DI 13510.010 Determining and Certifying the VR Continuous Period of SGA
Development of the VR agency report of work and completion of the VR certification form will determine whether the States will receive reimbursement for vocational rehabilitation services rendered to SSA beneficiaries/recipients. VR agencies generally have proof of employment before submitting claims so DOs must reconcile any conflicts about employment through complete development.
A. SGA Development
Begin development of work activity with the earliest month that the person might have worked after September 1980, unless OESP enters a later date in item 1.A.2. of the SSA-289-U3. (This date is important because completion of a VR continuous period of SGA before October 1981 (or the date OESP enters) rules out payment to the VR agency.)
Generally, the date the VR agency reported work started is a good guide. This date will be entered in the upper portion of the SSA-289-U3 by OESP. However, be alert to other evidence in file which clearly shows that work began at an earlier or later date.
Follow the SGA guidelines in DI 10501.015 on a month to month basis but DO NOT AVERAGE EARNINGS.
Evaluate title XVI blind recipients using the same guidelines applicable to blind title II beneficiaries.
Apply the rules for determining subsidy or Impairment-Related Work Expenses (IRWE) per DI 10505.010.
Always consider whether a person's services reflect SGA in those situations in which the earnings are below the SGA level. This would mainly apply in self-employment cases although it could apply to an employee. See DI 10505.020 and DI 10510.010.
If evidence shows that the person could not have worked at an SGA level (e.g., was hospitalized), show the month(s) and reason for no SGA in your response.
Resolve discrepancies by contact with the individual and, if necessary, the employer.
If information in file indicates the claimant was working at the SGA level as of a certain date and there is no evidence that work stopped, assume that the person continued to work at the same rate and number of hours as the preceding month.
B. Completion of the VR Certification Form, (“Request for Certification of SGA for Vocational Rehabilitation”)
OESP will complete the upper portion of the form and show the month the VR agency believes work began. OESP will also show the employer if the VR agency has identified an employer.
The remainder of the form will be completed by ODO, a DRS or a DO, as appropriate.
C. Certification of VR Continuous Period of SGA
Part 1 — Indicate by checking the appropriate block whether Block “A,” “B,” or “C” applies. (Check ONLY one.)
1. Block A
Check block A when a VR continuous period of SGA has been completed as defined in DI 13510.001 C.
a. Blocks A1 and A2
Complete if SGA development establishes that the individual met the requirements of a VR continuous period of SGA as defined in DI 13510.001 C.
Under A1 show which type of VR continuous period of SGA is met.
Under A2 show the first 9 months of SGA after September 1980 (or the date OESP entered in this block) which constitute a VR continuous period of SGA.
Do not use the start date of SGA supplied by the VR agency if evidence shows SGA started at a different time. (NOTE: TWP and EPE months can be used in a VR continuous period of SGA so long as they are at the SGA level.)
b. The First 9 Months
Identifying the first 9 months is critical because:
VR services after the ninth month are not reimbursable.
The VR agency's claim must be filed within 12 months following the ninth month of SGA.
2. Block B
Complete block B when the individual has not completed a VR continuous period of SGA. The information you enter in these blocks will be used to deny VR claims for reimbursement. Therefore, you should provide specific information to explain why work reported was not SGA or why 9 months of SGA within a 12 month period did not constitute a VR continuous period of SGA.
a. Blocks B.1., B.2., B.3.
Complete blocks B.1., B.2. and, if appropriate, B.3. if SGA development establishes that the individual did not complete a VR continuous period of SGA.
Under B.1., show the SGA months established. Or, if there were none, write “None.”
Under B.2., show the reason for work not being SGA (e.g., work stopped 5/83 or earnings were not SGA (mo/yr) because of subsidy or IRWE).
If after development it is found that there was no work, attach supporting documentation to the SSA-289-U3 to show the type of development that was undertaken.
Under B.3., complete if the individual performed 9 months of SGA during 11 or 12 consecutive months but did not meet the 9 out of 12 month condition in DI 13510.001 C.3. Show the reason that there was no work for those 3 months such as the individual quit the job despite an ability to continue working or quit because of medical reasons.
b. 9 Out of 12 Months
The 9 out of 12 months condition is met only if the reason for not performing SGA for 2 or 3 months was circumstances beyond the person's control and unrelated to the medical impairment.
3. Block C
Check block C if it cannot be determined whether a VR continuous period of SGA was completed. This block should be checked infrequently because we are dealing with reports of work activity.
a. Block C.1.
Check block C.1. only if the person is in terminated status and the information in file is not sufficient to establish or rule out a VR continuous period of SGA. Development must be undertaken if a person is in suspense for CDR, EPE, special pay status under an approved VR program, etc.
b. Block C.2.
Check block C.2. only if the folder is in an external location and is essential for a decision. Indicate the current folder location and the date of receipt at that location.
If the folder is in another DO, forward the SSA-289-U3 to that DO and advise OESP of your action. Do not check block C.2.
c. Block C.3.
Check block C.3. when any other reasons apply. Provide sufficient detail so that the reviewer can use this as a basis for further action.
D. Part II — Disability Status
It is important that the information about the disability status be provided to enable us to determine if reimbursement to a VR agency is proper.
1. Continuing Block
Check this block if the disability is continuing.
2. Ceased Block
Show the month and the year of cessation (not termination).
3. Basis For Cessation
a. Medical—Medical Reexamination Diary Set
Check this block if the evidence shows the case was ceased on a medical basis. The “Yes” block means there was a diary set. The “No” block means there was no diary.
If the basis for the cessation was for a reason other than a Medical cessation, check the “other” block and indicate the basis for cessation and the month benefits/payments stopped.
E. Routing the SSA-289-U3
The office that completes the SSA-289-U3 should route it to:Social Security Administration
Office of Employment Support Programs (OESP)
VRA Operations Team
P.O. Box 17714
Baltimore, Maryland 21235–7714