Effective Dates: 2/12/2026 - Present

Identification Number:
DI 12027 TN 12
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Statutory Benefit Continuation (SBC)
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 120 – Appeals Processing

Subchapter 27 – Statutory Benefit Continuation (SBC)

Transmittal No. 12, 02/12/2026

Audience

PSC: CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, ERE, FCR, FDE, RECONE, RECONR, RECOVR;
OCO-ODO: BET, CR, CST, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: REF;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OHO/OAO: OHAAC, OHACO (SAWDY), OHAHOs, OHAROs;

Originating Component

LP DP

Effective Date

Upon Receipt

Background

Effective with previously released instructions in EM-25033 published on May 28, 2025, statutory benefit continuation (SBC) election statements are collected on the SSA-792 (Statutory Benefit Continuation Election Statement). This policy change replaces the use of the SSA-795 (Statement of Claimant or Other Person) for SBC elections.

The new form SSA-792 standardizes the collection of an individual’s benefit continuation choices during a disability cessation appeal. The SSA-792 clearly explains the options available for continued disability benefits and Medicare coverage, as well as includes a section to complete the good cause statement for late filing, if applicable.

Summary of Changes

DI 12027.001 Statutory Benefit Continuation

We removed references to prior SBC forms and updated the section to include new instructions for the SSA-792

DI 12027.007 Who May Elect Statutory Benefit Continuation

We removed references to prior SBC forms and updated the section to include new instructions for the SSA-792

DI 12027.010 Processing Statutory Benefit Continuation

We removed references to prior SBC forms and updated the section to include new instructions for the SSA-792

DI 12027.050 Processing Statutory Benefit Continuation in Non-Payment for Non-Medical Reasons

We removed references to prior SBC forms and updated the section to include new instructions for the SSA-792

DI 12027.001 Statutory Benefit Continuation

CITATIONS:

Social Security Act -- Sections 223(g) and 1631(a)(7) ;
Regulations -- 20 CFR 404.1597 , 404.1597a , 416.995 , and 416.996

A. Benefit continuation during an appeal

When we determine that an individual’s physical or mental impairment(s) ceased, never existed, or is no longer disabling (i.e., medically improved), we notify the individual of the right to an appeal and to statutory benefit continuation (SBC) (if the individual is eligible for SBC). We will ask individuals who are eligible for SBC to complete the SSA-792 (Statutory Benefit Continuation Election Statement) and indicate on the form whether they elect or decline SBC.

For an overview of benefit continuation during the administrative appeal process, see DI 28001.070.

B. Situations when benefit continuation applies

1. Reconsideration and hearing levels

An individual may elect or decline SBC during a reconsideration or an Administrative Law Judge (ALJ) hearing appeal of:

a. Medical cessation

A medical cessation determination is an adverse determination where disability ceases for medical reasons. This includes adverse determinations in medical continuing disability reviews (CDR) and age 18 medical redeterminations.

b. Adverse medical reopening/revision

SBC election options apply to an adverse medical reopening/revision determination in the following types of cases:

  • •

    allowance to denial,

  • •

    allowance to closed period,

  • •

    continuance to medical cessation, and

  • •

    revision to a different cessation date.

2. Remands

SBC also applies in cases remanded to the ALJ by the Appeals Council (AC), including when a case is sent back to the ALJ after a court remand. In these situations:

  • •

    The ALJ’s decision or dismissal order on the medical cessation appeal is vacated and is no longer in effect.

  • •

    Pending a new decision by the ALJ or final action by the AC on the AC’s recommended decision, SBC is available to the individual and others receiving benefits on the individual’s record.

C. Situations excluded from benefit continuation

The continued benefit provisions do not apply to:

  • •

    a closed period of disability (i.e., an initial determination that an individual was disabled only for a specified period of time),

  • •

    an adverse medical reopening/revision to a later onset,

  • •

    a case pending at the AC or federal court level, or

  • •

    other SBC exclusion scenarios listed in DI 12027.015.

DI 12027.007 Who May Elect Statutory Benefit Continuation

A. Individuals eligible for benefit continuation

The option to elect statutory benefit continuation (SBC) only applies to the following individuals:

1. Title II beneficiaries

  • •

    Primary disability beneficiaries (i.e., the number holder (NH) in a disability insurance benefits (DIB) case).

