TN 5 (09-16)

DI 60099.045 Benefit Offset National Demonstration (BOND) Work Continuing Disability Review (CDR) Unit (L5R) Responsibilities

The BOND CDR unit in the Office of Research, Demonstration, and Employment Support (ORDES) develops work activity and adjudicates all cessation determinations for all BOND participants that meet the following criteria.

  • Participants who had a prior work cessation (applicant’s disability cessation (ADC) date and CDR=E) on the master beneficiary record (MBR) and the last work CDR completed is prior to the month before the start month of participation on the disability control file (DCF); or

  • Participants with cases that result in a work cessation determination for the current decision and the last completed work CDR is prior to the end of the participation period.

The FO and PSC faxes any work documentation for the BOND participant or beneficiary to the electronic disability file (eView, or NDR) Contact information for the BOND work CDR unit can be found at DI 60099.005E.2.

When PSC transfers a case currently in Paperless to L5R:

  • enter a remark in paperless that you have transferred the case to L5R;

  • fax all development in paperless to (410) 597-0149. This is important because the work CDR unit in L5R does not have any access to paperless and cannot see any development in that system; and

  • send the ACR to FIN.

A. Initiate work reviews

The BOND Work CDR unit (L5R) initiates work CDR reviews if Abt identifies the need for a work CDR and it appears that the earnings will result in a cessation determination. If L5R determines that the work is not substantial gainful activity (SGA), or the beneficiary does not return the SSA-820-BK (Work Activity Report- Self Employment) /SSA-821-BK (Work Activity- Employee) that we mailed to him or her, L5R establishes a work report in eWork and sends the work report to the FO of jurisdiction to initiate a work review based on normal rules.

B. Trial work period (TWP) not over determination

The BOND work CDR unit usually does not process TWP only determination because these cases can be processed under normal procedure by the field offices or payment centers. If L5R processes a TWP not over determination, L5R will:

  • process the decision to eWork;

  • generate a TWP not completed decision notice modified by BOND language in eWork;

  • use eWork to process the decision and update the DCF via the eWork push; and

  • fax documents (an SSA-821-BK or SSA-820-BK, earnings verifications (725s), and any pertinent impairment related work expenses (IRWE), subsidy letters, and determinations) into eView, or NDRED according to current policy.

C. Continuance determinations

The BOND work CDR unit processes continuance decisions by:

  • processing the decision to eWork;

  • using eWork to process the decision and update the DCF via the eWork push; and

  • faxing documents (an SSA-821-BK or SSA-802-BK, 725s, and any pertinent IRWE, subsidy letters and determinations) into eView, or NDRED, according to current policy.

D. Cessation determinations

For beneficiaries assigned to a treatment group, the BOND work CDR unit:

  • Codes earnings over the substantial gainful activity (SGA) limit for months after the grace period and during the BOND participation period as “zero;”

  • Uses eWork remarks and documents decisions with a full explanation detailing any proofs used as the basis for the determination;

  • “Commits” the decision in eWork;

  • Modifies and sends a due process notice with BOND language based on the proposed SGA cessation. The due process notice includes the name and the phone number of the ORDES analyst working the case;

  • Sets a 15-day tickle date in eWork;

  • Uses eWork to effectuate the SGA cessation determination;

  • Manually posts a cessation in DCF to close the pending work issue;

  • Processes a manual adjustment credit and award date entry (MACADE) action to post the SGA cessation month and issues a proper final notice explaining any overpayments or underpayments and BOND rules;

  • Updates the BOND stand along system (BSAS) with updated cessation dates and participation periods;

  • Updates the BOND Operations Data System (BODS) with the work CDR determination and processes development of a current year work estimate;

  • Faxes documents (an SSA-821-BK (Work Activity Report-Employee), SSA-820-BK (Work Activity Report - Self Employed Person), SSA-823 (Report of SGA Determination) and L-725s, or pay stubs with pertinent impairment related work expenses (IRWE), subsidy proofs, and determinations) into eView or non-disability repository for evidentiary documents (NDRED) according to current policy; and

  • Determines whether BOND offset applies for years that have a completed end of year reconciliation (EOYR), posts the offset to the MBR, and issues a separate notice if an overpayment or underpayment occurs during the BOND offset period.

