DI 28065.035 Completion of Form SSA-833-U5
For the most part, completion of Form SSA-833-U5 is the same for felony/ prisoner cases as for any medical CDR determination. However, certain items require special entries as described below.
A. Item 1B - Case type
Check block FZ in continuance determination based on confinement-related impairment(s).
B. Item 24 - Remarks
Enter: “Prisoner Case - Resolution of CD issue required upon reinstatement of benefits.” This entry applies in continuances based on insufficient evidence because of confinement.
C. Item 29 - Notice Instructions
Continuances: Enter: SSA-L1013
Cessations: Enter: ODO/DL
D. Item 34 - List Number
In addition to any other applicable list numbers, enter one of the following as applicable:
608 - Cessation in which a felony-related impairment is excluded from consideration.
610 - Benefits suspended due to confinement
623 - Prisoner Case. Freeze Only established.