Identification Number:
DI 13010 TN 41
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ORDES
Title:Work Activity
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 130 – Continuing Disability
Subchapter 10 – Work Activity
Transmittal No. 41, 07/29/2019

Audience

PSC: BA, CA, CS, DE, DEC, DTE, ICDS, IES, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CR, ERE, FCR, FDE, PETL, RECONE, RECONR;
OCO-ODO: BET, BTE, CR, CST, CT, CTE, CTE TE, DE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECONR, RECOVR;
ODD-DDS: ADJ, DHU;
FO/TSC: AWIC, CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR, WIL;

Originating Component

ORDES

Effective Date

Upon Receipt

Background

We learn about Social Security Disability Insurance (SSDI) beneficiaries' work activity in two primary ways: self-reported work and two types of earnings enforcements. We use the Department of the Treasury’s Internal Revenue Service (IRS) data to generate Continuing Disability Review Enforcement Operation (CDREO) earnings alerts. In 2017, we began using quarterly earnings received by the Office of Child Support Enforcement (OCSE) to generate alerts under the Quarterly Earnings Project (QEP). We updated the Program Operations Manual System (POMS) to add QEP enforcement criteria and processing instructions. Prior to 2019, we sent CDREO alerts for cases with a medical improvement expected (MIE) diary and IRS data showing earnings equal to or greater than 1 month of substantial gainful activity (SGA). For all other cases, we alerted cases showing earnings equal to or greater than 6 months of SGA. Starting in 2019, we will alert all cases based on the same criteria (when earnings are equal to or greater than 6 months of SGA). We updated the POMS to reflect this change.

Summary of Changes

DI 13010.027 Continuing Disability Review Earnings Enforcements

We changed the title from “Continuing Disability Review Enforcement Operation” to “Continuing Disability Review Earnings Enforcements” to better reflect the content of the section.

Subsection A: Updated to add background on QEP.

Subsection B: Updated to reflect the change for alerting MIE cases based on a showing of earnings equal to 1 month of SGA to alerting all cases based on 6 months of SGA. Added the alert criteria and threshold amounts for QEP.

DI 13010.027 Continuing Disability Review (CDR) Earnings Enforcements

A. Background for earnings enforcements

When a Social Security Disability Insurance (SSDI) beneficiary does not report his or her substantial earnings, we use enforcement operations to identify the earnings and generate alerts. The Continuing Disability Review Enforcement Operation (CDREO) uses earnings from the Internal Revenue Service (IRS) to alert technicians to conduct a work continuing disability review (CDR). We also use quarterly earnings received from the Department of Health and Human Services' Office of Child Support Enforcement (OCSE) in the Quarterly Earnings Project (QEP) to generate CDR alerts.

1. CDREO earnings

CDREO earnings include wages covered by the Federal Insurance Contributions Act (FICA), non-FICA covered earnings, and self-employment income under the Self-Employment Contributions Act (SECA). Although the output documents in paperless may show pension postings, they are not included in the posted summary earnings amount. The CDREO alerts show the earnings amount and trial work period (TWP) information from the disability control file (DCF), including the TWP start month and any TWP months completed during that enforcement year.

2. QEP earnings

QEP earnings include the quarterly wage data from the OCSE. OCSE data does not include any self-employment income (SEI). QEP alerts do not display the earnings amounts.

B. Enforcement alert criteria and threshold amounts

The enforcement operations send alerts to the Program Service Center (PSC) to conduct a CDR. CDREO and QEP alerts post to the DCF as “T2 Work CDR” events. To see these alerts, access the enforcement information through the Query Work Information Data (QWID) screen.

1. CDREO alert criteria and thresholds

CDREO compares the IRS earnings against set thresholds, and earnings posted to the DCF as verified. CDREO generates an enforcement alert when earnings are equal to or greater than six months of the substantial gainful activity (SGA) amount for that enforcement year. For more information on SGA, see DI 10501.000. CDREO generates three alerts per enforcement year. The QWID screen shows the investigation start date and the earnings amount. CDREO will not generate alerts for cases that are currently open or have recently closed reviews.

2. QEP alert criteria and thresholds

QEP generates an enforcement alert when quarterly earnings are equal to or greater than three times the SGA amount and indicate that the beneficiary has completed the TWP. QEP generates alerts four times per year. QEP generated alerts appear on the QWID screen, but do not display the earnings amount. QEP will not generate alerts for cases that are currently open or have recently closed reviews.

C. CDREO and QEP legends and descriptions

The following chart provides the legends of possible alerts, brief descriptions, and the Program Operations Manual System (POMS) references for the appropriate action(s).

1. CDREO legends and descriptions

Legend Description POMS References
POSSIBLE STATUTORY BLIND Posted earnings for a statutorily blind beneficiary.

DI 13010.135

DI 41001.001

FUTURE Medical Improvement Expected (MIE) DIARY MM/YY An upcoming medical diary is on the record. Access diary information from the Query Medical Information Data (QMID) screen.

DI 13010.012

DI 13010.660

PAST DUE MIE DIARY MM/YY A mature medical diary is on the record. Examine the QMID screen for diary information.

