review.

ELEMENT 2 - ISSUE CODE (Skeleton field)

Enter the two (2) digit issue code that identifies the issue for the case selected. See DCI for applicable codes.

ELEMENT 3 - CASE MATERIAL FOUND?

Enter the appropriate code to indicate whether case material for the selected case was found.

Enter:

Y = YES The case material was found.

N = NO The case material was not found. If the case material was not found, enter this code, and stop the review of the case.

"Case Material Found" means there must be a copy of the determination notice and all or some of the case investigation material, such as the factfinding documentation, so that there is a basis for evaluating the sampled case. Code the element Y (Yes) if you find any part of the case record. Continue the review, and fail any elements for which documentation is missing. The case material may be completely paper documentation, completely annotated automated records, or any combination of the two.

ELEMENT 4 - CORRECT ISSUE CODE?

Enter the appropriate code to indicate whether, based upon the review, the issue code in element 2 was the correct issue to be adjudicated.

Enter:

Y = YES The correct issue was adjudicated.

N = NO Based on review of the case material, there was no issue or the incorrect issue was adjudicated.

Remember that before an official ruling is made that the issue for the case selected is incorrect and the case fails quality, the case must be independently reviewed by two reviewers, and the outcomes compared to determine if they are the same. If the outcomes differ, then the case is subjected to an independent review by the third reviewer and to the reconciliation process for establishing the official outcome.

ELEMENT 5 - CORRECTED ISSUE CODE

If element 4 is Yes, leave this element blank.

If element 4 is No, enter the correct issue code. (See DCI for applicable codes.)

Enter:

(a) The code for the issue (other than "00" or "01") that should have been adjudicated;

Entering the alpha equivalent to "0" in elements 18-23 signifies that the case has failed nonmonetary determination quality because the reviewer concluded that the incorrect issue was adjudicated.

OR:

(b) Enter "00" if it is established that either no issue existed or the determination sampled was one with no potential to adversely affect the claimant's benefit rights, i.e., chargebacks, any uncontested earnings including those identified by BPC crossmatches, EB, DUA, TRA; stop review of the case.

Remember that before an official ruling is made that the issue for the case selected is invalid, the case must be independently reviewed by two reviewers, and the outcomes compared to determine if they are the same. If the outcomes differ, then the case is subjected to an independent review by the third reviewer and to the reconciliation process for establishing the official outcome.

The following excerpt from ET Handbook No. 401 is cited below for ease of reference:

 

ETA 207, NONMONETARY DETERMINATION ACTIVITIES(1)

1. Nonmonetary Determinations. A decision made by the initial authority based on facts related to an "issue" detected:

  • which has the potential to affect the claimant's past, present, or future benefit rights; and

  • for which a determination of eligibility was made

a. The following situations constitute nonmonetary determinations and should be reported:

(1) Determinations made because of misrepresentation, fraud, and/or overpayments, reportable on form ETA 227, Overpayment Detection/Recovery Activities, except those identified as uncontested earnings including those identified through the crossmatch program.

(2) A claimant's separation for a reason "other than lack of work" (such as "laid off, too slow, or failed to perform") that results in a nonmonetary determination.

(3) If controversy exists as to whether the claimant satisfies the conditions of an indefinite disqualification (i.e., until re-employed for a specific period or has earned a specific sum of money) that results in a nonmonetary determination.

(4) Investigation of a claimant's explanation for late reporting that results in a nonmonetary determination.

b. The following situations do not constitute nonmonetary determinations and should not be reported:

(1) Determination, relative to issues, made solely for deciding whether charges should be made to an employer's experience-rating account.

(2) Routine exploration of fact or questioning claimants associated with the claimstaking process except under circumstances of controversy. Examples of routine questioning or decisions not giving rise to a nonmonetary count are:

(a) Claimant's acceptance of the claimstakers conclusion that the week's earnings require a reduction in the benefit amount for that week.

(b) Claimant's acceptance of benefits for only a portion of a week claimed, when the State law provides for reduced benefits in cases where the claimant was ill or otherwise unavailable for work during part of the week.

(c) A determination on whether or not a stated period of time elapsed since a disqualifying act, satisfying the disqualification. This is part of the function of taking claims.

