TN 8 (06-04)

GN 04440.210 Correcting Group I Substantial Gainful Activity (SGA) Decisional Deficiencies

A. Introduction

Group I SGA decisional deficiencies occur when disability is allowed or continued despite clear evidence of SGA, and a FO-prepared SGA denial, cessation (per DI 13010.035) is required. See DI 28050.010 for procedure in CDR cases in which there is a work activity issue.

B. Policy-Corrective Action

Send group I decisional deficiencies involving SGA to the FO for preparation of an SGA denial or cessation. See DI 30005.217 for a further explanation of DDS corrective action procedures for group I work activity deficiencies.

C. Procedure-Review Component

For group I decisional deficiencies involving clear evidence the claimant is engaging in SGA:

  1. a. 

    Prepare an SSA-5524-U3 and send the case with the allowance or continuance to the FO.

  2. b. 

    Ask the FO to:

    • Prepare an SGA denial or cessation, if appropriate.

    • Return copies of the SSA-5524-U3 and the determination form to the review component for results data input. If preferred, the FO can notify the review component by phone or email when the determination is prepared rather than faxing or sending a copy of the determination form.

    • Contact the review component if an SGA denial or cessation is, for whatever reason, not appropriate, per DI 13005.115.

  3. c. 

    Notify the adjudicating component of the deficiency.

  4. d. 

    Send the notification without the folder but include copies of relevant documentation supporting the deficiency.

    NOTE: Individuals using a ticket as part of the Ticket to Work program (Section 111 of Public Law (P.L.) 160-170) will not be subject to regularly scheduled medical CDRs. Work activity, however, will still be investigated, with trial work period (TWP) months being documented and SGA determinations still being prepared at the conclusion of the TWP. Refer to DI 13010.012.

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GN 04440.210 - Correcting Group I Substantial Gainful Activity (SGA) Decisional Deficiencies - 04/18/2011
Batch run: 09/06/2012