The instructions in this section apply when an FTC issue occurs during the medical CDR process while the case is at a State disability determination services (DDS). If work activity is the sole issue, the field office (FO) has jurisdiction see DI 28020.050 and DI 28030.025.

The disability adjudicator must follow the guidelines for general development of CDR cases in DI 28030.000. For pre-hearing (PH) or Disability Hearing Unit (DHU) FTC cases follow CDR case processing instructions described in this section.

FTC occurs when an individual fails, without good cause, to do by a certain date what the Social Security Administration (SSA) or the DDS has asked them to do.

That is, the individual fails to:

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  Provide medical or other evidence; or

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  Attend a scheduled consultative examination (CE); or

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  Take any other required action that SSA or the DDS has requested.

A claimant's FTC without good cause will result in SSA or the DDS making a finding that disability has ended.

SSA considers an FTC cessation by the DDS to be a medical determination.

IMPORTANT: While an individual may fail to cooperate with a request for information or action, we have a responsibility to provide a medical determination based on the available evidence. Even when the individual fails to cooperate with an initial request for evidence or action, we may find that disability continues when supported by the case evidence.

The adult individual and their representative payee have a responsibility to cooperate with, and to take any action requested by, SSA or the DDS to complete the medical CDR. For a Title II disabled minor child and a Title XVI disabled child, this responsibility ultimately rests with adult responsible for the child (i.e., parent, guardian, relative, or other person acting on the child's behalf).

For additional information concerning Title II disabled minor children, see DI 23505.001.

For additional information concerning Title XVI disabled children and FTC, see DI 25205.020.

FTC is a Group II exception to the MIRS see DI 28020.900. Group II exceptions do not require a finding that the:

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  Individual is not currently disabled; i.e., do not require a finding of ability to engage in Substantial Gainful Activity (SGA) or,

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  Child's impairment(s) no longer causes marked and severe functional limitations for Title XVI child cases.

When the individual fails to cooperate with an initial request, the adjudicator must make a reasonable effort to develop all the evidence that does not require the individual's cooperation and make a determination using the CDR sequential evaluation process, as set forth in DI 28005.015. For explanation of "reasonable effort," see DI 22505.001A.2.

When the individual does not provide good cause for failing to comply with the DDSs request and the evidence is insufficient to support a continuance, the DDS will apply the Group II exception to the determination and terminate Title II benefits or Title XVI payments.

When the evidence is sufficient to make a continuance determination, FTC does not apply, see DI 28020.900 B.2.

When the individual fails to cooperate with a request for evidence or action, use the follow-up procedures for adult Title II and Title XVI initial and reconsideration cases explained in DI 23007.000.

For more information about procedures when FTC occurs in a Title XVI disabled child case, see DI 25205.020.

If the DDS receives a case where the FO identified FTC but did not do required FTC development before sending it to the DDS, the DDS adjudicator must return the case(s) to the FO for the required development in DI 13005.025, i.e., obtain interview forms and releases.

When a Title II individual is in terminated status due to work and does not cooperate with the FO during the medical CDR, the DDS must make a medical CDR determination to determine if entitlement or eligibility for extended Medicare benefits should continue, see Policy-Extended Medicare Eligibility DI 28055.001B.

When the individual does not provide good cause for failing to comply with the DDSs request and the evidence is insufficient to support a continuance, the DDS will apply the Group II exception, as explained in DI 28075.005D in this section. The month disability ends is the first month in which the individual fails to comply with an appropriate initial request by a certain date, without good cause, and we provided them an explanation that their benefits may cease as an effect of not cooperating. The cessation date will be the date the requested action or information was due.

EXAMPLE 1: Adult individual does not cooperate with DDS. Special handling is not involved.

The DDS adjudicator reviews the CDR case and obtains the medical records from the individual’s medical source(s).  The records are insufficient to make a determination.  On 09/03/2024 the adjudicator calls the individual to ask additional questions about their condition. There is no answer, so the adjudicator leaves a voicemail with their contact information and the date they called asking the individual to call by 09/13/2024, 10 days from the date of the message.  In addition to leaving a message, the adjudicator sends the individual a “call-in” letter dated 09/03/2024 with a due date of 09/18/2024 (10 days plus 5 days mail time) for the individual to call DDS.  The letter also explains if the individual does not call by the due date (09/18/2024), DDS may make a determination based on the evidence in file.  If we do so, we may determine the individual is no longer disabled and will no longer receive benefits. The individual does not call DDS by 09/18/2024. Therefore, the individual failed, without good cause, to do what DDS requested. The adjudicator documents on an SSA-5002 or on a Case Note in DCPS and “write to” the case development worksheet all the efforts they took to obtain the individual’s cooperation.  The adjudicator prepares a cessation determination using 09/18/2024 as the cessation date.

EXAMPLE 2: Adult individual requests CE to be rescheduled; however, the individual does not keep the rescheduled CE. Special handling is not involved.