(d) A decision on whether or not the claimant meets the minimum wage and employment qualifying requirement to establish a benefit year. This is part of the monetary determination and under no circumstances is it reported as a nonmonetary determination.

(e) Determinations on the existence of and/or number of dependents. These are part of the monetary determination and no separate count should be taken as either a nonmonetary or monetary determination.

(f) A decision on whether the claimant meets State requirements for establishing a subsequent benefit year (e.g., 30 days of bona fide work since exhausting a benefit series). This is part of the monetary determination function.

OR:

(c) Enter "01" if the case selected is outside the scope of the review; stop the review of the case.

Nonmonetary redeterminations are outside the scope of the review. A nonmonetary redetermination is defined in ET Handbook 401 as:

A decision made under statute, regulation, or well defined policy specifically requiring the reopening of a nonmonetary determination prior to the administrative appeal stage, and which affirms, reverses, or modifies a determination.

Nonmonetary Redeterminations are made under the following conditions:

a. The need for reconsideration arises as the result of a protest by an interested party, or from the agency's own initiative based upon new or additional information.

b. All pertinent evidence and records are actually re-examined.

c. A written redetermination notice is issued to the claimant and/or any other interested party, and is recorded.

A redetermination will always relate to the benefit period covered by the prior determination. (Facts concerning a different period, or involving a change in circumstances, may raise new issues calling for a new nonmonetary determination.)

Redeterminations do not include decisions which are changed due to periodic supervisory reviews in which errors may be corrected. Also, if the claimant objects to a nonmonetary determination, listening to a repeated earlier statement and explaining the decision does not constitute a redetermination. A redetermination can only be made as a result of either the receipt of new or additional information or a protest by the employer or claimant and must always result in a reconsideration of the original decision.

Other nonmonetary determinations may be found to be outside the scope of the review and should be coded "01." For example, if a data entry error caused an incorrect date in the automated system, skeleton fields could pass validation for a case which was actually determined outside the quarter being reviewed. The reviewer would code such a case "01," outside scope.

ELEMENT 6 - INTRASTATE CLAIM?

Enter the appropriate code to indicate whether the case selected is an intrastate claim.

Enter:

Y = YES The case selected is an Intrastate claim.

N = NO The case selected is an Interstate liable claim.


HINT: Claim type is based on the status of the claim at the time the nonmonetary determination is issued. If, upon review of the case material, the claim type on the SESA's claims history file is different, record in the comments section of the DCI the element number and the claim type recorded in the SESA system.

 

 

ELEMENT 7 - PROGRAM TYPE

Enter the program type as described below. If the program type on the SESA's claims history file differs from the program identified in the case material, record in the comments section of the DCI the element number and the program type recorded in the SESA automated system.

UI = A State program that that provides benefits to individuals financed (1) wholly from State trust funds (UI) or (2) partially from State trust funds and partially from UCFE and/or UCX program funds (joint UI/UCFE, UI/UCX, UI/UCFE/UCX claim).

UCFE = claim based wholly on Federal civilian service or partially on Federal civilian service and partially on Federal military service (UCFE/UCX).

UCX = claim based wholly on Federal military service (UCX only).



ELEMENT 8 - NONMONETARY DETERMINATION OUTCOME

Enter the appropriate code to indicate the nonmonetary determination outcome.

Enter A if the determination Allowed benefits.

Enter D if the determination Denied benefits.



ELEMENT 9 - OUTCOME REPORTED CORRECTLY?

Enter the appropriate code to indicate whether the outcome was correctly reported in the automated system:

Y = YES The evaluator determines, after reviewing the claimant history file and case file, that the outcome of the nonmonetary determination (Allow or Deny) was correctly reported for statistical reporting purposes.

N = NO The evaluator determines, after reviewing the claimant history file and case file, that the outcome of the nonmonetary determination (Allow or Deny) was incorrectly reported for statistical reporting purposes.



ELEMENT 10 - RESERVED FOR SESA USE ONLY

An entry must be made in this field. However, the entry may be used to capture any information the SESA would like to have available for analysis, such as local office number.

