Effective Dates: 9/23/2024 - Present

Identification Number:
DI 14510 TN 15
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ORDES
Title:Procedures for Cases Involving Participation in a VR or Similar Program
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 145 – Continued Payments to Individuals Participating in a Vocational Rehabilitation or Similar Program

Subchapter 10 – Procedures for Cases Involving Participation in a VR or Similar Program

Transmittal No. 15, 09/23/2024

Audience

PSC: BA, CA, CS, DE, DEC, DPS, DS, DT, DTE, FLC, ICDS, IES, ILPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CAQCR, CC, CR, CTE, ERE, FCR, FDE, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BET, BTE, CCE, CR, CST, CT, CTE, CTTA, DE, DEC, DS, DSE, PCS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: ADJ, DHU;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ORDES

Effective Date

Upon Receipt

Background

This transmittal removes outdated manual methods of communicating and transmitting documentation and adds electronic methods of communicating. We revise gender-specific language to gender-neutral language.

 

Summary of Changes

DI 14510.003 Field Office (FO) Procedures for Cases Involving Participation in Vocational Rehabilitation (VR) or Similar Program

Subsection A we replaced gender-specific language with gender-neutral language.

Subsection B we updated instructions for EDCS for clarity.

Subsection C we revised gender-specific language. We removed references to NDRED. We replaced instructions for faxing documentation with instructions for the Evidence Portal's barcode.

 

DI 14510.007 Field Office (FO) Procedures for Section 301 Cases after Office of Disability Operations (ODO) Determination

Subsection A we replaced the CFUI with eView and Evidence Portal.

Subsection B we replaced the CFUI with eView and Evidence Portal. We relocated the instructions for locating F.O. email address in DOORS.

Subsection C we replaced the CFUI with eView and Evidence Portal.

Subsection D we replaced the CFUI with eView and Evidence Portal.

Subsection E we replaced gender-specific language with gender-neutral language.

Subsection F we replaced instructions for faxing with instructions for the Evidence Portal's barcode.

Subsection G we added a referral poms to clarify instructions.

Subsection H we removed references to NDRED and replaced with Evidence Portal. We removed a revised POMS reference and replaced it with the correct POMS subsection. Removed instructions for faxing documentation and replaced it with transmitting via the Evidence Portal.

 

DI 14510.015 Office of Disability Operations (ODO) Procedures for Determining Participation in Vocational Rehabilitation (VR) or Similar Program

Subsection A we removed instructions for faxing and replaced the content with instructions for communicating through email.

Subsection B we updated the instructions for resolving development issues.

 

DI 14510.030 Office of Disability Operations (ODO) Procedures for Section 301 Post-adjudicative Actions

Subsection A we replaced gender-specific language with gender-neutral language.

Subsection B we removed instructions for faxing and sending MDW's and added instructions for transmitting via the Evidence Portal's new 4290 Barcode and/or email.

Subsection C we removed references to NDRED because technicians no longer use NDRED. We removed instructions for faxing (where applicable) and sending MDW's and added instructions for transmitting via the Evidence Portal's new 4290 Barcode and/or email.

In subsection D we removed instructions for faxing and added instructions for sending communications via email. Additionally, we replaced gender-specific pronouns with gender-neutral.

In subsection E we removed instructions for faxing and sending MDW's and added instructions for transmitting via email.

 

DI 14510.035 Appeals Process for Cases Involving Section 301 Determinations

Subsection A we removed references to NDRED because technicians no longer use NDRED. We removed instructions for faxing and added instructions for transmitting via the Evidence Portal's new 4290 Barcode. Additionally, we replaced gender-specific language with gender-neutral language.

Subsection B we removed references to NDRED because technicians no longer use NDRED. We removed instructions for faxing and added instructions for transmitting via the Evidence Portal's new 4290 Barcode. Additionally, we replaced gender-specific language with gender-neutral language.

Subsection C we replaced gender-specific language with gender-neutral language

 

DI 14510.003 Field Office (FO) Procedures for Cases Involving Participation in Vocational Rehabilitation (VR) or Similar Program

A. Identifying cases with participation in VR or similar program

The FO identifies cases involving participation in VR or a similar program as a part of the medical continuing disability review (CDR) and the Age 18 Redetermination process. For policy on Section 301 payments to beneficiaries participating in VR or a similar program, see DI 14505.010.

1. Continuing Disability Review Report - SSA-454-BK

Section 5 of the SSA-454-BK asks whether the beneficiary is participating in any vocational rehabilitation, employment, or other support services. The beneficiary may also indicate that they are participating in a vocational or job training program. Complete the appropriate sections of the SSA-454-BK with the name, address, and phone number of the service provider if the services or training are provided under any of the programs described in DI 14505.010B.

2. Age 18 Redetermination – SSA-3368-BK (Disability Report-Adult)

Section 5 of the SSA-3368-BK asks about education and training. If this section indicates that the beneficiary is in school, develop whether they're participating in an individualized education program (IEP). Section 10 asks whether the beneficiary is participating in vocational rehabilitation, employment, or other support services. If yes, record the name, address, and phone number of the organization, including the name of the counselor.

NOTE: If the beneficiary has an IEP, complete Section 10.

B. Transmitting the case to the disability determination services (DDS)

When you obtain all of the forms and information for the Medical CDR and the Age 18 Redetermination, route the case to DDS for the medical determination using the Electronic Disability Collection System (EDCS). Annotate the following remarks on the Master Beneficiary Record (MBR) special message field, the Supplemental Security Record (SSR) Remarks, or both: “Potential 301 case sent to DDS on MM/DD/YY.” EDCS will automatically add the "Potential Section 301" flag when the SSA-3368 or SSA-454 indicates participation in vocational rehabilitation, employment, or other support services.

