TN 49 (08-08)

DI 11010.055 Proof of Age (POA) and Citizenship for Disability Insurance Benefits (DIB) Claims

A. Policy - when age must be established

The Field Office (FO) will advise the claimant that we may need to see the claimant’s birth certificate (BC) or other evidence of age. Use proof of age (POA) tolerances when adjudicating claims, process the claim using GN 00302.030 Tolerances for Developing Evidence of Age.

1. Reason for the policy

Since the Date of Birth (DOB) is a material factor in the computation of disability claims, Proof of Age (POA) tolerance is used. (SEE GN 00302.030 Tolerances for Developing Evidence of Age).

2. Explanation

Follow the guidelines below to determine whether adjudication of a disability claim must be delayed until POA is received, or whether the claim can be processed and POA obtained after adjudication.

The FO must establish a diary when POA is being developed after adjudication. Complete the Decision Input (DECI) screen in Modernized Claims System (MCS) to establish the diary, see Decision Input (DECI) - MSOM MCS 009.013 and Diary Codes - GN 01040.010 for the list of diary codes. The diary ensures that follow-ups to secure the proof are made until the POA is received. Once POA is received, if the only update needed is the proof code, the FO follows Miscellaneous Online Edited Transaction (MONET) instructions in Benefit Data 1 (BEN1) - MSOM T2PE 007.026.

Forward all evidence of age to the office with jurisdiction of the disability file when a DOB determination is made after a disability file has been sent to the Processing Center (PC). Evidence of age can be input into Shared Processes, see Electronic Evidence Documentation and Retention - GN 00301.286 and Shared Processes Menu (SPMN) -MSOM EVID 001.002. In material POA cases, when the POA is submitted, the FO prepares an amended award per Electronic Form 101 Process (MS T2PE 009.001). All amended awards should be an EF 101. Control the case per Listings and Diaries – Adjudication - GN 01010.260A.2. Be alert to any determination, which may establish that the number holder (NH) or auxiliary is within the Medicare Supplemental Medical Insurance (SMI) enrollment period.

B. Procedures for processing POA

1. POA development before medical determination

Obtain POA before a medical determination only if insured status is involved (e.g., by one allegation, the claimant is under age 31 and meets insured status, or the claimant is age 31 or older and does not meet 20/40).

2. POA development after claim is allowed

Obtain POA after the claim is medically allowed but before input of the determination in the following situations:

  1. The claimant is insured under the special insured status rule for claimant’s disabled before-age-31 Special Insured Status for Disability Before Age 31 - RS 00301.140. If the claimant is insured under this provision and meets the 20/40 insured status requirement, POA is required if the benefits are affected (i.e., if the claimant could establish an earlier onset and/or a higher PIA using the special insured status rule).

  2. The claimant is within 6 months of age 55 or older and is filing under the special blindness provisions described in Disability Requirement - DI 10105.065.

  3. The claimant is entitled under the special insured status provisions of the 1972 amendments relating to statutorily blind individuals as described in Insured Status for Statutory Blindness - RS 00301.150.

3. POA development after adjudication

If POA is not obtained prior to adjudication and there is a DOB discrepancy, review partial adjudication process (Common Partial Adjudication Situations - GN 01010.120) and include appropriate DOB information in the notice. Show the least advantageous DOB. This may prevent an overpayment. Establish a diary per Diary Codes - GN 01040.010 and Diary Screen (DIAR) - MSOM MCS 009.015 to ensure the POA is received.

C. Proof of citizenship

Develop proof of citizenship or lawful presence before a medical decision to prevent the case from being placed in suspense status.