BASIC (03-86)

DI 41005.035 Exhibits

Exhibit 1Title II Cessation Basis Codes (Item 11 of SSA-833-U5)
Exhibit 2Title II Continuance Basis Codes (Item 12 of SSA-833-U5)
Exhibit 3Occupation Codes (Item 15 of SSA-833-U5
Exhibit 4Industry Codes (Item 15 of SSA-833-U5)
Exhibit 5Why Review Was Made (WRM) (Item 20 of SSA-833-U5
Exhibit 6International Classification of Diseases (ICD) Codes for Visual Impairments (Items 21 and 22 of SSA-833-U5)
Exhibit 7SSA-833-U5 Completed for DIB Attainment, DIB Allowed
Exhibit 8SSA-833-U5 Completed for DIB Attainment Freeze Continuance, DIB Denied
Exhibit 9Notice for Freeze Continuance, DIB Denied Cases - Statutorily Blind Individual Under Age 55 and Engaging in SGA
Exhibit 10Model Language for Freeze Continuance, DIB Denial Cases - Statutorily Blind Individual Age 55 or Over and Engaging in Comparable SGA
Exhibit 11SSA-833-U5 Completed for Statutorily Blind Individual, Work Continuance
Exhibit 12SSA-833-U5 Completed for Statutorily Blind Individual, Entitled to a TWP, (1) Under Age 55 and Engaging in SGA or (2) DIB or CDB Beneficiary Age 55 or Over and Engaging in Comparable SGA
Exhibit 13SSA-833-U5 Completed for Statutorily Blind Individual, Not Entitled to a TWP, (1) Under Age 55 and Engaging in SGA or (2) DIB or CDB Beneficiary Age 55 or Over and Engaging in Comparable SGA
Exhibit 14SSA-833-U5 Completed for Statutorily Blind DIB or CDB Beneficiary Age 55 or Over, Entitled to a TWP, Engaging in Noncomparable SGA
Exhibit 15Model Letter “W” - Redetermination Under 1972 Amendments - No Increase in PIA

Exhibit 1 - Title II cessation basis codes (Item 11 of SSA-833-U5)

Title II cessation basis codes (Item 11 of SSA-833-U5)

01Medical Condition Not Disabling—Medical Improvement Demonstrated—Able to Engage in SGA
02Medical Condition Not Disabling—Medical Improvement Not Demonstrated but Individual Has Benefited from Advances in Medical or Vocational Therapy or Technology—Able to Engage in SGA
03Medical Condition Not Disabling—Medical Improvement Not Demonstrated but Vocational Profile Enhanced by Vocational Therapy—Able to Engage in SGA
04Medical Condition Not Disabling—New or Improved Diagnostic Techniques or Evaluation Show Impairment(s) Not as Disabling as Considered to be at Time of Most Recent Prior Favorable Medical Determination—Able to Engage in SGA
05Medical Condition Not Disabling—Substantial Evidence that Any Prior Favorable Medical Determination of Entitlement to Benefits was Based on Error—Now Able to Engage in SGA
06Future Use
07Prior Determination was Fraudulently Obtained
08Widow(er)'s Impairment No Longer Meets or Equals the Listing of Impairments—Medical Improvement Demonstrated
09Widow(er)'s Impairment No Longer Meets or Equals the Listing of Impairments—Medical Improvement Not Demonstrated, but Individual Has Benefited from Advances in Medical Therapy or Technology
10Widow(er)'s Impairment No Longer Meets or Equals the Lisitng of Impairments—New or Improved Diagnostic Techniques or Evaluation Show Impairment(s) Not as Disabling as Considered to be at Time of Most Recent Prior Favorable Medical Determination
11Future Use
12Widow(er)'s Impairment No Longer Meets or Equals the Listing of Impairments—Substantial Evidence that Any Prior Favorable Medical Determination of Entitlement to Benefits Was Based on Error
13Failure to Cooperate
14Whereabouts Unknow
15Failure to Follow Prescribed Treatment
16Improvement Expected—Work SGA (Clear-Cut)
17TWP Completed—Work SGA—No Medical Issue
18TWP Completed—Work SGA—Medical Issue
19Not Entitled to a TWP—Work SGA
20EPE Reinstatement Denied—Work SGA
21EPE Suspension After Reinstatement—Work SGA
22EPE Termination—SGA After Reentitlement Period
       ESRD
26ESRD - Dialysis Ceased
27ESRD - Transplant, No Dialysis

Exhibit 2 - Title II continuance basis codes (Item 12 of SSA-833-U5)

