SSA - POMS: DI 13015.007 - Failure to Cooperate- Insufficient Evidence Decision (FTC) Reinstatement Procedures for a Continuing Disability Reviews (CDR)- Field Office (FO)

A. Reinstatement of benefits, beneficiary or recipient cooperates after FTC suspension

If the beneficiary or recipient cooperates with our request for necessary information within the 12-month suspension period and is otherwise eligible, reinstate benefits or payments by selecting "2" Transfer Case on the CDR FO Input (IFOA) screen of the Disability Control File (DCF) and:

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For medical CDRs, follow normal CDR processing instructions per DI 13005.025 Field Office (FO) Actions to Initiate a Continuing Disability Review (CDR) and DI 13005.030 Field Office (FO) Personal Contact and Exceptions. Complete a transfer action in the DCF to update the record and on the same day transfer the eCDR in the Electronic Disability Collect System (EDCS) or paper folder to the Disability Determination Services (DDS) for processing. The DCF transfer will reinstate benefits. Query the record to ensure benefits resume. For information on DCF inputs see MSOM CDR 001.007.
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If work activity is the sole issue, follow procedures in DI 13010.210 Extended Period of Eligibility (EPE) - Overview, to determine if benefit reinstatement is appropriate.

Note: The beneficiary or recipient does not file an appeal to have benefits reinstated.

1. Title II reinstatement of disability benefits

a. Beneficiary cooperates- medical CDR

The DCF transfer triggers a Master Beneficiary Record (MBR) update to reinstate benefits and pay retroactive benefits due to the beneficiary and auxiliaries from the first month of suspension. Allow two days for this action to process. If the DCF input to reinstate benefits fails, the system generates an alert to the Program Service Center (PSC) for their action. Do not attempt multiple inputs in the DCF.

Note: When the PSC must take a manual action to reinstate benefits because the DCF input did not process successfully, the (FO) must monitor and follow-up with the PSC until the PSC completes their action to update the record. If after 20 days from the attempted input the PSC action remains pending, send a high priority follow-up via the Modernized Development Worksheet (MDW). For follow-up guidelines, follow GN 01070.440D.2.

b. Beneficiary cooperates- work activity involved

If work activity is involved, follow DI 13010.210 Extended Period of Eligibility (EPE)- Overview to determine whether benefits are payable before reinstating.

c. Reinstating Title II benefits if case cannot be transferred to the DDS

If the otherwise eligible beneficiary responds to our request for necessary information, but the case cannot be transferred to the DDS (e.g., there is an administrative delay on forwarding CDRs to the DDS), benefits must be reinstated manually. Contact the PSC to reinstate benefits through a high priority MDW. See GN 01070.440D.2 for PSC follow-up time frames.

d. Benefits terminated for reason other than FTC

If Title II benefits terminate for a reason unrelated to FTC during the 12-month period of FTC suspension, and the beneficiary subsequently cooperates with the medical CDR by providing the requested information, benefits that were withheld due to FTC and prior to termination may be released to the beneficiary and auxiliaries. Because the benefits terminated, the FO must determine the payable months and work with the PSC to release payment.

Example: The FO places a childhood disability beneficiary (CDB) in suspense for FTC effective 03/2018 (projected termination month is 03/2019). The CDB marries and disability benefits are terminated 09/2018. In 02/2019, the CDB contacts the FO and provides all the information requested for the medical CDR. The FO releases benefits from 03/2018 through 08/2018 since the CDB cooperated prior to the end of the 12-month suspension.

2. Title XVI reinstatement of disability benefits

a. Recipient cooperates

Reinstate benefits per SI 02301.210 Reinstatement, and follow normal CDR processing instructions for completing the medical CDR.

b. Supplemental Security Record (SSR) coding necessary for reinstating benefits

If the payment status code is N20 and the recipient cooperates, remove the N20 payment status. This will update the Medical Issue (MG) field in the Disability Information (DISB) line of the SSR with a code of "P" showing that FTC status has been removed. Also, remove any SSR remarks that refer to FTC. Input a CDR transfer in DCF and transfer the eCDR or paper CDR folder to the DDS of jurisdiction.

c. Reinstating Title XVI benefits if case cannot be transferred to the DDS

If the otherwise eligible recipient responds to our request for necessary information, but now the case cannot be transferred to the DDS (e.g., there is an administrative delay on forwarding CDRs to the DDS), use the Modernized Supplemental Security Income Claims System (MSSICS) to reinstate benefits. Add a remark on the SSID with the reinstatement date and reason for not transferring the medical CDR.

B. Beneficiary or recipient cooperates, benefits terminated after 12 months of suspension

If the beneficiary or recipient does not cooperate to provide the requested information or evidence, and benefits are in suspense for 12 months, eligibility terminates in the 13th month and no medical determination is necessary. If the beneficiary or recipient contacts the FO after the termination, he or she may file an appeal if within their appeal period or file a new application. This includes Child Disabled Benefits (CDB) and Disabled Widows Benefits. For information on CDB and DWB re-entitlement, refer to DI 10115.001 Requirements for Entitlement to Childhood Disability Benefits (CDB) and DI 10110.001 Requirements for Disabled Widow(er)'s Benefits (DWB).

For subsequent applications, DDS may be able to establish onset in certain CDB re-entitlement situations, see DI 25501.330A.7 Establishing an Established Onset Date (EOD) for Childhood Disability Benefits (CDB) Claims. For DWB re-entitlement, the DDS may be able to establish onset if the prescribed period has not ended.

If work activity is involved, follow DI 13010.210 Extended Period of Eligibility (EPE)-Overview to determine if benefits are payable before reinstating.

C. Beneficiary or recipient cooperates after medical cessation- streamlined process does not apply

If the DDS processes a medical cessation due to FTC and the beneficiary or recipient cooperates after the cessation determination, obtain the appropriate appeal forms and route to the DDS (or the Office of Hearing Operations (OHO) for hearing requests). If the appeal period has passed and there is no good cause for late filing, the claimant may file a new application.

D. Beneficiary cooperates after Title II work cessation by the FO

1. Work issue cases

Refer to DI 13010.145 Reconsideration or Reopening of Continuing Disability Work Issue Cases- Title II.

2. Work and medical issue

If benefits ceased for FTC in a work CDR and the beneficiary cooperates after the work cessation, obtain an appeal if within the appeal period along with the medical CDR forms. If the appeal determination reverses the cessation determination and entitlement based on earnings can continue, transfer the medical CDR to the DDS.

3. Manually close the CDR in DCF for Title II FTC termination cases

If the Title II FTC termination posts to the MBR, the input sends a transaction to DCF during the DCF batch run. This transaction will usually close the CDR event in DCF. FOs should identify these cases in the Workload Action Center (WAC) and ensure the CDR event closes in DCF. If the CDR event is not closed, manually close the Title II FTC CDR issue on DCF by annotating STOP CDR (see DI 13010.620 and MSOM CDR 001.007).

Social Security

Program Operations Manual System (POMS)

DI 13015.007 Failure to Cooperate- Insufficient Evidence Decision (FTC) Reinstatement Procedures for a Continuing Disability Reviews (CDR)- Field Office (FO)