The field is limited to four alpha, numeric, or alpha-numeric characters.

The State may use the field to record a mixture of informational items, as in the following example:

(1,2) The first two digits -- number of weeks paid during the review quarter.

(01 through 13)

(3) 1 = The employer returned the initial request for information.

2 = The employer's representative returned the initial request for information.

3 = The initial request for information was not returned.

(4) 1 = The determination was appealed and upheld.

2 = The determination was appealed and overturned.

3 = The determination was not appealed.

The coding for a case might be 0033, indicating no weeks paid, the initial request for information was not returned, and the determination was not appealed. The individual elements of the field can be queried separately, as is done with elements in the Benefits Accuracy Measurement (BAM) database.

ELEMENT 11 - WEEK CLAIMED? (Skeleton field)

Enter the appropriate code to indicate whether a week was claimed before the nonmonetary determination was issued:

Y = YES The nonmonetary determination was issued after a week affected by the nonmonetary determination was claimed.

N = NO The nonmonetary determination was issued without, or prior to, a week affected by the nonmonetary determination being claimed.

NOTE: Because this is one of the five skeleton fields that will be pre-filled in order to determine the validity of the sample prior to assigning the case to the review team, the data cannot be changed by the reviewer. If the reviewer establishes that the pre-filled entry is incorrect, the reviewer will enter the element number and record the correct code in the comments section of the DCI.

ELEMENT 12 - WEEK ENDING (W/E) DATE OF FIRST WEEK AFFECTED BY THE DETERMINATION (Skeleton field)

The entry in this field should be the ending date (mmddyyyy) of the first week affected by the nonmonetary determination, taken from the SESA's benefit or nonmonetary determination history file.

Determination With Week Claimed: If the determination applies to a claimed week, enter the week ending date of the first week claimed which is affected by the determination.

Determination With No Week Claimed: If no week was claimed, the week ending date will be the end of the week in which the new, additional, reopened, or continued week was filed.



HINT: The week ending date is the first week which would be allowed or denied as a result of the determination.

Note: because this is one of the five skeleton fields that will be pre-filled in order to determine the validity of the sample prior to assigning the case to the review team, the data cannot be changed by the reviewer. If the reviewer establishes that the week claimed is incorrect, the reviewer will record the element number the correct code in the comments section of the DCI.



ELEMENT 13 - CORRECT WEEK ENDING (W/E) DATE?

Enter the appropriate response after evaluating the determination.

Enter:

Y = YES The week ending date was correctly reported.

N = NO The week ending date was incorrectly reported.



ELEMENT 14 - CORRECTED WEEK ENDING (W/E) DATE

Leave this element blank if element 13 is Y.

If element 13 is N, enter the correct week ending date (mmddyyyy) of the first week affected by the determination.



ELEMENT 15 - ISSUE DETECTION DATE

Enter, from SESA automated claimant or nonmonetary determination history file, the date (mmddyyyy) the SESA first detected the issue to which the nonmonetary determination applies.

The exception to this rule is a case where the claimant fails to file a timely certification and the State has a policy of waiting for a week to be claimed prior to making a determination. In such cases, the detection date for the original unresolved issue(s) is the date the claimant subsequently files an additional or reopened claim.

Issue detection date cannot precede issue occurrence date.







HINT: Refer to ET Handbook No. 401, Unemployment Insurance Reports Handbook, for additional information on issue detection date.

 

ELEMENT 16 - CORRECT ISSUE DETECTION DATE?

Enter:

Y = YES The evaluator determines, after reviewing the case material, that the SESA correctly recorded the issue detection date on the claimant and/or nonmonetary determination history file.

N = NO The evaluator determines, after reviewing the case material, that the SESA incorrectly recorded the issue detection date on the claimant and/or nonmonetary determination history file.



ELEMENT 17 - CORRECTED ISSUE DETECTION DATE

Leave blank if element 16 is Y.

If element 16 is N, enter the correct issue detection date (mmddyyyy).



ELEMENTS 18 THROUGH 23 ARE WHERE THE QUALITY OF THE NONMONETARY DETERMINATION IS SCORED

Factfinding -- Elements 18 through 21 fall under the category of factfinding for the nonmonetary determination quality review.

