TN 59 (07-99)

DI 11011.020 Completion of Form SSA-831-U3 In Adopted Decisions


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.

1. Item 15A

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 onset.

2. Item 16A

Show the appropriate primary diagnosis, if available from the systems query. If not available, leave blank and enter “2480” in the Code Number box.

3. Item 17

Enter the diary type, date, and reason following the instructions in DI 11011.005C.

4. Item 22

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.

5. Item 34

Show the remark, “Determination adopted from systems query or SSA-831-U3 dated        , SSN        .” If the date is unknown, enter “UNK”.

6. Item 37

Sign the SSA-831.

7. Item 38

Date the SSA-831-U3.

8. Prior Forms

Attach a photocopy of the prior SSA-831-U3 and any subsequent SSA-833-U3 to the new SSA-831-U3, if available.

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DI 11011.020 - Completion of Form SSA-831-U3 In Adopted Decisions - 11/19/2013
Batch run: 11/19/2013