When taking a disability/blindness Title XVI claim, review the non-medical evidence
to determine whether the applicant meets the requirements of income, resource, citizenship
or qualified noncitizen status, and fugitive felon provisions.
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If the applicant does not meet the non-medical requirements, the FO processes a non-medical denial. A medical determination by the DDS is not
required.
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If earned income is involved, and the applicant earnings are below the excess income limit after applying all
earned income exclusions, the FO must develop and document the information collected
to determine whether the applicant is engaging in substantial gainful activity (SGA).
If the FO determines the claimant is performing SGA, the FO processes the denial.
A medical determination by the DDS is not required.
NOTE: Record all appropriate findings about the individual's work on the SSA-821-BK (Work
Activity Report - Employee), or the SSA-820-F4 (Work Activity Report - Self-Employed
Person), as appropriate. Process SGA denials electronically, unless it is an EDCS
exclusion. SGA denials may apply before or after case transfer to the DDS.
References:
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DI 10501.025 Responsibilities and Procedures - Work Issue Cases
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DI 11055.065 Claimant Does Not Meet SSI Non-Medical Requirements
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DI 11055.095 Claimant Engaging in Substantial Gainful Activity (SGA)
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DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations
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If a disabled or blind claimant is ineligible based on the non-medical criteria, but
is a likely candidate for the Plan for Achieving Self-Support (PASS) program, initiate
a discussion about the PASS program. If an individual indicates an interest in PASS,
even when an unlikely candidate, you must discuss PASS with the individual.
Utilizing a PASS, an individual sets aside income or resources (including deemed income
and resources) that would otherwise affect eligibility or payment amount, provided
that these set-aside funds are used by the person to obtain items or services needed
to reach an occupational objective (i.e., a work goal).
If the claimant wants to apply, assist with completing the SSA-545-BK and
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Forward the PASS request to the PASS expert immediately, or
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Refer the individual to the PASS expert for assistance in developing the PASS.
NOTE: In an initial claim, a determination that the claimant is performing SGA precludes
the need for a PASS determination, because the person does not meet the disability
criteria for eligibility. For specific information about PASS, see SI 00870.000.
If a claimant applies for disabled child's benefits in the month attains age 18 and
parental deeming applies making the claimant ineligible for SSI as a DC, EDCS functionality
allows the technician to select an SSA-3820 (Child Disability Report) or an SSA-3368
(Adult Disability Report). When an SSI claimant files in the month the claimant attains
age 18, the SSA-3368 is required instead of the SSA-3820. Refer to Creating EDCS Cases
DI 81010.020. For information on application effective date, see SI 00601.009.