BASIC (10-15)

DI 28084.001 Introduction and Sample Forms SSA-832 and SSA-833

A. Introduction of the Forms SSA-832 and SSA-833

This subchapter provides instructions that the disability determination services (DDS) will follow when making a formal determination based on the evidence in file, or actions necessary when it is not possible to make a "substantive" determination despite repeated attempts to obtain the necessary evidence. The DDS uses the two Forms SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI) and SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal –Title II), to record the continuance or cessation determination.

NOTE: A description of Items 13 and 35 are not in this subchapter. When there is an attachment of a rationale, enter an “X” in Item 13. For more information on rationales, see DI 28090.000. To complete Item 35, see Routing-CDR Cases in section DI 32010.000. In addition, it is no longer necessary to complete Items 18 and 19.

Follow this list of actions that are necessary in every substantive determination:

  1. Develop a rationale and prepare the official determination;

  2. Prepare and release to the disabled individual the notice(s) appropriate to the determination;

  3. Generate systems input as needed;

  4. Complete and file the official determination forms correctly; and

  5. Route the case to its appropriate destination.

B. Exhibits of Forms SSA-832 and SSA-833

Use these links to view the latest version of each form:

  • For Title XVI cases, go to Form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI); and

  • For Title II cases, go to Form SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II).

C. Procedures for completing Forms SSA-832 or SSA-833

For Title XVI cases, obtain a Supplemental Security Record (SSR) query with segments disability information (DISB), conversion data (CONV), and mailing or payment address (ADDR) to determine whether the case is concurrent (Title II and Title XVI) or a non-rollback conversion. For Title II cases, obtain a Master Beneficiary Record (MBR) query to determine other entitlement to benefits, disabled individual's current address, etc.

To complete the form, enter the following:

  • an "X" on the form (SSA-832 or SSA-833) for items that require completion of a block; and

  • an "X” in the block on the left side of the line where a date entry is required.

D. Special instructions

When completing the SSA-832 for rollback and non-rollback cases see DI 28075.015, and for 1619 cases see DI 28075.620.

When completing the SSA-833 for extended period of eligibility (EPE) cases see DI 28055.030 and for prisoner and felon cases, see DI 28065.035.

When completing the SSA-833 for a determination of blindness when blindness was not previously established, see DI 13010.135I.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428084001
DI 28084.001 - Introduction and Sample Forms SSA-832 and SSA-833 - 01/13/2016
Batch run: 01/13/2016
Rev:01/13/2016