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.
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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.
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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:
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DI 10501.025, Responsibilities and Procedures - Work Issue Cases
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DI 11055.065, Claimant Does Not Meet SSI Non-Medical Requirements
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DI 11055.095, Claimant Engaging in Substantial Gainful Activity (SGA)
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DI 81010.030, Certified Electronic Folder (CEF) Exclusions and Limitations
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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
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Forward the PASS request to the PASS expert immediately, or
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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.