TN 1 (10-15)

DI 28095.015 Notice Designation, Suffix Usage, Pre-effectuation Review (PER) and Quality Assurance (QA) Sample Cases

A. Notice designation

The office responsible for preparing the notice will use Item 29 on the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II). The disability examiner will designate the notice by using the following codes in Item 29:

  • disability determination services (DDS) use “DDS/DL”;

  • program service center (PSC) use “PSC/DL”;

  • Office of Disability Operations (ODO) use “ODO/DL”; or

  • field office (FO) use “FO/DL”.

Use the appropriate code with the notice designation along with any required paragraphs and fill-ins, in proper sequence. Designate the office that will prepare the notice followed by the letter “S” in place of the notice instructions, if there is insufficient space in Item 29. For suffix “S” instructions see DI 28095.015B in this section.

If the DDS will prepare the notice but the notice will be release by another component, indicate “DDS/DL-S” in Item 29. In some special situations, the DDS examiner will not specify the notice information but will only designate the component responsible for the notice (for example, ODO/DL) in Item 29.

NOTE: For notice designation instructions, see NL 00603.025 Designating Notice Information on Disability Determination Form.

B. Insufficient space to provide notification instructions for a “S” suffix

In all types of cases there can be notification situations requiring special letters, paragraphs, suffixes or other instructions to ensure that we included all the factors relating to a particular case. Therefore, it is important that the disability examiner designate this in Item 29 of SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II), to ensure preparation of the appropriate notice. Pamphlets are also an important part of the notification process and you should include them with notices when applicable.

The DDS examiner will leave Item 29 of the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II) blank, if the notice will be computer generated based on the input of the proper regulation-basis code. If the notice is not computer generated, the DDS is responsible for providing information about the notice in Item 29 of the SSA-832 or SSA-833.

The amount of space in Item 29 of SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II) is limited. Sometimes you will need to use the suffix “S” in Item 29 and give the examiner special typing instructions on an SSA-865 (Special Instruction Notice –Disability). For suffix “S” cases:

  • Designate the notice and all applicable fill-ins and suffixes used in notifying the beneficiary or recipient identified in Item 5 of the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI or SSA-833 Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II);

  • On a separate line of the SSA-865 (Special Instruction Notice –Disability), designate any additional notices that are sent in the case and provide the applicable fill-in data;

  • Furnish the name and address of the party who will receive the notice;

  • Complete the SSA-865 (Special Instruction Notice –Disability) and place it on top of all material on the left side of the case folder.

The DDS may use locally devised typing instructions forms (instead of the SSA-865) if they are more compatible with word processing or other typing requirements, but only when the DDS prepares the notice and retains a copy in the file. (Do not prong file local typing forms.)

NOTE: If the DDS prepares the notice but another component will release it, include a designation on the SSA-865 (Special Instruction Notice –Disability) or local form to fold the undated notice for mailing, and place it in the file under the envelope flap for release by the appropriate component. Add a remark to the SSA-408 (Route Slip) identifying the office who will release the notice.

C. Attorney or other authorized representative for an "A” suffix

In some cases, a beneficiary or recipient authorizes another person to act on his or her behalf in pursuing his or her case and asserted rights before SSA. It is important for both the disabled individual and his or her representative to receive a copy of the determination notice. To notify both parties of the determination, enter suffix “A” in Item 29 of the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II). For accuracy of information, verify the name and address of the representative in Item 24 (Remarks) of the initial or reconsideration SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II).

NOTE: A representative payee is the person designated to handle benefits on behalf of an incapable beneficiary. The duties and responsibilities are to receive, disburse, conserve, and account for benefits belonging to a beneficiary. A representative payee may also act as a legal representative and seek a fee.

D. Authorized disclosure for a “Z” suffix

A beneficiary or recipient sometimes authorizes entitlement information for disclosure. You can recognize the authorization by its title and the beneficiary or recipient’s signature. It usually authorizes disclosure to an employer, labor union, welfare organization or mental institution. In these cases, place a “Z” in Item 29 of the SSA-832 or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II or Title XVI), for example, 443-Z.

E. Return of document requested for a “C25” suffix

When a beneficiary or recipient request the return of a document he or she submitted, enter “C25” in Item 29 of the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II) for example, 443-C25. (Paragraph C25 reads, “Enclosure: Document(s)”). If the beneficiary or recipient expressed concern about the loss of the document or requested special handling, use the “S” suffix and use registered or certified mail for notice and document on the SSA-865 (Special Instruction Notice-Disability).

Identify the returning document by marking it lightly with an “X” in pencil in the upper right corner. Place this document on top of all materials on the right side of the folder.

F. Pre-effectuation review (PER) and quality assurance (QA) sample cases

When the DDS is responsible for preparing a notice or personalized explanation and PER or QA selects the case for review, the DDS will:

  • prepare a notice with an explanation without a date,

  • fold it for mailing,

  • place it under the flap of the appropriate envelope, and

  • clip the notice inside the right hand side of the folder for release by the reviewing component.

NOTE: For cases involving a QA review see, DI 81020.135 and DI 81020.065. For cases in Electronic Disability Collect System (EDCS) involving a manual notice, see DI 81030.040 Review and Release of Notices – Certified Electronic Folders (CEF), DI 81020.130 Electronic Case Closure and NL 00603.100 How to Prepare the Notice.


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DI 28095.015 - Notice Designation, Suffix Usage, Pre-effectuation Review (PER) and Quality Assurance (QA) Sample Cases - 10/13/2015
Batch run: 10/13/2015
Rev:10/13/2015