NOTE: Children under the age of 18 who are participating in the programs described in DI 14505.010B.2. through DI 14505.010B.6 are eligible for Section 301 benefits. If a beneficiary indicates they are participating in an appropriate program, add the Section 301 flag to the case.

NOTE: For EDCS exclusions, attach routing slip SSA-408 to the outside of the folder, add the remark “Potential Section 301 Case” and transfer the folder to the DDS.

C. FO development after DDS medical determination

DDS medical determinations with potential for payment continuation under Section 301 have a DDSQ coded with "I301 Y". The SSA-832 and SSA-833 show "301 Case" in item 9I and the termination date in item 9C is blank.

Do not apply continuation of benefits under Section 301 when medical cessation is due to the beneficiary’s failure to cooperate (FTC) or whereabouts unknown (WU). Follow instructions in DI 13005.025 and SI 02301.235 for FTC and DI 13015.011 for WU. If the beneficiary files an appeal within 10 days requesting payment continuation, suspend Section 301 development per DI 14510.035A.

1. Medical continuance

If the DDS makes a medical continuance determination, do not develop for participation in a VR or similar program. Follow existing procedures to process the continuance decision. Delete the special messages from the MBR, SSR, or both.

2. Medical cessation

DDS notifies the FO of a medical cessation using the EDCS action page with the message, “CDR Cessation Added-Potential 301 Benefit Continuation.” For paper cases, DDS sends the CDR folder to the FO with a flag for potential 301 development.

The FO should check the Disability Control File (DCF) to verify that the medical CDR or Age 18 event is closed. If the event is not closed, take the following actions to manually close it:

  • •

    Select option #2 from the MCDR screen.

  • •

    Within the IFOA screen, select #10 CESSATION. Use this event type to update the cessation from the DDS determination (SSA-832 or SSA-833) and clear the DDS code from the OFFICE RESPONSIBLE FOR THE NEXT ACTION field.

Use SSA-4290-F5 to develop participation in VR or a similar program for potential entitlement to Section 301 benefits.

  • •

    Complete Part I, Section A of the SSA-4290-F5 with information EDCS obtained during the CDR or Age 18 Redetermination. Complete and sign Section B.

  • •

    Complete Part II by telephone or mail with the organization providing the VR or similar services.

a. Telephone contact

Telephone contact is the most efficient method for completing Part II of the SSA-4290-F5. Complete the appropriate section of Part II of the SSA-4290-F5 based on the type of organization.

  • •

    Part II, Section A – An Employment Network;

  • •

    Part II, Section B – A State VR Agency;

  • •

    Part II, Section C – Another Provider of VR, Employment, or Support Services (including SSA or another agency of the Federal government);

  • •

    Part II, Section D – An Educational Institution providing services under the IDEA (Individuals with Disabilities Education Act).

NOTE: If the beneficiary participates in a Plan for Achieving Self Support (PASS), SSA is the service provider. Ask the PASS specialist who approved the PASS to complete Part II, Section C of the SSA-4290-F5. For the telephone number of your local PASS specialist, see www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm.

If the contact states that the beneficiary is no longer taking part in the activities or services outlined in their plan, ask for the date participation ended and write this information under Question #2 on the form. Obtain answers to Questions #3 through #5, as if the beneficiary were still participating. Print the contact’s name in the signature block of the appropriate section and annotate “by phone.”

b. Mail contact

If you are unable to make telephone contact with the provider, send the SSA-4290-F5 to the provider with a signed and dated SSA-827 and a cover letter requesting their assistance using language similar to the following:

(Name of beneficiary ) reports that they are receiving (vocational rehabilitation services, employment services, educational services, or support services) from your organization. We need your assistance to determine if this beneficiary can continue to receive disability benefits based on their participation in your program and services. Please complete Part II, Section (A, B, C, or D, depending on the service provider) of the enclosed form, sign and return to us within 10 days. If (name of beneficiary) was participating in your program but stopped, please provide the date that participation ended. Enclosed is a postage-paid return envelope. If you have any questions, please call (contact name and phone number).

  • •

    Establish a 15-day diary on the CDR development worksheet (CDRW) of the DCF or SSI development worksheet for return of the SSA-4290-F5.

  • •

    Make a follow-up contact with the service provider by phone, if the provider does not return the SSA-4290-F5 within 15 days. Document all attempts to contact on an SSA-5002 (Report of Contact) and fax it into eView.

  • •

    If you do not receive the completed SSA-4290-F5 within 30 days, upload the incomplete SSA-4290 into eView and transmit it, along with the Potential Section 301 Case Flag, to the Office of Disability Operations' (ODO) Paperless Processing Center (PPC) using the Evidence Portal's (EP) 4290 Barcode.

D. Transmitting case to ODO

1. Title II cases

Section 301 continues payments (and Medicare) to the beneficiary and any auxiliaries on the record. Benefits continue while the section 301 determination is pending. The FO must:

 

  • •

    Add the remark, “Potential Section 301 determination sent to ODO on MM/DD/YY” to the special message field of the MBR;

  • •

    Create a 301DEC issue on the DCF using the CDRW and tickle the case for the month program participation is expected to end, or for one year from the current month, whichever is earlier;

  • •

    Fax the SSA-4290-F5 and any supporting documents into eView ; and

  • •

    Transmit the case to ODO by uploading the Potential Section 301 Case Flag along with the SSA-4290 and related documents, to ODO’s PPC using the EP's 4290 Barcode.

  • •
    • –

    NOTE: Do not conduct a work CDR on individuals receiving Section 301 benefits as they are medically ceased.

