TN 6 (03-04)
DI 10520.065 Diaries, Review, Notices, Appeals
A. Process - Diaries
Periodic review by the FO of cases involving IRWE that were material to a determination of SGA is necessary because of the likelihood of changes in both the amount of earnings and the amount of work expenses.
Any case in which IRWE were material to an SGA determination should be reviewed at least once a year or earlier if the material IRWE is expected to end in less than 12 months. Establish an issue of IRWE on the CDRW screen of the DCF and a 12 month diary/tickle (or earlier where appropriate). When the diary matures develop as necessary. (See DI 10520.065B.)
Where material IRWE are expected to end in less than 4 months, manually prepare and maintain a diary for the file in the FO for the shorter period. When the diary matures, develop as necessary. (See DI 10520.065B.)
B. Procedure for Review of IRWE Cases
When a diary matures on a case in which IRWE were material to a determination of either SGA or SSI countable earned income, review the case according to the following procedures.
Contact the beneficiary to:
ascertain whether there have been any changes in the amount of earnings or work expenses; and,
assure that the expenses upon which the determination of SGA or SSI countable earned income was based have actually been paid.
2. Verify Payment
Obtain proper verification from the beneficiary (as discussed in DI 10520.025) that demonstrates that payment was, in fact, made in the months for which the determination of SGA or SSI countable earned income was made.
It is not necessary to verify retrospectively the person's need for and use of the impairment-related item or service, unless evidence comes to the FO's attention which indicates the item or service was not used, or suggests the item or service was not needed, during the diaried period.
3. IRWE Material To Determination
Where IRWE were material to a determination of either SGA or SSI countable earned income, and either there has been a change in the amount of earnings or of IRWE, or development shows that the person did not pay for the IRWE for the entire period as projected in the original determination, reprocess the work activity.
Where the person continues to be eligible for benefits, inform him/ her of the results of the FO determination, remind him/her of the responsibility to report any future changes in earnings or IRWE, and diary the case for another 12-month period (or less, if appropriate).
Where the person is found to be engaging in SGA, see DI 13010.160 concerning cessation or suspension.
C. Process - Notices
Appropriate notices for the following specific circumstances will be found in DI 13095.140 and NL 00804.175. Notices are produced by eWork if they are used to adjudicate work issue CDR decisions.
1. Allowances Or Continuances
Advise a person to report any changes in earnings or IRWE when:
A claim is allowed or benefits continue because the deduction of IRWE results in earnings below the SGA level, or
SSI payments are affected because of the deduction of IRWE.
2. Denials Or Title II Cessations
Notify a person whose claim is denied or whose benefits are ceased when:
IRWE are not allowed as claimed, or
The amount of such expenses is insufficient to reduce the person's earnings below SGA, or to make the person eligible for SSI based on income.
D. Process - Appeals
All SGA determinations involving IRWE are subject to reconsideration, hearing and appeal, according to usual procedures. All SSI determinations involving reduction or cessation of payment because of IRWE require advance notice and the opportunity for continuation of payment pending appeal. (See NL 00803.015 for notices.)