TN 21 (12-06)
RS 00202.095 Last Child In Care Attaining Age 16 and Child's Disability Alleged
Citations:Section 2205 of P.L. 97-35
When the last child in care turns age 16 (age 18 if prior to 09/81), the spouse may continue to receive benefits if the child is disabled and the spouse meets the requirements for having a disabled child in care (CIC). A spouse who alleges that the last CIC is disabled must file an SSA-3368 on behalf of that child.
NOTE: Title II Redesign (T2RD) will automatically send a spouse who is receiving a benefit based on a CIC, a notice five months prior to the last child attaining age 16 informing him or her that benefits will end when the last child on the record attains age 16 unless the child is disabled (SM 03005.070 and SM 03020.100).
1. Field Office (FO) action
The FO will:
Obtain a Supplemental Security Income (SSI) query to see if the child has a disability decision prior to age 18. If yes and the decision cannot be adopted, the Disability Determination Section (DDS) will need to make a determination. For further instructions, see DI 11005.085B.4.d., Prior Claims Activity. For instructions about determining when FO adoption of the previous disability applies, see DI 11011.005, FO Adoption Decision.
Transfer the child's disability material to the appropriate DDS. See RS 00203.085 and RS 00202.095B.1.
REMINDER: References to EDCS processing can be found in DI 81010.000.
Notify the Processing Center (PC) using an MDW that a childhood disability determination is pending. Include in the text “Handle per RS 00202.095B.”
Explain to the spouse that:
His or her benefits will be suspended if the child attains age 16 before the disability determination is made. (See RS 00202.095A NOTE.)
If the child does attain age 16 before a disability determination is made, a notice will be sent but it will not include a decision about the child's disability (SM 03020.100).
A separate notice will be sent when the disability determination is completed.
Spouse's benefits may be reinstated if the child is found to be disabled and is in-care; a notice will be sent to that effect. (See RS 00202.090 when the spouse is age 62 but under FRA.)
Create a Special Message (CIPM) on the MBR advising that a childhood disability benefit (CDB) claim is pending and the date it was sent for a medical decision.
REMINDER: Remember to run the Disability Insured Status Calculator Online (DISCO) to determine if the child is insured on his or her own social security number (SSN). Consider entitlement on the child’s own SSN if he or she is insured.
2. PC action
When the PC receives notice that a childhood disability determination is pending, the CA/CTE will:
Diary the case for the first day of the month prior to the month the last CIC attains age 16.
Annotate the diary “Child's Disability Determination Pending-Spouse's Benefits End (mo./yr.).”
If T2RD has not already suspended the spouse’s benefits, send to a BA/BTE to suspend benefits using MACADE and send the appropriate notice if the last child attains age 16 before the disability determination is received. (See SM 03020.100 and SM 00848.425 for further processing instructions.)
Do not reinstate the spouse and place her or him in suspense status if benefits are terminated through the T2RD program. In those cases benefits will not be reinstated until the child is found to be disabled and in the spouse’s care.
Send the appropriate notice. (See NL 00703.561.)
RS 01310.001, Child In Care