Query the MBR to determine if the claimant was previously entitled to a disability benefit under Title II (i.e., disabled number holder, disabled surviving spouse, or disabled child). If entitlement has terminated, determine the reason for termination. A combination of three of the following MBR entries, along with a Ledger Account File (LAF) code of T6, T8, U, or X7, indicates entitlement terminated due to the performance of SGA:

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  BENEFIT Line - reason for suspension/termination (RFST) coding of DIBCES.

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  DIB Line - Cessation Disability Reason-code of E (CDR-E).

  NOTE: A medical cessation which occurs after an SGA cessation may overlay the CDR-E code with CDR-M coding. CDR-M coding is not conclusive evidence that benefits did not terminate due to SGA. Further, a medical cessation occurring after an SGA cessation does not preclude potential eligibility for EXR.

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  DIB Line - A difference between the extended period of eligibility begin date (EBD) and the disability benefit cessation (DBC) dates of three or more years.

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  DIB Line - An entry in the extended period of eligibility Medicare begin date (EMD) field that is at least 78 months earlier than the Medicare Part A termination date (or 24 months earlier if the Part A termination date is prior to 10/1/00).

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  HI-DIB Line - A Medicare Part A termination date more than 78 months (or 24 months if termination date is prior to 10/1/00) after the applicant's disability cessation date (ADC).

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  HISTORY Line - an RFST of EPESGA in the SUSP/TERM field, followed by DIBCES in subsequent lines.

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  SP MSG – A special message with information relating to SGA cessation and termination.

Review other sources of information to verify that termination was due to SGA, rather than medical or other reasons:

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  Work CDR application – compare the most recent decision with the DIB line and History data on the MBR.

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  Disability Control File (DCF) – query the most recent T2 WORK event (#6 on the ECDR screen) to see if the decision was a cessation.

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  eView or Evidence Portal (EP) – search eView or EP for a SSA-833.

NOTE: Be alert to situations in which the claimant stopped performing SGA within the extended period of eligibility, and to the possibility of reopening an erroneous decision. If you determine that benefits terminated due to work, review the most recent Work CDR determination. In these cases, do not pursue EXR, but instead pursue reopening of the prior decision to reinstate benefits.

Determine if the EXR request is within 60 months (five years) of the previous benefit termination. Add 59 months to the DBC month reflected on the DIB line to determine the end of the 60-month period. For further information about the EXR request period and consideration of good cause for late filing, refer to DI 13050.010. Also, consider the protective filing guidelines in DI 13050.015.

The FO technicians must screen cases for EXR eligibility per DI 13050.001 and DI 13050.045A, and discuss filing a new claim versus an EXR with the claimant per DI 13050.020.

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  If the claimant does not meet the technical requirements for EXR and insists on filing for EXR, the FO must deny the request per procedures in DI 13050.065D.

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  If the claimant chooses to file a new initial claim for disability benefits, you may use the request for reinstatement as a protective filing. Close out the protective writing per DI 13050.015E and GN 00204.012. Document the reason the claimant chose to file a new claim instead of an EXR in the remarks section of the new initial application.

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  If the claimant is eligible for EXR and decides to file an EXR request, follow the instructions below to complete the EXR request.

Establish an EXR event on the DCF following these steps:

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  On the MCDR screen, select 8=Establish Disability Review.

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  On the ECDR screen, select 2=EXR.

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  Complete the DRES screen to establish the EXR event.

Establish the case in the Electronic Disability Collect System (EDCS) and;

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  Enter the date of the Comparison Point Decision (CPD), using the most recent favorable medical decision date;

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  Enter the month benefits terminated due to work, see DI 13050.045A and DI 13050.050A.1;

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  Enter the established onset date from the previous entitlement;

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  Enter EXR filing date; and

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  Link the EXR with the prior CPD folder, per DI 81010.235.

NOTE: For any EDCS exclusions, follow paper folder procedures per DI 70005.001 and DI 70005.005.

Explain that the claimant must complete the forms before we can pay provisional benefits and reinstate Medicare. Use initial claims attestation scripts prior to and after filing out forms with the beneficiary per GN 00201.015F. Store the forms in eView or Evidence Portal (EP). The EXR request includes:

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  SSA-371 - Request for Reinstatement - Title II. To attest, access the form in Uniforms (if available), and in the “Witness Address” field, type in “ATTESTED” and list your name, your office code, and the date (e.g., Attested by John Doe DO123, 3/31/2020”) and save to the electronic folder. Note: The SSA-371 now includes the Medicare acknowledgement statement.

