TN 64 (09-09)

DI 11055.035 Determining Whether the SSI Claim Needs a Field Office (FO) or Disability Determination Services (DDS) Determination

A. Procedure for FO development and non-medical determination

When taking a disability/blindness Title XVI claim, review the non-medical evidence to determine whether the applicant meets the requirements of income, resource, citizenship or qualified alien status, and fugitive felon provisions.

  • If the applicant does not meet the non-medical requirements, the FO processes a non-medical denial. A medical determination by the DDS is not required.

  • If earned income is involved, and his or her earnings are below the excess income limit after applying all earned income exclusions, the FO must develop and document the information collected to determine whether the applicant is engaging in substantial gainful activity (SGA). If the FO determines the claimant is performing SGA, the FO processes the denial. A medical determination by the DDS is not required.

    NOTE: Record all appropriate findings about the individual's work on the SSA-821-BK (Work Activity Report - Employee), or the SSA-820-F4 (Work Activity Report - Self-Employed Person), as appropriate. Process SGA denials electronically, unless it is an EDCS exclusion. SGA denials may apply before or after case transfer to the DDS.

References:

If a disabled or blind claimant is ineligible based on the non-medical criteria, but is a likely candidate for the Plan for Achieving Self-Support (PASS) program, initiate a discussion about the PASS program. If an individual indicates an interest in PASS, even if he or she is an unlikely candidate, you must discuss PASS with him or her.

Utilizing a PASS, an individual sets aside income or resources (including deemed income and resources) that would otherwise affect his or her eligibility or payment amount, provided that these set-aside funds are used by the person to obtain items or services needed to reach an occupational objective (i.e., a work goal).

If the claimant wants to apply, assist him or her in completing the SSA-545-BK and

  • Forward the PASS request to the PASS expert immediately, or

  • Refer the individual to the PASS expert for assistance in developing the PASS.

NOTE: In an initial claim, a determination that the claimant is performing SGA precludes the need for a PASS determination, because the person does not meet the disability criteria for eligibility. For specific information about PASS, see SI 00870.000.

If a claimant applies for disabled child's benefits in the month he or she attains age 18 and parental deeming applies making the claimant ineligible for SSI as a DC, EDCS functionality allows the Claims Representative to select an SSA-3820 (Child Disability Report) or an SSA-3368 (Adult Disability Report). When an SSI claimant files in the month the claimant attains age 18, the SSA-3368 is required instead of the SSA-3820. Refer to Creating EDCS Cases DI 81010.020. For information on application effective date, see SI 00601.009.

B. Procedure for DDS development and medical determination

When the claimant meets the non-medical eligibility criteria, transfer the disability case to the DDS the same day with a complete disability application and medical materials (e.g., medical release forms, disability reports, and work activity forms).

Accept and include in the official disability folder any evidence or information that the claimant possesses relating to his or her alleged disabling condition. Stress to the claimant that submitting this evidence does not relieve him or her of the responsibility to assist SSA or the DDS to develop additional evidence.

References:

  • DI 10005.010, Field Office (FO) and Disability Determination Services (DDS) Exchange of Information and Coordination of Actions

  • DI 81010.030, Certified Electronic Folder (CEF) Exclusions and Limitations

  • DI 81010.085, Transferring Cases in Electronic Disability Collect System (EDCS)

  • DI 81010.125, Receiving Medical Evidence in the Field Office (FO)

C. Concurrent claims

A concurrent claim exists when a claimant files claims under both the Title XVI and Title II programs. For example:

  • A claimant files concurrently for disability under both Title XVI and Title II, and both claims require a disability determination; the FO transmits the case to DDS.

  • A claimant files a Title XVI disability claim and the claimant has a Title II disability claim already pending at DDS, the FO transmits the Title XVI portion of the case to the DDS. The FO must notify DDS that the claimant now needs concurrent disability determinations.

  • A claimant files a Title XVI disability claim and a Title II non-disability claim (e.g., retirement or survivor’s claim); transmit only the Title XVI case to DDS. The FO processes a determination for the Title II non-disability claim.

References:

  • DI 11055.055, Multiple Claims With SSI Involved

  • DI 11055.060, Jurisdiction and Routing of Title XVI and Concurrent Title XVI/Title II Claims for Claimants Who Move to or from Puerto Rico (PR), the U.S. Virgin Islands (VI), Mexico, or Canada

  • DI 11055.150, Preparation of the Official Disability Folder


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411055035
DI 11055.035 - Determining Whether the SSI Claim Needs a Field Office (FO) or Disability Determination Services (DDS) Determination - 06/01/2010
Batch run: 06/01/2010
Rev:06/01/2010