In the prior system of evaluating nonmonetary determinations, full credit was granted for an element when information was not obtained, but the documentation established that a reasonable attempt was made to obtain the information. However, there was no definition of what constituted a reasonable attempt.

For the purposes of this review, a set of minimum criteria has been established that defines "reasonable attempts" to obtain the material facts from the parties to the claim, including reasonable attempts to provide rebuttal opportunity when required. Failure of the SESA to meet these minimum criteria shall cause the element to fail. Many SESAs employ procedures that exceed these minimum criteria and are encouraged to continue to do so. However, for purposes of this review, the definition described below will be the definition against which the SESA's performance will be evaluated. The minimum criteria defining "reasonable attempts" to obtain information in the factfinding process (including rebuttal opportunity) are described below.

MINIMUM CRITERIA TO SATISFY

REASONABLE ATTEMPT(S) REQUIREMENTS

All attempts made to obtain information from any claimant, employer, or third party must be documented, i.e., WRITTEN DOWN IN THE Factfinding REPORT. The first attempt may be made by telephone or in writing. If by telephone, documentation must include the date, time, and name (and if appropriate, the title) of the individual who answered the telephone call, a copy of all correspondence written in the course of the investigation, and anything else which would establish the action taken.

Any deadline set for receipt of information before a determination is issued based on available evidence, must be reasonable. Generally, this would be the number of days normally allotted by a SESA for other activities, e.g., 5 days, 7 days, or 10 days, whether information is being requested in writing or by telephone, and in no case should be less than 48 hours.

If the adjudicator:

a. made telephone contact with the claimant, employer, or third party, a reasonable attempt is considered to have been made.

b. did not make telephone contact with the claimant, employer, or third party, a reasonable attempt is considered to have been made only if:



Conversely, an unsuccessful attempt, i.e., no answer, busy signal, or number not in service, to contact the claimant, employer, or third party, must be followed up in writing to be considered a reasonable attempt.

A request for information which is mailed to the last-known address is considered a reasonable attempt. If it is returned by the U.S. Postal Service as undeliverable, verify the address with current records. If the address is verified as correct, a reasonable attempt was made.

This element evaluates only the attempt made by the adjudicator. The quality of the factfinding will be evaluated as any other factfinding under the applicable factfinding element.

Do not penalize the adjudicator for missing information if the case file documentation substantiates that a reasonable attempt(s) was made to obtain the relevant and critical information.



ELEMENT 18 - CLAIMANT INFORMATION

The claimant must be given the opportunity to be heard, to present information on his/her behalf, particularly to provide any information on any potentially disqualifying issue.


Enter A (Adequate) if:
10 points

(a) all of the relevant and critical claimant information (the material facts) was obtained and documented in the written record; or

(b) relevant and critical claimant information is missing, but the documentation establishes that the attempts to obtain the information met the criteria previously defined as reasonable.

Enter I (Inadequate) if:
5 points

some of the relevant and critical claimant information is missing and there is no documentation to establish that the adjudicator met the reasonable attempt criteria to obtain the information.

Enter N (Not Obtained) if:
0 points

(a) none of the relevant and critical claimant information was obtained, and there is no documentation to indicate that the adjudicator met the reasonable attempt criteria to obtain it; or

(b) element 4 is N and element 5 is other than 00 or 01.



Intent of Element: The burden to discover the reason for the claimant's separation from work and his/her eligibility for benefits rests with the State. The intent of this element is to ensure that the factfinder gathered all facts from the claimant which were material to the issue. The determination will be based on the application of the State law to the material facts found.

HINT: Each type of issue requires a specific line of inquiry with the claimant to establish the facts relevant to the issue. In cases of discharge, the claimant must be afforded the opportunity to confirm or deny the reason(s) for discharge given by the employer if the information is potentially disqualifying.







ELEMENT 19 - EMPLOYER INFORMATION

Employer information is essential on discharge and refusal-of-work cases. Also, any time the claimant presents information which could be adverse to the employer, facts must be obtained from the employer.

The employer's failure to respond to a notice of initial claim filing does not absolve the SESA from further investigation. (See Claim Determination Standard - ES Manual, Section 6013.)

