TN 2 (02-06)
DI 13050.066 Initial Reinstatement Period - Title II
A. Policy – 24-Month Initial Reinstatement Period (IRP)
The 24-month initial reinstatement period is the period between the initial EXR entitlement month and the attainment of a total of 24 qualifying months (not necessarily consecutive) that make the individual eligible for a TWP. Reinstated benefits are not payable for any month the individual performs SGA during the IRP. SGA during the IRP is determined on a monthly basis using normal work incentives (IRWE, subsidy, etc.) that are applicable during the EPE.
Since SGA is computed on a monthly basis, work incentives not used after an EPE SGA cessation determination (income averaging, unsuccessful work attempt) do not apply to the IRP. SGA for blind individuals is based on blindness provisions. Benefits for auxiliaries also are suspended when a wage earner is suspended during the IRP due to SGA. Medicare coverage continues during SGA months.
The IRP is completed when the individual has received a total of 24 months of payable benefits. Do not count as a payable month any month the individual performs SGA or was in non-payment status due to any of the following:
Reduction, deduction or temporary suspense actions such as GPO, workers compensation offset, or overpayment recovery count as payable months.
After an individual has received 24-months (not necessarily consecutive) of payable benefits, the IRP is completed and the individual is entitled to:
a new 9-month trial work period;
a new 36-month reinstatement period (extended period of eligibility);
a new 60-month period to file an EXR request if the reinstated benefits terminate due to SGA earnings; and
a new period of extended Medicare coverage.
B. Procedure - Documenting the Initial Reinstatement Period
1. Electronic Processing of Payment Determinations During the IRP- eWork
Unless one of the exclusions in DI 13010.025B.3. applies, eWork should be used to assist with the development and adjudication of payment determinations during the IRP for Title II beneficiaries.
When evidence of earnings is received, establish a Work Review within eWork as outlined in DI 13010.025B.1.
Review the information presented on the Initiate Work Review screen. If the MBR is correctly coded with a DAC of F, eWork will establish the case as an EXR case and apply all applicable IRP policies. If the MBR is not correct, flag the case as an EXR case by placing a check in the EXR box. Correct the DOED if necessary. Enter the correct date of filing when prompted. See the eWork Help screen for assistance in determining the proper date.
NOTE: Although you can manually flag a case as an EXR case, enter it into eWork and begin development. IRP status changes cannot be finally processed until the MBR is corrected. Contact OCO/PC to request correction of the MBR. See the Help screens on the Initiate Work Review Screen for information on procedures.
If this is the first entry into eWork, enter the date of the EXR award determination and any prior IRP determination information. See the eWork Help screen for more information on determining the date of award.
After the date of award is entered, enter all payable months from date of entitlement through date of last determination to correctly determine IRP months.
When all development is completed, eWork will calculate the IRP months and proceed to the TWP and EPE if applicable. eWork will also produce the forms and notices needed for adjudication and the mainframe inputs necessary to effectuate the determination.
2. Manual Processing
EXR cases with non payment months during the IRP for any of the reasons listed in DI 13050.066A other than SGA are eWork exclusions. If the case is an eWork exclusion, manually prepare all development requests, notices and determinations. Use the CDRW to control development requests and outstanding issues.
a. Completing the 833
Document an SGA determination during the IRP on a SSA-833, (Cessation or Continuance Disability Determination or Transmittal). Complete the SSA-833 as you would for a SGA determination during the extended period of eligibility (EPE), with the following modifications.
Block 5; show the original claim date of onset.
Block 9; no entry. An IRP payment determination is neither a cessation nor continuance determination.
Block 24; annotate “EXR-IRP SGA” and record the months of SGA and non-SGA. If there is not sufficient space in the block to record the determination, use a continuation sheet (check block 13). This data is recorded in the same manner as EPE data.
IRP Begin Month: Show the month benefits were reinstated.
IRP Suspense Month: Show the first month in the IRP the individual engages in SGA.
IRP Reinstatement Allowed: Show the first month of non-SGA after a suspense month.
IRP Suspense After Reinstatement: Show the first month of SGA after a reinstatement.
IRP End Month: Show the last month of the IRP. This is the 24th month the individual did not engage in SGA after the IRP Begin Month. This date is needed to document the individual's reentry into the regular work incentive provisions (TWP/EPE/Extended Medicare).
If the period of earnings being reviewed goes beyond the IRP and through the new TWP, prepare a second SSA-833 for an EPE determination per DI 13010.170.
b. Effectuating the Determination
When adjudication is complete, input IRP suspense and reinstatement months to the PEC1 screen in the Postentitlement Online System (POS). Refer to MSOM T2PE 003.024 and MSOM T2PE 003.037 for instructions. Also input the appropriate monthly earnings and WORK DET code for each month of earnings in the review period per DI 13010.675 and place a remark on the Remarks screen of the DCF to document the IRP.
NOTE: Notices for IRP determinations are available in the Distributed Online Correspondence system (DPS).
3. Routing and Review
The DO has final adjudicative authority for all work issue CDR and IRP determinations and OCO/PC review is not required. When development is completed, print copies of any determinations and notices for retention in the claims folder. Send the paper material to OCO or the PC of jurisdiction, along with the SSA-820/821 and any other evidence submitted which may be useful in an appeal. OCO/PC will associate the material with the folder. Mark the material “No action needed-Prong file material”.
If eWork is used, do not maintain an ongoing paper file in the FO. An electronic record of the determination and earnings information is saved and available online in the automated databases, and information is posted to the DCF.
If eWork cannot be used, a paper file must also be maintained in the FO containing the following information:
copies of any determinations (SSA-899, SSA-833-U5, SSA-4268),
copies of manual notices sent,
IRWE/Special consideration computations,
any other information, such as relevant Reports of Contact, necessary to expedite the reinstatement or suspension of benefits, and
copies of evidence supporting the determination.