Identification Number:
Intended Audience:All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/
Originating Office:ORDP ODP
Title:Mandatory Use of Updated SSA-4814 and SSA-4815 Effective January 17, 2017 – One-Time-Only Instructions
Type:EM - Emergency Messages
Program:Title XVI (SSI); Disability
Link To Reference:See References at the end of this EM.
Retention Date: July 13, 2018
A. Purpose

This emergency message (EM) provides guidance on the use of the updated SSA-4814 (Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection) and SSA-4815 (Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection) for title XVI presumptive disability determinations. We have revised these forms for consistency with the final rule for evaluating human immunodeficiency virus (HIV) infection, which becomes effective January 17, 2017. The final rule includes new listings and listing criteria for evaluation of HIV infection under our disability programs.

B. Policy for use of updated forms and destruction of old forms

As of January 17, 2017, field offices (FO) and disability determination services (DDS) must use the revised versions of the SSA-4814 and SSA-4815 in order to make a finding of presumptive disability based on HIV infection per the instructions in DI 11055.241 or DI 23535.012. These forms will have the designation “(01-2017)” in the upper left corner after the form number. Do not make a finding of presumptive disability based on prior versions of the SSA-4814 or SSA-4815.

If an SSA-4814 or SSA-4815 is completed but unprocessed as of January 17, 2017, request a new SSA-4814 or SSA-4815 using the updated form. Similarly, follow up with medical sources currently in receipt of an outstanding SSA-4814 or SSA-4815. Explain that the prior form is no longer valid and provide a copy of the updated form.

Destroy all unused copies of prior versions of the SSA-4814 and SSA-4815 in order to prevent inadvertent use. FOs that supply copies of the SSA-4814 or SSA-4815 to medical sources as a courtesy can provide copies of the updated forms. However, these forms will also be available to medical sources electronically at Medical/Professional Relations on or shortly after January 17, 2017. Advise the medical sources that the prior versions of these forms are no longer valid and that we will no longer accept or process them.

Direct all program-related and technical questions to your Regional Office (RO) support staff or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns or problems to their Central Office contacts.<