TN 64 (09-09)

DI 11055.225 Handling Reports of Return to Work in Title XVI Cases after Transmittal to the Disability Determination Services (DDS)

A. Policy for handling reports of return to work in the field office (FO)

If the FO receives notice of work activity by the claimant after transmitting the case to the DDS, take the following actions:

  • Notify the DDS via the Update-After-Transfer (UAT) utility in the Electronic Disability Collect System (EDCS), telephone, or email that the claimant is working; and

  • Obtain an SSA-820/821 (Work Activity Report – Self Employed Person/Employee) per DI 10501.025.

Upon receipt of the SSA-820/821, make a substantial gainful activity (SGA) determination and either

  • Upload, or barcode and fax, the SSA-820/821 into the Certified Electronic Folder (CEF); or

  • For a case excluded from electronic processing that still requires a medical determination, forward the SSA-820/821 to the DDS with an attached SSA-408 (Route Slip).

Reference:

DI 81010.115, eForms

1. Evidence confirms substantial gainful activity (SGA)

If the information gathered on the SSA-820/821 confirms claimant engagement in SGA and there is no allegation of a visual impairment or no possibility that the claimant was disabled for at least 12 months beginning with the medical onset date, take the following actions:

  • Request via UAT that the DDS transfer jurisdiction of the case back to the FO or, if the official folder is paper, contact the DDS by telephone, fax, or email to request the DDS to return the Modular Disability Folder (MDF) to the FO ; and

    NOTE: The DDS transfers jurisdiction back to the FO unless it can readily make a medical or vocational denial.

  • Prepare the SSA-831 for an SGA determination if the DDS transfers the case and follow procedures for processing an SGA denial detailed in DI 11055.130.

2. Evidence confirms SGA but a possible unsuccessful work attempt (UWA) exists

If evidence suggests that the claimant may be engaging in SGA, but:

  • there is a possibility that claimant did not engage in SGA, or

  • the claimant's work activity ended, or

  • the work activity reduced below the SGA level during the 12-month period before the date current work activity began,

Then take the following actions:

  1. State the facts and conclusions in the appropriate items in the SSA-820/821;

  2. Notify the DDS via UAT of the possible closed period or open period of disability, trial work period (TWP) for Title II involvement, or potential UWA; and

  3. Upload, or create a barcode, faxing the SSA-820/821 into the CEF (see DI 81010.090).

3. Evidence confirms that the claimant is not engaging in SGA

  1. State the facts and conclusions in the appropriate items on the SSA-820/821;

  2. Upload, or create a barcode, faxing the SSA-820/821 into the CEF (for instruction, see DI 81010.090); and

  3. Notify the DDS via UAT that claimant is not engaging in SGA.

NOTE: If the claim is excluded from electronic processing and the official folder is a paper MDF, notify the DDS by telephone, email, for fax to confirm that the claimant is not engaging in SGA. Forward the documentation to the DDS, including an SSA-5002 (Report of Contact), if necessary, along with the completed SSA-820/821 with an attached SSA-408 to be associated with the folder.

B. Policy for reports of return to work received directly by DDS

If the DDS needs assistance regarding the claimant’s work activity, the DDS sends a request to the FO to secure an SSA-820/821 and develop the work.

DDS sends the request via:

  • An Assistance Request (AR), which appears on the FO’s EDCS Actions Page; or

  • Telephone, fax, or email, if the official folder is a paper MDF.

If the work is obviously SGA, the DDS returns the case to FO jurisdiction for an SGA denial.

NOTE: If the DDS has sufficient information to make a medical/vocational denial, the DDS makes such a determination before returning jurisdiction of the case to the FO.


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http://policy.ssa.gov/poms.nsf/lnx/0411055225