  • •

    Auxiliaries receiving benefits on the record of a primary disability beneficiary. (An auxiliary has the option to elect SBC, but the primary disability beneficiary must elect SBC for DIB and for the auxiliary’s benefits before the auxiliary may receive SBC.)

  • •

    Disabled widow(er)s.

  • •

    Disabled adult children.

  • •

    Mothers/fathers receiving benefits based on having a disabled child in care.

2. Title XVI beneficiaries

  • •

    Supplemental Security Income (SSI) recipients whose SSI eligibility is based on disability or blindness.

  • •

    Individuals receiving special SSI payments or Medicaid eligibility under section 1619(a) and (b) of the Social Security Act (Title XVI provisions) (see sections in SI 02302.000).

NOTE: 

Medicaid eligibility will continue for SSI recipients electing SBC in states where the Social Security Administration (SSA) determines Medicaid eligibility.

3. Concurrent beneficiaries

In a concurrent case, a beneficiary may elect to receive SBC on Title II or both titles.

For information on processing SBC elections on the SSA-792 (Statutory Benefit Continuation Election Statement), see DI 12027.010.

4. Medicare beneficiaries

An individual may request SBC of Medicare coverage with or without also requesting continuation of disability benefits.

  • •

    The beneficiary may elect SBC of both Parts A and B or only Part A or Part B.

  • •

    Generally, an individual who was entitled to Part A only at the time of disability entitlement may enroll for Part B coverage only during the General Enrollment Period (GEP) of January through March, with entitlement effective the first month after the month of the GEP enrollment. For more information on the GEP, see HI 00805.025.

  • •

    When an individual elects SBC of Medicare-only, only the Medicare coverage that was in effect as of the date of disability termination will continue. The beneficiary will be billed directly for any Part B premium. If the premiums are not paid, Part B entitlement will terminate.

NOTE: 

SBC does not apply to Medicare Qualified Government Employees (MQGE) only cases.

B. Auxiliary benefit continuation

1. Primary beneficiary

The primary beneficiary/NH electing SBC may:

  • •

    Elect or decline to have benefits continue for any auxiliaries, and

  • •

    specify which auxiliary may receive SBC and what benefit may continue.

2. Auxiliary beneficiary

  • •

    An auxiliary may receive SBC only if the primary beneficiary also elects SBC for that auxiliary.

  • •

    Each auxiliary receiving benefits on a DIB record has the option to elect or decline SBC.

Ask each auxiliary beneficiary eligible for SBC (or representative payee on their behalf, where appropriate, as described in DI 12027.010) to sign a separate SSA-792.

DI 12027.010 Processing Statutory Benefit Continuation

When an individual receives a medical cessation notice (or notice of an adverse medical reopening/revision determination), the notice will provide information about how to request an appeal and statutory benefit continuation (SBC) (if SBC applies).

A. Who may sign the SSA-792 (Statutory Benefit Continuation Election Statement)

  • •

    The individual eligible for SBC must be the person to sign the SSA-792 (unless that individual is legally incompetent or a minor child).

  • •

    Once an appeal of the medical cessation (or adverse medical reopening/revision) determination is filed, the eligible individual’s representative payee may sign the SSA-792.

NOTE: 

No authorized representative (attorney or non-attorney) may sign the SSA-792 on the individual’s behalf. If an authorized representative improperly signs the SSA-792 but it is filed timely, it will serve as a protective writing for SBC if a properly signed SSA-792 is later submitted within the 65-day appeal period.

B. When the individual contacts us

When the individual receives the medical cessation (or adverse medical reopening/revision) determination notice and contacts the field office (FO):

1. Explain benefit continuation and appeal information for the appropriate appeal level

2. Explain the time limits for appeal and benefit continuation requests

3. Provide the SSA-792 to the individual

Separate election statements are required at the reconsideration and ALJ hearing levels.

An individual can obtain the SSA-792 in the following ways:

  • •

    Directly from the SSA website at www.ssa.gov/forms.

  • •

    Through Upload Documents (which can be accessed with a MySSA account or a link on the SSA webpage).

  • •

    By contacting SSA over the telephone or visiting the FO in person to request the SSA-792 (if the individual visits in person, obtain the SSA-792 from inForm).

