TN 64 (09-09)

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

A. Introduction

SSI does not apply outside the 50 States, the District of Columbia, and the Northern Mariana Islands. Therefore, the Puerto Rico Disability Determination Services (DDS), Office of Disability Operations, Processing Centers (PC), and the Office of International Operations (OIO) (who prepare Title II disability determinations for foreign claimants) do not prepare SSI disability determinations.

When a claimant moves to or from Puerto Rico, the Virgin Islands, Mexico, or Canada and there is SSI involvement, apply the jurisdictional guidelines with respect to the SSI disability determination.

For situations that may arise, see DI 11055.060B and DI 11055.060C in this section. The situations presented in these subsections include instructions for the field office (FO) and the DDS jurisdiction and routing.

REFERENCE:

DI 12045.080 Title XVI and Concurrent Title II/XVI Reconsideration Requests When a Claimant Moves to or from Puerto Rico, the U.S. Virgin Islands, Mexico, or Canada

B. Procedure for the jurisdiction and routing of Title XVI and concurrent Title II and Title XVI claims excluded from electronic folder case processing for claimants who move to or from Puerto Rico or the Virgin Islands

Following are two claim situations involving a claimant moving to or from Puerto Rico or the Virgin Islands:

SITUATION #1 – Claimant files in U.S.

Claimant files a Title XVI-only or concurrent Title II and Title XVI claims in the U.S., and then moves to Puerto Rico or the Virgin Islands before or after transmittal to a U.S. DDS.

FO action – U.S. FO actions

If retroactive benefits would be payable:

  1. Annotate the disability file showing claimant's change of address. (If a transmittal was already done, notify the DDS of record about the change of address.)

  2. Send the medical portion to the U.S. DDS (if not already done).

  3. Send an informational Report of Contact (RC) to the Puerto Rico or the Virgin Islands FO to notify them of the current claim situation.

  4. When the DDS returns the disability determination:

    If the determination is an allowance:

    • Retain the Title XVI file.

    • Route Title II (for concurrent claims) to ODO or to the appropriate PC (following existing instructions).

    • Send copies of the SSA-831(s) (Disability Determination and Transmittal) to the Puerto Rico or the Virgin Islands FO.

    If the determination is a denial:

    • Retain Title XVI or concurrent Title II and Title XVI file.

    • Send copies of SSA-831(s) to the Puerto Rico or the Virgin Islands FO.

    FO action – Puerto Rico FO Actions

    Retain the SSA-831(s) sent by the U.S. FO.

    DDS action – U.S. DDS Actions

    • Retain jurisdiction for both claim(s).

    • Prepare the decision(s).

    • Route to the FO servicing the first U.S. address.

SITUATION #2 – Claimant files in Puerto Rico or the Virgin Islands

Claimant files for Title II in Puerto Rico or the Virgin Islands, then moves to the U.S. and files for SSI.

FO action – U.S. FO Actions

  1. Call Puerto Rico or Virgin Islands FO to ascertain the status of the Title II claim.

  2. Allowance - If a Title II disability allowance determination has been made and it is a paper claim:

    • Request a copy of the Title II SSA-831 and the SSA-250 (Development Worksheet) verifying the allowance.

    • Adopt the Title II determination and make necessary Title XVI payment input.

  3. Denial

    • Request that the Puerto Rico or the Virgin Islands FO send the folder to the U.S. FO.

    • Send the Title II denial file with the Title XVI disability/blindness material to U.S. DDS for a Title XVI determination.

  4. If the Title claim is still pending:

    • Request the Puerto Rico or the Virgin Islands FO to notify the U.S. DDS of the situation and request an expedited determination.

    • When the Puerto Rico or the Virgin Islands FO does make the disability determination, follow the steps in FO action – U.S. FO actions, Step 2 (for an allowance) or Step 3 (for a denial).

U.S. DDS action

Adjudicate the Title XVI claim, adopting Title II denial (if indicated).

Puerto Rico - DDS action
May transfer jurisdiction of the Title II claim to the DDS where the claimant currently resides.

NOTE: If the Puerto Rico DDS does transfer jurisdiction of the Title II claim to a U.S. DDS, the Puerto Rico DDS notifies the U.S. FO.

C. Procedure for the jurisdiction and routing of Title XVI and concurrent Title II and Title XVI claims excluded from electronic folder case processing for claimants who move to or from Mexico or Canada

Following are three claim situations involving a claimant moving to or from Mexico or Canada.

SITUATION #1

Claimant files for concurrent Title II and Title XVI in the U.S. and moves to Mexico or Canada before transmittal to DDS.

FO action

  1. Send the disability material to the DDS in the State of the claimant’s last U.S. residence. (Include an RC to alert the DDS about the change of address and to prepare a decision only for the Title XVI claim.)

  2. After DDS determination:

    • Retain Title XVI non-medical material and folder copy of SSA-831 for the Title XVI claim.

    • Send Title II material, photocopy of SSI SSA-831 and Title II disability material to OIO.

DDS Action

  1. DDS in State of last U.S. residence retains jurisdiction for Title XVI determination.

  2. Prepare the disability determination for Title XVI claim and return the folder to the FO.

SITUATION #2

Claimant files for Title XVI only or concurrent Title II and Title XVI claims in U.S. and moves to Mexico or Canada after transmittal to DDS.

FO Action

  1. Notify DDS of change in address.

  2. After DDS determination:

    • Retain the Title XVI material.

    • Denial - retain the Title II.

    • Allowance - send the Title II to OIO.

DDS Action

  1. DDS retains jurisdiction, and

  2. Prepares the disability determination for both claims and returns the folder to the FO.

SITUATION #3

Claimant files for Title II in Mexico or Canada, moves to the United States and files for Title XVI.

FO Action

Contact border FO with jurisdiction, requesting the status of the Title II claim.

  1. If the Title II determination has been made:

    • Allowance – Request a copy of SSA-831 and MBR (see SM 00510.000). Adopt and input the Title XVI disability allowance information.

    • Denial – Request folder from Office of International Operations (OIO). Send folder to DDS with an SSA-831 for the Title XVI claim.

  2. If the Title II determination is still pending:

    • Alert the border FO about the current claim situation.

    • Follow FO action, step 1, once the DDS makes the Title II determination.

DDS Action

Prepare the disability determination for the Title XVI claim.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411055060
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 - 10/22/2013
Batch run: 10/22/2013
Rev:10/22/2013