Effective Dates: 10/22/2024 - Present

Identification Number:
DI 26510 TN 44
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Completion of Form SSA-831-C3/U3 -- Title II, Title XVI and Concurrent Claims
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 265 – Initial Case Processing

Subchapter 10 – Completion of Form SSA-831-C3/U3 -- Title II, Title XVI and Concurrent Claims

Transmittal No. 44, 10/22/2024

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, CTE, ERE, FDE, FDEC, RECONE, RECONR;
OCO-ODO: CR, CTE, CTE TE, DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This transmittal updates the form SSA-831. The changes are consistent with new DCPS instructions on cases with a closed and open period of disability on the same filing. We also provide new entries for res judicata issues and adverse reopenings.

Summary of Changes

DI 26510.010 Completing Item 15 (Claimant Disabled) on the SSA-831

We made changes for a closed period and open period award on the same claim.

DI 26510.095 Completing Item 34 (Remarks) on the SSA-831

We removed item 34 remarks for DWB claims decided prior to the 1991 changes that are more than 30 years old and no longer in use. We added new entries for res judicata issues, adverse medical reopenings, and cases with a closed and open period award on the same claim.

We added new entries for res judicata issues, adverse medical reopenings, and cases with a closed and open period award on the same claim.

DI 26510.010 Completing Item 15 (Claimant Disabled) on the SSA-831

A. Procedure

1. Title II - General Disability Insurance Benefits (DIB)

Complete Item 15 as follows:

  • •

    Check the box in block A. and enter the established onset date (EOD) of disability in all cases where the claimant is disabled on or before the date the insured status requirement is last met.

  • •

    Check the box in block B. in addition to checking block A. and entering the EOD when a closed period of disability is established, and enter the date (month/day/year) disability ceased.

  • •

    Prepare one SSA-831 when both a closed and open period of disability are established based on a single application. Check the box in block A. and enter the EOD for the open period. In item 34, enter the following remark: "Interim Closed Period (enter EOD of the closed period and the date of the end of the closed period).

  • •

    Enter the last day of the month as the EOD when the month of onset is established but the day is unknown.

2. Disabled Widow(er) Benefits (DWB)

Check the box in block A. and enter the EOD in all cases where the claimant is disabled on or before the end of the prescribed period.

If:

  • •

    the exact EOD cannot be determined, but

  • •

    the evidence establishes the claimant was disabled before the end of the prescribed period, and

  • •

    the exact EOD is not material

Then, use the earliest EOD that can be established by the evidence of record.

NOTE: The controlling date is the latest date onset can be established without affecting the first month of entitlement.

For a closed period see DI 26510.010A.

3. DWB Medicare

Enter the controlling date in item 15A. if an exact onset date is not established but onset occurred no later than the controlling date.

Enter the exact date of onset if the widow became disabled after the controlling date and within the prescribed period.

NOTE: As in regular DWB cases, an exact date of onset of disability is not always material if the EOD is within the prescribed period. In Medicare cases, the Field Office (FO) determines controlling dates. The Disability Determination Services (DDS) is responsible for contacting the FO if no controlling date is provided. For a discussion of prescribed period and controlling dates see, Established Onset in Deemed Entitlement to Disabled Widow(er)'s Benefits for Medicare Claims DI 25501.360.

4. Childhood Disability Benefits (CDB)

Check the box in block A. when disability is established before attainment of age 22 or before the end of the reentitlement period. For additional information about onset in CDB claims, see DI 25501.330.

  • •

    Enter the last day of the month as the EOD when the month of onset is established but the exact date is unknown. NOTE: However, the exact date of the onset must be determined when the onset of disability occurs in the month a disabled child attains age 22.

  • •

    Enter the last day of the month before the month of attainment of age 18 when the evidence supports the individual was disabled before the month age 18 was attained and the exact date of onset cannot be determined without further development.

  • •

    Enter the last day of the month before the month of attainment of age 22 when the evidence supports the individual was disabled before the month age 22 was attained and the exact date of onset cannot be determined without further development and the application was filed after attainment of age 23. For additional information on CDB onset, See DI 25501.330A.8. NOTE: For information on a closed period, see DI 26510.010A.