NOTE: 

The individual may submit a written statement other than the SSA-792 to elect or decline SBC. In this situation, recontact that individual and explain that we would like the individual to complete and sign the SSA-792 to document the SBC decision. Provide additional assistance when necessary.

4. Provide appeal forms to the individual

The individual must appeal the medical cessation (or adverse medical reopening/revision) determination to have the SBC option.

The appeal forms are specific to the individual’s level of appeal. For forms used in disability claims and appeals, see DI 11005.016 and sections in DI 12026.000.

NOTE: 

Do not delay in processing an appeal to wait for an SSA-792.

5. Help the individual to complete forms

If the individual needs or requests help in completing any of the forms, help the individual with completing the form(s). For more information on completing and reviewing forms in disability claims, see DI 11005.022.

6. Document the contact

a. Contact made by telephone, fax, or mail - forms sent to individual

Prepare a report of contact to document the discussion and what forms were provided to the individual.

If the individual submits a reconsideration request without required forms, request the forms following instructions in DI 12026.020B.

If the individual submits a request for an ALJ hearing to appeal a reconsidered determination, do not delay in processing the appeal. Complete additional development upon request of the ALJ.

b. Contact made by office visit

Process the appeal and provide a copy of the completed appeal and SBC requests to the individual at the end of the interview. If the individual cannot finish completing the forms during the FO visit, follow the above instructions in DI 12027.010B.6.a in this section.

7. Systems inputs

The Electronic Disability Collect System (EDCS) has functionality to:

  • •

    automate benefit terminations,

  • •

    communicate record updates to the Disability Control File (DCF), and

  • •

    initiate Title II SBC payment and Medicare actions in medical cessation appeals.

NOTE: 

The Post-entitlement Online System (POS) is no longer used to initiate SBC. SBC reinstatements may require assistance from the Processing Center (PC) in Medicare-only continuations and other Title II cases when EDCS inputs do not update the payment status. For modes of requesting PC assistance, see GN 01070.228.

For Title XVI and concurrent cases, follow instructions in DI 81010.230.

a. Electronic process

Establish the appeal and SBC requests in applicable processing systems, following instructions in DI 81010.230.

b. System limitations and exclusions

SBC requests involving a Title II EDCS exclusion will require inputs on the EDCS Exclusion Appeal (EEAI) screen in DCF. For an explanation of the system inputs, see CDR 001.025.

SBC requests involving Title XVI will require a direct SSR update. For an explanation of the system inputs, see MSOM BUSSR 002.010, MSOM BUSSR 002.020, MSOM MSSICS 020.015, SM 01305.580, SM 01305.585, and SM 01601.685.

8. Folder documentation

Upon processing the appeal, use evidence portal (EP) or eView to enter the signed and completed SSA-792 into the electronic file.

If the official folder is paper, place the signed and completed SSA-792 in the blue section (E) of the modular disability folder (MDF).

DI 12027.050 Processing Statutory Benefit Continuation in Nonpayment for Nonmedical Reasons

A. Title XVI medical cessation appeal when payments have stopped for nonmedical reasons

A Supplemental Security Income (SSI) recipient in nonpayment status for a nonmedical reason when disability ceased may elect statutory benefit continuation (SBC):

  • •

    only at the time the nonmedical eligibility requirements are met, and

  • •

    only if the medical cessation (or adverse medical reopening/revision) appeal is still pending at that time.

NOTE: 

The determination notice will contain modified SBC language explaining when the recipient may make an SBC election. When the nonmedical eligibility requirements are later met on the SSI record, the associated SSA-L8155 (SSI Notice of Planned Action) will explain the 15-day time frame to elect payment continuation during appeal of the N07/N08 (medical cessation) nonpayment status. For when manual SSI notice preparation is required in N07/N08 cases, see NL 00801.010.

1. Record remains in nonpayment status during appeal

If the nonmedical requirements are not met on the date of the appeal request, do not obtain an SSA-792 (Statutory Benefit Continuation Election Statement) with the appeal request.

  • •

    Inform the recipient of the option to elect or decline SBC if the nonmedical requirements are later met and the appeal is still pending. (For the procedure on requesting SBC, see DI 12027.010.)

  • •

    Process the appeal and update the Supplemental Security Record (SSR), leaving the SSR in nonpayment status.