E. Non-countable income determinations

L5R applies the BOND $1 for $2 offset after determining the annual countable earnings estimate. To determine the countable estimate, subtract annual estimate of work incentives including sick, vacation, and holiday pay, IRWEs, subsidies, and special considerations from the gross estimate of wages or self-employment provided by the beneficiary. A determination on these work incentives deductions is the responsibility of the BOND work CDR unit in ORDES. Abt Associates (Abt) instructs BOND beneficiaries to submit proof of work incentives and other non-countable income. Abt downloads that information into the BOND Operations Data System (BODS).

The BOND work CDR unit is responsible for reviewing the evidence and making a determination on the deductions.

The CDR unit documents the decision in the BOND stand-alone system (BSAS) and faxes evidence associated with the decision into eView or NDRED as appropriate.

During the end-of-year reconciliation process, we exclude any non-proven work incentives, non-countable income, or denied estimates from the non-countable income deduction. This income is not countable unless the beneficiary provides documentation to substantiate the allegation.

NOTE: If a beneficiary has a net loss (i.e., self-employment loss and wages) process the case using the rules in SI 00820.210B.2.

F. SGA appeals

The BOND work CDR unit processes and adjudicates requests for reconsideration of SGA cessation decisions.

If a request for waiver accompanies a request for reconsideration, the work CDR unit issues a decision on the reconsideration. When that decision is final, the BOND work CDR unit forwards the waiver to the appropriate FO for a decision.

The process for appeals on BOND work CDR cessations includes the following:

  • A BOND beneficiary may file an appeal on an SGA cessation determination, a BOND overpayment, or both;

  • The FO faxes all SSA-561-U2 (Request for Reconsideration) and all supporting documentation to the electronic folder via eView or NDRED. The FO sends an MDW to L5R to let them know there is a reconsideration filed on the cessation determination and to annotate the eWork Development Worksheet with the appeal information;

  • Abt or the BOND beneficiary mails or faxes the SSA-561-U2 to ORDES’s centralized work CDR unit. Abt annotates the receipt of the request in their system (the address for L5R is in DI 60099.005E.2.);

  • ORDES processes reconsiderations on overpayments related to BOND offset calculations. These occur primarily after the end of year reconciliation (EOYR) process. For more information on BOND overpayments as a result of the EOYR process, see DI 60099.075C;

  • FOs handle all other (non-BOND) appeals under usual procedures. FO staff handles hearings requests, Appeals Council requests, and requests for a waiver of BOND-related overpayments and residual overpayments resulting from reconsidered SGA cessation decisions. Abt site offices assist BOND participants with appeal and waiver forms; and

  • FOs and PCs are responsible for all appeals for SGA cessation determinations or overpayments established after the BOND participation stop date on the DCF.

G. eWork functionality for BOND

Non-BOND offices adjudicate all BOND cases not resulting in a cessation determination or requiring a work CDR after a cessation determination for a period prior to the BOND participation period .

For BOND cases adjudicated in the field offices or payment centers, the eWork system recognizes the case is a BOND case and adds a BOND paragraph to the notice generated in eWork that reminds participants they are in BOND. Allow normal processing of the following BOND cases if the field office or payment center processed the case:

  • Trial work period (TWP) determinations;

  • Extended period of eligibility (EPE) continuances;

  • Initial Reinstatement Period (IRP) determinations for Expedited Reinstatement (EXR) cases;

  • Technical denials and re-openings to technical denials; and

  • Any review that covers a period that begins after the BOND participation stop date. This includes cases that cease after the 36th month of the EPE but during the BOND period. Any work review initiated after the BOND participation period begins with the month after the BOND participation period ended or the date of the last work CDR, if one was already performed after BOND ended.

H. eWork limitations

  • eWork does not distinguish between a work CDR ADC and any other type of cessation (e.g., medical, failure to cooperate, etc.). If there is an ADC date for any reason, eWork prompts you to send the case to L5R for development. Until the problem is corrected by L5R, continue to transfer these types of cases to L5R to process. If there are special case situations, annotate the issues on the eWork development worksheet.

  • eWork does not allow you to dispose of a work report when the last work CDR completed in eWork is during the BOND participation period and there is an ADC on the MBR.

I. Undeliverable BOND notices

Send undeliverable BOND Notices to L5R to review after you follow normal undeliverable mail procedures in GN 02605.005.

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DI 60099.045 - Benefit Offset National Demonstration (BOND) Work Continuing Disability Review (CDR) Unit (L5R) Responsibilities - 09/07/2016
Batch run: 09/07/2016