Basic (03-86)

DI 43520.050 Completion Of The SSA-831-U5 by INTPSC's DDS Function - Title II

The SSA-831-U5 may be completed by typewriter or ball point pen. If pen is used care must be taken to write legibly and to make sure all copies are clear.

FDE's and RECONE's should complete items 11 and 15 through 38 of the SSA-831-U5 as described in DI 26510.000 for initial claims and DI 27015.001 for reconsideration claims. Follow DI 26510.000 for completion of the SSA-831-U5 in title II reopening cases. The following exceptions apply when completing the SSA-831-U5 in INTPSC:

Items 30-33 (Disability Examiner--DDS/Review Physician--DDS/Date)

Make no entry in these blocks.

Items 37-38 (SSA Representative) (SSA Code) (Date)

The FDE/RECONE should sign in item 37 and in the “SSA Code” block enter “INTPSC.” Enter the current date in item 38.

(See DI 26510.001 for preparation of the SSA-831-U5 in initial Title XVI cases; DI 27015.001 for Title XVI reconsideration cases, and DI 27530.025 for XVI reopening cases.)