Enter "A" (Adequate) if:
10 points

(a) all of the relevant and critical employer information is obtained and documented in the written record; or

(b) relevant and critical employer information is missing, but the documentation establishes that the attempts to obtain the information met the reasonable attempt(s) criteria.

Enter "I" (Inadequate) if:
5 points

some of the relevant and critical employer information is missing and there is no documentation to establish that the adjudicator met the reasonable attempt criteria to obtain the information.

Enter "N" (Not Obtained) if:
0 points

(a) none of the relevant and critical employer information was obtained, and there is no documentation to indicate that the adjudicator met the reasonable attempts criteria to obtain it; or

(b) element 4 is N and element 5 is other than "00" or "01."

Enter "X" (not applicable) if:
10 points

such information was neither relevant and critical nor applicable.

Intent of Element: To ensure the factfinder gathered as many facts of sufficient quality and quantity as necessary to support the findings and rationale for the determination rendered. The factfinder for the SESA gathers all material facts from an employer. The need for employer information applies to all discharges, and to all refusal of work cases, and also when the claimant alleges that the employer's actions justified the claimant's leaving his/her work under non-disqualifying circumstances.



ELEMENT 20 - INFORMATION (FACTS) FROM OTHERS

Often it is necessary to get relevant information from parties other than the claimant or the employer. "Others" includes, but is not limited to, physicians, union officials, school officials, public transportation officials, licensing agencies and other governmental agencies such as Welfare, Workers' Compensation, Employment Service (ES), and the Immigration and Naturalization Service (INS).

Enter "A" (Adequate) if:
10 points

(a) all of the relevant and critical information from others is obtained and documented in the written record; or

(b) relevant and critical information from others is missing, but the documentation establishes that the attempts to obtain the information met the criteria previously defined as reasonable.

Enter "I" (Inadequate) if:
5 points

some of the relevant and critical information from others is missing and the documentation does not establish that the attempts to obtain the information met the criteria previously defined as reasonable.

Enter "N" (Not Obtained) if:
0 points

(a) none of the relevant and critical information from others was obtained and there is no documentation to indicate that the adjudicator made reasonable attempts to obtain it; or

(b) element 4 is N and element 5 is other than "00" or "01."

Enter "X" (not applicable) if:
10 points such information was neither relevant and critical nor applicable.

Intent of Element: To ensure the adjudicator gathered all material facts from other parties who may possess information which is relevant and critical to resolve the issue adjudicated. The relevant and critical facts gathered from others, combined with the facts from the claimant and/or employer, should form the basis for the determination rendered.

 

ELEMENT 21 - REBUTTAL OPPORTUNITY PROVIDED

In the administrative application of the eligibility and disqualification provisions of the Unemployment Insurance Laws, the term "rebuttal" has acquired a meaning somewhat different from its strictly legal concept.

In the factfinding process a "rebuttal" means the presentation of facts or arguments, to overcome a factually established presumption for a tentative holding of eligibility or ineligibility. In other words, a mere allegation unsupported by any facts does not establish a factual presumption requiring a rebuttal.

A "rebuttal" must be distinguished from basic factfinding, which is essentially exploratory. The necessity for a rebuttal comes into play when complete statements have been obtained from opposing parties and there continues to be disagreement as to the facts.

It is the adjudicator's responsibility to offer rebuttal opportunity when opposing parties disagree as to the facts of an issue. If rebuttal is necessary, the adjudicator must contact, or make reasonable attempts to contact, both parties and must attempt to resolve the controversy. Often, after interviewing both the claimant and the employer, contradictory information remains unresolved. If each party is given the opportunity to respond fully to the other's allegations, further contact is not necessary if it is clear to the adjudicator that neither party has new information to add.



Enter "O" (Offered) if:
10 points

(a) all parties were contacted, when necessary, and offered the opportunity to rebut an adverse, factually established presumption, and the case file is documented with the manner by which the opportunity for rebuttal was provided; or

(b) the fact-finder met the reasonable attempts criteria to provide the parties with the opportunity to rebut the potentially adverse information and the case file contains the documentation of rebuttal being offered in person, by telephone, and/or by mail. The documentation must include: the date and time of contact(s) if done in person; date and time of contact(s) if by phone; and date by which a response to the SESA was required.