2. Title XVI cases

Due to the automated N07/N08 process, benefit payment termination may trigger before ODO makes the Section 301 determination. Benefits continue pending the Section 301 determination. While the Section 301 determination is pending, the FO must:

 

  • •

    Input a Vocational Rehabilitation Plan (VP) diary using the diaries (UDIA) function in Direct SSR Update with a diary date of one year from the date of the medical cessation (see MS BUSSR 002.019.) The VP diary prevents the case from updating to an N07/N08 payment status;

  • •

    Annotate the SSR Remarks, “Potential Section 301 determination sent to ODO on MM/DD/YY;”

  • •

    Create a 301DEC issue on the DCF using the CDRW and tickle the case for the month program participation is expected to end, or for one year from the current month, whichever is earlier;

  • •

    Create an issue on the Development Worksheet;

  • •

    Fax the SSA-4290-F5 and any supporting documents into eView; and

  • •

    Transmit the case to ODO by uploading the Potential Section 301 Case Flag , along with the SSA-4290 and related documents, to ODO’s PPC using the EP's 4290 Barcode.

NOTE: All Title XVI eligibility provisions, including income counting and resource guidelines continue to apply while the Section 301 determination is pending.

E. No longer participating in VR or similar program

1. Participation stopped prior to, or in the month of, medical cessation or during the two months after medical cessation

If the beneficiary stopped participating prior to, in the month of, or during the two months after medical cessation, there is no potential Section 301 eligibility. The two-month grace period would include any payment due for the month of cessation plus the following two months.

 

  • •

    Fax the completed SSA-4290-F5 into eView;

  • •

    Terminate benefits based on the medical cessation;

  • •

    Delete any REMARKS on the SSR or MBR, which are outdated or no longer apply and verify the cessation is posted to the DCF;

  • •

    Add a Remark(s) that VR participation ended and give the date, MM/DD/YY; and

  • •

    Prepare and send the Title II, Title XVI, (or both) Section 301 denial notice located in the Document Processing System (DPS).

NOTE: For instructions on how to evaluate a possible temporary interruption in participation, see DI 14505.010D.

2. Participation stopped after the second month after the month of medical cessation, or later

If the beneficiary stopped participating in the qualifying program after the second month following the month of medical cessation:

  • •

    Develop Potential Section 301 eligibility for the period from the cessation month through the month participation ended;

  • •

    Fax the SSA-4290-F5 into eView;

  • •

    Create a 301 issue on the DCF using the CDRW to control for the return of the case; add the remark, “Pending 301 determination;”

  • •

    Add an issue on the MCS or Development Worksheet;

  • •

    Transmit the case to ODO by uploading the Potential Section 301 Case Flag , along with the SSA-4290 and related documents, to ODO's PPC using the EP's 4290 Barcode; and

  • •

    Suspend benefits until ODO makes its determination.

NOTE: If the beneficiary requested Statutory Benefit Continuation (SBC) during an appeal for a medical cessation determination, do not suspend benefits.

a. Title II suspension input

  • •

    Input S9 suspension effective the month after participation ended;

  • •

    Add the remark, “S9 due to pending 301 determination, participation ended MM/DD/YY” to the special message field of the MBR; and

  • •

    Prepare the notice per DI 14510.003E.2.c.

b. Title XVI suspension input

  • •

    Input payment status N05 for the month after participation ended and suppress the systems-generated notice;

  • •

    Add the remark, “N05 due to pending 301 determination, participation ended MM/DD/YY” to the SSR; and

  • •

    Prepare a notice per DI 14510.003E.2.c.

c. Important Information notice

  • •

    Prepare and send an “Important Information” notice. For Title II cases, use the SSA-L951-U2 (Social Security Notice Letterhead); for Title XVI cases, use a SSA-L8165-U2 (Important Information).

  • •

    Send the notice to the beneficiary and the representative payee. Use the following language:

      

    “When we notified you that your disability had ended, we also told you that you might be eligible for continued payments if you are currently participating in an appropriate program of vocational rehabilitation, employment training, or educational or other services. Your program provider told us that you stopped participating in your program on MM/DD/YY. We are sending your case to another office for a special decision about whether you are eligible for continued payments for the month your disability ceased through MM/YY. We will send you another letter when we make our decision. We will suspend your benefits effective MM/YY while we wait for this decision.

    If you have any questions, you may contact your local Social Security office. The address and telephone number are printed at the top of this notice. If you call or visit a Social Security office, please have this notice with you. It will help us answer your questions.”

DI 14510.007 Field Office (FO) Procedures for Section 301 Cases after Office of Disability Operations (ODO) Determination

A. Identifying a Section 301 determination

You can identify Section 301 cases in several ways:

 

  • •

    Remarks on the Master Beneficiary Record (MBR) and Supplemental Security Income Record (SSR);

  • •

    A “Y” in the 301 Indicator of the Disability Determination Section Query (DDSQ);

  • •

    A Disability Control File (DCF) event indicating “301 case” on the query CDR screen (QCDR) or the CDR Entitlement (ECDR) screen (Title II cases) and Development Worksheet (Title XVI cases);

  • •

    A copy of the Section 301 decision into eView or the Evidence Portal (EP).

B. Procedure when ODO approves Section 301 payments

1. Title II cases

The Section 301 provision allows continued benefits (including Medicare and Medicaid) to the beneficiary and any auxiliaries on the record following medical cessation until the beneficiary stops participating in the vocational program, or ODO determines that continued participation will not increase the likelihood of permanent removal from the disability rolls. ODO annotates the decision in the special message field of the MBR. The FO checks eView and EP for the Section 301 decision and updates the 301DEC tickle accordingly when the 301DEC tickle on the DCF CDRW matures.

