TN 8 (09-10)
DI 13005.040 Completion of Form SSA-454-BK (Continuing Disability Review Report) in Adult CDR Cases
The SSA-454-BK (Continuing Disability Review Report) collects information necessary for a continuing disability review (CDR) and Expedited Reinstatement (EXR) cases. It obtains updated information relating to the status of a disabled person’s condition since the date of the last favorable medical disability decision, i.e., the comparison point decision (CPD). The report also collects updated pertinent information about the disabled person’s medical and non-medical sources and treatments, work status, educational and vocational training, and current daily activities.
SSA staff is responsible for informing the disabled person, representative payee, or appointed representative that we will use the information collected to evaluate continuing eligibility for disability payments and that we will determine whether medical improvement has occurred.
NOTE: For age 18 Medical Redeterminations, use the SSA-3368-BK (Disability Report - Adult).
DI 11070.000, Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law 104-193 as Modified by P.L. 105-33) FO
DI 13050.000, Expedited Reinstatements
DI 13005.005, Basis for Deciding Continuance of Disability
B. Making work-related determinations
Field Office (FO) staff determines whether the disabled person qualifies for, or is already participating in, a trial work period, an extended period of eligibility, 1619 provisions, or other work-incentive programs, e.g., the Ticket to Work Program. FO staff is responsible for making any work-related determination prior to sending a case to the Disability Determination Services (DDS) for a medical review. If the FO determines a full medical review is needed, the FO will initiate the CDR process by establishing the review on the Disability Control File (DCF), if not already established
C. Collecting information – FO responsibilities
The FO obtains the:
Completed SSA-454-BK (Continuing Disability Review Report),
SSA 827 (Authorization to Disclose Information to the Social Security Administration (SSA)),
Paper CPD folder if the CPD folder is not electronic, and
SSA-3367-F5 (Disability Report – Field Office) with items 1, 9 and if applicable, 10-12 completed using either the eForm or a preprinted paper SSA-3367-F5.
The disabled person, representative payee, or appointed representative, must answer all questions on the SSA-454-BK. For questions that the person completing the form does not know the answers to, or for those that are not applicable, “don’t know,” “none,” or “does not apply” should be entered.
D. Description of the SSA-454-BK
This CDR report parallels the format of the SSA-3368-BK.
1. Page 1 – Top Box
The top of Page 1 includes spaces for the FO to add the:
“Date of the last medical disability decision”, i.e., the CPD (see DI 28010.105),
Claim number, including the Beneficiary Identification Code (BIC),
Number Holder’s name, and
Type(s) of case(s) for review (e.g., DIB, TXVI DI, etc.).
2. Section 1 – Information about the Disabled Person
This section collects basic identifying information about the disabled person.
3. Section 2 – Contacts
This section collects the name, relationship, address, phone number and language preference of someone who can assist the disabled person with the CDR information, if necessary. This person can be the representative payee, appointed representative, a relative, friend, or any person willing to assist the disabled person. This section also collects information about the person completing the report for the disabled person.
4. Section 3 – Medical Condition(s)
This section collects information about the physical and mental condition(s) that limit the disabled person’s ability to work.
5. Section 4 - Work
This section collects information about any employment or work a person has performed since the last medical disability decision (CPD). If the question is answered “Yes”, the FO must complete work development (See Work Activity, DI 13010.000) before sending the case to the DDS.
6. Section 5 – Medical Treatment
This section collects information about treating sources, types of treatment received, and medical tests performed. This information is necessary to compare the disabled person’s current condition to the condition at the time of the CPD. The complete names, addresses (including zip code), and telephone numbers of the treating sources are necessary.
The SSA-454-BK contains space for up to five treating sources. If the disabled person has more than five treating sources, add the additional information to Section – 11 Remarks.
7. Section 6 – Other Medical Information
This section collects information about any additional sources that have medical information about any of the disabled person’s physical or mental conditions. Examples of other sources include, but are not limited to, worker’s compensation board, vocational rehabilitation agencies, insurance companies, prisons, attorneys, and social service agencies.
8. Section 7 – Medicines
This section collects the names of prescription and non-prescription medicines, prescribing physicians (if any), and reasons for the medicines the disabled person is taking. If a prescribing physician is listed in this section, the physician’s information should be placed in Section 5 – Medical Treatment.
9. Section 8 – Education and Training
This section collects information about any additional education or training the disabled person has received since the CPD. The DDS needs this information to evaluate medical improvement and to determine whether an exception to medical improvement applies.
10. Section 9 – Vocational Rehabilitation, Employment, or Other Support Services
This section collects information regarding the disabled person’s participation in any vocational rehabilitation, or participation in any type of work support services. If the disabled person is participating in the Ticket to Work program, see DI 55025.010 for instruction.
11. Section 10 – Daily Activities
This section collects detailed information about a disabled person’s daily activities. The DDS uses this section to determine how the disabled person’s condition(s) affects the ability to perform substantial gainful activity.
12. Section 11 – Remarks
This section provides space for any additional information the person completing the form wishes to provide.