2. Payment reinstatement during appeal

When an individual requests SBC because the nonmedical requirements are currently met:

  • •

    Verify that the cessation appeal is still pending at the reconsideration or hearing level.

  • •

    Redetermine SSI eligibility factors in the routine manner. (For changes that may affect SSI eligibility, see sections in SI 02301.000.)

  • •

    Explain the opportunity to elect or decline SBC. (For SBC provisions and processing instructions, see DI 12027.001 through DI 12027.010.)

  • •

    If the individual elects SBC, reinstate SSI at the applicable payment level.

3. Payment continuation recipient becomes ineligible

Send the claimant an SSA-L8155 which includes Goldberg/Kelly (GK) appeal rights and payment continuation on the adverse action to suspend SBC for a nonmedical factor. For GK information, see SI 02301.300.

4. Establishing nonpayment for nonmedical reasons

B. Title II benefit suspension due to work activity

When a Title II beneficiary works while receiving SBC during the appeal of a medical cessation (or adverse medical reopening/revision) determination:

  • •

    suspend the benefits for months of substantial gainful activity (SGA) after the trial work period (TWP), and

  • •

    reinstate the benefits for months of non-SGA within the extended period of eligibility (EPE).

Suspension of SBC is not an initial determination subject to appeal. However, the initial SGA determination may be appealed.

The due process notice must be sent before suspension.

  • •

    For due process in work issue cases, see DI 13010.185.

  • •

    For notice requirements in Title II due process actions, see GN 03001.005.

C. Title II work activity determinations during benefit continuation

SGA and TWP determinations made during SBC are eWork exclusions. For documenting the work determinations, see procedures outlined in DI 13010.026.

1. Development indicates the work is substantial

For potential SGA earnings (i.e., wages above the "clearly not SGA" threshold, or self-employment):

  • •

    Verify reported work activity and earnings.

  • •

    Determine if beneficiary is entitled to a TWP (following instructions in DI 13010.035).

  • •

    Query the Disability Control File (DCF) and eWork information to determine if there were prior months of trial work.

2. Trial work months exhausted

When the beneficiary is engaging in SGA and the TWP is exhausted:

  • •

    If the beneficiary has an employer, prepare an SSA-821 (Work Activity Report - Employee). (For documenting employment cases using the SSA-821 and the SSA-823 (Report of SGA Determination), see DI 10505.035.)

  • •

    If the beneficiary is self-employed, prepare an SSA-820 (Work Activity Report - Self-Employment). (For documenting self-employment cases using the SSA-820 and the SSA-823, see DI 10510.025.)

  • •

    Send advance (due process) notice of suspension.

    NOTE: 

    Do not prepare an SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) while the medical cessation appeal is pending.

  • •

    After 15 days from the date of the advance notice, if the SGA is continuing, input S9 (miscellaneous suspension) for the current operating month (COM). Notify the appropriate Processing Center (PC) to suspend SBC effective the current SGA month (without any retroactive adjustment for SGA) and to convert the S9 to S7 (EPE SGA) or another nonpayment status as appropriate. Provide the PC the following information:

    • –

      FO location (city, state) and processing technician information: FO Code, FO technician's name, FO technician's phone number.

    • –

      Request Title: Title II, Suspension of Benefit Continuation Payments - SGA.

    • –

      Claim Account Number (CAN): The wage earner's social security number (SSN).

    • –

      Beneficiary Identification Code (BIC) that was assigned for Title II purposes.

    • –

      Name: Surname followed by the first three letters of the individual's first name.

    • –

      Suspension months: specify the months for which payments should be suspended and whether the suspension is to continue.

  • •

    Store the forms in the Certified Electronic File (CEF). In a CEF exclusion case, forward the original forms (e.g., SSA-821, SSA-823) to the appropriate office for association with the cessation appeal folder.

For modes of requesting PC assistance, see GN 01070.228.

3. Beneficiary responds to proposed benefit suspension

If the beneficiary alleges the work is not SGA or otherwise contests the proposed suspension:

  1. a. 

    Review any new evidence and, if necessary, develop to resolve conflicting issues.

  2. b. 

    Process the suspension or continue payment accordingly.

  3. c. 

    Send the beneficiary notice on an SSA-L951 (Social Security Notice Letterhead) explaining the outcome, excluding appeal rights.

