DI 11025.010 Disabled Minor Child Determination Needed to Continue Entitlement to a Parent
IMPORTANT: In this section, we use the term Parent to mean the parent of the Disabled Minor Child. Do not confuse the term Parent with Parent’s benefits, as explained in RS 00209.001.
If a child is disabled and the parent meets the requirement for having a child in care (CIC), when the last child in care attains age 16 (age 18 prior to 9/81), the spouse, mother, or father may continue to receive benefits. The child’s benefits could continue to age 18 regardless of whether he or she is disabled. SSA must obtain a disability determination for the disabled minor child (DMC), only to entitle the parent. The DMC can file the claim up to 6 months before they attain age 16.
The system automatically sends a notice five months before the last child attains age 16. It tells the parent their benefits end when the child attains 16, unless a child in their care is disabled.
A. CIC requirements
In addition to having a child in care, the parent must also exercise parental control and responsibility for a mental disability, or provide personal services for a physical disability.
RS 01310.001, Conditions for Entitlement and Definitions
RS 01310.010, Exercising Parental Control and Responsibility
RS 01310.015, Personal Services
RS 01310.035, Mentally Disabled Child
RS 01310.040, Physically Disabled Child Age 16 or Over
B. Field Office (FO) action
When the parent contacts SSA, explain that:
If the child attains age 16 before the disability determination is made, he or she will receive a notice that his or her benefits will be suspended;
We send a separate notice after the Disability Determination Services (DDS) makes a disability determination;
If the child is disabled and the parent meets the CIC requirements, we will reinstate the benefits.
C. Taking a DMC disability claim
Develop the disability claim as follows:
Obtain a Supplemental Security Income (SSI) query to see if the child is receiving SSI. If yes, consider a collateral estoppel adoption. The FO will not adopt the SSI decision unless we previously completed an age 18 Medical Redetermination, or the DDS allowed the DC case using adult criteria. DDS must make an adult determination;
If the DMC is not receiving SSI, consider taking an SSI claim since you have an allegation of disability;
If the DMC worked, consider the possibility of entitlement on his or her own Social Security number. Use Disability Insured Status Calculator Online (DISCO) or Informational Certified Earnings Record System (ICERS) to verify possible insured status. Make sure you develop lag so that you consider all earnings;
Explain the CIC requirements. If the parent states he or she does not provide these services based on the alleged disability, do not send claim to DDS. If parent insists on filing, obtain statement from parent as to CIC not met and process as a denial per DI 11025.010E.2. in this section.
Complete the case in Electronic Disability Collect System (EDCS). In most cases, you will not load a new claim in Modernized Claims System (MCS). Complete MCS exclusions in EDCS per DI 81010.020. Complete an SSA-3368 (Disability Report-Adult), SSA-827 (Authorization to Disclose Information to the Social Security Administration), and SSA-3367 (Disability Report-Field Office).
Complete an SSA-795 (Statement of Claimant) with parent’s allegations of control and responsibility or personal services, or both. Have parent sign the form per GN 00201.010B and fax into EDCS (or if case is EDCS exclusion, retain in paper folder).
D. Controlling a DMC claim
Since there is no control in MCS and Processing Center (PC) action may be required:
Fax a request into paperless to notify the PC or send them a Modernized Development Worksheet (MDW). Tell the PC that a childhood determination is pending. Include in the text “Handle per RS 00202.095B”. If the DMC determination is still pending when the child attains age 16, the PC places the parent in suspense status. If the parent is in terminated status, the PC will not reinstate the parent and place him or her in suspense. Benefits will not be reinstated until the child is found to be disabled and in the parent’s care;
Create a special message on the Master Beneficiary Record (MBR) showing that a DMC claim is pending and the date sent to DDS;
Control the case on MDW unless the claim is in MCS.
E. Sending a DMC case to DDS
The following additional instructions relate to DMC cases only:
Enter in the remarks section of the SSA-3367, “For (spouse’s), (mother’s), or (father’s) benefits only. First possible MOE for parent (date)”. Enter the first day of the first month of possible entitlement for the parent. This date will never be before the month the DMC attains age 16;
If the parent alleges the child has both a physical and mental impairment, also show “child in care” in the 3367 remarks. This remark alerts the DDS that they need to identify a documented mental impairment not already shown as a primary or secondary diagnosis. This information is necessary to determine if the parent meets the child in care requirements;
If the case is an EDCS exclusion, (e.g., SSI CDR is secured with the claim) prepare a Modular Disability Folder (MDF). Transmit the claim to DDS using an SSA-831 (Disability Determination and Transmittal). The field office completes items 1-14, and enters the same remarks (from the previous bullets) in item 11 of the SSA-831; see DI 11010.205, Completing the SSA-831.
F. Processing a DMC allowance
1. Determine if CIC criteria are met
The CIC criteria you use depends on whether the child is mentally disabled, physically disabled, or both. Compare the diagnosis codes in 16A, 16B, or in the SSA-831 remarks with the adult diagnosis codes in DI 26510.015G.1., Mental Disorders (12). If one of the DMC’s diagnosis codes is on the list of mental disorders, the child has a mental impairment. Any other code represents a physical impairment.
a. Child is mentally disabled or physically disabled with mental involvement
When the child has a mental impairment:
The parent must exercise parental control and responsibility, which means supervising the child's activities and participating in the important decisions about the child's physical and mental needs. For more information, see RS 01310.010, Exercising Parental Control and Responsibility.
If the child’s diagnosis code is on the mental disorders list, consider the parent’s statement to determine if he or she exercises parental control and responsibility. Fax your determination into EDCS.
b. Child is physically disabled
When the child is physically disabled:
If the diagnosis code is not on the mental disorders list, then consider the condition as a physical impairment.
The parent must provide personal services to meet the CIC requirements.
Personal services do not include routine household services performed for all members of the household. For the type of services that the parent needs to provide for the DMC, see RS 01310.015, Personal Services.
Consider the parent’s statement to determine if he or she meets the personal service requirements. Fax your determination into EDCS.
2. Notifying PC of allowance
If the case is not an MCS exclusion, process it through MCS. Otherwise, take the following actions:
Fax SSA-3601 (Claims Routing) and actionable material into paperless, or send an MDW. If case is EDCS exclusion, notify PC that you are sending a paper file;
Annotate SSA-3601 (Claims Routing) or MDW remarks with “CDB claim to continue mother or father’s or spouse’s benefits”;
Provide the DMC’s disability onset date.
NOTE: If we suspended the parent’s benefit, the PC reinstates the benefit.
INFORMATION: PC posts the DMC’s disability determination on the MBR to enable automatic conversion to CDB at age 18.
G. Process a DDS denial of DMC claim
Take the following actions to process the DMC denial:
If you are unable to process the claim through MCS, complete a manual action through Manual Adjustment Credit and Award Data Entry (MACADE) ;
Update the special message on the MBR;
Release the disability denial notice, if DDS did not release it.