5. Title XVI

Check the box in block A. when a disability is established. Leave the box blank only if statutory blindness is established, and complete item 18 instead DI 26510.025D.)

The EOD in a Title XVI only case or a concurrent case involving a Title XVI allowance and a Title II denial for technical reasons (such as not disabled at date last insured) is usually the date of filing (or protective date of filing, if earlier).

In a concurrent Title XVI/Title II dual allowance case:

  • •

    use the Title II EOD as the Title XVI EOD, even if it is earlier than the filing date or protective filing date (The Established onset Date for Title XVI Claims DI 25501.370)

  • •

    If the Title XVI filing date is earlier than the Title II EOD (and the claimant met the medical and technical requirements for disability as of the Title XVI filing date, establish an EOD under each title without regard to the other.

Check block B. if the date of cessation occurs in or after the month of filing. Complete in the same manner as a Title II claim when a closed period of disability is established.

Check the box in item 19A. if the date of cessation occurs prior to the month of filing. Show the EOD (not the filing date) in block 15A in accordance with the evaluation principles in “Closed Period” DI 25510.001 – DI 25510.015.

In block 15A. show the EOD (not the filing date). See the evaluation principles in "Closed Period" DI 25510.001 - DI 22510.015.

If the FO or DDS previously entered a date in Item 15A for a presumptive disability (PD) that needs to be changed, enter the correct onset. If the SSA-831 is paper, draw a line through the date previously entered and enter the date following the same rules.

B. References

DI 26510.095 Completing Item 34 (Remarks) on the SSA-831

Use Item 34 to alert SSA personnel to any special circumstance or situations in previous Items on the SSA-831.

NOTE: This chart includes only a few examples of special situations that might be annotated in Item 34. It is not an exhaustive list.

 

Situation

Enter In Remarks

Claimant cannot be located at last known address or claimant’s whereabouts unknown.

Claimant’s whereabouts unknown.

Disability Determination Services (DDS) has received a statement regarding capability - allowance only; or The Field Office (FO) indicates that an Retirement and Survivor Insurance (RSI) claim has been filed (see When to Develop Capability, DI 23001.005B).

"Claimant capable (or incapable) per Dr. (name) report of (date)."

Claimant’s impairment meets listing 12.05A.

"Claimant incapable - Listing 12.05A.

When capability development was needed (see When to Develop Capability, DI 23001.005B) and DDS has been unable to secure evidence of capability - recommendation based on evidence in file - allowance only; or the FO indicates that an RSI claim has been filed.

"Capability unresolved - review of medical evidence (identify by source and date) suggests claimant is capable (or incapable)."

When capability development was needed (see When to Develop Capability, DI 23001.005B) and DDS has been unable to secure evidence of capability - allowance only; or

The FO indicates that an RSI claim has been filed.

"Capability unresolved."

NOTE: It is not necessary to specify capability for a minor child since the child will already have a representative payee. However, if Item 5 of the Disability Determination and Transmittal, SSA-831 (or elsewhere) indicates that the claim was filed by the child, consider the question of capability.

DDS recommends payment of benefits before completion of its onset development (Onset, DI 25501.000).

"Return folder to DDS after award payment-possible earlier date of onset (date) to be developed."

Potential Onset Date (POD) is less than 5 full calendar months before the month of death and no earlier onset is possible.

"Death in waiting period-no possibility of earlier onset."

Established onset date (EOD) is different than POD in Title II cases.

"Change in onset" [This applies whether the EOD is favorable or unfavorable to the claimant.]

EOD after the month of filing in Title XVI cases.

“Adverse onset.”

More than one optional diary reason applies.

"Diary reasons (show applicable reason codes)".

Vocational Diary established.

"Vocational Diary established."

Trial Work Period (TWP) Diary Established.

"TWP Diary (month/year)."

Case reviewed by DDS Quality Assurance.

"DDS QA."

Earnings discrepancy indicated by the presence of an unprocessed Form SSA-7000-U3, Notice of Determination of Self-Employment Income; SSA-7010-U3 Notice of Determination of FICA Wages or SSA-4500-U6, Federal Determination of Error in State’s Wage Reports, in file.

