TN 62 (02-97)
DI 32521.025 DDS Completion of Determination Forms
An SSA-831/832/833-U3, as appropriate, must be completed for every case, with certain special entries.
Prepare an SSA-831/832/833-U3, as appropriate, with the following special entries.
1. Affirmation of denial/cessation
Enter in the “Remarks” section “ Dixon Review -Unfavorable. This Determination Affirms the Determination of (date of prior denial/ cessation).”
2. Reversal of denial/cessation
For reversals of denials/cessations, enter in the “Remarks” section “ Dixon Review - Favorable (or 'Partially Favorable' if onset date, closed period or later cessation date is established.) This Determination Revises the Determination of (date of prior denial/cessation).” If work activity is involved (see DI 32521.015B.3.b.), enter “File contains work activity that needs to be adjudicated by the FO.”
3. Multiple determinations reopened
If more than one Dixon determination is being reopened, enter in the “Remarks” section “ Dixon Review - (Favorable, Partially Favorable, or Unfavorable). This Determination Revises the Determinations of (dates of all prior denials/cessations covered under Dixon ).”
4. Reopening with subsequent allowance
If a claim is being reopened and there is a subsequent allowance, annotate:
Subsequent allowance in the SSA-831-U3 “Remarks” section “Superseded by Dixon Reopening Decision of (date of Dixon SSA-831-U3). This Determination Remains the CPD for Future CDRs.”
The Dixon reopening SSA-831-U3 in the Remarks section, “Allowance of (date of subsequent allowance) Not Superseded by this Dixon Reopening Determination but remains the CPD for Future CDRs.”
Follow DI 27021.005 and DI 27021.020 to determine if a brief supplemental rationale is necessary.