TN 3 (08-13)
DI 55025.001 Determining Ticket Status
A. General Information about ticket status
Once a beneficiary is eligible to participate in the Ticket to Work program, the decision to use a ticket is voluntary. We cannot initiate a medical continuing disability review (CDR) during any period a beneficiary “uses” a ticket (as defined in the regulations). This protects beneficiaries who participate in the Ticket to Work program from having their return to work efforts disrupted based on a medical cessation determination resulting from a scheduled medical CDR. For information on processing medical CDRs for beneficiaries with tickets, see DI 55025.010.
We ensure the integrity of the disability programs by requiring that beneficiaries make progress when using the ticket in order to maintain medical CDR protection. Therefore, once the beneficiary has assigned his or her ticket, he or she must make progress toward his or her vocational goals according to certain requirements. For the timely progress review requirements, see DI 55025.025C.
NOTE: Two contractors perform the role of the program manager (PM) for the Ticket to Work program. For more information about the role and responsibilities of the PM, see DI 55005.001.
B. Definitions for ticket status terms
1. Assignable ticket
A ticket is assignable to an employment network (EN) or State vocational rehabilitation (VR) agency acting as an EN if a beneficiary:
is between age 18 through 64,
is in current payment status, and
is not subject to one of the exclusions listed in DI 55002.005C.
To assign a ticket, the EN or State VR agency acting as an EN and the beneficiary must complete and sign an employment plan to achieve a work goal. For more information on employment plans, see DI 55020.001. Once the beneficiary assigns the ticket, the ticket’s status is “In Use” on the disability control file (DCF).
NOTE: Although a beneficiary cannot assign a ticket at age 65 or later, if he or she assigned the ticket prior to attaining age 65, the ticket remains active until full retirement age when the ticket terminates. For information on who is eligible for a ticket, see DI 55002.005B.
2. Ticket “In Use” statuses
a. In Use
The “In Use” status means the beneficiary assigned his or her ticket to an EN or State VR agency serving as an EN to receive employment support services. The EN and beneficiary must complete and send a signed individual work plan (IWP) to the PM before assigning the ticket.
b. In Use SVR
The “In Use SVR” status means a beneficiary has a ticket that is assignable and is receiving VR services from a State VR agency under the VR cost reimbursement option. The “In Use SVR” status begins on the effective date of the individualized plan for employment (IPE). For information on employment plans, see DI 55020.001.
If the beneficiary signs the IPE when the ticket is not assignable, the “In Use SVR” effective date is the first day the ticket is assignable after the beneficiary signs the IPE and is receiving VR services.
3. Using a ticket
“Using a ticket” refers to a specified period of time when the beneficiary receives VR services from an EN or State VR agency and makes the progress toward self-sufficiency that is required under the regulations. The period of using a ticket begins on the effective date of the assignment of the ticket to an EN or State VR agency acting as an EN, or the date a beneficiary with a ticket begins receiving services from the State VR agency under the cost reimbursement option.
4. Initiation date on medical continuing disability review (CDR)
The CDR initiation date is the date on the notice sent to the beneficiary that informs him/her that SSA is beginning to review the disability case. The FO inputs the CDR initiation notice date to DCF on the CDR FO Input Screen (IFOA) following MSOM CDR 001.007.
If you do not have the notice, you can query the following DCF screens to identify the CDR initiation notice date.
IFOA screen shows the notice date in the DIRECT RELEASE NOTICE INIT field.
General Ticket Query (TKQY) shows the notice date in the CDR INITIATION DATE field.
CDR Query Screen (QCDR) shows the notice date as the DIRECT RELEASE initiation DATE field.
5. Extension period; 90-day period following case closure
If a beneficiary ticket status is "In Use" or "In Use SVR" and the ticket becomes unassigned, the beneficiary is entitled to a period of 90 days during which he or she may reassign the ticket. During this period, called the extension period, the ticket is considered to be in use, the ticket status is "Not Assigned In Use - Extended," and the ticket continues to protect the beneficiary from a medical CDR. A beneficiary may reassign a ticket during this period even if his or her disability-related cash benefits cease because of work and earnings.
