The EXR package includes:
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SSA-372 - Request for Reinstatement - Title XVI. Staple this to the front of the SSA-8000-BK;
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SSA-8000-BK-Application for Supplemental Security Income;
NOTE: Complete the SSA-8000-BK in the same manner as for a pre-effectuation review contact
(PERC). Develop all factors of eligibility immediately
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SSA-454-BK - Continuing Disability Review Report;
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SSA-3367- Disability Report-Field Office;
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SSA-827 - Authorization to Disclose Information to the Social Security Administration;
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SSA-820-BK or SSA-821-BK - Work Activity Report (Self-Employment) or Work Activity Report (Employee); and
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SSA-823 - Report of SGA Determination
Request wage and employment information authorization and record it in the Wage and
Employment Information Authorization (WEIA) application per, GN 00204.150C.
NOTE: If the interview is by telephone, send the EXR forms for signature, along with the
60-day EXR close-out notice per DI 13050.015E. Explain that the claimant must sign and return the forms before we can pay provisional
benefits.