Review the following elements of the SSR to determine if disability ended due to work:

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  CMPH segment - the last entry in the Payment Status (PS) field is T31;

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  CMPH segment - there is an entry of N01 in the PS field in the month before the T31 month; and

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  ENIH segment - there is earned income in the month before the T31 month.

Review the following additional sources of information to verify that termination was due to work:

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  Notice - the claimant may have a notice stored in the online notice retrieval system (ORS) that explains the basis for termination; and

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  Other records such as a Modernized Development Worksheet (MDW).

Determine if the EXR request is within 60 months of the previous termination (T31) month. Add 59 months to the T31 month reflected on the SSR to determine the end of the 60-month period. For further information about the EXR request period and consideration of good cause for late filing, refer to DI 13050.010. Also, consider the protective filing guidelines in DI 13050.015.

The FO technicians must screen cases for EXR eligibility per DI 13050.001A, DI 13050.050A and discuss filing a new claim versus an EXR with the claimant per DI 13050.020.

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  If the claimant is not eligible for EXR due to not meeting the technical requirements for EXR and insists on filing for EXR, the FO must deny the request per procedures in DI 13050.065D.

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  If the claimant chooses to file a new initial claim for disability benefits, you may use the request for reinstatement as a protective filing. Close out the protective writing per DI 13050.015E and GN 00204.012. Document the reason the claimant chose to file a new claim instead of an EXR in the remarks section of the new initial application.

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  If the claimant is eligible for EXR and decides to file an EXR request, follow the instructions below to complete the EXR package and process the request.

Establish an EXR event on the DCF following these steps:

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  On the MCDR screen, select 8=Establish Disability Review.

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  On the ECDR screen, select 2=EXR.

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  Complete the DRES screen to establish the EXR event.

Establish the case in the Electronic Disability Collect System (EDCS) and:

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  Enter the date of the Comparison Point Decision (CPD), using the most recent favorable medical decision date;

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  Enter the month benefits terminated due to work, see DI 13050.045A and DI 13050.050A.1;

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  Enter the established onset date from the previous entitlement;

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  Enter the EXR filing date; and

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  Link the EXR with the prior CPD folder per, DI 81010.235.

  NOTE: For any EDCS exclusions, follow paper folder procedures per DI 70005.001 and DI 70005.005.

Explain that the claimant must complete the forms before we can pay provisional benefits. Use initial claims attestation scripts prior and after filling out the forms with the beneficiary per GN 00201.015F. Store the forms in eView or Evidence Portal (EP). The EXR request includes:

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  SSA-372 - Request for Reinstatement - Title XVI. To attest, access the form in Uniforms (if available), use the attestation script in GN 00201.015F, and in the “Witness Address” field, type in “Attested” and list your name, your office code, and the date (e.g., Attested by John Doe DO123, 3/31/2020”) and save to the electronic folder.

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  Complete the SSA-454-BK - Continuing Disability Review Report, SSA-3367- Disability Report-Field Office, and SSA-827 - Authorization to Disclose Information to the Social Security Administration in EDCS. You may attest the SSA-827 per DI 11005.056D.2.

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  SSA-820-BK or SSA-821-BK - Work Activity Report (Self-Employment) or Work Activity Report (Employee) and in the “Witness Address” field, type in “ATTESTED” and list your name, your office code, and the date (e.g., Attested by John Doe DO123, 3/31/2020”) and save to the electronic folder. Use these forms to develop and document all work activity beginning with the month of filing.

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  SSA-823 - Report of SGA Determination. You may use the click and sign feature in Uniforms to complete form SSA-823. In Item 2C under Continuing Disability Review/Post-Entitlement (CDR/PE), document the following:

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    the month of filing, and

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    the SGA determination for the month of the EXR filing to present. If there is SGA in the month of filing, add the remark "SGA in the month of filing, First possible MOE IS MM/YY". Note: Document first possible month of entitlement in MM/YY format regardless of SGA.

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  SSA-8000-BK-Application for Supplemental Security Income. Complete the SSA-8000-BK in the same manner as for a pre-effectuation review contact (PERC). Develop all factors of eligibility immediately. A signature is not required as it serves as a supplement to the EXR request.

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  SSA-8240-Request wage and employment information authorization and record it in the Wage and Employment Information Authorization (WEIA) application per, GN 00204.150C.

If there is an aged spouse, obtain an initial application for SSI Aged and establish entitlement using normal requirements for entitlement. If there is a previously eligible spouse, you may also reinstate the spouse if they request reinstatement and meets the EXR requirements.

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  If the spouse is blind or disabled, worked, and meets EXR screening requirements in DI 13050.050A in this section and complete an SSA-372 for the spouse; and

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  Complete an SSA-454-BK and SSA-827.

Start provisional benefits if eligible. For more information about provisional benefits, see DI 13050.030.

If the CPD is electronic, the FO may transfer the EXR request to the servicing DDS. If the CPD folder is paper, the FO must wait for the receipt of the paper CPD folder before transferring the EXR request to the servicing DDS. DDS will need the comparison point decision (CPD) folder to make the EXR medical determination. If the CPD folder is paper, follow folder retrieval instructions in DI 13015.030 through DI 13015.250, and DI 40525.020 through DI 40525.150. If you are unable to locate the CPD folder, follow instructions in DI 13015.080 and DI 13015.090. If the CPD folder was processed in EDCS, you will be able to "link" it to the EXR case when you create it in EDCS. Note: Completing the "REQUEST FOLDER (Y): " field on the DRES screen will not result in the prior file being sent to you. You will need to request any prior paper folder through PCACS, following normal procedures.

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  Select the transfer option within EDCS and transfer to servicing DDS;

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  Update the DCF taking the following steps:

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  Transfer the event to the servicing DDS per DI 13010.620 ;

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  Establish an issue (for example, EXRDDS) on the DCF development worksheet (CDRW) to control for the DDS decision. For more information about the CDRW, see DI 13010.605 .

If the EXR request is an EDCS exclusion, pair the completed EXR packet with the prior decision folder. If the prior decision was an electronic file, see DI 81010.030E. Attach the "EXR Case Flag" view In PDF to the paper medical folder, and mail the paper folder to the appropriate DDS.

If, during the interview you determine that the claimant is incapable of managing their own provisional benefits, develop for a representative payee. If the claimant had a representative payee in the previous entitlement period, determine if the claimant still needs a representative payee. For more instructions about payee development, refer to DI 13050.075.