NL 00708.010 Usage Chart for Numbered Paragraphs Applicable to Reconsideration and Hearing/Appeals Notices (Disability Cases)

A. Introductory Paragraphs

 ParagraphFill-ins

DIB and DWB

    
DWB and DIB—Affirmation of Denial, Cessation or Onset Date-Non-State-No Physician Participation5011
DWB and DIB Affirmation of Denial, Cessation or Onset Date—Non-State—Physician Participation501A1

DIB or Freeze

DWB and DIB Affirmation of Denial, Cessation or Onset Date—State—Physician Participation501B1
DIB or Freeze—Affirmation of Denial, Cessation or Onset Date—Non-State—No Physician Participation504None
DIB or Freeze—Affirmation of Denial, Cessation or Onset Date—Non-State—Physician Participation504ANone

CDB

DIB or Freeze—Affirmation of Denial, Cessation or Onset Date—State Physician Participation504BNone
CDB—Affirmation of Denial or Cessation—Non State—No Physician Participation505None
CDB Affirmation of Denial or Cessation—Non-State Physician Participation505ANone

DWB

CDB—Affirmation of Denial or Cessation—State—Physician Participation505BNone
DWB—Affirmation of Denial, Cessation or Onset Date—Non-State—No Physician Participation570None
DWB—Affirmation of Denial, Cessation or Onset Date—Non-State—Physician Participation570.1None

Miscellaneous

DWB—Affirmation of Denial, Cessation or Onset Date—State—Physician Participation570.2None
Title XVI Claims Escalated to Reconsideration Level416None
Reconsideration Affirmation Lead-in Paragraph556None
Escalated Title II Claim-Title XVI Claim at Reconsideration Level585None
Combined Initial - Reconsideration Determination5861
Escalated Title II Claim - Other Title II Claim at Reconsideration Level5872

B. Disability Requirement, Explanation of Disability Provisions

 ParagraphFill-ins

DIB

    
DIB—Not Disabled—General510None
DIB—Not Disabled—Earnings Test Has Expired or Will Expire In or Before the Quarter Following the Date the Letter is Prepared5112
DIB—Not Disabled When Earnings Test Last Met—AOD Before Age 245121
DIB—Not Disabled When Earnings Test Last Met—AOD Between Ages 24-31512.11
DIB—Not Disabled When Earnings Test Last Met—AOD At or After Age 31—(Disability Not Due to Statutory Blindness)512.2None
DIB—Explanation of Disability Requirement520None
DIB—Explanation of Disability Requirement—Earnings Test Not Expired520.11
DIB—Explanation of Disability Requirement—Earnings Test Expired—AOD Before Age 24520.21
DIB—Explanation of Disability Requirement—Earnings Test Expired—AOD Between Ages 24-31520.31
DIB—Explanation of Disability Requirement—Earnings Test Expired—AQD At or After Age 31—(Disability Not Due to Statutory Blindness)520.41
DIB—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Earnings Requirement Not Met—EOD Before Age 24521.3  
DIB—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Earnings Requirement Not Met—EOD Between Ages 24-31521A3
Disabled in Quarter Alleged or Onset Established Established Later Than Alleged—Earnings Requirement Not Met—EOD At or After Age 31—(Disability Not Due to Statutory Blindness)521B4
DIB—Not Disabled in AOD or At Any Time Thereafter Up to and Including Last Quarter in Which Earnings Requirement Met—AOD Before Age 24521.1.2  
DIB—Not Disabled in AOD or At Any Time Thereafter Up to and Including Last Quarter in Which Earnings Requirement Met—AOD Between Ages 24-31521.112
DIB—Not Disabled in AOD or At Any Time Thereafter Up to and Including Last Quarter in Which Earnings Requirement Met—AOD At or After Age 31—(Disability Not Due to Statutory Blindness)521.122
DIB—Not Disabled at Any Time Earnings Requirement Met—AOD Before Age 24521.201
DIB—Not Disabled at Any Time Earnings Requirement Met—AOD Between Ages 24-31521.211
DIB—Not Disabled at Any Time Earnings Requirement Met—AOD At or After Age 31—(Disability Not Due to Statutory Blindness)521.221
Statutory Blindness—Not Disabled At Any Time Earnings Requirement Met—AOD 1973 or Later521.231
Statutory Blindness (1972 Amendments)—Not Insured at AOD-AOD 1973 or Later521.243

CDB

Statutory Blindness—Not Disabled When Earnings Requirement Test Last Met-AOD Before 1973521.252
CDB—Explanation of Disability Requirement522None
CDB—Disability Must Start Before Age 22522.1None
CDB—Explanation of Claimant's Rights After Cessation522.2  
CDB—7-Year Period for Reentitlement Ended Before EOD522.32
CDB—Not Disabled At AOD or At Any Time Within 7-Year Period After End of Prior Entitlement522.42
CDB—Reentitlement—Not Disabled At Any Time Before 7-Year Period Ended522.5 1
CDB—Reentitlement—Disability More Than 7 Years After Prior Period Ended Cannot Serve to Qualify522.6None

DWB

CDB—Reentitlement—Advice Regarding Worsening of Condition522.71
DWB—Explanation of Disability Requirement (Widow)572None
DWB—Explanation of Disability Requirement (Widower)572.1None
DWB—Explanation of Disability Requirement (Surviving Divorced Wife)572.2None

