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:
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.