Complete the following items on the SSA-831:
Item 17 (Diary)
Regular procedures apply – DI 26510.020, DI 26525.000.
Item 22 (Reg. basis code)
See DI 26510.045 for codes.
Most common codes: (A1) meets listing, (B1) equals listing, (C1) med/voc
Item 23 (Med List No)
If claimant meets or equals a listing–show listing code. See DI 26510.050 for Item 23 format – enter up to 7 positions of the appropriate listing number, e.g.
listing 4.02 A2 should be coded as “004.02A2”.
Items 32 – 33
Complete items 32 through 33 per DI 26510.090. See DI
24501.002C.2. for the Medical Consultant/Psychological Consultant (MC/PC) signature requirements.
See DI 24501.004 for medical specialty codes for Item 32 B.
NOTE: The MC/PC signature requirements for Joint Freeze SSA-831s are the same as for dual
Items 37 and 38
Sign and date—SSA code is “04”
Items 20, 25A and 28
Usually completed by the Railroad Retirement Board (RRB)—if not, complete these entries
per DI 26510.035, DI 26510.065, and DI
Make two photocopies of the SSA-831; annotate one “Folder copy” and the other one
“Data copy” at the bottom of the form. On these copies only, change the diagnosis
basis codes in Items 16A and B to the SSA codes per DI 26510.015. Do not amend the coding on the original RRB SSA-831.
File the original SSA-831 on the left side of the folder.
Most common codes: (F1) non-severe, (H1) past work, (J1) other work
Items 19, 20 and 25A
Usually completed by RRB–if not, complete these entries per DI 26510.030, DI 26510.035, and DI 26510.065 respectively
Items 32-33, 37 and 38
Same as for allowances
Make two photocopies of the SSA-831. Annotate one copy “Folder copy” and the other
one “Data copy”. On these copies only, change the diagnosis basis coding in Item 16A
and B to the SSA codes per DI 26510.015. Complete the field office code and address in Item 12. Do not amend the coding on
the original RRB SSA-831.