TN 59 (07-99)
If the determination of the new claim is made by adopting the prior determination,
complete the SSA-831-U3 per DI 11010.205 with the exceptions shown below. Store the SSA-831 in the certified electronic folder
(CEF). For paper claims, store the SSA-831 in the Non Disability Repository for Evidentiary
Documents (NDRED) and in the modular folder.
Enter the date of disability onset. See DI 11011.001B.1.c. when the date first insured on the title II claim is later than the title XVI claim
Show the appropriate primary diagnosis, if available from the systems query. If not
available, leave blank and enter “2480” in the Code Number box.
Enter the diary type, date, and reason following the instructions in DI 11011.005C.
Enter the Regulation Basis Code from the systems query, if available. If not available,
enter “CE” for title II claims. Regulation Basis Codes correspond as follows from SSI to title
II: A61=A1, A62=B1 and A63=C1.
Show the remark, “Determination adopted from systems query or SSA-831-U3 dated , SSN .” If the date is unknown, enter “UNK”.
Sign the SSA-831.
Date the SSA-831-U3.
Attach a photocopy of the prior SSA-831-U3 and any subsequent SSA-833-U3 to the new
SSA-831-U3, if available.