The Field Office (FO) employees are responsible for applying the UWA policy when claimants apply for Title II or Title XVI benefits or when beneficiaries receive Title II benefits based on disability after working in employment or self-employment despite:

• •

  severe impairment, or

• •

  involuntary discontinuing or markedly reducing such work.

We may use UWAs to help DDS establish an onset date, which may affect Primary Insurance Amounts (PIA) or the retroactivity of disability benefits.

NOTE: The FO is responsible for a final determination of a UWA in work continuing disability review (CDR) cases and when determining if collateral estoppel applies. See DI 11011.001 for information about applying collateral estoppel.

When determining if a work attempt was unsuccessful, request an SSA-821-BK (Work Activity Report – Employee) or SSA-820-BK (Work Activity Report – Self Employed Person) and consider these three questions:

1. a. 

   Was the work activity substantial enough to warrant a finding that they engaged in SGA during the time he or she actually worked? For a definition of substantial gainful activity, see DI 10501.001.

2. b. 

   How long did the work last?

3. c. 

   Did the claimant or beneficiary stop the work, or reduce it to the non-SGA level due to the impairment or the removal of special conditions related to the impairment?

Review the information on the SSA-821-BK or SSA-820-BK and record the UWA information on Form SSA-823 (Report of SGA Determination – For SSA Use Only). For more information on form SSA-823, see DI 10505.035G.

NOTE: If work is below SGA, UWA does not apply. Do not mark a UWA on the SSA-823 if work is below SGA.

The DDS has the final responsibility for determining whether a period of work was a UWA in initial claims and medical CDRs. For DDS processing instructions for UWAs, see DI 24005.001.

FO employees use the UWA policy in initial Title II and Title XVI disability cases to assist DDS with establishing the onset of disability date. FO employees use the UWA policy in Title II continuing disability cases to determine whether the disability continues or ceases because of work activity.

The UWA policy does not apply when determining whether benefits are payable during the re-entitlement period of the Extended Period of Eligibility (EPE) after there is a cessation determination due to SGA. The EPE re-entitlement period begins with the month immediately following completion of the Trial Work Period (TWP) and ends 36 months later (unless a rolling EPE applies). The UWA does not apply to the TWP. However, when considering a work effort as a potential UWA, always evaluate the entire period of work before determining if it meets the UWA criteria, even when some of the months fall within the TWP.

NOTE: Do not apply UWA policy to work occurring in the Initial Reinstatement Period (IRP) in Expedited Reinstatement (EXR) cases. For more information about the IRP, see DI 13050.066.

Examples of evaluating a period of work with SGA in the TWP:

Example 1

The beneficiary begins work at the SGA level in the sixth TWP month. The work effort continues at the SGA level for 7 months, and ends in the third month of the EPE. Even though there are only 3 months of SGA after the TWP, we cannot consider the work as a UWA because the entire work effort exceeds 6 months.

Example 2

The beneficiary begins work at the SGA level in the ninth TWP month and ends in the third month of the EPE. Because the period of SGA lasted only 4 months, you may evaluate and determine that the three months that fall in the EPE are a UWA.

To consider work activity a possible UWA:

• •

  the work activity must have ended, or have been reduced to the non-SGA level, within 6 months due to the impairment; or

• •

  the work activity must have ended, or have been reduced to the non-SGA level because of the removal of special conditions related to the impairment that are essential to the further performance of work. For examples of special conditions, see DI 11010.145F.

Accept the documented allegation when the reason work ended or reduced has a reasonable relationship to the impairment.

For policy on averaging earnings refer to DI 10505.015.

Example of a work effort that last 6 months or less:

Work from November 5, 2015, through a date no later than May 4, 2016, is a work effort of “6 months or less.”

SGA-level work lasting more than 6 months cannot be a UWA regardless of why it ended or reduced to the non-SGA level.

Example of a work effort that lasted over 6 months:

Work at the SGA level from November 5, 2015, through May 30, 2016 is a work effort of “over 6 months.”