TN 49 (08-08)

DI 11010.090 Multiple Claims – Supplemental Security Income (SSI) Claim Involved

A. Introduction

An SSI claim may occur in combination with one or more of the existing Title II disability (Disability Insurance Benefits (DIB), Disabled Widow(er) s Benefits (DWB), Childhood Disability Benefits (CDB)) and/or non-medical categories. A Title II non-medical claim is processed in the usual manner. Check Modernized Claims Systems (MCS), Master Beneficiary Record (MBR), Modernized Supplemental Security Income Claims System (MSSICS) and Supplemental Security Record (SSR) for a previously filed Title II disability claim, verify the status of any prior claims and provide information which may be necessary in completing the current action.

B. Procedure - concurrent Title II/Title XVI claims filed

When sending the file to Disability Determination Services (DDS) for a medical decision for official paper folders, prepare separate SSA-831s,Disability Determination and Transmittal for each type of disability claim. Do not prepare SSA-831s if no medical determination is needed, e.g., for a technical denial, substantial gainful activity (SGA) denial or a collateral estoppel decision. The Disability Report forms SSA-3368 (Disability Report – Adult), SSA-3367 (Disability Report – Field Office), and SSA-3369 (Work History Report) can be entered into the Electronic Disability Collect System (EDCS), see DI 81010.025, Completing Electronic Disability Collect System (EDCS) Forms for Initial Claims. See Certified Electronic Folder (CEF) Exclusions and Limitations, DI 81010.030 when a claim cannot be entered into EDCS.

C. DDS determination not necessary - SGA denials

If the claimant is working, the work is determined to be SGA, and the claimant does not allege a visual impairment, record the determination in accordance with Responsibilities and Procedures - Work Issue Cases - DI 10501.025 and follow Claims Involving Work Activity - DI 11055.045. For CEF cases see Processing Field Office (FO) Determinations - DI 81010.140D.

Process the SGA denial, using the proper denial code as listed in Completing the SSA-831- DI 11010.205, and prepare the notice from the Document Processing System (DPS) program. The notice is located in DPS in the Initial Claims folder. Follow the procedure in Preparing Notices in Disability Claims - DI 11010.345C for notice guidelines. Mail the notice to the claimant or appropriate applicant. Retain the paper Title II and Title XVI files in the FO until the appropriate shipment or destruction date.

D. DDS determination not necessary – non-medical denials

If non-medical denials are involved on both claims, e.g., SSI Income and Resources denial and DIB denial for lack of insured status, retain both the Title II claim and the SSI claim in the FO (if the official file is paper) unless one of the exceptions in Routing Concurrent Disability Insurance Benefits – Retirement and Survivor Insurance (DIB-RSI) Claims - DI 11010.300 applies.

E. DDS determination necessary

Send the disability material on both claims to the DDS. When critical non-medical requirements are in question on the Title II claim (see Field Office (FO) Operating Instructions for Deferred Title II Initial Claims - DI 11010.030) and a disability determination is required on the Title XVI claim, forward the official folder to the DDS. Document the folder with the FO action being taken on the disability claim. Be sure to enter the following in EDCS remarks section or in Item 11, Remarks of each SSA-831 before sending the claim to the DDS:

  • “Concurrent Title II/XVI claim”

  • “Title II claim pending in FO”

  • “SSI material on SSN forwarded” (date first claims material was forwarded to the DDS) on the Title II SSA-831.

For claims entered into EDCS, see Transferring Cases in Electronic Disability Collect System (EDCS), DI 81010.085. When the critical non-medical requirements are resolved on the Title II claim being held, and a DDS Title II determination is necessary, transfer the Title II claim to the DDS. For claims entered into EDCS see Using the Update-After-Transfer (UAT) Utility - DI 81010.095. Then proceed as follows:

  • SSI Claim in the FO

    If the SSI claim is being forwarded to the DDS after the Title II claim:

    • Prepare and forward a SSA-5002, report of contact (RPOC) per DI 81010.085, Transferring Cases in Electronic Disability Collect System (EDCS) and DI 81010.032, Sending an Electronic Disability Collect System (EDCS) Exclusion to the Disability Determination Services (DDS) after a Certified Electronic Folder (CEF) Has Been Established and Transferred, or an SSA-831 and any disability evidence to the DDS.

    • Transmit the material using the prescribed electronic processing method.

    • For paper claims, place the SSI documents in a brown two part folder to be attached to the Modular Disability Folder (MDF) previously transferred to the DDS.

    • For claims entered into EDCS, use the UAT utility.

      If the SSI claim is a technical denial and has not been sent to DDS, it is not necessary to notify the DDS. For non CEF claims that were entered into EDCS for CEF cases see Creating Electronic Disability Collect System (EDCS) Cases - DI 81010.020

  • Title II Claim in FO

    If the critical non-medical requirements are met:

    • Prepare a Title II MDF, since this is the initial Title II transmittal. Forward the RPOC with the paper MDF, SSA-831, and any disability evidence to the DDS. Place the Title II non-medical material in the paper MDF. If SSI data was previously transmitted to the DDS, the DDS associates the official folders. For claims that were entered into EDCS, see use the UAT utility.