Enter "N" (Not Offered) if:
0 points

(a) rebuttal opportunity should have been offered but was not; or

(b) there is no documentation in the case file to indicate that the adjudicator met the reasonable attempts criteria to provide rebuttal opportunity to the parties; or

(c) element 4 is N and element 5 is other than "00" or "01."


Enter "X" (not applicable) if:
10 points

Rebuttal was neither necessary nor applicable.

Intent of Element: To ensure that the adjudicator recognized the necessity to provide rebuttal opportunity when the case record(s) showed that conflicting information was obtained from the parties. Rebuttal is required when there is information which is contradictory, apparently inconsistent or otherwise adverse to a party. This element evaluates only the quality of the attempt made, not the quality of the facts obtained.

HINT: If this element fails because rebuttal opportunity was not provided, the quality of "Claimant Information" and/or "Employer Information" must also be scored as "Inadequate" (5 points).

Failure to obtain basic factfinding from either the claimant or the employer should not result in a reduced score under Rebuttal Opportunity.


Elements 22 through 23, Application of Law and Policy and The Written Determination, complete the quality review.


ELEMENT 22 - LAW AND POLICY CORRECTLY APPLIED

The SESA must retain a written record of the facts considered for determinations. The written record must be sufficiently complete to enable the reviewer to conclude that the adjudicator acted with reasonable assurance that his/her determination of eligibility was consistent with the application of State law to the material found. The record may be maintained wholly or in part within the SESA's automated benefits system. Printouts of the record should be obtained when assembling the case file in advance of assigning the case to the quality review team.

The adjudicator must apply the appropriate State law and policy to the material facts obtained and documented in the case file. Law and policy establish whether a discharge was or was not for misconduct or whether a voluntary quit was or was not with good cause.

Law and policy define what is good cause for refusing a job offer, or whether the claimant satisfied the State's eligibility requirements.



Enter "M" (Meets) if:
50 points

all of the relevant and critical facts were obtained and the nonmonetary determination is clearly correct. This score would be in order only when all relevant and critical facts were obtained or the SESA met the reasonable attempts criteria to obtain the facts.

Enter "Q" (Questionable) if:
30 points

some of the relevant and critical facts were not obtained which, had they been obtained, may have changed the outcome. In the absence of those facts, correct application of law and policy cannot be established.

Enter "X" (Does Not Meet) if:
0 points

(a) some or all of the relevant and critical facts were obtained and the nonmonetary determination is clearly incorrect. This score would be in order only when all relevant and critical facts were obtained or the SESA met the reasonable attempts criteria to obtain the facts.

(b) element 4 is N and element 5 is other than "00" or "01."

Intent of Element: To assess whether the adjudicator applied relevant provisions of State law and policy to the facts obtained for the correct issue.



HINT: If there are any reductions in elements numbered 18, 19, 20, or 21, "Q" (Questionable) is the only entry that can be made for Element No. 22. Conversely, if these elements are all scored "A" (Adequate) , "X" (Not Applicable), or "O" (Obtained), Element No. 22 cannot be entered as "Q" (Questionable), but must be entered as either "M" (Meets) or "X" (Does Not Meet).

ELEMENT 23 - THE WRITTEN DETERMINATION

The written determination is the SESA's initial decision whether to "allow" or "deny" a UI claim as a result of its factfinding investigation. It is a particularly sensitive aspect of the nonmonetary determination process. It informs and explains the adjudicator's determination to the interested parties.

Federal requirements mandate the issuance of a written determination notice to the claimant when benefits are denied (see Part V, par. 6013B of the ES Manual). State law and policy define interested parties who must be issued a written determination. If a written determination is required, it must include: (1) a summary statement of the material facts (the determining fact(s) on which the determination is based), (2) the reasons for allowing or denying benefits, and (3) the conclusion or legal result of the decision. Because it represents the first-level position of the SESA pertaining to benefit eligibility and benefit charges, it is the document upon which an adversely affected party will decide whether to appeal.

