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
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
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.