2. Title XVI cases

The FO receives Title XVI and concurrent Section 301 payment continuation cases with the Section 301 flag from ODO by email (accessing the Detailed Office/Organization Resource System (DOORS) to identify the appropriate email address) with the subject line “Action: Section 301 VP Diary Update Needed”. The FO takes the following actions:

 

  • •

    Input or update the Vocational Rehabilitation Plan (VP) diary using the diaries (UDIA) function in Direct SSR Update. The VP diary prevents the case from updating to an N07/N08 payment status;

  • •

    Update the 301DEC issue on the DCF and Development Worksheet; and

  • •

    Annotate the SSR remarks with “Section 301 payment continuation. Program participation expected to end MM/YY”

ODO reviews the SSR for the updated VP diary. ODO should follow up by email if the FO has not updated the VP diary within 15 days.

NOTE: If N07/N08 termination occurred, reinstate benefits effective with the N07/N08 month. If N07/N08 termination has not occurred, the FO removes the N07/N08 future action.

C. Procedure when ODO approves Section 301 payments for a closed period

1. Title II cases

ODO processes the termination action, sends the closed period notice, and annotates the decision in the special message field of the MBR. The FO checks eView and EP for the Section 301 decision, and receipts in the 301DEC tickle when the 301DEC tickle on the DCF CDRW matures.

2. Title XVI cases

ODO sends the closed period notice and emails the FO advising them to:

 

  • •

    Delete the VP diary;

  • •

    Receipt in the 301 Issue on the DCF and Development Worksheet;

  • •

    Input N07/N08, effective with the month after the month shown in item 9C of the SSA-832 (Cessation Or Continuance of Disability or Blindness Determination and Transmittal - Title XVI); and

  • •

    Annotate the SSR remarks with “Section 301 closed period MM/YY-MM/YY.”

ODO reviews the SSR for the N07/N08 input. ODO follow up by email if the FO has not updated the diary within 15 days.

D. Procedure when ODO denies Section 301 payments

1. Title II cases

ODO processes the termination action, sends the denial notice, and annotates the decision in the special message field of the MBR. The FO checks eView and EP for the Section 301 decision and receipts in the 301DEC tickle when the 301DEC tickle on the DCF CDRW matures.

2. Title XVI cases

ODO will sends the denial notice and emails the FO advising them to:

 

  • •

    Delete the VP diary;

  • •

    Receipt in the 301 Issue on the DCF and Development Worksheet;

  • •

    Input N07/N08, effective with the month after the month shown in item 9C of the SSA-832; and

  • •

    Annotate the SSR remarks with “Section 301 denial.”

ODO reviews the SSR for the N07/N08 input. ODO follow up by email if the FO has not updated the diary within 15 days.

E. Procedure for work reported while receiving Section 301 payments

When you receive a work report for a beneficiary receiving Section 301 payments, issue a receipt per DI 13010.020 and ask if they are still participating in a program of VR, employment, training, educational, or other support services.

Document the information, including the name and address(es) of the service provider(s) (if any), on an SSA-5002 (Report of Contact) and send it to ODO by uploading the Potential Section 301 Case Flag along with the SSA-5002 and any other related documents to the Paperless Processing Center (PPC) using the EP's 4290 Barcode.

NOTE: Using the 4290 Barcode will ensure the documents are routed to the correct component.

1. Title II cases

Do not create a work review in eWork.

Do not process a work CDR or a substantial gainful activity (SGA) determination for beneficiaries receiving Section 301 payments. Such beneficiaries are not entitled to a Trial Work Period (TWP), or Extended Period of Eligibility (EPE).

If the beneficiary files an appeal of the medical cessation with payment continuation, the FO suspends Section 301 development.

If the suspension of Section 301 development is due to SBC, the FO refers to DI 12027.050. The FO determines if the TWP has been completed and if the claimant would be placed in S9 if there is SGA in the EPE.

2. Title XVI cases

Non-disability provisions, such as income counting and resource limits, continue to apply to beneficiaries receiving Section 301 payments. Apply the earned and unearned income exclusions to the work and earnings of these beneficiaries as appropriate. This includes Impairment-Related Work Expenses (IRWE), Blind Work Expenses (BWE), Student Earned Income Exclusions (SEIE), and the Plan to Achieve Self-Support (PASS). We can modify a PASS while a beneficiary is receiving Section 301 payments; however, we cannot approve a new PASS after we determine that the beneficiary is no longer disabled.

F. Procedure when ODO requests assistance from the FO

ODO may request assistance from the FO by email to:

 

  • •

    Obtain information about the service provider, or

  • •

    Determine the status of a beneficiary’s participation in a VR or similar program, or

  • •

    Determine whether such program ended,

If ODO requests FO assistance, obtain an updated SSA-4290-F5 (Development of Participation in Vocational Rehabilitation (VR) or Similar Program) and complete parts I and II. Return the SSA-4290-F5 to ODO using the EP's 4290 Barcode.

G. Procedure when Section 301 payments terminate

When a beneficiary completes or stops participating in the program, benefits terminate effective the month after the month of completion, or the month after the month participation stopped.

EXAMPLE: If the beneficiary completes the VR or similar program during October 2023, payments terminate effective November 2023.

1. Title II cases

ODO sends the required notices, updates the remarks on the MBR and terminates benefits. If ODO does not receipt the DCF tickle, the FO will complete this action.

2. Title XVI cases

ODO releases the termination notice, annotates the DCF, and sends an email to the FO requesting immediate action to terminate benefits with the effective date.

The FO processes the termination with a two-day action:

Day 1 - Use MSSICS Direct SSR Update:

 

  • •

    Delete the VP diary;

  • •

    Transmit the MG code of T with the disability cessation date (if not already on the record) using the Continuing Disability Review (UDCR) Screen;

  • •

    Input a Remark indicating the period of Section 301 eligibility and termination date; and

  • •

    Suppress all notices per SM 01301.675.

Input ensures the correct cessation date shows on the record.

