TN 2 (05-15)

DI 28003.035 Exhibit – Continuing Disability Review (CDR) Process

Exhibit - - SSA-847-U3

 

Completion of SSA-847-U3 (Social Security Administration Request For Case Action) Form

The adapted version of the SSA-847-U3 (Social Security Administration Request For Case Action) should be used to transmit all paper CDR and MINE cases to the field. Prepare in duplicate with the following entries (all entries must be printed):

1. a. 

   name of DDS and code

2. b. 

   DO name and code

3. c. 

   MOD

4. d. 

   claim number (SSN and BIC)

5. e. 

   an “x” in the applicable block for the reason for the CDR; and

6. f. 

   sign and date in the lower right corner.

Staple the original to the front of the folder and route the copy to the consultant.