Follow current non-medical completion criteria, except as noted below. If sufficient
non-medical development is complete prior to the DDS decision, the FO, following existing
instructions, triggers the claim to be processed through EC by doing a non-medical
Along with discretion to defer non-medical development, FOs have authority to delay
payment for a short period of time (e.g., 5 working days) if deferred auxiliary development
can be completed within that time.
The most efficient way to accomplish this delay is to withhold the non-medical completion.
When the CR chooses to defer development, but allowance seems possible, and there
are auxiliaries involved, the FO may delay or remove the non-medical completion input.
When proof of age is not critical to eligibility, as explained in Proof of Age (POA)
for Disability Insurance Benefits (DIB) Claims - DI 11010.055, trigger for non-medical completion without completing proof of age development.
However, evidence of citizenship or lawful presence is developed before non-medical
completion input to prevent the case from being placed into suspension status. Citizenship
or lawful presence is not an entitlement factor; it is required for payment of benefits.
See Eligibility for Disability Insurance Benefits (DIB) or the Disability “Freeze”-
DI 10105.005B. If the FO adjudicates the claim without proof of citizenship it results in a LAF
S9 (NOUSCP). If the FO then reinstates the claimant via the Postentitlement Online
System (POS), in most cases the input changes the LAF code from “S9” to “C” and release
any retroactive benefits due with a notice that is posted to ORS (Online Retrieval
System). Certain conditions shown on the MBR, (e.g., SSI Windfall Offset, Attorney
Fees, etc) prevents the action from automating. In these cases POS generates an on-screen
message that the case is an exclusion and is being sent to PC for manual processing.
CRs should use caution when triggering a claim without proof of citizenship
NOTE: To expedite payment to the claimant, certain FO requirements are modified as explained
below. These modifications do not apply to concurrent Title II/ XVI cases because
the correct Title II benefit amount is needed to compute the windfall offset, reducing
the amount of the retroactive Title XVI benefit by the amount of the retroactive Title
II benefit. Process claims involving windfall offset after workers compensation (WC)
The following instructions apply when evaluating WC and lag earnings:
WC development need not be completed prior to the FO non-medical completion trigger.
If the actual amount of compensation has not been verified at the initial interview,
the FO may trigger for non-medical completion using the claimant's allegation or the
State maximum amount until proof is provided, unless lag earnings affecting the Average
Current Earnings (ACE) are involved. If lag earnings are involved, request evidence
per RS 01404.005 – Lag Period – and Lag Earnings. If not received, do not input non-medical completion,
and do not initiate development until a favorable disability determination is reached.
Always request the claimant to submit proof of lag earnings. If evidence is not submitted
per RS 01404.005 – Lag Period – and Lag Earnings, do not include lag earnings in the FO non-medical
completion trigger. This applies to cases where lag earnings affect benefit amount
but not insured status. If insured status is in question, lag development is critical
to eligibility and must be pursued. See Guidelines for Deferral of Non-Medical Development
- DI 11010.025 and Responsibilities of Field Office (FO) and Disability Determination Services (DDS)
- DI 11010.140.