Effective Dates: 01/10/2022 - Present Previous | Next

Basic (01-22)

DI 28055.030 Preparation of Form SSA-833-U3 Impairment Severity Determination

A. Procedure - General

Complete, strip, and route the SSA-833-U3 the same as any other medical CDR determination except for the following entries or actions noted at B through F, below. (See DI 28055.040 for MQGE cases; SM 06001.001 regarding the National Disability Determination Services System (NDDSS).)

B. Procedure - Completion of Title II Only Continuance

1. Item 9 - Determination Findings

  1. a. 

    Check the “Impairment Severity” block.

  2. b. 

    Check block A.

  3. c. 

    Do not complete blocks D, E, F, G, or H. (These blocks are completed by the FO and ODIO/PSC-DRS.)

2. Item 20 - Why Review Was Made (WRM)

Enter: 08.

3. Item 24 - Remarks

  1. a. 

    Enter: “Supplemental Determination-Impairment Disabling-Disability Previously Ceased”.

  2. b. 

    Enter other remarks as appropriate.

C. Procedure - Completion of Title II Only Cessation

1. Item 9 - Determination Findings

  1. a. 

    Check the “Impairment Severity” block.

  2. b. 

    Check block B.; fill in the month, first day of the month, and year in which impairment severity ceased.

  3. c. 

    Do not complete block C.

  4. d. 

    Do not complete blocks D, E, F, G, or H. (These blocks are completed by the FO and ODIO/PSC-DRS.)

2. Item 20 - Why Review Was Made

Enter: 08.

3. Item 24 - Remarks

  1. a. 

    Enter: “Supplemental Determination-Impairment Not  Disabling-Disability Previously Ceased”.

  2. b. 

    Enter other remarks as appropriate.

D. Procedure - Title II Portion of Concurrent Title II-Title XVI Case

In both continuance and cessation determinations,complete the title II portion following procedures in B. and C. above.

E. Procedure - Rationale Requirements

Follow the same requirements applicable to other continuing disability determinations except for the nonmedical issues and conclusion sections discussed in 1. and 2. below. See DI 28090.000 for when a rationale is required.

1. Nonmedical Issues

  1. a. 

    Discuss entitlement to a TWP and state the month/year the TWP was completed. (This information is either in the rationale for the SGA cessation determination or the notice of SGA cessation.)

  2. b. 

    Incorporate the SGA determination, noting the date disability ceased due to SGA.

  3. c. 

    State that the present CDR is the result of a review of the individual's continued entitlement to the EPE provisions of the Social Security Act.

2. Conclusion

In the EPE medical determination, address the issue of continued impairment severity, not the issue of continuation or cessation of disability.

  • •

    Indicate that impairment severity continues/has ceased for purposes of the EPE provisions of the Social Security Act.

  • •

    Do not indicate a month of benefit termination in impairment severity cessation determinations.

F. Reference

  • •

    See DI 28084.001 for general SSA-833-U3 instructions.

  • •

    See DI 32010.001 for EPE case routing  instructions.

  • •

    See DI 28075.620 for title XVI instructions in 1619 cases.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428055030
DI 28055.030 - Preparation of Form SSA-833-U3 Impairment Severity Determination - 01/10/2022
Batch run: 10/04/2024
Rev:01/10/2022