When the field office (FO) or disability determination services (DDS) receives an allegation that monthly earnings are below the TWP service month threshold level (for the TWP service month amounts, see DI 13010.060) in an initial entitlement case, and we do not have evidence indicating that the claimant:

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  may actually engage in SGA, or

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  is in a position to defer or suppress earnings (see “NOTE” in DI 10505.003B.1. in this section).

Then:

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  do not re-contact the claimant on the work activity or complete a SSA-821-BK; and

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  do not determine the exact amount of monthly countable earnings.

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  accept the claimant’s allegation if their statement does not conflict with any other information in the file. Document your findings according to the instructions in this section.

When the FO receives a reconsideration on the initial claim determination, follow instructions in DI 12005.010.

EXAMPLE: A claimant files for disability 12/10/2011, and states that they stopped working due to their disability on 11/02/2011. The FO forwards the claim to the DDS, and documents the alleged onset date 11/02/2011. The DDS receives notification from the claimant that they started working one morning a week for their employer again (performing light clerical duties) in 01/2012, and is earning $200 a month. Since the claimant is earning below the TWP service amount, and they are not in any position to suppress or defer their earnings, AND the DDS does not have any evidence that conflicts with the claimant’s allegation, the DDS does not have to send this case to the FO to make an SGA decision. The DDS makes a determination that the earnings are clearly not SGA, and continues to process the case.

NOTE: Do not apply this policy to earnings amounts that are equal to or greater than the TWP service amounts, expedited reinstatement (EXR) cases, self-employed individuals, or for individuals who are in a position to control their earnings, such as closed family corporations. You must process self-employment cases and questionable work activity cases following the self-employment SGA guidelines in DI 10510.001.

The DDS does not make SGA decisions in CDRs. Refer all work issues to the FO or PC, following procedure in DI 28050.010A.4.

When the FO or PC receives information from the beneficiary that they work, and their monthly earnings meet all of the following:

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  the total earnings match those in the master earnings file (MEF) total earnings (or the discrepancy is not significant to the determination); and

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  there is no discrepancy with earnings posted in the Office of Child Support Enforcement (OCSE) query; and

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  all earnings postings are clearly below the TWP level (even when considering possible reallocation); and

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  there is no other evidence (e.g., 3rd party report, or PM verified earnings on the Shared Process) indicating that the individual may be engaging in SGA or in a position to defer or suppress earnings.

Then:

Do not re-contact the beneficiary regarding the work activity, or complete a work activity report. You do not need to determine the exact amount of monthly countable earnings. Instead, follow these guidelines:

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  determine that the work activity is not SGA, because earnings are clearly below the TWP level; and

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  document the file with your findings on the eWork remarks screen, by documenting the earnings amount and verifying by allegation. Also, document your findings on an SSA-5002, and fax the form into the electronic folder. If the case is a not a certified electronic folder, fax the form into the NDRed, and insert it into the modular disability folder (MDF).

When a claimant alleges working at levels that are clearly above the SGA level and there is no reason to question the accuracy of their statements and information on the SSA-821 or SSA-820 indicate that:

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  there is no evidence of subsidy, special conditions or impairment related work expenses (IRWE); and

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  the claimant verified that there is no subsidy, special conditions, or IRWE involved; or

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  the evidence is clear that subsidy, special conditions, or IRWE will not reduce earnings below the SGA level; and

Then:

Do not re-contact the claimant regarding the work activity or determine the exact amount of countable earnings. Instead, follow these guidelines:

• •

  determine that the work activity is SGA, as it is clearly above the SGA level; and

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  document your findings on an SSA-823 (Report of SGA Determination-For SSA Use Only); and

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  document EDCS, following the instructions in DI 81010.140.

For more information on documenting employment cases, see DI 10505.035. For instructions on how to process title XVI initial SGA denials, follow instructions in SI 00602.001.

If information on the SSA-821 and alleged monthly earnings meet all of the following:

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  the total earnings match those in the MEF total earnings (or if the discrepancy is not significant to the determination per DI 10505.005D.1);

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  there is no evidence or allegation of subsidy or special conditions, IRWE, or the evidence is clear that the alleged subsidy, special condition, or IRWE would not reduce countable earnings below the SGA level; and

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  all earnings postings are clearly above the SGA level (even when considering possible reallocation).

Then:

You do not need to re-contact the beneficiary regarding the work activity or determine the exact amount of monthly countable earning. Instead, follow these guidelines:

• •

  determine that the work activity is SGA as it is clearly above the SGA level; and

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  continue processing the CDR using eWork. For more information on processing work CDRs, see DI 13010.025.