4. Applying trial work months

If the beneficiary engaging in SGA is eligible for a TWP:

  1. a. 

    Store the work activity report form(s) using Evidence Portal (EP) or eView and set a tickle (control) date for end of the TWP.

  2. b. 

    If the medical cessation appeal is a CEF exclusion, forward the original form(s) to the appropriate office for association with the official folder.

  3. c. 

    At the end of the TWP, if the medical appeal is still pending, update and verify work and earnings information.

  4. d. 

    When the TWP is exhausted, follow instructions in DI 12027.050C.2 in this section.

5. Reinstatement

When the reinstatement is for months that earnings are not SGA and the appeal of the medical cessation (or adverse medical reopening/revision) determination is still pending, follow EPE instructions in DI 13010.215.

D. Title II benefits are in suspense due to imprisonment of beneficiary

Generally, a disability insurance benefits (DIB), childhood disability benefits (CDB), or disabled widow(er) benefits (DWB) beneficiary in prison will be in payment suspense status at the time of the medical cessation (or adverse medical reopening/revision) determination.

1. Ceased prisoner

A ceased prisoner beneficiary:

  1. a. 

    Is not eligible for SBC.

  2. b. 

    May become eligible for SBC upon release from prison, if the medical appeal of the cessation (or adverse medical reopening/revision) determination is still pending at the time.

2. Eligible auxiliaries

Eligible auxiliaries who are receiving benefits at the time of the cessation or adverse reopening/revision determination are eligible for SBC during appeal.

3. Modified notice

A modified cessation (or adverse medical reopening/revision) notice is required to:

  1. a. 

    Explain to the ceased prisoner beneficiary:

    • •

      appeal rights;

    • •

      that benefit continuation is not now available but may be available later; and

    • •

      the 10-day (plus 5 days for mailing) time frame to elect SBC for eligible auxiliaries.

  2. b. 

    Explain the SBC provisions to eligible auxiliaries.

E. Title II appeal filed for ceased prisoner beneficiary

1. Ceased prisoner appeal

For a prisoner appeal of a medical cessation (or adverse medical reopening/revision) determination:

  1. a. 

    Process the appeal in the routine manner for medical appeals. (For related appeal processing instructions, see sections in DI 12000.000.)

  2. b. 

    Obtain the SSA-792 for any auxiliaries.

  3. c. 

    Notify the appropriate PC of SBC elections for auxiliary benefits (following guidance in GN 01070.228).

2. Reinstatement requested upon prison release

When the beneficiary requests reinstatement upon prison release:

  1. a. 

    Verify:

    • •

      The appeal is pending on a medical cessation or eligible adverse medical reopening/revision determination.

    • •

      The prisoner's release date with appropriate authorities. (For Title II reinstatement policies in prison releases, see GN 02607.840.)

    • •

      That all other eligibility factors continue to be met. (For factors affecting eligibility, see GN 02602.005.)

  2. b. 

    Obtain a signed and completed SSA-792. (For SBC provision instructions, see DI 12027.001 through DI 12027.010.)

  3. c. 

    Remind the claimant of reporting responsibilities while receiving SBC.

  4. d. 

    Reinstate benefits effective the first full month of non-confinement.

  5. e. 

    Do not withhold any of the SBC benefits for possible attorney fees.

  6. f. 

    Notify the appropriate PC to process the reinstatement. Provide the PC the following information:

    • •

      FO location (city, state) and processing technician information: FO Code, FO technician's name, and FO technician's phone number.

    • •

      Request Title: Prior Prisoner Case Reinstatement Now Applicable.

    • •

      CAN: The Wage Earner's SSN.

    • •

      BIC for the suspended beneficiary.

    • •

      Name: The suspended beneficiary's surname followed by the first name and initial.

    • •

      Event Date: (MM/YY) Effective month benefits are to resume (first full month of non-confinement).

    • •

      Remarks: "Title II, SBC pending medical cessation/reopening" followed by the reason for reinstatement (e.g., parole, completion of sentence, commutation of sentence, or conviction overturned).

3. Follow-up procedures

After 45 days:

  1. a. 

    Verify that the reinstatement is completed.

  2. b. 

    If reinstatement has not been processed, send a follow-up request to the PC (following guidance in GN 01070.228).


DI 12027 TN 12 - Statutory Benefit Continuation (SBC) - 2/12/2026