6. Ticket unassignment or ending “In Use SVR” status
If a beneficiary, an EN, or a State VR agency acting as an EN decides not to continue with the ticket assignment, the party dissolving the relationship must make a request in writing to the PM to unassign the ticket.
If a beneficiary decides to discontinue working with a State VR agency that chose the cost reimbursement option, the beneficiary must notify the State VR agency that he or she will no longer participate. The State VR agency will notify the PM once the case closes.
7. Ticket reassignment
A beneficiary may reassign a previously assigned ticket or place it in the “In Use SVR” ticket status if he or she meets the ticket-eligibility criteria in DI 55002.005B and DI 55002.005C. The reassignment is effective on the first day the beneficiary meets these requirements.
NOTE: During the extension period or the 90-day period immediately following the case closure by the State VR agency, a beneficiary can reassign his or her ticket whether or not he or she meets the eligibility criteria described in DI 55002.005B and DI 55002.005C.
8. Inactive status
A beneficiary must make a written request to the PM to place his or her ticket in inactive status. For the PM’s contact information, see the PM Website. When the ticket is in inactive status, the ticket remains assigned but the beneficiary is not exempt from medical CDRs.
A beneficiary may reactivate his or her ticket by making a written request to the PM. If the beneficiary had been working with an EN or a State VR agency acting as an EN, the ticket may be reactivated only if it has remained assigned. If the beneficiary had been working with a State VR agency under the cost reimbursement option, the ticket may be reactivated only if the ticket is available for assignment and the beneficiary is receiving services from the State VR agency.
9. Failed timely progress review (FTPR)
When a beneficiary does not meet the work or educational requirements for a timely progress review, the DCF will show the ticket status as "Assigned-Not In Use-FTPR," and the beneficiary will be subject to scheduled medical CDRs. There is no 90 day extension period for FTPR. The beneficiary must meet the criteria set for the timely progress review before returning to “In Use” status.
C. Initiating a medical CDR for a ticket holder
To determine if we can initiate a medical CDR for a ticket holder, review the “General Ticket Query” (TKQY) screen in the DCF to determine the ticket status of a beneficiary. This query will show information about the beneficiary's ticket status. For information on the general ticket query, see MSOM CDR 004.003.
The following chart shows the ticket status terms on the general ticket query and the relationship of the ticket status to the policy on medical CDRs for ticket holders.
NOTE: Since June 1, 2011, we no longer mail ticket packages with the form SSA-1359 (Ticket to Work) enclosed. When a beneficiary is selected for a ticket, the ticket status is “eligible” on the DCF. Within a few days after selection, the PM changes the ticket status from "eligible" to "mailed" on the DCF. The mailed status allows the DCF to process ticket actions such as assigning the ticket.
D. When CDR protection and program participation end as a result of ticket termination
A beneficiary is no longer protected from scheduled medical CDRs and is no longer eligible to participate in the Ticket to Work program if his or her ticket terminates. For information on ticket termination, see DI 55002.055.
E. When CDR protection ends but program participation may continue
A beneficiary is no longer protected from scheduled medical CDRs if he or she fails to reassign his or her ticket or otherwise place the ticket with a State VR agency by the end of the 90-day extension period following ticket unassignment or case closure. (See DI 55025.001B.5) In that situation, the ticket is no longer considered to be “in use,” but the ticket has not terminated.
A beneficiary’s protection from scheduled medical CDRs will also end if the PM:
places the ticket in inactive status based on the beneficiary’s request, and the ticket status changes to “Assigned Not In Use – Inactive,” or “Not In Use SVR – Inactive”; or
determines the beneficiary did not meet the timely progress requirements, and the ticket status changes to “Assigned Not In Use