Effective Dates: 05/17/1999 - Present Previous | Next

Basic (03-86)

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

  1. 1. 

    Continuances: Enter: SSA-L1013

  2. 2. 

    Cessations: Enter: ODO/DL

D. Item 34 - List Number

In addition to any other applicable list numbers, enter one of the following as applicable:

  1. 1. 

    608 - Cessation in which a felony-related impairment is excluded from consideration.

  2. 2. 

    610 - Benefits suspended due to confinement

  3. 3. 

    623 - Prisoner Case. Freeze Only established.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428065035
DI 28065.035 - Completion of Form SSA-833-U5 - 05/17/1999
Batch run: 04/14/2014
Rev:05/17/1999