Identification Number:
EM-16015 REV
Intended Audience:All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/
Originating Office:ORDP ODP
Title:Form SSA-3367 changes not reflected on the EDCS 3367
Type:EM - Emergency Messages
Program:Title II (RSI); Title XVI (SSI); Disability
Link To Reference:See References at the end of this EM.
Retention Date: October 12, 2017

Retention Date: December 14, 2016

Revision: We revised EM-16015 by amending section C.2. and adding additional instructions clarifying what steps the FO needs to take when attempting to complete work activity reports and the claimant does not cooperate. We also clarify how the FO needs to document attempts to acquire the work information when the claimant does not cooperate.

A. Purpose

This emergency message (EM) alerts all field offices (FO) and disability determination services (DDS) of the recent updates made to paper form SSA-3367 Disability Report – Field Office. We will update the EDCS 3367 to conform to paper form SSA-3367 at a future date. This EM provides interim instructions for completion of the EDCS 3367 consistent with POMS DI 11005.045 Completing Form SSA-3367 (Disability Report – Field Office) and the 03/2016 version of form SSA-3367.

B. Background
    Changes to form SSA-3367 remove entries we no longer use and make minor clarifications to the form. These changes are not in EDCS.

C. EDCS instructions
    In EDCS:
    1. Do not use the following check blocks under “Reason for Potential Onset Date”:

      · SSI alien - The DDS no longer needs to be aware of the procedure for developing onset on a non-citizen case for deeming purposes as P.L. 104-193 eliminated the rule of sponsor to alien deeming if the alien became disabled.
      · Stat. blind - The POD does not provide information about blind onset, see DI 25501.220A.4 Potential Onset Date (POD). The POD considers potential non-blind disability entitlement factors only and does not guide development for statutory blindness.
      2. Do not use the following check block under “Reason for Potential Onset Date: Work before or after AOD”:

        · “820/821 pending (or in file)” Date Requested: The FO is responsible for investigating and making an SGA determination on work after onset unless the work met the requirements for “clearly not SGA.” See DI 10505.003 for the requirements for clearly not SGA.
            o The FO must document attempts to acquire a completed form SSA-820/821 in the “Other” section of the Potential Onset Reason section on the EDCS 3367. If using the paper SSA-3367, the FO should check “Other” in Item 4, “Reason for Potential Onset Date” and explain in Item 5. There should not be any pending SSA-820-BK (Work Activity Report – Self-Employment) or SSA-821-BK (Work Activity Report – Employee) forms at the time the FO sends the case to the DDS. The FO must complete the SSA-823 (Report of SGA Determination) when applicable and check the box “823 in file.” When the FO selects the “823 in file” option, they must also select if work is UWA, SGA, or Not SGA. This will allow for the transfer of the claim to the DDS; see MSOM MSS15-083 EDCS.

            o If the claimant does not cooperate in providing evidence for the SSA-820-BK or SSA-821-BK, the FO must follow the instructions in DI 11018.005 before determining that they cannot obtain an SSA-820-BK or SSA-821-BK. If the FO is unable to complete their investigation of the claimant’s work because they could not secure the claimant’s cooperation they must either:

                § deny the case for insufficient evidence if the issue is whether the claimant is currently performing SGA, or

                § if the SGA issue relates to onset, the FO should indicate that onset is limited to the last date they are able to verify the claimant performed SGA due the claimant’s failure to cooperate.

      3. The non-blind DLI is written as “Date Last Insured” while form SSA-3367 indicates “Non-blind date last insured (DIB/Freeze cases)”: Only the non-blind DLI belongs in this field.

      4. There is no check box or field to enter the date for the blind DLI. If a claimant alleges blindness or a visual impairment, enter the following statement in the remarks section: “If claimant is found statutorily blind, the blind DFI is MM/DD/YYYY and the blind DLI is MM/DD/YYYY.”

    Follow the guidance in DI 81010.025A for completing the EDCS 3367. For detailed instructions, see DI 11005.045 . We made updates to form SSA-3367 as described above. We will update the EDCS 3367 at a future date.

    Direct all program-related and technical questions to your RO support staff or PSC OA staff. RO Support staff or PSC OA staff may refer questions or problems to their CO contacts


    Form SSA-3367 Disability Report – Field Office
    DI 10505.003 Evaluating and Developing Earnings that Clearly are or are not Substantial Gainful Activity (SGA)
    DI 10505.035 Documenting Employment Cases Using Forms SSA-821-BK (Work Activity Report – Employee) and SSA-823 (Report of SGA Determination – For SSA Use Only)
    DI 11005.045 Completing the SSA-3367 (Disability Report – Field Office)
    DI 11018.005 Field Office Responsibilities When a Claimant Fails to Cooperate (FTC)
    DI 24001.005 Work Activity Development Responsibilities
    DI 25501.220 Potential Onset Date (POD)
    DI 81010.025 Completing Electronic Disability Collect System (EDCS) Forms for Initial Claims
    EM-16015 REV - Form SSA-3367 changes not reflected on the EDCS 3367 - 07/12/2016