TN 15 (11-02)

DI 13010.180 Completing the Explanation of Determination SSA-4268

Include a summary of the evidence supporting the determination that the beneficiary was or was not engaged in substantial gainful activity (SGA) in the SSA-4268-U4. Also list TWP service months, if applicable. If eWork is used to prepare the determination, the SSA-4268 information will automatically be generated.

A. Procedure - Continuances

Show the rationale for a continuance in the SSA 4268. For example: work activity after the trial work period (TWP) did not represent substantial gainful activity (SGA); or although work was at a SGA level, it ended within 3 months of the end of the TWP due to the impairment.

B. Procedure - Cessation

In the rationale for a cessation show:

  • that the beneficiary was or was not entitled to a TWP,

  • what work activity is SGA and why, and

  • the month of cessation.

    In a “Failure to Co-operate” or “Whereabouts Unknown” case document the efforts to locate the beneficiary or gain the beneficiary's cooperation, providing pertinent dates.

C. Procedure - Identifying Information

Enter the name of the beneficiary, the number-holder (in childhood disability claim (CDB) or disabled widow claims benefit (DWB)) and the social security number in the appropriate spaces at the top of the SSA-4268-U4.

D. Procedure - Signature And Date

Initial and date the SSA-4268-U4.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0413010180
DI 13010.180 - Completing the Explanation of Determination SSA-4268 - 07/05/2012
Batch run: 07/05/2012
Rev:07/05/2012