If the nonmedical requirements are not met on the date of the appeal request, do not obtain an SSA-792 (Statutory Benefit Continuation Election Statement) with the appeal request.

• •

  Inform the recipient of the option to elect or decline SBC if the nonmedical requirements are later met and the appeal is still pending. (For the procedure on requesting SBC, see DI 12027.010.)

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  Process the appeal and update the Supplemental Security Record (SSR), leaving the SSR in nonpayment status.

When an individual requests SBC because the nonmedical requirements are currently met:

• •

  Verify that the cessation appeal is still pending at the reconsideration or hearing level.

• •

  Redetermine SSI eligibility factors in the routine manner. (For changes that may affect SSI eligibility, see sections in SI 02301.000.)

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  Explain the opportunity to elect or decline SBC. (For SBC provisions and processing instructions, see DI 12027.001 through DI 12027.010.)

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  If the individual elects SBC, reinstate SSI at the applicable payment level.

Send the claimant an SSA-L8155 which includes Goldberg/Kelly (GK) appeal rights and payment continuation on the adverse action to suspend SBC for a nonmedical factor. For GK information, see SI 02301.300.

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  For excess income, see sections in SI 00800.000.

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  For excess resources, see sections in SI 01100.000.

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  For institutionalization, see sections in SI 00520.000.

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  For Title XVI prisoner provisions, see GN 02607.050.

For potential SGA earnings (i.e., wages above the "clearly not SGA" threshold, or self-employment):

• •

  Verify reported work activity and earnings.

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  Determine if beneficiary is entitled to a TWP (following instructions in DI 13010.035).

• •

  Query the Disability Control File (DCF) and eWork information to determine if there were prior months of trial work.

When the beneficiary is engaging in SGA and the TWP is exhausted:

• •

  If the beneficiary has an employer, prepare an SSA-821 (Work Activity Report - Employee). (For documenting employment cases using the SSA-821 and the SSA-823 (Report of SGA Determination), see DI 10505.035.)

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  If the beneficiary is self-employed, prepare an SSA-820 (Work Activity Report - Self-Employment). (For documenting self-employment cases using the SSA-820 and the SSA-823, see DI 10510.025.)

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  Send advance (due process) notice of suspension.

  NOTE: 

  Do not prepare an SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) while the medical cessation appeal is pending.

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  After 15 days from the date of the advance notice, if the SGA is continuing, input S9 (miscellaneous suspension) for the current operating month (COM). Notify the appropriate Processing Center (PC) to suspend SBC effective the current SGA month (without any retroactive adjustment for SGA) and to convert the S9 to S7 (EPE SGA) or another nonpayment status as appropriate. Provide the PC the following information:

  • –

    FO location (city, state) and processing technician information: FO Code, FO technician's name, FO technician's phone number.

  • –

    Request Title: Title II, Suspension of Benefit Continuation Payments - SGA.

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    Claim Account Number (CAN): The wage earner's social security number (SSN).

  • –

    Beneficiary Identification Code (BIC) that was assigned for Title II purposes.

  • –

    Name: Surname followed by the first three letters of the individual's first name.

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    Suspension months: specify the months for which payments should be suspended and whether the suspension is to continue.

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  Store the forms in the Certified Electronic File (CEF). In a CEF exclusion case, forward the original forms (e.g., SSA-821, SSA-823) to the appropriate office for association with the cessation appeal folder.

For modes of requesting PC assistance, see GN 01070.228.

If the beneficiary alleges the work is not SGA or otherwise contests the proposed suspension:

1. a. 

   Review any new evidence and, if necessary, develop to resolve conflicting issues.

2. b. 

   Process the suspension or continue payment accordingly.

3. c. 

   Send the beneficiary notice on an SSA-L951 (Social Security Notice Letterhead) explaining the outcome, excluding appeal rights.

If the beneficiary engaging in SGA is eligible for a TWP:

1. a. 

   Store the work activity report form(s) using Evidence Portal (EP) or eView and set a tickle (control) date for end of the TWP.

2. b. 

   If the medical cessation appeal is a CEF exclusion, forward the original form(s) to the appropriate office for association with the official folder.

3. c. 

   At the end of the TWP, if the medical appeal is still pending, update and verify work and earnings information.

4. d. 

   When the TWP is exhausted, follow instructions in DI 12027.050C.2 in this section.

When the reinstatement is for months that earnings are not SGA and the appeal of the medical cessation (or adverse medical reopening/revision) determination is still pending, follow EPE instructions in DI 13010.215.

A ceased prisoner beneficiary:

1. a. 

   Is not eligible for SBC.

2. b. 

   May become eligible for SBC upon release from prison, if the medical appeal of the cessation (or adverse medical reopening/revision) determination is still pending at the time.

Eligible auxiliaries who are receiving benefits at the time of the cessation or adverse reopening/revision determination are eligible for SBC during appeal.

A modified cessation (or adverse medical reopening/revision) notice is required to:

1. a. 

   Explain to the ceased prisoner beneficiary:

   • •

     appeal rights;

   • •

     that benefit continuation is not now available but may be available later; and

   • •

     the 10-day (plus 5 days for mailing) time frame to elect SBC for eligible auxiliaries.

2. b. 

   Explain the SBC provisions to eligible auxiliaries.

For a prisoner appeal of a medical cessation (or adverse medical reopening/revision) determination:

1. a. 

   Process the appeal in the routine manner for medical appeals. (For related appeal processing instructions, see sections in DI 12000.000.)

2. b. 

   Obtain the SSA-792 for any auxiliaries.

3. c. 

   Notify the appropriate PC of SBC elections for auxiliary benefits (following guidance in GN 01070.228).

When the beneficiary requests reinstatement upon prison release:

1. a. 

   Verify:

   • •

     The appeal is pending on a medical cessation or eligible adverse medical reopening/revision determination.

   • •

     The prisoner's release date with appropriate authorities. (For Title II reinstatement policies in prison releases, see GN 02607.840.)

   • •

     That all other eligibility factors continue to be met. (For factors affecting eligibility, see GN 02602.005.)

2. b. 

   Obtain a signed and completed SSA-792. (For SBC provision instructions, see DI 12027.001 through DI 12027.010.)

3. c. 

   Remind the claimant of reporting responsibilities while receiving SBC.

4. d. 

   Reinstate benefits effective the first full month of non-confinement.

5. e. 

   Do not withhold any of the SBC benefits for possible attorney fees.

6. f. 

   Notify the appropriate PC to process the reinstatement. Provide the PC the following information:

   • •

     FO location (city, state) and processing technician information: FO Code, FO technician's name, and FO technician's phone number.

   • •

     Request Title: Prior Prisoner Case Reinstatement Now Applicable.

   • •

     CAN: The Wage Earner's SSN.

   • •

     BIC for the suspended beneficiary.

   • •

     Name: The suspended beneficiary's surname followed by the first name and initial.

   • •

     Event Date: (MM/YY) Effective month benefits are to resume (first full month of non-confinement).

   • •

     Remarks: "Title II, SBC pending medical cessation/reopening" followed by the reason for reinstatement (e.g., parole, completion of sentence, commutation of sentence, or conviction overturned).

After 45 days:

1. a. 

   Verify that the reinstatement is completed.

2. b. 

   If reinstatement has not been processed, send a follow-up request to the PC (following guidance in GN 01070.228).