TN 5 (01-16)

DI 14510.003 Field Office (FO) Procedures for Cases Involving Participation in Vocational Rehabilitation (VR) or Similar Program

A. Identifying VR or similar cases

The FO identifies cases involving participation in VR or a similar program as a part of the medical continuing disability review (CDR) or Age 18 Redetermination process. For policy on Section 301 payments to beneficiaries participating in VR or a similar program, see DI 14505.010.

1. Continuing Disability Review Report - SSA-454-BK

Section 8 of the SSA-454-BK asks whether the beneficiary is participating in any vocational rehabilitation, employment, or other support services. The beneficiary may also indicate that he or she is participating in a vocational or job training program. Complete the appropriate sections of the SSA-454-BK with the name, address, and phone number of the service provider if the services or training are provided under any of the programs, including a PASS, described in DI 14505.010B.

2. Age 18 Redetermination – SSA-3368-BK (Disability Report-Adult)

Section 5 of the SSA-3368-BK asks about education and training. If this section indicates that the beneficiary is in school, develop whether he or she is participating in an individualized education program (IEP). Section 10 asks whether the beneficiary is participating in vocational rehabilitation, employment, or other support services. If yes, record the name, address, and phone number of the organization, including the name of the counselor.

NOTE: If the beneficiary has an IEP, complete Section 10.

B. Transmitting the case to the disability determination services (DDS)

When you obtain all forms and information for the Medical CDR or
Age 18 Redetermination, route the case to DDS for the medical determination. Annotate the following remarks on the Master Beneficiary Record (MBR) special message field, the Supplemental Security Record (SSR) Remarks, or both: “Potential 301 case sent to DDS on mm/dd/yy.”

1. Electronic CDR (eCDR)

Add a “Potential Section 301 Case “flag” in the Electronic Disability Collect System (EDCS) to identify that the beneficiary is participating in VR or a similar program.

NOTE: Children under the age of 18 who are participating in the programs described in DI 14505.010B.2. through DI 14505.010B.6 are eligible for Section 301 benefits. If a beneficiary indicates they are participating in an appropriate program including Promoting Readiness of Minors in SSI (PROMISE), add the Section 301 flag to the case.

2. Paper folder

Attach route slip SSA-408 to the outside of the folder, add the remark “Potential Section 301 Case” and transfer the folder the DDS.

C. FO development after DDS medical determination

Do not apply continuation of benefits under Section 301 when medical cessation is due to the beneficiary’s failure to cooperate (FTC) or whereabouts unknown (WU). If the beneficiary files an appeal within 10 days with payment continuation, suspend Section 301 development per DI 14510.035A.

1. Medical continuance

If the DDS makes a medical continuance determination, do not develop for participation in VR or similar program. Follow existing procedures to process the continuance decision. Delete the special messages from the MBR, SSR, or both.

2. Medical cessation

DDS will notify the FO of a medical cessation via the EDCS action page with the message, “CDR Cessation Added-Potential 301 Benefit Continuation.” For paper cases, DDS will send the CDR folder to the FO with a flag for potential 301 development.

The FO must close the pending medical CDR or Age 18 event in the Disability Control File (DCF).

  • Select option #2 from the MCDR screen.

  • Within the IFOA screen, select #10 CESSATION. Use this event type to update the cessation from DDS affirmation and clear the DDS code from the OFFICE RESPONSIBLE FOR THE NEXT ACTION field.

Use SSA-4290-F5 to develop participation in VR or a similar program for potential entitlement to Section 301 benefits.

  • Complete Part I, Section A of the SSA-4290-F5 with information from the CDR or Age 18 Redetermination. Complete and sign Section B.

  • Complete Part II by telephone or mail with the organization providing the VR or similar services.

a. Telephone contact

Telephone contact is the most efficient method for completing Part II of the SSA-4290-F5. Complete the appropriate section of Part II of the SSA-4290-F5 based on the type of organization.

  • Part II, Section A – An Employment Network;

  • Part II, Section B – A State VR Agency;

  • Part II, Section C – Another Provider of VR, Employment, or Support Services (including SSA or another agency of the Federal government);

  • Part II, Section D – An Educational Institution providing services under the IDEA (Individuals with Disabilities Education Act).

NOTE: If the beneficiary participates in a PASS, SSA is the service provider. Ask the PASS specialist who approved the PASS to complete Part II, Section C of the SSA-4290-F5. For the telephone number of your local PASS specialist, see www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm.

