In item 9 of the SSA-833-U5, check “disability.” Complete blocks 9J, 9J(1) and 9J(1)(b). Enter the first month and year of SGA in
block 9J(1)(b). Complete item 9C as shown in DI 41005.001J.3. and show the second month (plus year) after the month shown in block 9J(1)(b).
See DI 41005.035, Exhibit 13 for an example of the completed Form SSA-833-U5.