    • If the non-medical requirements are not met and the claim has not been sent to the DDS:

    It is not necessary to notify the DDS. For CEF claims see DI 81010.020. Creating Electronic Disability Collect System (EDCS) Cases. Process the Title II claim in accordance with DI 11010.075, Title II Technical Denials, and Claims Not Requiring a Disability Determination.

  • Concurrent Title II/XVI Claims with Railroad (RR) Involvement

    • If the non-medical requirements are met for both claims:.

      Send the folder and the disability material for both claims to Great Lakes Program Service Center/ Disability Processing Branch (GLPSC/DPB). If it is subsequently determined the claimant is not eligible, contact GLPSC/DPB and request return of the folder. If the claimant alleges he/she has filed a disability application with the Railroad Retirement Board (RRB), see The Exchange of Medical Evidence Between RRB and SSA — DI 11050.030 concerning medical development

    • If the claimant does not meet SSI non-medical requirements:

      Prepare an RC for the SSI file showing "Title II/Career RR claim forwarded to GLPSC/DPB on (date)" and send only the Title II claim to GLPSC/DPB. Be sure to include all evidence pertinent to the Title II claim. Enter "concurrent Title II/XVI claim" in Item 11, Remarks of the Title II SSA-831. In addition, enter "SSI denied by FO on non-medical issue" to alert GLPSC/DPB about the disposition of the SSI claim. Retain the SSI claim in the FO.

F. Procedure - claimant is Title II Disability Beneficiary or is entitled to a freeze

When Title II disability entitlement can be verified and is continuing, follow the instructions FO Adoption Decisions - DI 11011.005.

G. Procedure - prior Title II denial or cessation -- Title II folder not in FO

Send the SSI disability material in the official folder to the DDS. Verify the prior action. Enter "prior Title II denial (or cessation)" on the EDCS remarks page or in Item 11, Remarks of the SSA-831 and document the file to give the DDS as much information about the prior claim as is available from FO records. Do not request the prior folder. If the prior denial was on a disability basis, or was on a non-medical basis and there is indication that the Title II non-medical requirements may now be met, obtain a Title II claim and process as a concurrently filed Title II/XVI case. If a current Title II claim is not filed, document the SSI official folder with the reason. If the claimant is engaging in SGA, see Claimant Engaging in SGA - DI 11055.095.

H. Procedure - Title II allowance pending in FO or previously forwarded for payment action

If the DDS or Disability Quality Branch (DQB) returns a Title II determination of allowance to the FO, take the following action:

1. Continuous period of disability is established

If the claimant meets the SSI non-medical requirements, and the Title II allowance is treated as the final determination in accordance with Multiple Claims - SSI Involved - DI 11055.055 (Collateral Estoppel), input the Title XVI allowance; place a photocopy of the Title II SSA-831 and an Abbreviated Account File Query (AACT) in the paper MDF. Do not send the SSI case to the DDS. For processing Collateral Estoppel cases electronically see Processing Field Office (FO) Determinations - DI 81010.140C.

If the Title II claim is still pending in the FO, complete the necessary action on it and route the Title II claim to the appropriate Processing Center (PC).

2. Closed period of disability is established

If the Title II claim is a CEF and the Title XVI claim can be entered into EDCS, see Creating Electronic Disability Collect System (EDCS) Cases (DI 81010.020.D). The DDS can view the medical evidence from the Title II claim in eView. If the Title II claim is not a CEF and the official folder is a paper MDF, prepare a SSA-831 for the Title XVI claim and transmit it to the DDS for a determination. Convert the electronic file to an official paper file per Certified Electronic Folder (CEF) Exclusions and Limitations - DI 81010.030C. Include a copy of the Title II SSA-831 and disability material in the SSI file. If the Title II claim is still pending in the FO, complete the necessary action on it and route the Title II claim to the appropriate PC.

3. Visual impairment alleged – statutory blindness not established

If the SSI claimant alleges a visual impairment and statutory blindness was not established in connection with the Title II allowance, send the SSI case to the DDS for a determination on the issue of statutory blindness. If the Title II claim is a CEF and the Title XVI claim can be entered into EDCS, see Creating Electronic Disability Collect System (EDCS) Cases - DI 81010.020D. The DDS can view the medical evidence from the Title II claim in eView. If the Title II claim was not a CEF and the official folder is a paper MDF, include an SSA-5002 (Report of Contact) (either paper or electronic) in the SSI folder to explain to the DDS the reason for the determination.

NOTE: Title II cannot adopt decisions from Title XVI BI cases per FO Adoption Decision - DI 11011.005.

I. Procedure - prior Title II denial - Title II folder in FO

If the Title II claim is a CEF and the Title XVI claim can be entered into EDCS, the DDS can view the medical evidence from the Title II claim in eView. See Creating Electronic Disability Collect System (EDCS) Cases - DI 81010.020D. If the Title II claim is a CEF and the official folder is a paper MDF prepare a SSA-831 for the SSI claim, place it and any new disability material in the Title II official folder, and transmit it to the DDS for a disability determination on the SSI claim.

J. Procedure - SSI claim filed while appeal action pending at the Administrative Law Judge (ALJ), Appeals Council (AC), or Court Level