Identification Number:
SI 02309 TN 13
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Critical Birthday and Insured Status Diaries
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 023 – Posteligibility Events
Subchapter 09 – Critical Birthday and Insured Status Diaries
Transmittal No. 13, 11/25/2018

Audience

OCO-OEIO: CR, FCR, FDE, RECONE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

 

Summary of Changes

SI 02309.010 Processing the Insured Status (KZ) Diary - Supplemental Security Income (SSI)

We are updating SI 02309.010D, Step 5 to clarify how FO technicians handle cases when a recipient agrees to a later onset date.

At the end of this paragraph, "Another common finding is that the recipient agreed to a later onset date during the hearing resulting in the same situation even though the decision might show as a fully favorable rather than a partially favorable decision.", we are adding "Determine the potential onset date (POD) by evaluating the non-medical factors (e.g., work issues, DFI, DLI, prescribed period). That date may be earlier than the claimant’s alleged onset date (AOD). Develop the case for the earliest POD. The claimant does not need to contact the FO for an earlier AOD in order for the FO to develop for the earliest POD."

SI 02309.010 Processing the Insured Status (KZ) Diary - Supplemental Security Income (SSI)

A. Introduction to the KZ diary selection process

The Supplemental Security Record (SSR) sets the KZ diary for eligible recipients and eligible spouses who may qualify for a Title II benefit. The process to determine insured status occurs semi-annually.

Beginning December 2017, the KZ diary selection process expanded to include statutory blind insured status. Statutory blindness under both Title II and Title XVI:

  • means a central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and

  • considers an eye that has a limitation in the field of vision where the widest diameter of the visual field extends to an angle no greater than 20 degrees as having a central visual acuity of 20/200 or less.

For more information about statutory blindness for Title II and Title XVI, see DI 26001.001 and DI 10105.070.

The KZ diary sets only on an SSR in current pay, force due, or 1619(b). For more information on 1619 Policy Principles, see SI 02302.010.

The KZ diary indicates the recipient may:

  • be fully insured for Title II retirement benefits (see RS 00301.105);

  • be fully insured for Title II disability benefits and meet the 20/40 requirement for Title II disability benefits (see RS 00301.120); or

  • meet the special insured status requirement for recipients disabled prior to age 31 (see RS 00301.140); or

  • meet the statutory blind insured status when the SSR contains a primary or secondary diagnosis code of 3694 indicating statutory blindness, or an ID code of BI, BC, or BS.

The SSR does not set a KZ diary if the recipient receives, or has received, Title II benefits on his or her own record. However, the SSR sets the diary for a recipient who receives Title II auxiliary or survivor's benefits. For retirement insured status, the recipient must be age 61 years and 9 months, or older, at the time of the redetermination run that sets the KZ diary.

For more information about the SSR criteria for the KZ diary selection, see SM 01501.250B.

NOTE: The system tests all periods from the Supplemental Security Income (SSI) date of onset (DOO) and reviews the period beyond the DOO with the exception of statutory blindness cases (see EXCEPTION in SI 02309.010A in this section).

The SSR uses all quarters of coverage earned through the test quarter. If an alleged earlier disability onset arises again. consider an alleged earlier disability onset when you process the KZ diary. Consider if collateral estoppel applies, see DI 11011.001.

EXCEPTION:In statutory blindness cases, the KZ diary process uses the date of birth rather than the SSI date of onset. If you find blind insured status, the recipient requires a Title II medical determination. Do not adopt Title XVI statutory blindness determinations because duration, onset, and substantial gainful activity requirements differ in Title II and Title XVI statutory blindness cases.

B. Exceptions to taking a Title II application

You are required to take a Title II application to process the KZ diary, except when:

  1. 1. 

    The recipient receives a higher Title II benefit than the potential retirement insurance benefits (RIB) or disability insurance benefits (DIB) computation, and filing for a lesser RIB or DIB amount is not advantageous to the recipient (see SI 00510.001C);

  2. 2. 

    The current payment status has a non-pay code, including payment status code E01, suspense, or terminated status code (unless the case is in 1619(b) status); or

  3. 3. 

    A Title II application for the recipient’s only potential Title II eligibility is pending at the reconsideration, hearing, or Appeals Council Review level of appeal.

  4. 4. 

    The SSR indicates a technician correctly developed and documented a KZ diary, and the diary resets based on the monthly selection process. (Do not redevelop the KZ diary. Confirm the file is documented properly using Step 5 in SI 02309.010D in this section.).

CAUTION : You must consider whether RIB benefits were previously considered (beginning at age 61 years and 9 months, or older) before taking no action to re-develop or clearing the reset diary.

C. Recipients receiving higher Title II benefits than potential RIB or DIB

When you take a new Title II application, follow the instructions in GN 00201.005C.

  1. 1. 

    Explain the advantages and disadvantages of filing an application to the recipient.

  2. 2. 

    Allow the recipient to decide whether to file. If the recipient files an application, use the Development Documentation (DDKZ) screen in Modernized Supplemental Security Income Claims System (MSSICS) to document the KZ diary development and completion.

  3. 3. 

    Document the action taken about the potential entitlement using the appropriate page:

Use the SSR Remarks Data line to document the potential entitlement development. In addition, use Form SSA-5002 (Report of Contact) to document this development and fax into the Non-Disability Repository for Evidentiary Documents (NDRED).

Make sure the SSR Remarks data line and Form SSA-5002 indicate that:

  1. 1. 

    The RIB/DIB will probably never exceed the current Title II amount; or

  2. 2. 