 

Day 2 - Use SSI Data Inputs – SPE1 (PE Single Input):

 

  • •

    Input N07/N08 per SM 01305.001 or an SZ code of N per SM 01301.450 for the month benefits terminate per ODO's instructions (See also SM 01305.005 to determine the code, message, and action required for each payment status (PS) field reject and alert); and

  • •

    Suppress all notices.

Input ensures the correct months of payment after cessation are shown on the record.

NOTE: Check all inputs for the proper C01 and N07 months to ensure the overpayment or the underpayment is correct.

ODO reviews the SSR for the N07/N08 input. ODO follow up by email if the FO has not updated the diary within 15 days.

H. Procedure when FO learns that participation in VR or similar program ceased or the program ended

The FO may receive new or revised information about the beneficiary’s participation in a VR or similar program from the beneficiary or the service provider during a Redetermination (RZ) or other Post-Entitlement (PE) actions.

1. Title II cases

During any PE discussions, ask the beneficiary or representative payee if they are participating in VR or a similar program if the MBR has a 301 indicator or 301 payment remarks. If the beneficiary stopped participating or the program ended, accept the allegation and:

 

  • •

    Obtain a statement from the beneficiary on an SSA-5002 (Report of Contact) showing the date the program ended or the date participation ceased and fax it into eView or EP;

  • •

    Send a manual due process notice. Follow the instructions in DI 14510.007H.3;

  • •

    Wait 15 days for a response to the due process notice;

If there is no response or the information you receive does not change the decision to suspend benefits, input an S9 suspension the month after participation ended and:

 

  • •

    Input a 60-day diary (301DEC) using the CDRW on the DCF for case control;

  • •

    Transmit the Potential Section 301 Case Flag and SSA-5002 to ODO using the EP's 4290 Barcode;

  • •

    Check the block “Case S9.” Provide the effective S9 date and the date participation stopped or the program ended;

  • •

    Update the remarks on the MBR, “Section 301 participation ended. Sent to ODO MM/DD/YY.”

2. Title XVI cases

During an RZ or any other PE event, if the case has a VP diary, ask the beneficiary or representative payee if they are participating in VR or a similar program. If the beneficiary states that the program ended for any reason, accept the beneficiary’s allegation, and:

  • •

    Obtain a statement from the claimant on an SSA-5002 or on the Person Statement page in the Consolidated Claims Experience (CCE) Supplemental Security Income pages, showing the date the program ended or the date participation ceased and fax it into eView or EP;

  • •

    Send a manual due process notice. Follow instructions in DI 14510.007H3; and

  • •

    Wait 15 days for a response to the due process notice.

If you receive no response, or the information you receive does not change the decision to suspend benefits:

  • •

    Input payment status N05 with the next Current Operating Month (COM) to avoid multiple overpayments;

  • •

    Establish a tickle on the DCF or the Development Worksheet page for case control;

  • •

    Suppress the systems-generated notice;

  • •

    Add the Remark, "N05 due to pending 301 determination, participation ended MM/YY” to the SSR;

  • •

    Transmit the Potential 301 Flag and SSA-5002 to ODO using the EP's 4290 Barcode;

  • •

    Check the block “Case N05.” Provide the effective N05 date and the date participation stopped or the program ended.

3. Due process notice

For Title II cases, send the SSA-L951-U2 (Social Security Notice Letterhead). For Title XVI cases, send an SSA-8165-U2 (Important Information) notice to the beneficiary and the representative payee using the following language:

“We plan to suspend your benefits, effective MM/YYYY, because you told us that you are no longer participating in your approved program of vocational rehabilitation, employment training, educational, or other support services.

On <fill in date of previous notice>, we notified you that your disability had ended, but we would continue to pay you because you were participating in an appropriate program of vocational rehabilitation, employment training, or educational or other services.

You told us that you stopped participating in your program in MM/YYYY.

Another office will make the special decision about whether you are eligible for payments for the month your disability ended through the month your participation in the program ended. We will notify you of their decision in another letter.

If you have any questions, you may contact your local Social Security office. The address and telephone number are printed at the top of this notice. If you call or visit a Social Security office, please have this notice with you. It will help us answer your questions.”

I. Beneficiary responds to due process notice regarding the suspension

If the beneficiary disagrees with the suspension:

  • •

    Ask if the information we have is correct.

  • •

    If the beneficiary has information that proves they are in VR or a similar program, document the response on an SSA-5002.

  • •

    If the beneficiary does not have proof, but claims they are participating in VR or a similar program, use form SSA-4290-F5 and SSA-827 (Authorization to Disclose Information to the Social Security Administration) to obtain evidence from the service provider.

  • •

    If the beneficiary states our information is correct, explain the suspension of benefits and explain that it is a terminating event, since the DDS determined that the beneficiary is no longer disabled and no longer eligible for Section 301 benefits.

  • •

    If the claimant agrees with the suspension, but indicates they are disabled and wants to file a new claim, record the protective filing date in the appointment system for the new claim to be taken after the record has been terminated.

J. Past due VP diaries

ODO follows up on matured VP diaries and no FO action is required. However, if you discover a past due diary during an RZ or PE event, check eView or EP for recent development requests and denial or allowance notices. If there is no recent case activity, send an email to OCO.ODO.OSB.SECTION.301@ssa.gov alerting ODO of the past due VP diary.

K. Policy for overpayments resulting from continuing payments

A beneficiary who is overpaid because they received continued payments while awaiting a Section 301 determination can be found without fault for the overpayment if the person acted in good faith in believing they were participating in a qualified program and cooperated with our development of participation. However, this does not mean that an automatic waiver applies. You must develop for a full waiver (defeats the purpose or against equity and good conscience per GN 02250.100 and GN 02250.150 ).

The following are examples of when a person may not have acted in good faith:

  • •

    The beneficiary knew they did not begin participating in a program before the medical cessation or that participation did not continue for at least two months after cessation.

