Assessment of functional abilities
|
Continuance
|
-
-
•
SSA-4734-BK Physical Residual Functional Capacity Assessment (RFC)
-
•
SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment (MRFC)
|
|
Cessation
|
|
Assessment of functional abilities
|
Continuance
|
|
|
Cessation
|
|
Basis for determination
|
Continuance
|
Items 10 and 12 on the SSA-832/833
|
|
Cessation
|
-
•
Items 10 and 11 on the SSA-832/833
-
•
Personalized cessation notice (PCN)
|
Basis for the most recent prior favorable medical determination, i.e., CPD
|
Continuance
|
-
•
Administrative law judge (ALJ) decision
-
•
Appeals Council (AC) decision
-
-
•
SSA-831 Item 22 (Regulation basis code)
-
•
SSA-832 or SSA-833 item 10
-
•
SSA-5002 Report of Contact
|
|
Cessation
|
-
•
ALJ, AC or court decision
-
-
-
•
SSA-832 or SSA-833 item 10
-
|
Beneficiary's reason for continued entitlement or cessation
|
Continuance
|
-
•
SSA-454-BK Continuing Disability Review Report
-
•
SSA-820-F4 Work Activity Report (Self-Employed Person)
-
•
SSA-821-BK Work Activity Report
-
•
SSA-5002 or SSA-553 Special Determination
|
|
Cessation
|
|
Citation of jobs and incidence
|
Continuance
|
Not applicable
|
|
Cessation
|
Report by a vocational specialist
|
Date of CPD
|
Continuance
|
-
•
Case summary, developmental worksheet, or disability determination evaluation
-
•
Prior determination or decision
-
|
|
Cessation
|
-
•
Case summary, developmental worksheet, or disability determination evaluation
-
-
•
Prior determination or decision
-
|
Discussion of comparison of medical findings under MIRS
|
Continuance
|
-
-
-
•
SSA-832 or SSA-833 item 10
-
•
SSA- 2506-BK Psychiatric Review Technique (PRTF)
|
|
Cessation
|
-
-
-
-
-
•
SSA-832 or SSA-833 item 10
|
Evidence sources
|
Continuance
|
Medical evidence
|
|
Cessation
|
-
-
•
Personalized cessation notice
|
Medical facts
|
Continuance
|
|
|
Cessation
|
|
Pain-related issues
|
Continuance
|
-
•
Any medical listing that specifically mentions pain
-
-
-
|
|
Cessation
|
|
Reason for current review
|
Continuance
|
-
-
•
SSA-831, SSA-832, or SSA-833 diary block
-
•
SSA-832 or SSA-833 item 20
-
•
SSA-847 Request for Case Action
-
•
SSA-5526 Request for Assistance-Disability
|
|
Cessation
|
-
-
-
•
SSA-831, SSA-832, or SSA-833 diary block
-
•
SSA-832 or SSA-833 item 20
-
-
|
Resolution of conflicting medical opinions
|
Continuance
|
Resolved by the determination of a continuance (SSA-832 or SSA-833
|
|
Cessation
|
|
Resolution of inconsistencies material to the determination
|
Continuance
|
Resolved by the determination of a continuance (SSA-832 or SSA-833
|
|
Cessation
|
|
Statement of nonmedical issues
|
Continuance
|
-
-
-
-
-
•
SSA-899 Continuing Disability Review (Completed by the PSC's)
|
|
Cessation
|
-
-
-
-
•
SSA-454-BK or SSA-832/833
-
|
Vocational rule used for medical-vocational determinations
|
Continuance
|
Item 14 on the SSA-832 or SSA-833
|
|
Cessation
|
Item 14 on the SSA-832 or SSA-833
|