If the contact states that the beneficiary is no longer taking part in the activities or services outlined in his or her plan, ask for the date participation ended and write this information under Question #2 on the form. Obtain answers to Questions #3 through #5, as if the beneficiary were still participating. Print the contact’s name in the signature block of the appropriate section and annotate “via phone.”

b. Mail contact

If you are unable to make telephone contact, send the SSA-4290-F5 to the provider with a signed and dated SSA-827 and a cover letter requesting their assistance using language similar to the following:

 

(Name of beneficiary) reports that he or she is receiving (vocational rehabilitation services or employment services educational services, or support services) from your agency, organization, or institution. We need your assistance to determine if this beneficiary can continue to receive disability benefits based on his or her participation in your program or services. Please complete Part II, Section (A, B, C, or D, depending on the service provider) of the enclosed form, sign and return to us within 10 days. If (name of beneficiary) was participating in your program but stopped, please provide the date that participation ended. Enclosed is a postage-paid return envelope. If you have any questions, please call (contact name and phone number).

Establish a 15-day diary on the CDR development worksheet (CDRW) of the DCF or SSI development worksheet for return of the SSA-4290-F5.

Make a follow-up contact with the service provider by phone, if the provider does not return the SSA-4290-F5 within 15 days.

Document all the attempts on an SSA-5002 and fax it and the incomplete SSA-4290-F5 into eView or Non-Disability Repository for Evidentiary Documents (NDRED) if you do not receive the completed SSA-4290-F5 within 30 days.

Fax the Potential Section 301 Case Flag to the Office of Disability Operations’ (ODO) Paperless Processing Center (PPC) using the paperless fax number 1-877-385-0643.

D. Transmitting case to ODO

1. Title II cases

Section 301 continues payments (including Medicare) to the beneficiary and any auxiliaries on the record. Benefits continue pending the section 301 determination.

The FO must:

  • Add the remark, “Potential Section 301 determination sent to ODO on mm/dd/yy” to the special message field of the MBR;

  • Create a 301DEC issue on the DCF using the CDRW and tickle the case for the month program participation is expected to end, or for one year from the current month, whichever is earlier;

  • Fax the SSA-4290-F5 and any supporting documents into eView or NDRED; and

  • Transmit the case to ODO by faxing the Potential Section 301 Case Flag to ODO’s PPC system using the paperless fax number 1-877-385-0643.

2. Title XVI cases

Due to the automated N07/N08 process, benefit payment termination may trigger before ODO makes the Section 301 determination. Benefits continue pending the Section 301 determination. While the Section 301 determination is pending, the FO must:

  • Input a Vocational Rehabilitation Plan (VP) diary via the diaries (UDIA) function in Direct SSR Update with a diary date of one year from the date of the medical cessation (see MS BUSSR 002.019.) The VP diary prevents the case from updating to an N07/N08 payment status;

  • Annotate the SSR Remarks, “Potential Section 301 determination sent to ODO on mm/dd/yy;”

  • Create a 301DEC issue on the DCF using the CDRW and tickle the case for the month program participation is expected to end, or for one year from the current month, whichever is earlier;

  • Fax the SSA-4290-F5 and any supporting documents into eView or NDRED; and

  • Transmit the case to ODO by faxing the Potential Section 301 Case Flag to ODO’s PPC system using the paperless fax number 1-877-385-0643.

NOTE: All Title XVI eligibility provisions, including income counting and resource guidelines continue to apply while the Section 301 determination is pending. We can modify a PASS during this period; however, we cannot approve a new PASS.

E. No longer participating in VR or similar program

1. Participation stopped prior to, or in the month of, medical cessation or during the two months after medical cessation

If the beneficiary stopped participating prior to, in the month of, or during the two months after medical cessation, there is no potential Section 301 eligibility. The two-month grace period would include any payment due for the month of cessation plus the following two months.

  • Fax the completed SSA-4290-F5 into eView or NDRED;

  • Take action to terminate benefits based on the medical cessation;

  • Delete any REMARKS on the SSR or MBR, which are outdated or no longer apply and verify the cessation is posted to the DCF;

  • Add a Remark(s) that VR participation ended and give the date, MM/DD/YY; and

  • Prepare and send the Title II, Title XVI, or both denial of Section 301 payments notice located in the Document Processing System (DPS).

NOTE: For instructions on how to evaluate a possible temporary interruption in participation, see DI 14505.010D.

2. Participation stopped after the second month after the month of medical cessation, or later

If the beneficiary stopped participating in the qualifying program after the second month following the month of medical cessation:

  • Develop Potential Section 301 eligibility for the period from the cessation month through the month participation ended;

  • Fax the SSA-4290-F5 into eView or NDRED;

  • Create a 301 issue on the DCF using the CDRW to control for the return of the case; add the remark, “Pending 301 determination;”

  • Transmit the case to ODO by faxing the Potential Section 301 Case Flag to the PPC system using the paperless fax number 1-877-385-0643; and

  • Suspend benefits until ODO makes its determination.

NOTE: If the beneficiary requested Statutory Benefit Continuation (SBC) during an appeal for a medical cessation determination, do not suspend benefits.

a. Title II suspension input

  • Input S9 suspension effective the month after participation ended;

  • Add the remark, “S9 due to pending 301 determination, participation ended MM/DD/YY” to the special message field of the MBR; and

  • Prepare the notice per DI 14510.003E.2.c.