PRESCRIBED PERIOD:
Prescribed period begins with the latest of:
a.
|
_______ Month of number holder’s (NH’s) death
|
b.
|
_______ Last month of previous
entitlement to DWB that terminated
because disability
ceased
|
c.
|
_______ Last month of entitlement to E
(Mother's) benefits
|
Prescribed period ends with the earliest of:
a.
|
_______ Month before the month
widow(er) attains age 60. (In Medicare - only cases, leave
blank.)
|
b.
|
_______ If filing for Medicare only,
the month before the month widow(er) attains age
65
|
c.
|
_______ Last day of 84th month
following the month the prescribed period began
|
CONTROLLING DATE
1.
|
Select the latest
of:
|
a.
|
_______ 12 months retroactive from
filing date1
|
b.
|
_______ NH's month of death
|
c.
|
_______ Month widow attains age
50
|
d.
|
_______ Month after the last month of
entitlement to E or DWB
|
2.
|
_________ Indicate 1st day of 5th month before
date selected in 1. above
|
3.
|
_________ Indicate the alleged onset date
or the potential onset date, (see the chart in DI
25501.220C.1.b. for POD instructions)
|
4.
|
_________ Indicate the later date of 2.
and 3. above
|
5.
|
_________ Indicate the date the
prescribed period ends
|
6.
|
_________ Indicate the earlier of 4 and 5
above
|
7.
|
_________ In a remarried
widow(er)’s claim,
indicate the date of
remarriage;
otherwise, leave
blank.
|
8.
|
_________ Indicate the earlier of 6 and 7
above.
This date is the CONTROLLING
DATE
|
1 For DWB Medicare-only claims in which the widow(er) alleges amyotrophic lateral sclerosis,
enter the month of entitlement to “D” or “E” benefits.
In a remarried widow(er)'s claim, the controlling date will be established as of the
date of remarriage (line 7), if the remarriage occurred after the attainment of age
50, and the date of remarriage is earlier than the controlling date that would otherwise
be derived from calculations in the guide (line 6). This is because one of the requirements
for entitlement as a remarried widow(er) is that the widow(er) was disabled at the
time of remarriage. In such situations, the remarriage is deemed not to exist. See
RS 00207.003.
Remarriage may also be deemed not to exist in a subsequent DWB claim if the disabled
widow(er) was previously entitled to DWB at the time of remarriage and then subsequently
had entitlement terminated due to, for example, SGA. In this situation, leave item
7 in the guide blank.