30Impairment Meets Listings
31Impairment Meets Listings (DWB)
32Impairments Equals Listings
33Impairment Equals Listings (DWB)
34Impairment Plus Vocational Factors
3535-40 Years of Arduous Work
36Disability Continues—Medical Improvement Not Demonstrated and No Exception Applies
37Disability Continues—Data from Most Recent Prior Favorable Medical Determination Insufficient to Assess Medical Improvement
38EPE Reinstatement—Work Not SGA
39TWP Not Completed
40TWP Completed—Work Not SGA
43Periodic Review Pre-CDR Review Rediary (ODO, PSC-DRS and INTPSC)
44Reported Income Does Not Constitute Service Months
45Not Entitled to a TWP—Work Doesn't Demonstrate Ability for SGA
       ESRD
47Dialysis
48Transplant—Severity Continues

Exhibit 3 - Occupation codes (Item 15 of SSA-833-U5)

PROFESSIONAL TECHNICAL AND MANAGERIAL OCCUPATIONS

01Occupation in architecture, engineering, and surveying
02Occupation in mathematics and physical sciences
04Occupation in life sciences
07Occupation in medicine and health
09Occupation in education
10Occupation in museum, library, and archival sciences
11Occupation in law and jurisprudence
12Occupation in religion and theology
13Occupation in writing
14Occupation in art
15Occupation in entertainment and recreation
16Occupation in administrative specializations
18Managers and officials

CLERICAL AND SALES OCCUPATIONS

19Other professional, technical, and managerial occupations
20Stenography, typing, filing, and related occupations
21Computing and account-recording occupations
22Production and stock clerks and related occupations
23Information and message distribution occupation
25Sales occupation, services
26Sales occupation, consumable commodities
27Sales occupation, commodites other than consumable
28Other clerical occupation

SERVICE OCCUPATIONS

29Other sales occupation
30Domestic service occupations
31Food and beverage prepartion and service occupation
32Lodging and related service occupation
33Barbering, cosmetology, and related service occupation
34Amusement and recreation service occupation
35Other personal service occupation (e.g., hostesses, stewards, hospital attendants, practical nurses, etc.)
36Apparel and furnishings service occupation
37Protective service occupation
38Office service occupation

AGRICULTURAL, FISHERY, FORESTRY, AND RELATED OCCUPATIONS

39Other nonpersonnel service occupation
40Plant farming occupation
41Animal farming occupation
44Fishery and related occupation
45Forestry occupation
46Hunting, trapping, and related occupation

PROCESSING OCCUPATIONS

47Other agricultural, fishery, forestry and related occupation
50Occupation in processing of metal
51Ore refining and foundry occupation
52Occupation in processing of food, tobacco, and related products
53Occupation in processing of paper and related materials
54Occupation in processing of petroleum, coal, natural and manufactured gas, and related products
55Occupation in processing of chemicals, plastics, synthetics, rubber, paint, and related products
56Occupation in processing of wood and wood products
57Occupation in processing of stone, clay, glass, and related products
58Occupation in processing of leather, textiles, and related products

MACHINE TRADES OCCUPATIONS

59Other processing occupation
60Metal machining occupation
61Metalworking occupation
62Mechanics and machinery repairers
64Paperworking occupation
65Printing occupation
66Wood machining occupation
67Occupation in machining stone, clay, glass, and related materials
68Textile occupation

BENCHWORK OCCUPATIONS

69Other machine trades occupation
70Occupation in fabrication, assembly, and repair of metal products
71Occupation in fabrication and repair of scientific, medical, photographic, optical horological, and related products
72Occupation in assembly and repair of electrical equipment
73Occupation in fabrication and repair of products made from assorted materials
74Painting, decorating, or related occupation
75Occupation in fabrication and repair of plastics, synthetics, rubber and related products
76Occupation in fabrication and repair of wood products
77Occupation in fabrication and repair of sand, stone, clay, and glass products
78Occupation in fabrication and repair of textile, leather, and related products

STRUCTURAL WORK OCCUPATIONS

79Other benchwork occupation
80Occupation in metal fabricating
81Welder, cutter, or related occupation
82Electrical assembling, installing, and repairing occupation
84Painting, plastering, waterproofing, cementing, or related occupation
85Excavating, grading, paving, or related occupation
86Construction occupation

MISCELLANEOUS OCCUPATIONS

89Other structural work occupation
90Motor freight occupation
91Transportation occupation
92Packaging and materials handling occupation
93Occupation in extraction of minerals
95Occupation in production an distribution of utilities (e.g., energy, water, sewage)
96Amusement, recreation, motion picture, radio and television occupations not included in the proceedings

Exhibit 4 - Industry codes (Item 15 of SSA-833-U5)

AGRICULTURE, FORESTRY, FISHING, HUNTING AND TRAPPING

01Agricultural production - crops
02Agricultural production - livestock
07Agricultural services
08Forestry

MINING AND COAL AND GAS EXTRACTION (INCLUDING URANIUM

09Fishing, hunting, and trapping
10Metal mining
11Anthractie mining
12Bituminous coal and lignite mining
13Oil and gas extraction

CONSTRUCTION

14Mining and quarrying of nonmetallic minerals, except fuels
15Building construction - general contractors and operative builders
16Construction other than building construction - general contributors
17Construction - special trade contracts (e.g., plumbing, heating, electrical, carpentry, etc.)

