TN 57 (07-16)
DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS)
A. Determining the proper DDS
Use the claimant's actual or last known physical residence when transmitting the disability claim to the DDS. The physical residence determines DDS jurisdiction, not his or her mailing address. When transmitting a case to the DDS for a determination, send it to the DDS in the state where:
The claimant physically resides or if unknown, his or her last known residence.
If the claimant is living in the U.S. but using an Army Post Office (APO) or Fleet Post Office (FPO) (see NL 01510.010 Use of Army Post Office (APO), Diplomatic Post Office (DPO), and Fleet Post Office (FPO) Addresses), obtain the individual's home address and send the case to the DDS in the state where he or she physically resides or is last known to have resided.
If a qualified representative files on behalf of a claimant, transmit the case to the DDS in the state where the claimant physically resides or where his or her last known residence is located.
If claimant resides outside the U.S. refer to DI 11010.275 Sending Cases to Office of Central Operations/Office of International Operations (OCO/OIO).
State jurisdiction does not change if the claimant is absent (or expects to be absent) from the state for 60 days or less. For example, if the claimant has his or her home in Illinois but is temporarily (60 days or less) hospitalized in Indiana at the time of transmittal to the DDS, the claimant is determined to be residing in Illinois and the claim should be sent to the Illinois DDS.
B. Claimant moves before DDS makes a determination
If the claimant notifies the field office (FO) of his or her change of permanent state of residence and the case is pending at the DDS:
The FO notifies the DDS using the Update-After-Transfer Utility (UAT) for claims that have been entered into EDCS. See DI 81010.095 Using the Update-After-Transfer (UAT) Utility. For paper cases, contact the DDS by phone or email.
The DDS may make a “No Determination” back to the originating FO on the case if substantive development has been undertaken. If this is done, it is the responsibility of the FO to transfer the case to the new servicing DDS. The original DDS may retain jurisdiction if they are ready to render the disability decision or may transfer the claim to the DDS of the new state of permanent residence to prepare the disability determination.
NOTE: Transfer is not mandatory.
If the DDS transfers the case, the DDS documents the folder with the claimant's new address and information about any outstanding development received since the filing of the claim. For claims that have been entered into EDCS see DI 81020.125 Electronic Case Routing Before Final Determination.
The transferring DDS notifies the FO with jurisdiction regarding the change of address.
C. DIB or freeze application filed after death
Jurisdiction of a claim after the death of the claimant is with the DDS in the state where the claimant was residing (or was last known to have resided) immediately before his or her death. The following criteria must be met:
An application is timely filed (GN 00204.005 Claimant Dies Before Filing/Effectuation);
Death occurred after completion of the waiting period (DI 10105.025 Basic Requirement for Freeze, and DI 10105.070 Waiting Period for Disability Insurance Benefits (DIB)), and;
The deceased’s alleged onset date (AOD), or the potential onset date (POD) is within the disability insured status period.
The claimant's residence determines jurisdiction if death occurred in a foreign country.
D. DIB or freeze claim - visual impairment alleged
An individual filing for disability due to statutory-blindness may qualify for DIB or freeze if he or she has fully insured status only. See RS 00301.150 Insured Status for Statutory Blindness.
Send the case to the DDS if the claimant:
Alleges a visual impairment; and
Is fully insured at or after the alleged onset of the visual impairment, even if the 20/40 or special insured status requirement is not met.
For more information on statutory blindness and visual impairment allegations, refer to DI 11005.070.
E. Parent(s) filing for DIB and child filing on grandparent’s earnings record (E/R)
In this situation, there are two claims - a DIB claim by the parent and a child's claim involving a parent's disability filed on the E/R of a grandparent. Process as follows:
Develop each claim separately.
Send the DIB case of the parent to the DDS in the state in which the parent resides.
The established onset date (EOD) for the DIB claimant, who is the parent in the child's claim, may not be timely for the child to meet the relationship requirements on the grandparent's E/R. It is possible to have an allowance of the parent’s DIB claim and a denial on the grandchild’s claim because the parent’s onset date is not at one of the applicable times specified in GN 00306.235 Entitlement Requirements- Benefits Based on E/R of Grandparent.
F. DIB claims involving work activity
If the claimant meets any of the following criteria, route the case to the DDS:
The claimant is engaging in work activity but the FO concludes that the work activity is not Substantial Gainful Activity (SGA). For SGA earnings guidelines refer to DI 10501.015 Tables of SGA Earnings Guidelines and Effective Dates Based on Year of Work Activity.
The claimant engaged in SGA after alleged onset but ceased SGA and, in a DIB re-entitlement claim, cessation of SGA occurs prior to the date the insured status, prescribed period or re-entitlement period expires. Develop the reason for discontinuance or reduction of work (DI 11010.035 Avoiding Unnecessary Development in DIB Claims).
Current work is SGA but a closed period of disability is possible because the claimant did not engage in SGA due to impairment during the 12-month period before the date current SGA began.
In Title II claims, the month in which the claimant began engaging in SGA must have been within 14 months prior to the month of application. In Supplemental Security Income (SSI) claims, the date in which the claimant began engaging in SGA must have been in the month after the month of application.
A DIB/freeze or SSI claimant is engaging in SGA and alleges a visual impairment. For information on statutory blindness requirements see DI 11005.070 Field Office Title II and Title XVI Disability Claims for Blindness and Visual Impairment Allegations.
Note: The FO must make and document an SGA determination before transferring the claim to DDS for a medical determination.
G. Filing a new claim while receiving Title II or Title XVI benefits
See DI 11011.005 FO Adoption Decision instructions. If the claim is a Certified Electronic Folder (CEF) see DI 81010.140 Processing Field Office (FO) Determinations.
H. Pending disability determination in DDS – claimant files a different claim type disability claim in another state
Use the following procedures for these cases:
Notify the DDS processing the first case to transfer the case to the DDS in the state where the claimant is currently residing. For claims entered into EDCS, see DI 81020.125 - Electronic Case Routing Before Final Determination.
Route the second case to the DDS where the claimant is currently residing. (Include a message in EDCS indicating that the DDS with the first case was notified to transfer the previously filed claim.)
EXAMPLE: The claimant filed a DIB claim in New York (NY). While the NY DDS is developing the case, the claimant moved to Pennsylvania and filed for SSI. The Pennsylvania DDS has jurisdiction for preparing both the DIB and SSI disability determinations. (See DI 20101.045F Jurisdiction User’s Guide)
I. Filing a disability claim prior to date first insured (DFI)
Annual reporting of earnings and the assignment of quarters of coverage based upon annual totals, make it possible to determine insured status for months prior to the actual accrual of the insuring quarter. A disabled claimant may file a disability claim prior to meeting insured status. Take a disability application and adjudicate it as an allowance, if appropriate, when the number holder (NH) does not meet insured status in the filing date month but will meet it in a future month within the same calendar year. However, the claim cannot be effectuated until all factors of entitlement are met. If a claimant files a disability claim prior to meeting insured status:
Transmit the claim to the DDS for a disability determination with the DFI as the POD (or if later based on other non-medical requirements), unless otherwise excluded by procedures in this subchapter. For information on POD refer to DI 25501.220 Potential Onset Date (POD). For information on transferring claims to DDS in EDCS refer to DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).
Do not technically deny these cases for lack of insured status.