TN 49 (08-08)
DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS)
A. Procedure - determining proper DDS
Use the individual's actual or last known physical residence when transmitting the disability material to the DDS. This address determines DDS jurisdiction, not his/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 his/her last known residence; but
If the individual's residence is in one State and the servicing post office is in another State, send it to the State where he/she physically resides.
If the claimant is living in the U.S. but using an Army Post Office (APO) or Fleet Post Office (FPO) (see Use of APO and FPO Addresses - NL 01510.010), obtain the individual's home address and send the case to the DDS in the State where he/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 his/her last known residence.
If claimant resides outside the U.S. refer to Sending Cases to OCO/OIO - DI 11010.275.
An absence from the State, expected to last 60 days or less, is temporary and State jurisdiction does not change. For example, if the claimant has his/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, send the claim to the Illinois DDS.
B. Procedure – claimant moves before DDS makes a determination
If the Field Office (FO) receives notification that the claimant has changed his/her permanent State of residence from the claimant, after the case has been transferred to the DDS, and before the determination has been made, the FO notifies the DDS using the Update-After-Transfer Utility (UAT) for claims that have been entered into EDCS. See Using the Update-After-Transfer (UAT) Utility - DI 81010.095. The FO calls or emails the DDS for paper cases. 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 Electronic Case Routing Before Final Determination - DI 81020.125.
The transferring DDS notifies the FO with jurisdiction regarding the change of address.
If the FO receives notification from the individual of a change in permanent State of residence, the FO notifies the DDS using the Update After Transfer utility (UAT) for electronic files per Using the Update-After-Transfer (UAT) Utility -DI 81010.095. The FO calls or emails the DDS for paper cases.
C. Procedure - 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/her death. The following criteria must be met:
An application is timely filed (Claimant Dies Before Filing/Effectuation - GN 00204.005);
Death occurred after completion of the waiting period (Basic Requirement for Freeze - DI 10105.025, and Waiting Period for Disability Insurance Benefits (DIB) - DI 10105.070), and;
The deceased met disability insured status at or within 1 year of alleged onset date (AOD).
The claimant's residence determines jurisdiction if death occurred in a foreign country.
D. Procedure - DIB or freeze claim - visual impairment alleged
An individual filing for disability due to statutory-blindness, may qualify for DIB freeze or entitlement to DIB if he/she has fully insured status only. See Deemed Fully Insured - RS 00301.106.
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 or within 1 year before such onset in the case of a non-traumatic 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. Procedure - parent(s) filing for DIB and child filing on grandparent’s Earnings Record (E/R)
In this situation, there are two claims - a child's claim involving a parent's disability and a separate DIB claim by the parent. 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 onset date established 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 Entitlement Requirements- Benefits Based on E/R of Grandparent - GN 00306.235.
F. Procedure – 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).
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 (Avoiding Unnecessary Development in DIB Claims - DI 11010.035).
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.
G. Procedure – filing a new claim while receiving Title II or Title XVI benefits
See FO Adoption Decision - DI 11011.005 for Collateral Estoppel (FO Adoption Decision Needed) instructions. If the claim is a Certified Electronic Folder (CEF) see Processing Field Office (FO) Determinations - DI 81010.140C.
H. Procedure – pending Disability Determination in DDS – claimant files another type of Disability claim in another State
Use the following procedure for these cases:
Notify the DDS processing regarding the first case, requesting DDS to transfer the case to the DDS in the State where the claimant is currently residing. For claims entered into EDCS see Electronic Case Routing Before Final Determination -DI 81020.125.
Route the second case to the DDS where the claimant is currently residing. (Include a remark/message indicating that the DDS with the first case was notified to transfer it.)
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 When to Develop and Verify Impairment Related Work Expenses (IRWE) - DI 11010.185 when the claimant moves to or from Puerto Rico, Mexico, or Canada.)
I. Procedure – filing a Disability claim prior to date first insured
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. Therefore if a claimant files a disability claim prior to meeting insured status:
Transmit the claim to the DDS for a disability determination, unless otherwise excluded by procedures in this subchapter.
Do not technically deny these cases for lack of insured status.
If DDS makes a favorable disability determination, the FO corrects the onset date to the first day of the quarter the claimant meets insured status. This becomes the established onset date (EOD), and the waiting period is counted from the EOD.
NOTE: When transferring any claim to the DDS that has been entered into EDCS see Transferring Cases in Electronic Disability Collect System (EDCS) - DI 81010.085.