TN 3 (01-07)
DI 13015.010 Failure to Cooperate (FTC) Suspension and Cessation/Termination Months and Whereabouts Unknown (WU) Cessation Date Determination
A. Policy - Suspension and Termination Months in FTC Cases
A streamlined FTC process was implemented for medical CDRs on January 27, 2007, in the FO. If the FO annotates the FTC decision to the DCF on or after January 27, 2007, the streamlined FTC process applies.
Suspend benefits in the first month that all attempts to have the beneficiary cooperate have failed (See DI 13015.005) and good cause is not found. Non-payment (suspension) will be effective the first month that does not cause an overpayment. Benefits to the beneficiary and any auxiliaries will be suspended. If the beneficiary does not cooperate during the period of suspension, benefits to the beneficiary and any auxiliaries will be terminated in the 13th month. No benefit continuation will be offered (See DI 13015.015).
Example: On 03/08/07, the FO sent a letter to the beneficiary requesting completion and return of CDR forms. The beneficiary did not return the forms. The FO exhausted all efforts to contact the beneficiary, e.g., phone calls, contacts with financial institutions for a current address, etc. On 04/02/07, the FO sent a follow-up letter. No response was received by 04/16/07, so benefits are suspended effective 05/07 (if this is the first month that does not cause an overpayment). If the beneficiary does not cooperate during the period of suspense, benefits will be terminated effective the 13th month (05/08).
If work is the sole issue for a title II beneficiary in FTC cases, cease benefits in the first month that all attempts to have the beneficiary cooperate have failed (See DI 13015.005A.2.) and good cause is not a factor.
B. Policy - Cessation or Suspense Month in WU Cases
In WU cases, the cessation or suspense month is the month in which the individual's whereabouts were unknown, but no earlier than the month in which the continuing disability issue arose.
Example: The FO sends a letter on January 27, 1997, for the title II claimant to call by February 11, 1997. The letter is returned address unknown in February 1997, and the claimant cannot be located. Determine that the disability ceased February 1997.
If work is the sole issue in a title II case, and an employer or other source provides sufficient evidence before the WU issue arises, make an SGA determination. Do not continue to develop the work issue once the WU issue is identified. If enough information is contained in the file to make a cessation decision due to work before WU is demonstrated, the determination should be adjudicated and the WU issue should be resolved at a later date. Annotate the MBR that WU existed at the time of adjudication. If there is not enough evidence in file, then a cessation for WU is appropriate (See chart II in DI 13015.005C.3.). See also DI 13010.170 for instructions on preparation of the SGA determination. If there is a work issue continuance, terminate title II benefits for WU. Suspend all title XVI cases (PSY S06) until whereabouts are discovered. See SM 01305.590.