TN 38 (09-15)
DI 28030.010 Understanding and Using Supplemental Security Income Display (SSID, SSI2 or SSI3) Query Replies to Determine Title II Entitlement and Title XVI Eligibility
A. Overview of the SSID
1. The SSID is an online complete record request. A SSI2 will give the requested segments, and an SSI3 is a general query. The Disability Determination Service (DDS) should obtain a query reply in order to:
Avoid doing unnecessary continuing disability reviews (CDRs).
Apply the correct standard(s) when doing the CDR.
Avoid duplicating actions when concurrent issues are identified belatedly.
If the DDS determines they do not need to process or should stop processing a CDR, including a Title XVI-only CDR, a “No Determination” or “Transfer” referral is appropriate. For more information on referring cases, see DI 28030.001E.
2. Obtaining an SSID query reply may provide critical information:
In deciding whether the CDR should proceed.
When trying to locate the SSI recipient to obtain additional information or determine if the recipient will cooperate with a consultative examination (CE) request.
In determining whether recipients who were eligible for State Aid to the Permanently and Totally Disabled/Aid to the Blind (APTD/AB) prior to July 1, 1973 continue to meet State plan disability criteria.
In determining whether the CDR involves both Title II and Title XVI, or Title XVI only. It may show that a Title XVI-only CDR referral actually involves both Title II and Title XVI.
B. DDS use of the query
Individuals must meet eligibility requirements in order to receive disability payments. The field office (FO), recipient, or third-party contact generally provides this information about the recipient’s payment eligibility. The DDS should not assume the recipient meets the eligibility requirements if this information is missing.
The SSID query reply is an essential tool in processing CDRs. It is useful for verifying information, or for identifying situations that the DDS may be unaware of, but are essential facts in processing a CDR referral. For specific instructions about understanding SSID query replies, see DI 28030.010C in this section.
The DDS must make a system query upon receipt, and review the SSID query reply along with the information in the case file to determine if a CDR should proceed or stop. To determine whether a CDR is appropriate, see DI 28003.005 or DI 28030.001E.
The query reply may show:
The recipient is not currently eligible for SSI (as indicated by the payment status (PSY) field values). For more information on PSY field values, see DI 28030.010.C.2.b, in this section.
The recipient has moved or there has been a change of payee.
The recipient is entitled to benefits under Title II (specifically the ledger account file (LAF) information). This may indicate a concurrent CDR and concurrent determinations are required.
The DDS must obtain a second query before making the final determination and before the National Disability Determination Services System (NDDSS) record closure input, to determine whether:
A Title XVI CDR is needed.
The correct standard was applied in making the CDR determination.
Concurrent Title II entitlement is an issue.
C. Understanding the Title XVI supplemental security income (SSI) record using the SSID query system
1. Determining Title II entitlement in the SSID query system
a. The Ledger Account File (LAF) code – determining Title II benefit payment status
The LAF codes in the RCRD segment of the SSID reply will show one of the following entries:
“C” or “E” if the beneficiary currently receives Title II benefits.
“E” when payment is certified to the Railroad Retirement Board (RRB). This code may indicate the case involves a career RRB recipient and the DDS should return the case to the FO.
“S” denotes entitlement, but benefit payments are suspended (e.g., LAF code “S6” indicates suspension pending development for a better (correct) address, while “S8” indicates representative payee development is underway and benefit payments have been suspended pending the outcome of that development).
“N” or “ND” indicates that a Title II application was filed and was denied.
“T” indicates there was entitlement to Title II benefits in the past, but that entitlement ended.
For a complete list of LAF codes and definitions, see SM 00550.020.
b. The unearned income data (UMIH) segment
The UMIH segment of the SSID shows receipt of various types of unearned income, including Title II benefits and the associated claim number. Title II benefits are coded as “A” type unearned income in the Type (T) field. For a complete explanation of the UMIH segment, see SM 01601.760.
c. When to contact the servicing FO regarding Title II entitlement
In Title XVI-only CDR referrals, the DDS should contact the servicing FO if the SSID query indicates current Title II entitlement but it is unclear whether a Title II CDR is necessary.
A suspended payment status may indicate the CDR is not necessary. The DDS should contact the FO for the reason for suspension.
Whenever information received in connection with the CDR raises doubt about how the DDS should proceed and the disability examiner cannot resolve the issue, contact the FO and obtain sufficient information to determine if and how the DDS should proceed with the CDR.
2. Determining Title XVI eligibility and other factors that may affect DDS processing of a Title XVI CDR
The DDS should review the SSID, SSI2, or SSI3 queries to make the determination of Title XVI eligibility and whether and how to proceed with the CDR. Consider query information when contact with the recipient is material to how the DDS will proceed with the CDR, and on what basis (e.g., failure to cooperate, whereabouts unknown, etc.) the DDS makes its CDR determination.
b. Payment status - The PSY field
A PSY field code of C01, E01, E02, M01, or M02 indicates the recipient is eligible for SSI. The DDS should not stop the CDR based on payment status.
A PSY code beginning with “T” indicates the recipient’s SSI benefits have been terminated (e.g., T01 means the individual is deceased, while T31 indicates that eligibility has been terminated) and the individual is no longer eligible for benefits. The DDS should consider stopping the CDR.
For all other PSY codes (e.g., those beginning with an “H”, “N”, “P”, or “S) the DDS must contact the servicing FO to find out whether a CDR determination is required. No FO contact is needed if the claim folder already contains documentation (usually on a Form SSA-5002 (Report of Contact)) indicating the FO is aware of the payment status and requires a CDR determination be made.
For a complete list and description of the payment status codes, see SM 01305.001G.
c. Mailing addresses, residence addresses, and telephone numbers
The ADDR segment of the SSID query reply provides mailing address data. If the mailing address differs from the recipient’s residence address, a different address displays in the RADR portion of the ADDR segment. The recipient’s telephone number is in the ADDR segment in the TL field. For complete information on the ADDR segment, see SM 01601.535.
d. Representative payee information
Information describing a representative payee, including the telephone number, is in the Representative Payee Data or REPY segment. For a complete description of the information and fields in the REPY segment, see SM 01601.565.
e. Legal guardian information
Information describing a legal guardian, including the telephone number, is in the Legal Guardian Data or LEGG segment. For a complete description of the information and fields in the LEGG segment, see SM 01601.505.
f. Authorized representative (attorney or non-attorney) information
Information describing an authorized representative, including the telephone number, is in the Authorized Representative or AUTH segment. For a complete description of the information and fields in the AUTH segment, see SM 01601.490.
g. When to contact the FO regarding Title XVI eligibility
The DDS should consider contacting the servicing FO for assistance when the issue of the recipient’s whereabouts cannot be resolved (after reviewing the SSI queries), and resolution of that issue will affect how the CDR is processed.
DI 81020.127 Processing “No Determination” (ND) Claims
OS 03501.400 SSI Queries
SM 01601.175 Selective Request - SSI2
SM 01601.205 General SSI Query - SSI3
DI 81020.050 Online Scanning Procedures