Basic (03-86)

DI 43520.035 Completion of SSA-831-U5 by the DO Function - MQGE Claims

When a disability determination is necessary for a disabled worker, disabled child, or disabled widow(er) who files an application for Medicare based on the worker's Federal employment, complete the SSA-831-U5 in the same manner as for a regular DIB, CDB, or DWB claim (DI 43520.030). Also enter in item 11, “MQGE claim.” Follow the additional instructions in DI 43520.040 for SGA denials.

In addition, if the NH is insured only under the transitional provision in this law, also enter the following remark in item 11, “Insured status under transitional provision of P.L. 97-248.” (The DDS function needs this information for workload reporting purposes.)