When the examiner determines that an earlier onset is not possible and accepts the
onset shown as correct, prepare a revised SSA-831 to process the denial. If the case
is electronic, move the prior SSA-831 to the “Green Section” of the folder and create
a barcode to scan the revised SSA-831 into the “Yellow Front” section of the electronic
folder. In addition, instruct the module Claims Authorizer (CA) to include the sample
standard paragraph shown below within the notice for Death within 5 Months of Onset.
The CA must also create a barcode titled “T2 Notice of Disapproved Claim” and scan
a copy of the notice into the “Red Section” of the electronic folder.
Complete the special entries for the SSA-831 as follows:
Item 5: Show “deceased” instead of address
Item 16: Enter “none established”
Item 22: Enter reg-basis code X3
Item 34: Enter “NH died MMDDYY, before being disabled 5 full calendar months and earlier
onset cannot be established.”
Sample of Standard Paragraph - Death within 5 Months of Onset
A person who is disabled for at least five full calendar months may be eligible for disability benefits. (1) was not eligible
for these benefits because (2) is given as the date the disability started and
death occurred on (3). Therefore, the claim for disability benefits is denied.
Alleged onset date (MM/DD/YY)
NOTE: If death occurred before 1973, substitute “6” months for “5” months.