When a statutorily blind individual for whom a freeze has been established ceases SGA (see DI 10501.015.), that person must file an SSA-16-F6 to become entitled to monthly disability benefits. If an SSA-16-F6 is not in file, the Payment Center (PC) will complete an SSA-5526-U3 and request the Field Office to secure one. (for component responsibilities, see DI 41001.001). Do this before taking any other action. If other additional development is needed, e.g., resolution of a work issue, request it at the same time. If the period of disability freeze has been continuous and the person has previously served a waiting period, they do not have to serve another waiting period.

1. 1. 

   The PC will prepare a “DIB attainment” SSA-833-U5 in accordance with DI 41005.001 and the instructions below. See DI 41005.035, Exhibit 7 for an example of this completed form.

   1. a. 

      Item 1A

      Show the SSN of the primary beneficiary and BIC “A.”

   2. b. 

      Item 1B

      Check “DIB” block.

   3. c. 

      Item 9

      Check “disability” block. Check blocks 9J, 9J(1), “Began,” and block (a). Complete the month/year blocks as follows:

      1. 1. 

         After “Began,” show the month and year statutory blindness began. If the first of the month is involved, add a remark in item 24: “Date Stat Blindness began (date).”

      2. 2. 

         After block (a), show the month and year the individual became disabled for cash benefit purposes. This will be the first month of non-SGA.

   4. d. 

      Item 12

      Enter code 30. Show the medical list number.

   5. e. 

      Item 20

      Enter code 14 or 15, as appropriate. See DI 41005.035, Exhibit 5.

   6. f. 

      Item 24

      Show “Stat Blind - MOE to DIB (date).” See g. below for when DI 41005.001 W.3. remarks would be applicable. Also see DI 41005.001 W.4.-9. for other remarks.

   7. g. 

      Item 29

      Leave this item blank unless the W/E is age 55 or over and engaged in noncomparable SGA in or after the first month of entitlement to DIB. In this instance, show the remarks in DI 41005.001 W.3. and include the following notice on an SSA-865 (SSA-573 in PSC-DRS) for inclusion in the award notice.

      “The law provides that based on your impairment, you are entitled to disability insurance benefits. However, no payment may be made for any month in which you engage in substantial gainful activity that does not require skills or abilities comparable to those of any gainful activity in which you previously engaged with some regularity and over a substantial period of time. It has been determined that the work you have done is substantial gainful activity as described above. Therefore, it is necessary to withhold (your benefits for the month(s) of       ) (all of your benefits). Notify your Social Security office promptly if you stop working or if your earnings are significantly reduced in any month as benefits may be payable to you for those months.”

2. 2. 

   Prepare an SSA-4268-U4 as a continuation sheet for a rationale. See DI 41005.005 C. & D. An example of the rationale is:

   •  

     “This W/E was granted a period of disability as of (date of onset). The W/E has been in freeze status since. The W/E has stopped work and filed a new application for disability benefits on (date of filing). We have determined that they have been under a disability for cash benefit purposes since (date work stopped). There is no work or medical issue and stat blindness continues.”

     The rationale may have to be adjusted depending on the facts in the particular case.

3. 3. 

   Prepare an SSA-559 to refer the case to a CA. Enter in remarks: “SSA-833-U5 DIB attainment. Please prepare SSA-101-U3.”

1. 1. 

   The PC will prepare a SSA-833-U5 in accordance with DI 41005.001 and the instructions below. See DI 41005.035, Exhibit 8 for an example of this completed form.

   1. a. 

      Item 1A

      Show the SSN of the primary beneficiary and BIC “A.”

   2. b. 

      Item 1B

      Check “DIB” block.

   3. c. 

      Item 9

      Check “disability” block. Check blocks 9J, 9J(1), “Began,” and block (b). Complete the month/year blocks after “Began” and after block (b). Show in both places the month and year statutory blindness began. If the first of the month is involved in the “Began” date, add a remark in item 24: Date Stat Blindness began (date).”

   4. d. 

      Item 12

      Enter code 30. Show the medical list number.

   5. e. 

      Item 20

      Enter code 14 or 15, as appropriate. See DI 41005.035, Exhibit 5.

   6. f. 

      Item 24

      See DI 41005.001 W.4.-9. for remarks.

   7. g. 

      Item 29

      Show “DL” for dictated letter. If the individual is under age 55, use the letter from NL 00705.330 (see DI 41005.035, Exhibit 9. If the individual is age 55 or over and is engaging in comparable SGA, use the model language from DI 41005.035, Exhibit 10. When sending to typing, include a copy of the notice on the model language.

2. 2. 

   Prepare a personalized explanation of the decision on an SSA-4268-U4 (see NL 00601.010 B.2.) and ask the typist to attach it to the dictated letter.

3. 3. 

   The technical rationale should be prepared on a separate SSA-4268-U4. See DI 41005.005.