  • •

    The beneficiary did not cooperate with Section 301 development requests from the Social Security Administration (SSA) or DDS.

  • •

    The beneficiary withheld information about income or resources causing an overpayment for another reason.

IMPORTANT: If you must make a 'fault' determination, consider any physical, mental, educational, or linguistic limitations the beneficiary has that affect their ability to act in good faith. For instructions on making ‘fault’ or ‘without fault’ findings, see SI 02260.010 and GN 02250.005C.

DI 14510.015 Office of Disability Operations (ODO) Procedures for Determining Participation in Vocational Rehabilitation (VR) or Similar Program

A. Procedure for identifying cases

The Disability Determination Services (DDS) must make a medical cessation determination before continued payment of payments to beneficiaries participating in an appropriate program of VR services, employment services, or other support services may occur. The field office (FO) will develop participation in VR or a similar program per DI 14510.003C.

To prevent erroneous termination of a potential Section 301 case, ODO takes the following action immediately upon receipt of a case.

  • •

    For a Title II case, check the Master Beneficiary Record (MBR) special message field for Section 301 remarks. If there are no remarks, annotate the MBR special message field for "Section 301 determination pending - do not take action on medical cessation -- MM/DD/YY."

  • •

    For a Title XVI case, check the Supplemental Security Record (SSR) for Section 301 remarks and the Vocational Rehabilitation Plan (VP) diary. If there are no remarks or the VP diary is not present, email a request to the servicing FO to input the diary and update the remarks on the SSR.

B. Procedure for development of an appropriate program

Review the SSA-4290-F5 (Development of Participation in a Vocational or Similar Program) and development obtained by the FO to verify that the beneficiary is participating in VR or a similar program that meets the definition of an appropriate program of VR services, employment services, or other support services as described in DI 14505.010B.

Request further documentation from the provider of services, if necessary, to determine whether the program meets the requirements. Such documentation may include copies of licenses, registration or accreditation.

  • •

    If a provider refuses to provide information on an SSA-4290-F5 because of privacy concerns, mail or fax them a signed SSA-827 (Authorization to Disclose Information to the Social Security Administration). If the provider still refuses to provide the information, document the refusal and contact the individual and inform them that the provider is unwilling to disclose the required information and ask the individual to contact the provider to ask them to send the required information; document your contact with the individual, on a form SSA-5002 Report of Contact. If you are unable to obtain the information:

  • •

    For an initial Section 301 case - make a denial determination

  • •

    For a Section 301 follow-up diary case - send a due process notice to terminate benefits

C. Procedure to develop current participation

Review the SSA-4290-F5 to determine whether the beneficiary is currently participating in the program per DI 14505.010C.

  • •

    We determine a beneficiary to be participating in VR or a similar program if a beneficiary is taking part in the activities and services outlined in the individual work plan (IWP), individualized plan for employment (IPE), or from an appropriate provider described in DI 14505.010B.

  • •

    For a beneficiary participating in a Plan to Achieve Self-Support (PASS), the PASS specialist who approved the PASS will complete Part II, Section C of the SSA-4290-F5. To contact the PASS specialist, visit www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm .

  • •

    We determine a student aged 18 through 21 receiving services under an individualized education program (IEP) to be participating in the program if the student is taking part in the activities and services outlined in the IEP.

We determine current participation when the SSA-4290-F5 is dated within the preceding 90 days, and the beneficiary is taking part in the activities and services outlined in the plan or program. A “yes” response to question two of Part II, Section A, B, C, or D indicates current participation.

D. Procedure for additional evaluation factors

1. Current documentation

The SSA-4290-F5 and all supporting documentation used to make a likelihood determination must be dated within the preceding 90 days. If development is older than that, contact the provider by telephone to update the information and record the contact on an SSA-5002 (Report of Contact).

2. Continued participation

The beneficiary’s participation in the program must have started before the month disability or blindness ceased and must continue beyond the two-month grace period after the medical cessation.

For interruptions in participation, see DI 14505.010D.

3. Work goal

For beneficiaries other than students ages 18 through 21 in an IEP, there must be a specific occupational or employment goal. NOTE: “Competitive employment” is not sufficient.

4. Education, skills, and work experience

A description of the education, work skills, or work experience that the beneficiary will acquire by completing the program or continuing in the program for a specified period.

5. Completion date

There must be a projected completion date for the program.

DI 14510.030 Office of Disability Operations (ODO) Procedures for Section 301 Post-adjudicative Actions

A. Procedure for report of work affecting continued eligibility for Section 301 payments

ODO may receive reports of work directly from the beneficiary, the provider of services, or from the field office (FO), see DI 14510.007E. When you receive a work report, determine if the work experience is part of the beneficiary's Individual Work Plan (IWP), Individualized Plan for Employment (IPE), similar individualized written employment plan, or Individualized Education Program (IEP). If so, you do not take further action.

If the work experience is not part of the beneficiary's plan, determine if the beneficiary stopped participating in their plan or if they completed the program. If the beneficiary stopped participating or completed the program, terminate benefits per DI 14510.030C.

If the beneficiary is still participating in a program but the work experience is not part of the plan, consider:

  • •

    Is the work at the substantial gainful activity level?

  • •

    Has the beneficiary acquired the education, work skills, or experience that was the basis for the initial likelihood determination?

These are indicators that continued participation in the program will no longer increase the likelihood of the beneficiary's permanent removal from the disability or blindness benefit rolls. If participation in the program will not increase the likelihood of the beneficiary's permanent removal from the disability or blindness benefit rolls, terminate benefits per DI 14510.030C.