Appropriate law and policy references cited in the written determination must be based on the facts contained in the factfinding records. This information must be provided to the parties when a formal determination is issued. When a written determination notice is not required, the case documentation must cite the material facts and rationale for the determination.

Enter "A" (Adequate) if:
10 points

(a) the written determination presents:

(1) a summary statement of the documented material facts upon which the determination is based;

(2) the reasoning for allowing or denying benefits (or for accepting one set of facts over another, i.e., a credibility finding);

(3) the conclusion of law and the legal result.

(b) a written notice of determination is not required (an informal determination), and the case file has an adequate summary statement of the material facts and the reasoning for the determination is adequate to demonstrate that law and policy were correctly applied.

Enter "I" (Inadequate) if:
5 points

(a) the summary statement of material facts and reasons for allowing or denying benefits does not show clearly why benefits are allowed or denied; or

(b) all of the factfinding is simply transferred to the written determination rather than just the material facts pertinent to the issue; or

(c) the adjudicator's reasoning statement is incomplete or absent, thus not supporting the outcome; or

(d) the written notice contains grammatical errors and/or misspelled words which can cause simple communications problems; or

(e) a written notice of determination is not required (an informal determination), and the case file has an incomplete summary statement of the material facts found and/or the reasoning for the determination is incomplete to demonstrate that law and policy were correctly applied.



Enter "X" (Completely Wrong) if:
0 points

(a) the determination clearly conflicts with State law and policy; or

(b) the material facts cited in the written determination are different from, or are not documented in the case file, or serious communications problems are caused by the presentation of the facts; or

(c) a written determination was not issued when required; or

(d) a written notice of determination is not required (an informal determination), and the case file lacks a summary statement of the material facts found and/or lacks the reasoning for the determination to demonstrate that law and policy were correctly applied; or

(e) element 4 is N and element 5 is other than "00" or "01."



HINT: "(d)" under "Inadequate" is the proper reference when the summary of the material facts and/or the reasoning for the determination are incomplete.

"(e)" under "Completely Wrong" is the proper reference when the summary of the material facts and/or the reasoning for the determination are totally missing or are totally wrong.

If "X" (Completely Wrong) is entered for Written Determination, the entry for Application of Law and Policy:

Cannot be "M" (Meets)

Must be "X" (Does Not Meet) if entries for Elements 18-21 are "A" (Adequate), "X" (Not Applicable) or "O" (Obtained).

Must be "Q" (Questionable) if any of the entries for Elements 18-21 are other than "A" (Adequate), "X" (Not Applicable), or "O" (Obtained).



ELEMENT 24 - APPEAL INFORMATION

The Federal Claim Determination Standard (CFR 602) and the ES Manual (Part V, Sections 6010-6015) require that the claimant must be given information with respect to

his/her appeal rights. It follows then that the same appeals information must be provided to an employer who is deemed an interested party to the determination.

1. The following information must be included in the notice of determination to the interested parties:

(a) that they have the right to appeal, or if the State law requires or permits a protest or redetermination before an appeal, that they may protest, or request a redetermination; and

(b) the period within which the appeal, protest, or request for redetermination must be filed.

2. The following information must be included either in the notice of determination or in separate informational material referred to in the notice.

(a) The manner in which the appeal, protest or request for a redetermination must be filed either by mail or in-person and the place(s) where the appeal, protest, or request for redetermination can be mailed or filed/delivered in-hand;

(b) Any circumstances which will extend the appeal, protest, or redetermination period (such as non-workdays, good cause, etc.) beyond the date stated in the notice of determination; and

(c) Where the party can obtain additional information and assistance about filing an appeal, protest, or request for redetermination.

Enter:

"S" = Sufficient If the written determination notice met criteria 1(a) and (b), contains a statement that refers the recipient to other SESA documents that were either provided during a benefit rights interview or that are available upon request, and that documentation conforms to the criteria in 2(a)(b) and (c).

If a written determination is not required (informal determination), enter "S" for this element.

"I" = Insufficient If the written determination notice does not conform to 1(a) and (b), and 2(a)(b) and (c).