C. Disability Requirement, Explanation of Disability Provisions, Insert Guides

 ParagraphFill-ins
DIB or Freeze-Termination Due to Work Activity5305
DIB or Freeze—Disability Must Exist When Earnings Requirement is Met533None
DIB or Freeze—Disability After Earnings Requirement Last Met Cannot Serve to Qualify533ANone
DIB or Freeze—Condition Not Severe When Earnings Requirement Met533BNone
DIB or Freeze—Disability Must Start At Least 5 Months Before Full Retirement Age534None
DIB or Freeze534ANone
DIB or Freeze—Disability Must Start At Least 5 Months Before the Month of Attaining Full Retirement Age and When Earnings Requirement Met535None
Definition of SGA5361
DWB—Disability Must Exist When Specified 7-Year Period Requirement Met577None
DWB—Disability After Specified 7-Year Period Cannot Serve to Qualify577.1None
DWB—Condition Not Severe When Specified 7-Year Requirement Last Met577.2None
DWB—Disability Must Start At Least 5 Months Before Age 60—Widow578None
DWB—Disability That Starts Less Than 5 Months Before Age 60—Cannot Serve to Qualify—Widow578.1None
DWB—Disability Must Start At Least 5 Months Before Age 60—Widower578.2None
DWB—Disability That Starts Less Than 5 Months Before Age 60—Cannot Serve to Qualify—Widower578.3None

D. Earnings Requirement, Explanation of Earnings Provisions

 ParagraphFill-ins

DIB or Freeze

    
DIB or Freeze—Meeting Earnings Requirement After Onset Date541None
DIB or Freeze—Date Earnings Requirement Was Last Met5421
DIB or Freeze—Claimant Aged 62-65—Possible Entitlement to Reduced RIB543None
DIB or Freeze—Not Disabled—Claimant Will Attain Retirement Age Before Earnings Test Expires544None
DIB or Freeze—General Description of Earnings Requirement546None
DIB or Freeze—Description of 6/12 Test—Disability Before Age 24546.1None
DIB or Freeze—Description of Earnings Requirement—Disability Between the Ages 24-31546.2None
DIB or Freeze—Description of Earnings Requirement—Disability Age 31 or Later546.3None
Description of Earnings Requirement—Statutory Blindness—AOD 1973 or Later547None
Description of Old and New Earnings Requirement—Statutory Blindness548None

DWB

DIB—Allowance Under 1972 Amendments—StatutoryBlindness5493
DWB—Explanation of Specified 7-Year Period (Widow)573None
DWB—Explanation of Specified 7-Year Period (Widower)573.1None
DWB—Explanation of Specified 7-Year Period (Surviving Divorced Wife)573.2None
DWB—Date Specified 7-Year Period Last Met5751
DWB—Seven Year Period Ended Before EOD575.32
DWB—Not Disabled at AOD or at Any Time Within 7-Year Period575.52

E. Disability Requirement, Explanation of Disability Provisions, Cessation

 ParagraphFill-ins

DIB or FREEZE

    
Freeze Cessation523A2
DIB Cessation—Work Activity—Trial Work Period524None
Freeze Cessation—Work Activity524ANone

CDB

DIB Cessation—Work Activity—No Waiting Period Served524BNone
CDB Cessation—Work Activity—TWP Previously Used525(B)None

DWB

CDB—Denied Before Age 22—Possible Worsening of Condition525(C)2
DWB Cessation—Medical Improvement—Widow576None
DWB Cessation—Medical Improvement—Widower576.1None
DWB Cessation—Medical Improvement—Surviving Divorced Wife576.2None
DWB Cessation—Work Activity—Widow576.3None
DWB—Cessation—Work Activity—Widower576.4None

Miscellaneous

DWB Cessation—Work Activity—Surviving Divorced Wife576.5None
DIB or Freeze—Determination Concerns Only Disability Application544(A)None
Favorable Disability Determination by Veterans Administration—General550None
P&T Pension Award by Veterans Administration551None
Disability Benefits by Other Than Veterans Administration552None
Partial Allowance in Freeze Cases5532
Conclusion of Disability by Attending Physician554None
DIB—Explanation of Claimant's Rights After Cessation555None

F. Reconsideration and Hearing Standard Paragraphs

 ParagraphFill-ins
Previous Action Revised Upon Reconsideration Not Primarily Due to Additional Evidence136(A)None
Previous Action Revised Upon Reconsideration—Primarily Due to Additional Evidence136(C)None
Previous Action Revised Upon Reconsideration—(For Residents Other Than U.S., Guam, American Samoa, Philippines, Canada, Mexico, Western Samoa and British Virgin Islands)136(D)FNone
Previous Action Revised Upon Reconsideration—After Implied Request (For Residents Other Than U.S., Guam, American Samoa, Philippines, Canada, Mexico, Western Samoa and British Virgin Islands)136(E)FNone
Program Service Center Reconsiders Case Remanded Prior to a Hearing137None
Hearing Paragraph for Reconsidered Disability Cases140None
Hearing Paragraph Used in Reconsideration Notice Where Claim is Denied on the Basis of Res Judicata140(A)None
Reconsideration Paragraph - Disability Ceases - Payments Continue142None
Reconsideration Paragraph - Disability Ceases - Payments Terminate1431
Appeals Paragraph - Disability Ceases - Payments Continue149None
Appeals Paragraph - Disability Ceases - Payments Terminate1501
Title II Medical Cessation Appeals Language - Advance Notice Required - SSI Payments Being Made305None
Expedited Appeals Process941None

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900708010
NL 00708.010 - Usage Chart for Numbered Paragraphs Applicable to Reconsideration and Hearing/Appeals Notices (Disability Cases) - 05/12/2004
Batch run: 01/27/2009
Rev:05/12/2004