B. Procedure when the diary matures

1. Title II

When the Disability Control File (DCF) diary date for the vocational rehabilitation (VR) or similar program matures for a Title II case, an issue appears on the DCF tickle list and ODO receives an alert in the Paperless Processing Center.

If the diary is for program completion, follow the instructions in DI 14510.030E.

If the diary is for follow-up, contact the provider of services to determine the status of the beneficiary's participation in the program or to determine if the program ended.

2. Title XVI

When the Vocational Rehabilitation Plan (VP) diary matures for a Title XVI case, ODO receives a diary alert.

If the diary is for program completion, follow the instructions in DI 14510.030E.

If the diary is for follow-up and enough information is available on the system, contact the service provider to determine the status of the beneficiary's participation in the program or to determine if the program ended.

Otherwise, send a request for assistance by email to the servicing FO. Be as specific as possible in your request. Explain what information you need from the service provider and if you need an updated SSA-4290-F5 (Development of Participation in Vocational Rehabilitation or Similar Program). The F.O. transmits any documentation using the Evidence Portal's (EP) 4290 Barcode and eView.

C. Procedure when program is completed or individual stopped participating

Terminate benefits effective the month after the month of completion or the month after the month participation stopped. For example, if the VR or similar program is completed in October 2023, then payments terminate effective November 2023 (for information on the termination process, see DI 14510.030E in this section).

For Title II cases, process the medical cessation. 

For Title XVI cases, send the termination flag, by email, with Subject Line: Payment Termination/Immediate Action Needed, to the servicing FO to process the medical cessation.

For both Title II and Title XVI cases,

print a copy of the existing SSA-832 (Cessation Or Continuance of Disability or Blindness Determination and Transmittal - Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal - Title II) medical cessation determination, insert a handwritten date in item 9C showing the month and year of the termination. Identify the entry with “VR Benefit Termination Month." Initial the changes and upload a copy of the form into Paperless Processing Center system using the paperless fax number 1-877-385-0643 and the EP or eView.

D. Procedure when the program is not completed

If the beneficiary did not complete the VR or similar program, contact the service provider to determine the status of the program.

If the development indicates that the beneficiary is continuing participation in the program, determine if the beneficiary acquired the education, work skills, or experience that was the basis for the initial likelihood determination.

  1. 1. 

    If yes, determine that continued participation in the program will no longer increase the likelihood that the beneficiary will not return to the disability or blindness benefit rolls and terminate payments on this basis, see DI 14510.030E in this section.

  2. 2. 

    If no, review the status of the program to determine whether continued participation in the program will provide the beneficiary with the education, work skills or work experience that was the basis for the initial likelihood determination.

    1. a. 

      If yes, determine that continued participation in the program will increase the likelihood that the beneficiary will not return to the disability or blindness benefit rolls and continue payment on that basis.

    2. b. 

      If no, determine that continued participation in the program will no longer increase such likelihood and terminate payments on that basis, see DI 14510.030E in this section.

1. Continued participation increases likelihood

If the beneficiary's continuing participation in the program will increase the likelihood that they will not return to the disability or blindness benefit rolls, re-diary the case for review.

For a Title II case, use the Disability Control File (DCF).

For a Title XVI case, send a request, by email, to the FO to extend the VP diary, if necessary.

2. Continued participation will no longer increase likelihood

If the beneficiary's continued participation in the program no longer increases the likelihood that they will not return to the disability or blindness benefit rolls, terminate benefits effective the month after the month in which you make the determination.

For termination process, see DI 14510.030E in this section.

E. Procedure for termination of Section 301 payments

1. Title II case

  • •

    Send an advance notice to the beneficiary advising of the planned termination of payments and affording due process. See Notices Required Before And After Taking A Title II Adverse Action GN 03001.015.

  • •

    After the beneficiary has an opportunity to respond, if termination is still appropriate, forward the case to the benefit authorizer for termination action.

  • •

    Send a notice to the beneficiary advising of the termination of payments, see notices DI 14515.015.

  • •

    Update the special message field on the Master Beneficiary Record (MBR), “Section 301 benefit termination MM/YY.”

  • •

    Close the DCF annotating the Section 301 decision.

2. Title XVI case

  • •

    Send an advance notice to the beneficiary advising of the planned termination of payments and affording due process. See Notices Required Before and After Taking a Title II Adverse Action GN 03001.015.

  • •

    After the beneficiary has an opportunity to respond and termination is still appropriate, email the termination flag to the servicing FO and request termination.

  • •

    Close the DCF annotating the Section 301 decision.

  • •

    Send a notice to the beneficiary advising of the termination of payment. See notices DI 14515.015.

  • •

    Place the case in Development Hold File (DHF) for 15 days.

  • •

    After 15 days, check the Supplemental Security Record (SSR) to verify that the FO deleted the VP diary.

  • •

    If the FO has not acted, send a follow-up email with the subject line "Follow-up Request Action: Section 301 Termination and VP Diary Update Needed".

  • •

    If the FO has not acted after the follow-up email, call the F.O.'s administrative line.

DI 14510.035 Appeals Process for Cases Involving Section 301 Determinations

A. Procedure for appeal of medical cessation

1. Reconsideration request

If the Disability Determination Services (DDS) issues a medical cessation determination, the beneficiary may request a reconsideration of the decision.

a. Appeal filed within 10 days with payment continuation

If the beneficiary files an appeal within 10 days, with a payment continuation request:

  • •

    Suspend Section 301 development;

  • •

    Process the payment continuation;

  • •

    Complete the request for reconsideration and route the claim to Disability Determination Services (DDS);

  • •

    Annotate the master beneficiary record (MBR) special message field or the supplemental security record (SSR) remarks field with “Potential 301 case pending medical cessation recon MM/DD/YY.”

