Audience:

DO/BO/TSC:
CR, CR TII, DRT, FR, OA, OS, RR, SR
OCO-ODO-IND:
CATA, RECONR
OCO-ODO-SHARE:
BA, CA
OCO-OIO:
BA, CA, CATA, FCR, RECONR
PSC:
BA, CA, CRTA, CS, ICDS, IES, ISRA, PETE, RECONR

TN 5 (09-98)

RS 01310.001 Conditions for Entitlement and Definitions

A. Policy - General

To become entitled based on having a child in care, the child in care must be a child of the number holder (NH) (as defined in RS 00203.001C.) who is under age 16 or disabled and entitled to child's benefits.

NOTE: A childhood disability beneficiary (CDB) is entitled for all months of his/her extended period of eligibility (EPE) including non-payment months; therefore, if a mother, father, or young spouse receives benefits because he or she has a disabled adult child in care and that child’s benefits are in suspense due to an EPE, the mother, father, or young spouse may continue to receive benefits if he or she meets the in-care requirements.

B. Policy - Entitlement

1. Spouse's Benefits

a. Spouse Under Age 62

The child must be entitled on the number holder's (NH) earnings record (ER) but may receive benefits on another ER.

NOTE: Once entitled, the spouse can continue receiving unreduced benefits as long as the spouse has in care a child of the NH entitled to child's benefits on any ER.

b. Spouse Age 62 to Full Retirement Age (FRA)

The child may be entitled on any ER. Child in care is not a requirement for spouse entitlement once he/she attains age 62. (RS 00202.001C.) However, the benefits are not reduced for any month in which he/she has an entitled child of the NH in care. (RS 00615.201) See RS 00615.010 if the spouse is also entitled to a reduced RIB.

NOTE: Unreduced benefits continue as long as the spouse has an entitled child of the NH in care. (RS 00615.010)

c. Divorced Spouse Age 62 to FRA

The child may be entitled on any ER.

NOTE: Divorced spouse benefits will not be reduced for any month if he/she has a child in care in the first MOET. (RS 00615.010 and RS 00615.201A.2.)

2. Mother's/Father's Benefits

The child may be entitled to benefits on any ER.

NOTE: Mother/father benefits based on having an entitled child of a fully insured NH in care, are payable until FRA. Thereafter, widow(er) benefits are payable. If the NH is not fully insured, mother/father benefits can continue at FRA as long as there is an entitled child in care. See RS 00208.085.

3. Surviving Divorced Mother's/Father's Benefits

The claimant must have in care his/her natural or legally adopted child who is entitled on the NH's ER but may be receiving benefits on the ER of another. See NOTE in RS 01310.001B.2.

4. Widow(er)'s Benefits

Although child in care is not a requirement for entitlement, the benefits of a widow(er) will not be reduced below the amount of the mother's/father's benefit for any month he/she has in care a child of the NH entitled to benefits on any ER. (RS 00615.340)

C. Policy - Child In Care Age/disability

A child in care is a child who is:

  1. Under age 16; or

  2. Age 16 or older and mentally disabled; or

  3. Age 16 or older and physically disabled or

  4. Age 16 or older and physically disabled with mental involvement, i.e., a secondary mental diagnosis (item 16B on the SSA-831-U3) or a documented mental impairment (item 34, remarks portion of the SSA-831-U3). See RS 01310.001E. and DI 26510.095

D. Policy - Child In Care Standard

1. Under age 16

The claimant exercises parental control and responsibility. See RS 01310.010.

2. Age 16 or Older and Mentally Disabled

The claimant exercises parental control and responsibility. See RS 01310.010 and RS 01310.035.

3. Age 16 and Older and Physically Disabled

The claimant performs personal services. See RS 01310.015 and RS 01310.040.

4. Age 16 or Older and Physically Disabled With Mental Involvement

For in care purposes, the child is treated as mentally disabled. The claimant exercises parental control and responsibility. See RS 01310.010.

E. Procedure

1. Establishing Child's Disability

Develop the child's disability under Title II of the Social Security Act. See RS 00203.085.

2. Physical and Mental Impairment Alleged

If the child's disability is being developed in conjunction with deciding the spouse's/surviving spouse's initial or continuing entitlement and the child alleges both a physical and mental impairment, show “child in care” in the remarks field of the disability transmittal screen. This will alert the DDS to identify in the remarks field of the SSA-831-U3 a documented mental impairment which is not already shown as a primary or secondary diagnosis.

3. Determining Child in Care Standard

a. Child in Care Developed in Conjunction with Child's Disability

After the DDS has made the determination, use the primary and secondary diagnosis fields and the remarks field on the SSA-831-U3 to decide the child in care standard. Refer to RS 01310.001D.

b. Child in Care Developed Subsequent to Child's Disability Claim

When the last child in care attains age 16 and continuing entitlement depends on having in care an already entitled disabled child or the NH's spouse pursues entitlement based on having in care an already entitled disabled child, use the primary (D1G) and secondary (SD1G) diagnosis fields on the MBR and the MCS Report of Contact screen from the child's prior CDB claim to decide the child in care standard per RS 01310.001D. See RS 00203.085A.4.

4. Childhood Mental Impairment Codes

The following codes which appear in items 16A and/or 16B of the SSA-831-U3 and the DIG/SDIG fields on the MBR denote a childhood mental impairment. Any other code represents a physical impairment.

2940 — Organic Mental Disorders

2950 — Schizophrenic, Delusional (Paranoid), Schizoaffective, and Other Psychotic Disorders

2960 — Mood Disorders

3180 — Mental Retardation

3000 — Anxiety Disorders

3060 — Somatoform Disorders

3070 — Eating and Tic Disorders

3010 — Personality Disorders

3120 — Conduct Disorder

3138 — Oppositional/Defiant Disorder

3030 — Psychoactive Substance Dependence Disorders, Alcohol

3040 — Psychoactive Substance Dependence Disorders, Drugs

2990 — Autistic Disorders and Other Pervasive Development Disorders

3140 — Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder

3150 — Developmental and Emotional Disorders of Newborn and Younger Infants

3152 — Learning Disorder

3153 — Speech and Language Delays

3195 — Borderline Intellectual Functioning


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0301310001
RS 01310.001 - Conditions for Entitlement and Definitions - 01/10/2011
Batch run: 01/10/2011
Rev:01/10/2011