MANUFACTURING

18Other construction
20Food and kindred products
21Tobacco manufacturers
22Textile mill products
23Apparel and other finished products made from fabrics and similar materials
24Lumber and wood products, except furniture.
25Furniture and fixtures
26Paper and allied products
27Printing, publishing and allied industries
28Chemicals and allied products
29Petroleum refining and related industrices
30Rubber and miscellaneous plastic products
31Leather and leather products
32Stone, clay, glass, and concrete products
33Primary metal industries
34Fabricated metal products, except machinery and transportation equipment
35Machinery, except electrical
36Electrical and electronic machinery, equipment, and supplies
37Transportation equipment
38Measuring, analyzing, and controlling instruments; photographic, medical, and optical goods; watches and clocks

NON-MANUFACTURING

39Other manufacturing industries
40Railroad transportation
41Local and suburban transit and interurban highway passenger transportation
42Motor freight transportation and warehousing
43U.S. postal service
44Water transportation
45Transportation by air
46Pipe lines, except natural gas
47Transportation services
48Communication
49Electric, gas, and sanitary services
50Wholesale trade - durable goods
51Wholesale trade - nondurable goods
52Building materials, hardware, garden supply, and mobile home dealers
53General merchandise stores
54Food stores
55Automotive dealers and gasoline service stations
56Apparel and accessory stores
57Furniture, home furnishings and equipment stores
58Eating and drinking places
59Miscellaneous Retail
60Banking
61Credit agencies other than banks
62Security and commodity brokers, dealers, exchanges, and services
63Insurance companies
64Insurance agents, brokers, and service
65Real estate
66Combinations of real estate, insurance, loans, law offices
67Holding and other investment offices
70Hotels, rooming houses, camps, and other lodging places
72Personal services
73Business services
75Automotive repair, services, and garages
76Miscellaneous repair services
78Motion pictures
79Amusement and recreation services, except motion pictures
80Health services
81Legal services
82Educational services
83Social Services
84Museum, art gallaries, botanical and zoological gardens
86Membership organizations
88Private households
89Miscellaneous services
91Executive, legislative, and general government, except finance
92Justice, public order, and safety
93Public finance, taxation, and monetary policy
94Administration of human resources programs
95Administration of environmental quality and housing programs
96Administration of economic programs
97National security and international affairs
99Nonclassifiable establishments

Exhibit 5 - Why review was made (WRM) (Item 20 of SSA-833-U5)

01Court Remand (Based on Social Security Disability Benefits Reform Act of 1984)
02Reopened Mental Impairment Case (Based on Social Security Disability Benefits Reform Act of 1984)
03Decision Reviews Required by the Social Security Disability Benefits Reform Act of 1984. Other than those included in 01 and 02 above.
04Medical Improvement Expected (Medical Reexamination Diary)
05Medical Improvement Possible (3 Year Periodic Review Diary)
06Medical Improvement Not Expected (5 Year Periodic Review Diary)
07Medical Improvement Not Expected (7 Year Periodic Review Diary)
08EPE Medical Review
09Adoption Issue
10TWP Diary Matured
11Voluntary Report of Medical Improvement
12Earnings Posted—Medical Reexamination Set
13Earnings Posted—No Medical Reexamination Set
14Voluntary Report of Work—Medical Reexamination Set
15Voluntary Report of Work—Medical Reexamination Not Set
16Third Party Report
17State VR Report
18Court Order (Other Than Medical Improvement—Individual or Class Member)
19Post Transplant ESRD
20Special (Use only when specifically instructed)
21Other (If “Other” code used, indicate why review was made (WRM) in item 24)
22“301” Case Review Diary
00Vocational Rehabilitation Diary Maturity (not “301” case)
 For Possible Future Use (DO NOT USE UNLESS SPECIFICALLY INSTRUCTED)
23Medical Improvement Expected (Medical Reexamination Diary)—Moratorium Case
24Medical Improvement Possible (3 Year Periodic Review Diary)—Moratorium Case
25Medical Improvement Not Expected (7 Year Periodic Review Diary)—Moratorium Case
26EPE Medical Review—Moratorium Case
27Voluntary Report of Medical Improvement—Moratorium Case
28Third Party Report—Moratorium Case
29State VR Report—Moratorium Case
30“Clear Cut” Case—Moratorium Case
31Mental Impairment—Moratorium Case

Exhibit 6 - Impairment codes for visual impairments (Items 21 and 22 of SSA-833-U5)

ListingDiagnostic
Category
Impairment
Code
2.02Retinal Detachments and Defects3610
2.02Glaucoma3650
2.02Cataract3660
2.02Low Vision3690
2.02Statutory Blindness3694
2.03AStatutory Blindness3694
2.03Visual Disturbances3680
2.04Visual Disturbances3680