BASIC (07-08)

DI 11020.045 Using the SSA-831-U3 to Transmit Cases to the Disability Determination Services (DDS) or to the Processing Center (PC)

A. Completing SSA-831-U3 in field office

If a claim cannot be processed in the Electronic Disability Collect System (EDCS), use the SSA-831-U3 to transmit the claim to the DDS or to the PC per instructions in DI 11010.205, “Completing the SSA-831.” In these situations, complete sections 1-14 on the SSA-831-U3 and place it in the front section of the Modular Disability Folder (MDF).

The following items on the SSA-831-U3 relate only to Childhood Disability Benefit (CDB) claims:

Item 4 - SSN

Enter the SSN of the individual on whose Earnings Record (ER) benefits are claimed. In CDB claims, also show the claim symbol, e.g., HC1.

Item 6 Wage Earner’s Name

In CDB cases, enter the name of the insured individual from the first line of the application.

Item 7 - Type Claim (Title II)

CDB - R - Childhood Disability Benefits (RSI NH)

CDB - D - Childhood Disability Benefits (DIB NH)

Item 11 Remarks - see subsection DI 11020.045A. in this section.

B. Situations Requiring Notations in “Remarks”

1. Childhood Disability Benefit/Disability (CDB/DIB) with the same claim number

In cases involving a disabled number holder (NH) and a disabled child auxiliary living in different jurisdictions, cross-refer each SSA-831-U3 by entering “(CDB or DIB) application for (name of NH or disabled child) forwarded to (DDS, ODO, DQB, DRS, or OIO) on (date)” per DI 11010.085, Multiple Type Title II Claims.

2. DIB/CDB with different claim numbers

When a disabled child has disability insured status on his or her own SSN and has filed an SSA-16-F6 in addition to the SSA-4-BK, enter “See (parent's name) (parent's SSN) for CDB claim” on the SSA-831-U3 prepared for the SSA-16-F6.

3. Railroad Board (RRB) involved

Enter “Dependent RR Annuitant” if a claim for CDB is filed by an individual who is entitled to a survivor's RR annuity as a disabled dependent of a career RR worker.

4. Reentitlement CDB claim

Enter “Reentitlement CDB claim” and “Prescribed period” followed by the beginning and ending month of the 84-month period following the month medical termination of last entitlement to CDB in subsequent CDB claims where disability is alleged within 84 months after the last CDB termination if the termination was based on substantial gainful activity of the CDB.

5. Termination of Spouse's, Mother's, or Father's benefits

When requesting a disability determination on a child, age 15 years and 6 months to age 18, to entitle a parent, complete the SSA-831-U3 as is usually done for a disabled adult child and enter in item 11, “For (enterspouse's, mother's, or father's", as appropriate) benefits only. First possible Month of Entitlement (MOE) for parent is (MM/YY).” Enter the first day of the first month of possible entitlement for the parent because, in some cases, the parent can be entitled for the first full month a disabled minor child is in care. However, this date need never be any month before the child attains age 16.

6. Application of res judicata is possible

When a subsequent CDB claim is being transmitted in accordance with the fourth bullet in DI 11020.070 “Subsequent CDB Claims to be Sent to the DDS”, enter the remark “Prior Claim attached. Review for application of Res Judicata”. If you could not locate the prior claim, enter, “Prior claim not located. Substantive determination necessary”.


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