Identification Number:
DI 13015 TN 11
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Special CDR Issues
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 130 – Continuing Disability
Subchapter 15 – Special CDR Issues
Transmittal No. 11, 10/19/2021

Audience

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

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Policy is updating this section to specify that these instructions are for medical continuing disability reviews (CDR). We removed references to work CDRs and updated the Program Service Center (PSC) procedures for transferring CDR jurisdiction to the field office (FO).

Summary of Changes

DI 13015.011 Whereabouts Unknown (WU) Policy for a Continuing Disability Review (CDR) – Field Office (FO)

Title: We updated the section title to clarify that this guidance applies to medical CDRs.

Introduction: We added a NOTE clarifying that this policy applies only to medical CDRs.

Subsection A- We reorganized the content for clarity and removed subsection A.3, because WU procedures do not apply to work CDRs.

Subsection B.3- We updated procedures to clarify that the PSC transfers the CDR to the FO.

DI 13015.011 Whereabouts Unknown (WU) Policy for Medical Continuing Disability Reviews (CDRs) – Field Office (FO)

CITATIONS:

20 CFR sections 404.1579(e)(3); 404.1579(g)(6); 404.1586(e)(3); 404.1587; 404.1594(e)(3); 404.1594(g)(7); 404.1596(b)(2)(ii); 416.994(b)(4)(iii); 416.994(a)(f)(3)

This subchapter addresses WU policy when the FO is unable to locate the beneficiary or recipient during the medical CDR process. The FO, Disability Determination Services (DDS), or Program Service Center (PSC) may identify the WU issue at any point during development. However, the FO is responsible for developing and processing WU issues.

NOTE: These instructions do not apply to Title II work CDRs. For work CDRs, see DI 13010.025 .

A. WU medical CDR policy

1. Overview of WU

WU occurs when, after exhausting all reasonable efforts, the FO is unable to locate the beneficiary or recipient. A WU issue may arise at any point during a CDR. For information on the FO's required contact attempts, see DI 13015.013.

2. WU cessation (Title II) or suspension (Title XVI) month

When there is insufficient evidence to justify a continuance, we will stop benefit payments for the first month in which the FO, DDS, or PSC discovers that the beneficiary or recipient's whereabouts are unknown, but no earlier than the month in which the continuing disability issue arose.

REMINDER: The FO must follow the steps in DI 13015.013 before ceasing (Title II) or suspending (Title XVI) payments due to WU.

a. Title II cessation

For Title II, WU is a nonmedical cessation of benefits. Therefore, statutory benefit continuation (SBC) does not apply to Title II WU cessations. Refer to DI 12027.015 for more information on SBC requirements.

EXAMPLE: On 1/27/2021, the FO sends a letter requesting that the Title II beneficiary call by 2/11/2021. The Post Office returns the letter on 2/10/2021 indicating that the addressee is unknown at that address. After following all development steps in DI 13015.013, the FO cannot locate the beneficiary. The FO determines that the beneficiary's disability ceased beginning 2/2021. After two grace months, benefits terminate as of 05/2021.

b. Title XVI suspension

For Title XVI, WU is a technical suspension of benefits (payment status "S06"). This is different from Title II in which we cease benefits.

NOTE: Goldberg-Kelly (GK) procedures do not apply to Title XVI WU cases. An S06 suspension is an exception to systems GK due process procedures. See SI 02301.240 Whereabouts Unknown (S06).

B. Jurisdiction of the medical CDR

1. CDR is pending at the FO

The FO is responsible for initiating the CDR and securing the requested medical information per DI 13005.025 and DI 13005.030 . If the FO is unable to locate the beneficiary or recipient, after following the steps in DI 13015.013, the FO makes a WU determination.

2. CDR is pending at the DDS

If the DDS is unable to locate the beneficiary, the DDS documents their attempt to locate the beneficiary following DI 28075.005 and returns the case to the FO as a "no determination" case. This documentation must be available to the FO in the current folder. If the FO is unsuccessful in locating the beneficiary or recipient, the FO will prepare a WU determination per DI 13015.013.

3. CDR is pending at the PSC

If the PSC cannot complete the CDR because they are unable to locate the beneficiary, the PSC transfers jurisdiction of the CDR to the FO. The PSC will update the Disability Control File (DCF) to transfer the CDR to the FO of jurisdiction along with an electronic or paper SSA-5526-U3 Request for Assistance-Disability form. The FO will then proceed with WU development per DI 13015.013.


DI 13015 TN 11 - Special CDR Issues - 10/19/2021