    If known, the month and year that the RIB is higher than the widow(er)’s (WIB) in RIB/WIB cases. The SSR reselects the KZ diary each year if a technician does not take an application. The remark provides guidance on when to take a RIB application, if applicable. Filing a RIB application fulfills the “filing for other benefits” requirement (i.e., once the RIB exceeds the WIB).

For more information on documentation requirements with the application policy, see SI 00601.035.

D. Processing the KZ diary

Coordinate the processing of a scheduled redetermination and KZ diary. Develop the diary when you initiate development to reinstate the recipient's benefits. If an exception applies, you may need to develop as described in SI 02309.010B in this section.

Do not remove the diary. Follow the steps in the chart to process the KZ diary:

Step

Action

1

Review a current SSR to see if you must take other post eligibility actions.

2

Take a Title II application even if it appears that the recipient is not insured. If the Title II application is for disability benefits but the claimant does not meet insured status, you may be able to take an abbreviated application (see GN 00204.009).

If the SSR contains a primary or secondary diagnosis code of “3694” or an ID code of “BI,” “BC,” or “BS,” run a blind insured status computation using the recipient’s date of birth (see SI 02309.010A in this section).

Consider when the recipient can file and adjudicate the application. For more information about an applicant filing a claim before entitlement, see GN 00204.007C;

Check for possible entitlement to auxiliary or survivor benefits (see GN 00204.022);

For disability claims, consider an earlier disability onset date than established for SSI. Also consider whether the evidence in file suggests disability insured status;

Make sure there is no open Title II application based on the SSI application that the recipient filed previously, or an earlier date for you to establish the Title II application filing date;

For more information on the scope of the application, see GN 00204.027; and

For protective filings, see GN 00204.010.

A redetermination may serve as a protective filing for Title II benefits (see GN 00204.015).

REMINDER: Consider a possible earlier date of onset when processing the KZ diary, as advised in SI 02309.010A in this section.

Review the certified earnings record (CER) with the recipient to develop incomplete earnings, gaps in postings, or lag earnings.

For more information on CERs, see GN 01010.009.

For more information on the wage development policy, see RS 01404.003B.

If an earlier application filing date does not exist, the protective filing date is the date we contact the claimant (or proper applicant) and determine that the claimant wishes to file for Title II benefits. Do not use the date the KZ diary set as a protective filing date.

For more information on the application filing date policy, see GN 00204.007.

3

Explain the effect of receiving Title II benefits on the recipient’s SSI payment;

If the recipient does not file for Title II, follow the procedures in SI 00601.035C.4.;

If the recipient fails to file for other benefits, follow the procedures in SI 00510.001 through SI 00510.030;

If the recipient files for Title II, but does not elect full retroactivity, see SI 00510.001 through SI 00510.030. Suspend SSI payments using payment status code N06 when the recipient does not comply with the requirement to file for other benefits;

If the recipient does not comply with the general requirement to provide information, such as complete a redetermination, suspend SSI payments using payment status code N20 (see SI 02301.235).

For a description of the suspension codes, see SM 10802.130; and

Do not delete the KZ diary.

4

Once you have a signed Title II application, transmit Title II entitlement ("A" unearned income) with recent filing code (code "R") to the SSR (see SM 01305.240).

For information about posting type “A” unearned income using MSSICS, see MS INTRANETSSI 014.044.

5

Clear the KZ diary only after you have a valid Title II application.

Update the DDKZ screen accordingly, and clear the KZ diary without further development if the exception applies in SI 02309.010B.1 in this section.

Do not clear the KZ diary if you suspended benefits for failure to file for other benefits, failure to cooperate, or any other reason. Update the DROC screen accordingly.

For non-MSSICS cases, document Form SSA-5002 and fax into NDRED.

IMPORTANT: A KZ diary can reset when it appears we approved a recipient at a hearing while insured for Title II, but his or her record does not show a Title II payment. In these cases, review the hearing decision to see how we addressed Title II.

A common discovery is an administrative law judge issued a partially favorable decision and the onset date was later than the date last insured (DLI). Therefore, find no Title II eligibility for that period.

Another common finding is that the recipient agreed to a later onset date during the hearing resulting in the same situation even though the decision might show as a fully favorable rather than a partially favorable decision. Determine the potential onset (POD) by evaluating the non-medical factors (e.g., work issues, DFI, DLI, prescribed period). That date may be earlier than the claimant's alleged onset date (AOD). Develop the case for the earliest POD. The claimant does not need to contact the FO to develop for the earliest POD.

When a KZ diary resets, do not re-develop or clear the subsequent KZ diary if the case was correctly developed and documented in the claims path. Enter Remarks (RMKS) on the SSR and document MSSICS via a DROC to identify these cases. If the reset diary is associated with a pending RZ or limited issue (LI) profiled for a reason other than the reset KZ diary, clear the KZ diary to complete the pending RZ or LI.

Document the DDKZ screen with the file documentation remarks: “Reset KZ Diary Previously Developed and Documented.” To identify reset diaries, look for limited issues profiled solely on a KZ diary with following SSR characteristics:

CRZD profile of ‘X’;

CRZD selection indicator of ‘X’; and

KZ is the only RZ/LI priority diary in the DIAR field.

AND

An RZ/LI completion in the same or previous fiscal year; or

MSSICS DDKZ screen completed in the same or previous fiscal year.

CAUTION : You must consider whether RIB benefits were previously considered (beginning at age 61 years and 9 months, or older) before taking no action to re-develop or clearing the reset diary.

6

Follow up with the Title II adjudicator using local procedures to determine that the recipient filed and is pursuing the claim if the field office uses specialization.

For more information on monitoring the compliance for filing for other benefits, see SI 00510.025.


SI 02309 TN 13 - Critical Birthday and Insured Status Diaries - 11/25/2018