TN 12 (02-12)

DI 10501.025 Clearly Not SGA

The field office (FO), and processing center (PC) normally resolves title II, title XVI, and concurrent substantial gainful activity (SGA) work issues. There are certain, limited situations when the disability determination services (DDS) can make an SGA determination if the work is clearly not SGA.

A. Defining clearly not SGA

We define “clearly not SGA” as earnings from employment that are clearly below the trial work period (TWP) service month threshold level (for the TWP service months amounts, see DI 13010.060). If a claimant or beneficiary alleges earnings that are below the TWP service month threshold, and there is no evidence that conflicts with his or her allegation, or indicates that he or she may be in a position to control or suppress earnings:

  • do not complete an SSA-821-BK, Work Activity Report—Employee;

  • determine that the work is not SGA; and

  • continue to process the case without documenting the work with an SSA-821-BK.

The following subsections discuss responsibilities and procedures for handling work issues in initial and post-entitlement cases.

See Also:

DI 10501.001 Meaning of SGA and Scope of Subchapter

DI 10505.003 Evaluating and Developing Earnings that Clearly Are or Are Not Substantial Gainful Activity (SGA) - Field Office (FO) and Disability Determination Services (DDS) Procedure

B. FO and PC responsibilities

1. Documenting work activity

Unless you have a case that is “clearly not SGA,” document all appropriate information about a claimant’s or beneficiary’s work on the SSA-821-BK or SSA-820-BK, Work Activity Report, according to instructions in DI 10505.035 and DI 10510.025. For detailed instructions on processing “clearly not SGA” cases, see DI 10505.003.

2. Work is SGA

a. Initial claims

  • When you determine that the work is SGA at the initial claim level (after considering all applicable work incentives), and the claimant does not allege a visual impairment:

    1. Document the work activity on the SSA-821-BK or SSA-820-BK, and make your determination on the SSA-823, Report of SGA Determination—For SSA Use Only.

    2. Process the claim following instructions in DI 11010.190. For SSI claims, follow instructions in DI 11055.095.

  • If a claimant engages in SGA and does allege a visual impairment, make an SGA determination based on the SGA blind amounts, and route the case to the DDS for a disability determination.

  • For title XVI cases, when you determine that the work is above SGA, but below the income break-even point, an abbreviated application is not appropriate. For more information on the income break-even point, abbreviated application process and income rules for title XVI claims, see SI 00602.001C, SI 00810.350, and DI 11055.045.

IMPORTANT: Be alert to the possibility of an unsuccessful work attempt (UWA) or a closed period of disability. The DDS has final responsibility for UWA decision, except in continuing disability reviews (CDRs) that do not involve a medical issue. In addition, be alert to an open period of disability and the possibility of a trial work period (TWP), in those cases when the beneficiary did not engage in SGA for the 12-month period before the current SGA began.

See Also:

DI 11010.145 Unsuccessful Work Attempt (UWA)

DI 11010.205 Completing the SSA-831

DI 11010.345 Preparing Notices in Disability Claims

DI 81010.140 Processing Field Office (FO) Determinations

b. Continuing disability reviews (CDRs)

When you determine the work is SGA when conducting a work CDR, or in a reconsideration of a title II cessation case, process the claim following the instructions in DI 13010.025.

See Also:

DI 13010.145 Reconsideration or Reopening of Continuing Disability Work Issue Cases – Title II

DI 13010.170 Completing the SSA-833 (Cessation or Continuance of Disability or Blindness Transmittal –Title II)

3. Work is not SGA

When you determine that the work is not SGA:

  • Use the SSA-821-BK or SSA-820-BK to document work activity (unless the work activity is clearly not SGA, per DI 10505.003).

  • Complete the SSA-823, Report of SGA Determination –For SSA Use Only, if appropriate.

  • Complete the SSA-833-U3, following instructions in DI 13010.170.

For more information on when you must complete the work activity reports and the SSA-823, see DI 10505.035 and DI 10505.003.

4. How the FO should handle development requests

If you receive a request from the DDS or processing center (PC) to develop a work issue:

  • complete the development;

  • record the determination as to whether the work activity constitutes SGA on the SSA-823;

  • fax the SSA-823 into the electronic folder if the case is a CEF (if paper, forward it with the development to the requester);

  • respond to the assistance request, following procedures in DI 81020.100; and

  • if you require PC action, fax the material to PC paperless.

If the work issue involves title XVI, make any required changes to the Supplemental Security Record (SSR) prior to forwarding the material.

C. DDS responsibilities in SGA determinations

1. SGA determinations

The FO is normally responsible for work activity determinations. However, the DDS can make an SGA determination in certain limited situations where it is clear that the work activity does not represent SGA. For a definition of “clearly not SGA,” see DI 10501.025A in this section. If you learn that a claimant is working in an initial entitlement case, and the work activity is clearly not SGA:

  • Document your determination that the work is clearly not SGA on an SSA-5002, Report of Contact, or if available, document your findings in eCAT, or the electronic case worksheet, and continue to process the case. For evaluating and processing “Clearly not SGA” cases, see DI 10505.003.

  • If the work activity does not meet the criteria of clearly not SGA, send an electronic assistance request (AR) in eView to the FO requesting SGA development. For more information on processing an AR, see DI 81020.100C.

2. Work activity when processing a medical CDR

If you learn that a beneficiary is working when you process a medical CDR, follow the instructions in DI 28050.010.

3. Work comparability decisions in blind cases

The DDS makes work-comparability decisions for the special definition of blindness for claimants or beneficiaries age 55 and over. For more information on work comparability provisions, see DI 26005.001D.

4. UWA issues

The DDS also has the final responsibility for determining whether a period of work is a UWA, except in CDR cases where there is not a medical issue. For more information on UWA, see DI 24005.001.


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http://policy.ssa.gov/poms.nsf/lnx/0410501025
DI 10501.025 - Clearly Not SGA - 09/13/2013
Batch run: 09/13/2013
Rev:09/13/2013