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  Complete the SSA-454-BK - Continuing Disability Review Report,SSA-3367- Disability Report-Field Office, and SSA-827 - Authorization to Disclose Information to the Social Security Administration in EDCS. You may attest the SSA-827 per DI 11005.056D.2.

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  SSA-820-BK or SSA-821-BK - Work Activity Report (Self-Employment) or Work Activity Report (Employee) and in the “Witness Address” field, type in “ATTESTED” and list your name, your office code, and the date (e.g., Attested by John Doe DO123, 3/31/2020”) and save to the electronic folder.

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    Use these forms to develop and document all work activity in the 12-month retroactive period, or from the Benefit Termination Month (BTM), whichever is later. Use the initial claim policy rules to evaluate earned wages per DI 10505.005D in EDCS.

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  SSA-823- Report of SGA Determination. You may use the click and sign feature in Uniforms to complete form SSA-823. In Item 2C of the Continuing Disability Review/Post-Entitlement (CDR/PE) section, document the following:

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    The month of EXR filing (and protective filing date if applicable), prior termination month, and the SGA determination for each month in the retroactive period. If possible retro-activity prior to the month of filing exists, indicate in the remarks, "possible retro-activity exists prior to the month of filing".

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    If there is SGA in all months of the 12-month retroactive period and in the month of filing, the first possible MOE is the month following the month of filing. In this situation, annotate the remarks of the SSA-823 with “SGA in the month of filing, First possible MOE is MM/YY”. Note: Document first possible month of entitlement regardless in MM/YY format regardless of SGA.

    NOTE: The retroactive period does not include months prior to the BTM. Therefore, if the BTM is fewer than 12 months before the request for EXR, do not provide SGA and non-SGA determinations for months prior to the BTM. If SGA work stopped prior to the BTM, review the prior termination decision and determine if reopening is appropriate.

    Example: EXR filing date is 09/2022. Benefits previously terminated in 01/2022. The retroactive period is 01/2022-08/2022. The claimant engaged in SGA in 01/2022 through 03/2022. The claimant did not engage in SGA 04/2022 through 09/2022. The earliest MOE the DDS could establish is 04/2022, the first non-SGA month in the retroactive period.

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  SSA-16-BK-Application for Disability Insurance Benefits, SSA-10-BK Application for Widow(er)’s Insurance Benefits, or SSA-4-BK. A signature is not required as it serves as a supplement to the EXR request.

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  SSA-8240-Request wage and employment information authorization and record it in the Wage and Employment Information Authorization (WEIA) application per, GN 00204.150C.

Start provisional benefits, if eligible. Do not use the Critical Payment System (CPS) to initiate provisional payments. For more information about provisional benefits, see DI 13050.025A.

If the CPD is electronic, the FO may transfer the EXR request to the servicing DDS. If the CPD folder is paper, the FO must wait for the receipt of the paper CPD folder before transferring the EXR request to the servicing DDS. DDS will need the comparison point decision (CPD) folder to make the EXR medical determination. If the CPD folder is paper, follow folder retrieval instructions in DI 13015.030 through DI 13015.250, and DI 40525.020 through DI 40525.150. If you are unable to locate the CPD folder, follow instructions in DI 13015.080 and DI 13015.090. If the CPD folder was processed in EDCS, you will be able to "link" it to the EXR case when you create it in EDCS. NOTE: Completing the "REQUEST FOLDER (Y): " field on the DRES screen will not result in the prior file being sent to you. You will need to request any prior paper folder through PCACS, following normal procedures.

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  Select the transfer option within EDCS and transfer to the servicing DDS.

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  Update the DCF taking the following steps:

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  Transfer the event to the servicing DDS per DI 13010.620;

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  Establish an issue (for example, EXRDDS) on the DCF development worksheet (CDRW) to control for the DDS decision. For more information about the CDRW, see DI 13010.605.

  If the EXR request is an EDCS exclusion, pair the completed EXR packet with the prior decision folder. If the prior decision was an electronic file, see DI 81010.030E . Attach the "EXR Case Flag View" in PDF to the paper medical folder, and mail the paper folder to the appropriate DDS.

If during the interview you determine that the claimant is incapable of managing their own provisional benefits, develop for a representative payee. If the claimant had a representative payee in the previous entitlement period, determine if the claimant still needs a representative payee. For more instructions about payee development, refer to DI 13050.075 .