TN 14 (12-10)

GN 04440.941 Chart for Determination Forms Prepared or Corrected in the Review Component

Whenever you change any of the fields listed in this section and the Office of Quality Review legacy system has not designated the case as 831-enabled, you must send a copy of a corrected or review component prepared SSA-831–C3/U3 (Disability Determination and Transmittal) form to the Wilkes-Barre Data Operations Center (WBDOC) per GN 04440.150B. and GN 04440.150C.

A. SSA-831/32/33 DATA

SSA-831 FIELD(S)

SSA-832/3 FIELD(S)

 

3

n/a

Filing Date

Indicates the date the claim is filed

11

n/a

Reconsideration Date

Date of request for reconsideration of the Social Security Administration (SSA) decision

15 & 19

9

Result of Determination

Indicates whether the determination allowed or denied benefits

15A.

5

Date Disability Period Began

Indicates Onset of Disability

15B.

9

Date of Cessation

16A.

21

Body System Codes

Indicates the general type of impairment – e.g., respiratory system, cancer

16A.

21

Primary Impairment Codes

Code that defines the primary disabling impairment

16B.

22

Secondary Impairment Code

Code that defines the secondary disabling impairment

17

23

Diary

Indicates diary type, diary date, and diary reason

18A. & B.

9J.

Blindness Indicator

22

n/a

Regulation Basis Code

Indicates the SSA regulation on which the decision is based

23

n/a

Medical List Number

Coded on “meets and equals” allowance decisions (See Code of Federal Regulation, Appendix 1, Subpart P)

26

n/a

List Numbers

Used to track certain records – you can code up to 10 list numbers

26

n/a

Study List Code

Used internally to identify special studies

26

n/a

Litigation Codes

Codes that identify court case class membership – you can code up to 10 classes.

34

n/a

Capability Development Flag

Indicates whether a claimant is capable to manage his or her own benefits

34

9

Drug or Alcohol Addiction

Indicates whether dr