“Earnings discrepancy.”

At the time of determination, claimant is working and the work may meet criteria for TWP month(s). (TWP can begin no earlier than the filing date or DOE, whichever is later.)

“TWP” case.

An interim notice is prepared.

“SSA-1157-U2 (DI) or (SI).”

Representative payee files for claimant after receipt of SSA-831 in DDS, insufficient space in Item 5 to show change.

“John Doe for Mary Doe”

Medicare only and concurrent Disability Insurance Benefits (DIB)/Medicare qualified government employment (MQGE) claims

"MQGE Case"

Res judicata issue in a subsequent Title II claim. See DI 27516.001.

"Res judicata does not apply" or "Res judicata applies"

The claimant dies prior to adjudication and a determination is necessary for Medicaid purposes only.

"Died (date of death). Determination for Medicaid Only."

Drug Addiction and Alcoholism (DAA) is not material, DAA Condition.

"DAA Not Material-DAA Condition (X, Y, or Z, as applicable)." See Drug and Alcohol Addiction (DAA), SM 05905.059.

No current evidence of DAA condition.

DAA previously established on the record in a prior determination/decision.

"No evidence of DAA condition--W." See Drug and Alcohol Addiction (DAA), SM 05905.059.

DAA is material. Denial.

"DAA is material-(A, D, or B, as applicable)." See Drug and Alcohol Addiction (DAA), SM 05905.059.

If the FO annotates "Child in Care," a claimant is seeking initial or continuing entitlement based on having a disabled child in care who is alleged to have both a physical and mental impairment.  Enter this remark if a documented mental impairment exists which is not shown as the primary or secondary diagnosis.

Type of mental impairment, type of report; e.g., “Intellectual Disability, Dr. Moore's Report, July 22, 2006."

A disability determination is needed for an individual who received transferred resources from an Supplemental Security Income (SSI) applicant or recipient. The determination is needed to establish whether the person who transferred the resources is eligible for SSI.

"Disability determination needed for SSI transfer of resources case. Alleged onset date is the date of the resource transfer. See Exceptions Transfers to a Trust, SI 01150.121."

SSI claimant attains age 18 after claim filed but before we make a determination or decision. See, If You Attain Age 18 After You File Your Disability Application But Before We Make A Determination or Decision, DI 25201.010.

Period starting with attainment of age 18 adjudicated under adult rules.

Childhood case allowance – medical evidence indicates that maternal drug or alcohol addiction is an underlying cause of the impairment (i.e., child born addicted).

“Possible Representative Payee issue – impairment related to maternal drug or alcohol abuse. See medical report from___________, dated_____.”

Childhood case allowance – medical evidence indicates the child’s mother or father is an alcoholic or drug addict.

“Possible Representative Payee issue – mother/father has a drug/alcohol abuse problem. See medical report from__________, dated_____.”

Childhood case allowance – medical evidence indicates that the child may suffer from abuse.

“Possible Representative Payee issue – medical evidence indicates child abuse. See medical report from_________, dated _____.”

DIB, Childhood Disability Benefit (CDB) or Disabled Widow's Benefit (DWB) felony or confinement impairment denials.

“Disabling impairment is (felony) or (confinement) related.”

DDS enters one of these remarks in Re-entitlement claims for Disability and Medicare Benefits per DI 23050.001

"Count prior months of benefit entitlement toward Medicare waiting period" (fully favorable determination); or "Do not count prior months of benefit entitlement toward Medicare waiting period" (partially favorable determination).

Possible Fraud or Similar Fault (FSF) in a determination or decision, per DI 23025.000

"FSF in the determination - see related documents in file."

Closed and open period of disability established on a single application.

Interim Closed Period (enter EOD for closed period and date of the end of closed period)

Adverse Medical Reopening

Adverse Medical Reopening. Revised Determination dated ___________.

Reconsideration of an Adverse Medical Reopening (RAMR) with a closed period decision.

Revised systems input required-FO must request Payment Center (PC) update diary to closed period.

DI 26510 TN 44 - Completion of Form SSA-831-C3/U3 -- Title II, Title XVI and Concurrent Claims - 10/22/2024