DI 40505.100

DI 13010.012

NO SPECIAL CONDITIONS APPLY Posted earnings, but there are no special conditions associated with this case. DI 13010.010

2. QEP legend and descriptions:

Legend Description POMS Reference

QUARTERLY EARNINGS CASE TRANSACTION: YYQX QEP - CONTINUING DISABILITY REVIEW

QEP selection based on NDNH earnings in the identified quarter. DI 13010.010

D. Process for earnings review

1. Examining the earnings evidence

The CDREO and QEP alerts are a starting point for work reviews. You must evaluate work activity in the entire review period. Review earnings verification sources, starting with the paystub table in eWork, per DI 10505.005. Review the prior eWork determination for complete and accurate processing. Only screen out a review if it meets one of the criteria in the chart below.

2. Screen out procedures

The following chart provides guidelines for processing CDREO and QEP alerts that do not prompt a work CDR, and only applies when development of a work CDR was not initiated. If you initiated a work CDR in eWork, complete the work review. For instructions on processing work CDRs, see DI 13010.023.

When The Situation Is: Take This Action:
  • The previous determination shows that earnings were not pay for work performed (i.e., the earnings were sick pay, vacation pay, disability benefits, etc.); and

  • the posted earnings amount is from the same employer and consistent with the prior development.

  • Write no action necessary (NAN) and fully document your rationale on the DCF Remarks Screen.

  • Close the DCF Work CDR as a “STOP CDR.”

  • The previous determination indicates that earnings are “clearly not SGA,” see, DI 10501.025.

  • earnings are from the same employer;

  • the earnings amount meets the criteria for “clearly not SGA;” and

  • there are no prior work cessations on the record.

  • Write “NAN” and fully document your rationale on the DCF Remarks Screen.

  • Close the DCF Work CDR as a “STOP CDR.”

  • Posted earnings are in the year of death.

  • Write “NAN” on DCF remarks screen.

  • Close DCF Work CDR event.

  • Posted earnings are in the year a person attains full retirement age (FRA)(except disabled adult child claims) and;

  • claimant is still in the TWP; or

  • posted earnings are SGA after the grace period and prior to month of FRA or termination.

  • Write “NAN” and fully document your rationale on the DCF Remarks Screen.

  • Close DCF Work CDR event.

  • If earnings exceed annual retirement test limit, send case to a benefit authorizer (BA) for adjustment action.

  • Statutory blind person is not eligible for cash benefits because he or she is in a freeze status.

  • Write “STAT BLIND Freeze-NAN” on the DCF Remarks Screen.

  • Close the DCF as a “STOP CDR.”

  • Medical CDR in progress.

If medical CDR is in progress in the field office (FO), the FO has jurisdiction of the CDREO alert, the PSC must:

  • Transfer the DCF to the FO with jurisdiction of the medical CDR; and

  • Fully document the reason for the transfer on the DCF Remarks Screen.

  • Person is in terminated status – earnings are in or before the year entitlement terminated.

If the posted earnings do not indicate a reopening revision under the rules of administrative finality. For more information on administrative finality, see DI 13010.145.

  • Write “NAN” on the DCF Remarks Screen.

  • Close the DCF as a “STOP CDR.”

  • Prior determination shows that work was not SGA and that;

  • subsidy or impairment related work expenses (IRWE) were not material to the previous determination;

  • wages/SEI for the same employer are consistent with the amount(s) previously developed; and

  • there is no previous cessation on the record.

  • Write “NAN” on the DCF Remarks Screen and fully document your rationale.

  • Close the DCF as a “STOP CDR.”

  • Prior 833-U3 determination shows that sheltered work was not SGA.

  • The current earnings are below SGA.

  • Write “NAN” issue on the DCF Remarks Screen.

  • Document that the prior determination shows sheltered work not SGA and subsequent earnings are not SGA.

  • Close the DCF Work CDR as a “STOP CDR.”

  • Reduced RIB beneficiary with a disability freeze because use of military or railroad credits precludes disability payments; and

  • the person now meets DIB insured status using Social Security earnings.

E. DCF jurisdiction

1. Work review

Enforcement alert output documents are assigned to the PSC that maintains jurisdiction of the CDR case. To prevent duplication of development efforts, it is important to keep the location of the work review the same in both the eWork and DCF systems. If a work CDR is currently open in the DCF, follow these guidelines to process a QEP or CDREO alert:

  • Check eWork for a pending work review. If there is no pending eWork review or an eWork review is pending in your location, continue processing the CDR.

  • If an eWork review is pending in another location (FO or other PSC), transfer the DCF event to that location, document the reason for the transfer on the DCF remarks screen and in the General Remarks of the eWork development worksheet, and clear the CDREO alert.

  • Fax all development documentation into eView or into CFUI if no eView exists.

2. Pending work report

If a work report is pending in eWork, but no one initiated a work review, the FO maintains jurisdiction of the work report and subsequent work review. Follow the steps below:

  • Enter a dated remark on the eWork development worksheet and the CDR Remarks Input (IRMK) screen explaining that you are transferring the CDREO or QEP alert based DCF event to the FO location based on the pending work report; and

  • Clear the Paperless controls as “NAN,” and add a comment that you transferred the enforcement to the FO.


DI 13010 TN 41 - Work Activity - 7/29/2019