TN 31 (01-00)

DI 23570.025 Processing Childhood and Age 18 Disability Redeterminations

A. Procedure - fully favorable determinations

1. General

Complete all actions (e.g., completion of Form SSA-538 (Childhood Disability Evaluation Form) for childhood cases, release of notices, etc.) using existing procedures for processing continuances in CDRs.

2. Notices

Use the special notices and language (i.e., “Notice of Continuation”) developed initially for this workload.

3. Form SSA-832-C3 coding

Complete Form SSA-832-C3/U3 as usual with the following exceptions:

Item 12

Childhood - Use existing Reason for Continuance Codes for Meets (71), Medical Equals (73), and Functional Equals (78) continuances. Do not use Reason for Continuance code 79 (IFA-Comparable Severity) as the IFA is no longer an appropriate basis for fully favorable determination. Do not use Reason for Continuance codes based on lack of medical improvement; e.g., 76 for “No Medical Improvement,” because medical improvement is not the issue for disability redetermination cases.

Age 18 - Use existing Reason for Continuance Codes for Meets (70), Medical Equals (72), and Vocational Factors (74). Do not use Reason for Continuance codes based on lack of medical improvement; e.g., 76 for “No Medical Improvement,” because medical improvement is not the issue for disability redetermination cases.

Item 20 — Enter one of the following Why Review Was Made (WRM) codes as appropriate:

Childhood

  • 27 — IFA Disability Redetermination (Always use this code for a childhood disability redetermination if the original determination involved an IFA)

  • 28 — Maladaptive Behavior Disability Redetermination

Age 18

  • 29 — Age 18 Disability Redetermination

Item 24 — Childhood and Age 18 - Enter the Remark, “P.L. 104-193.”

B. Procedure - unfavorable determinations

1. General

Follow existing processing procedures except as indicated in items DI 23570.025B.2. and DI 23570.025B.3.

2. Notices

Prepare and release the notice of an unfavorable disability redetermination decision. Use the special cessation notices developed initially for this workload.

NOTE: When a legally competent adult beneficiary has a representative payee, the DDS should send the cessation notice to the adult competent beneficiary. Also send a modified copy of the cessation notice to the representative payee. The representative payee's notice should not contain personal information. Include the decision paragraph and the sentence “(Beneficiary Name) has been given a more detailed explanation of our decision” on the personalized attachment.

3. Form SSA-832-C3 coding

Complete Form SSA-832-C3/U3 as usual with the following exceptions:

Item 9

Childhood - complete as usual unless the cessation date is prior to April 1, 1997. In that situation, the date in 9.C. will be 06/97 (see DI 23570.020D.1.).

Age 18 - complete as usual

Item 11

Use the following codes as appropriate. If benefits are being ceased due to FTC, the FTC code 62 should be used.

Childhood

  • 95 — IFA Disability Redetermination does not meet new definition of disability. (Always use this code on childhood disability redeterminations if the original determination was based on an IFA.)

  • 96 — Maladaptive Behavior Disability Redetermination, does not meet new definition of disability.

Age 18

  • 97 — Age 18 Disability Redetermination, does not meet adult disability standards.

Item 20 — Enter one of the following WRM codes as appropriate:

Childhood

  • 27 — IFA Disability Redetermination (Always use this code for a childhood disability redetermination if the original determination involved an IFA)

  • 28 — Maladaptive Behavior Disability Redetermination

Age 18

  • 29 — Age 18 Disability Redetermination

Item 24 — Childhood and Age 18 - Enter the Remark, “P.L. 104-193.”

See DI 14510.010B.2.c. if the case is a potential 301 case.

4. NDDSS input

Make all inputs to the National Disability Determination Serv