NOTE: If the DDS subsequently confirms the cessation, the FO receives a 301RECON tickle on the DCF CDRW screen (WAC CDR Tickles list). Receipt the tickle and resume Section 301 development per DI 14510.003C.

b. Payment continuation not applicable

When a payment continuation request is not applicable:

  • •

    Process the reconsideration and route the claim to DDS;

  • •

    Complete Section 301 development and fax the SSA-4290-F5 (Development of Participation In Vocational Rehabilitation or Similar Program) and supporting documents into eView;

  • •

    Transmit to the Office of Disability Operations (ODO) by uploading the Potential 301 Flag along with the SSA-4290 and related documents to ODO's Paperless Processing Center (PPC) system using the Evidence Portal's (EP) 4290 Barcode;

  • •

    Annotate the MBR special message field or SSR remarks field with “Potential Section 301 determination sent to ODO MM/DD/YY.”

2. Hearing request before an administrative law judge (ALJ)

If DDS affirms the medical cessation decision, the beneficiary may request a hearing on the decision.

a. Hearing request filed within 10 days with payment continuation

If the FO receives a hearing request filed within 10 days with a payment continuation request:

  • •

    Suspend Section 301 development;

  • •

    Process the payment continuation;

  • •

    Process the hearing request;

  • •

    Annotate the MBR special message field or the SSR remarks field with, “Potential 301 case pending medical cessation hearing MM/DD/YY.”

NOTE: If the hearings office confirms the cessation, the FO receives a 301RECON tickle on the DCF CDRW screen (WAC CDR Tickles list). Receipt the tickle and resume Section 301 development per DI 14510.003.

b. Payment continuation not applicable

When a payment continuation request is not applicable:

  • •

    Process the hearing request;

  • •

    Complete the Section 301 development and fax the SSA-4290-F5 and supporting documents into eView;

  • •

    Annotate the MBR special message field or SSR remarks field with, “Appeal pending at the Office of Hearings Operations (OHO), SBC declined, and potential Section 301 determination sent to ODO on MM/DD/YY.”

  • •

    Transmit to ODO by uploading the Potential 301 Flag along with the SSA-4290 and related documents to ODO's PPC using the EP's 4290 Barcode.

B. Procedure for appeal of ODO determination on Section 301 payments

A determination that an individual is not eligible for Section 301 payments is an initial determination that has appeals rights.

1. Supporting documentation

When an individual appeals a determination regarding eligibility for continuing payments, take the statement as to why they disagree with the determination. Obtain documentation that supports their allegations about participating in a qualifying program. Document the information on an SSA-5002 (Report of Contact).

EXAMPLE: If the individual claims that they are participating in a program of VR services and takes part in the activities and services outlined in their employment plan, but received a notice denying Section 301 payments, obtain copies of any materials to support the statement. Use an SSA-4290-F5 to obtain evidence from the provider of services.

NOTE: Statutory benefit continuation rights do not apply to appeals of termination of Section 301 payments.

2. Reconsideration of ODO determination

If the FO receives a request for reconsideration of the ODO determination on continued payment:

  • •

    Obtain an SSA-561-U2 (Request for Reconsideration) and supporting documentation.

  • •

    Fax the SSA-4290-F5, SSA-561-U2, and related documentation into eView.

  • •

    Upload the Potential 301 Flag using the EP's 4290 Barcode.

If the case is at DDS for a medical cessation appeal when you receive the request for reconsideration of the ODO determination, hold the material until we make a determination on the cessation appeal. Annotate the Special Message field of the MBR or Remarks field of the SSR with, “Potential Section 301 case awaiting medical appeal decision.”

If we affirm the cessation, forward the request for reconsideration to ODO. Upload the Potential Section 301 Case Flag along with the SSA4290 and related documents to the PPC using the EP's 4290 Barcode.

If we reverse the cessation, you do not need an ODO determination.

3. Hearing before ALJ

If the FO receives a request for a hearing on the issue of Section 301 payments:

  • •

    Obtain an HA-501-U5 (Request for Hearing by Administrative Law Judge) and supporting documentation.

  • •

    Send the case to the hearing office.

If a medical appeal is pending when you receive the appeal of the ODO determination:

  • •

    Fax the material into eView and hold until the ALJ makes a decision on the cessation.

  • •

    Annotate the Special Message field of the MBR or Remarks field of the SSR with, “Potential Section 301 case waiting medical appeal decision.”

If the ALJ affirms the cessation, forward the hearing request following usual procedures.

If the ALJ reverses the cessation, you do not need a hearing on the issue of Section 301 payments.

4. Appeals Council (AC) review

If the beneficiary is dissatisfied with the result of the ALJ hearing on the Section 301 determination, they may request AC review of the ALJ decision. Obtain form HA-520-UF (Request for Review of Hearing Decision/Order) and any supporting documentation.

If a medical cessation appeal is pending when you receive a request for AC review, hold the material until the AC makes a decision. Annotate the special message field of the MBR or remarks field of the SSR with “Potential Section 301 case awaiting appeal decision.”

If the AC affirms the cessation, forward the request for AC review following usual procedure, as explained in DI 12020.001.

If the AC reverses the cessation, you do not need an AC review on the issue of Section 301 payments.

C. Procedure for appeal of termination of Section 301 payments

ODO terminates Section 301 payments effective with the month after the month in which one of the following first occurs:

  • •

    The beneficiary completes a program of VR services, employment services, or other support services;

  • •

    The beneficiary stops participating in the program for any reason;

  • •

    ODO determines that the beneficiary’s continued participation in the program will no longer increase the likelihood that they will not return to the disability or blindness benefit rolls.

The appeals process is the same as described in DI 14510.035B.

NOTE: Statutory benefit continuation rights do not apply to appeals of terminations of Section 301 payments.


DI 14510 TN 15 - Procedures for Cases Involving Participation in a VR or Similar Program - 9/23/2024