On 09/09/2024 the DDS adjudicator sends a letter to the individual explaining we need a CE, and we have scheduled it for 10/07/2024.The letter also explains if the individual does not keep the appointment, we may make a determination based on the evidence in file.  If we do so, we may determine that the individual is no longer disabled and will no longer receive benefits.  The individual confirms the appointment. However, on the date of the CE the individual does not keep the appointment.  The individual contacts DDS and explains they were ill and would like another appointment.  The adjudicator determines that the illness is good cause for missing the CE and reschedules the appointment for 10/25/2024. The individual confirms they will attend the CE.  However, the individual again does not attend the CE.  The individual does not contact DDS to explain why they did not attend the rescheduled CE.  The adjudicator documents all the efforts they took to ensure the individuals cooperation to keep the CE on an SSA-5002 or on a Case Note in DCPS and “write to” the case development worksheet. The adjudicator prepares a cessation determination using 10/25/2024 as the cessation date.

EXAMPLE 3: Adult individual with representative payee. Special handling is involved.

This individual alleges difficult walking because of a broken left leg that occurred in 201. The DDS adjudicator requests medical evidence form all the pertinent medical sources. The current medical evidence reveals that the claimant walks unassisted but with a limp. The file contains an x-ray that is about a year old.  It shows that the left leg fracture is completely healed.  There is no evidence of any other significant current physical problems.  The adjudicator determines that the physical part of the case is complete and submits the case to the medical consultant for determination and signature. During review of the medical evidence, the adjudicator finds a note stating the claimant’s mother helps with general activities such as grocery shopping, keeping up with his appointments, etc., because the claimant has memory problems. The mother is the representative payee. 

The adjudicator calls the mother on 09/30/2024 to determine if the individual has significant memory problems and can’t reach her, so they leave a voice mail to call by 10/10/2024 (10 days from the voice mail). On the same day, the adjudicator sends a “call-in” letter with a due date of 10/25/2024 (10 days plus 5 days mail time). The letter also states that if the mother doesn’t contact us by the due date, we may make a determination based on the evidence in file.  If we do so, we may determine the claimant is no longer disabled and will no longer receive benefits.  The mother does not call by the due date. The adjudicator calls the mother to follow up the letter, talks to her, and obtains ADLs. It is determined a mental CE is needed and the CE process is explained to her. The CE is scheduled for 12/03/2024 and the mother confirms they will attend.   The claimant and the  mother do not keep the appointment; nor do they contact DDS to explain the reason why.  Therefore, the individual and his representative payee failed, without good cause, to do what DDS requested. The adjudicator documents on an SSA-5002, or on a Case Note in DCPS and “write to “the case development worksheet all the efforts they took to obtain the individual’s cooperation. The adjudicator prepares a cessation determination using 12/03/2024 as the cessation date.

Follow the FTC development procedures Failure to Cooperate in DI 23007.000 and document all efforts made to resolve the issues on an SSA-5002 (Report of Contact), or on a Case Note in the Disability Case Processing System (DCPS) and "write to" the case development worksheet (CDW). Include the following:

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  Efforts to resolve the issue(s), and the dates,

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  Results of the efforts, and

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  Justification for a cessation.

The DDS makes the FTC determination. For all situations, the cessation date cannot be earlier than the date the continuing disability issue arose.

Prepare the Form

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  SSA-832-U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or

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  SSA-833-U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II)

Follow the instructions Completion of Continuing Disability Review Determination Forms (SSA-832 and SSA-833)in DI 28084.000.

Also prepare any other relevant forms which explain the determinations.

Upload the completed forms to the certified electronic folder (CEF) or place the completed paper forms into the paper folder and forward the folder(s) to the FO.

See also:

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  DI 28080.110 Processing Medical Cessation Cases for Disability Determination Services (DDS)

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  DI 28095.105 Title II Medical Cessation Notices Chart

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  DI 28095.110 Title XVI Medical Cessation Notices Chart

A cessation determination due to FTC, is eligible to receive, statutory benefit continuation (SBC) because it is a medical determination.

The individual has 60 days to appeal a cessation determination. The usual CDR appeal procedures apply. For Standards and Development Guidelines for the Reconsideration CDR Process, see DI 29005.001. If applicable, the DDS hearing officer will revise the cessation date. To determine the cessation month, see DI 28005.205C.1.

When the appeal period has expired, the DDS may only consider reopening if the rules of administrative finality allow (See Conditions for Reopening a Final Determination or Decision, DI 27505.001).

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  DI 22505.014 Requesting Evidence or Action from the Claimant or Third Party

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  DI 22510.016 Claimant Consultative Examination (CE) Notice and Confirmation Procedures

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  DI 22510.019 Consultative Examination (CE) Appointment Notice Follow-up and Reminder

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  DI 23007.000 Failure to Cooperate

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  DI 25205.020 Failure to Cooperate and Insufficient Evidence in Title XVI Disabled Child (DC) Cases

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  DI 28005.205 Determining the Cessation Month in Continuing Disability Review (CDR) Cases

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  DI 28020.001 General -- Groups I and II Exceptions to Medical Improvement (MI)

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  DI 28080.110 Process Medical Cessation Cases for Disability Determination Services (DDS)

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  DI 28084.000 Completion of Continuing Review Determination Forms (SSA-832 and SSA-833) - Table of Contents

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  DI 28095.105 Title II Medical Cessation Notices Chart

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  DI 28095.110 Title XVI Medical Cessation Notices Chart