ELEMENT 25 -- DATE DETERMINATION ISSUED: (Skeleton field)

Enter the date (mmddyyyy) the determination notice was mailed, or, if no notice was required, enter the date payment is authorized, waiting week credit is given, or an offset is applied.

This element is used to validate that the time lapse for this case was correctly reported on the ETA 9052 and 9053 reports.

If, upon review of the case material, the date is incorrect, identify the element and enter the corrected determination issue date in the comments section of the DCI.

NOTE: This information also provides the starting date for computing time lapse for SESA implementation of the outcome of the determination, i.e., updating the claims file in accordance with the determination issued.



ELEMENT 26: DETERMINATION FULLY IMPLEMENTED

Enter:

"Y" = YES (1) if, in the case of an allowance of benefits, the claimant was given waiting period credit and/or paid benefits for ALL eligible weeks that may have been pending up to the date the determination was made, or

(2) if, in the case of an allowance of benefits and another issue pending prevents payment, the automated system has been updated to reflect the outcome of the determination under review.

(3) if, in the case of a denial of benefits, the claimant's benefit history file(s) is updated in its entirety to indicate that benefits are denied and that weeks claimed, if any, are prohibited from being paid, or

(4) if, in the case of a denial for past weeks paid, that the claimant's benefit history file is updated to identify those weeks as denied and flagged as either actually or potentially overpaid, or

(5) if no weeks are claimed, the determination is entered into the State's automated system.

"N" = NO If the determination was not fully implemented in accordance with the above criteria.

Intent of Element: This element, in conjunction with elements 25 and 27, provides time lapse data to determine how quickly the SESA acted in response to the nonmonetary determination to ensure that benefits were paid when due for all weeks held pending the determination, or how quickly the SESA updated the claim records with permanent stop pay orders and requalifying information, if required, resulting from the denial of benefits, or other required data to accurately reflect the outcome of the determination.

This element will provide information to (1) determine that, in the case of an allowance of benefits, the claimant is paid benefits for ALL weeks that may have been pending up to the date the determination was made, or (2) that, in the case of a denial of benefits, the claimant's benefit history file is updated to indicate that benefits are denied and that weeks claimed, if any, are prohibited from being paid, or (3) in the case of a denial for past weeks paid, that the claimant's benefit history file is updated identifying those weeks as denied and actually or potentially overpaid.



ELEMENT 27 -- DATE DETERMINATION FULLY IMPLEMENTED:

Enter the date (mmddyyyy) that the SESA fully implemented the outcome of the nonmonetary determination.

Leave blank if element 26 is N.

Intent of Element: This element, in conjunction with elements 25 and 26, provides time lapse data to determine how quickly the SESA acted to ensure that benefits were paid when due for all weeks held pending the determination, or how quickly the States updated the claim records with permanent stop-pay orders and requalifying information, if required, resulting from the denial of benefits (or other required data to accurately reflect the outcome of the determination).

Implementation time lapse will be based on a review of the claimant's benefit history file that is obtained from the SESA's main claimant file. Examples of implementation time lapse may be (1) the amount of time it takes the SESA to release a stop pay order and either grant waiting week credit or issue payment(s) to claimants upon allowance of the claim after the nonmonetary determination is issued or (2) the extent to which the SESA updates its benefit files with the outcome of a determination to deny benefits and/or establish an overpayment after a determination of ineligibility or overpayment has been issued.



HINT: The date fully implemented may be earlier than the date the determination was issued.



THE COMMENTS SECTION.

Each DCI contains a comments section that allows up to 20 lines of text. The evaluator must provide an explanation of why an element received less than the maximum points allowed for the applicable nonmonetary determination quality elements and/or did not conform to the data validation criteria. Identify the element number to which the comments apply and then record the comments at the conclusion of the quality review.

The comments to be entered into the automated reports system will come from the DCI representing the official outcome of the tripartite quality review, excluding quality elements 18 through 23, which must be retained in hard copy for State use in program improvement planning. The comments containing information about any data validation element which the tripartite review identified as incorrect will be entered into the automated system for transmission to the National Office.

1. Excerpt from ET Handbook 401, 2nd Edition, Change 7, Section I.(E)(1a&b),pp. I-4-3 to I-4-5.