Identification Number:
DI 23570 TN 34
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law (P.L.) 104-193 as Modified by P.L. 105-33) - DDS
Type:POMS Transmittals
Program:Title XVI (SSI),Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 235 – Specific Case Instructions
Subchapter 70 – Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law (P.L.) 104-193 as Modified by P.L. 105-33) - DDS
Transmittal No. 34, 11/30/2021

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, CTE, ERE, FCR, FDE, FDEC, RECONE;
OCO-ODO: CST, DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This transmittal contains a revised version of POMS subchapter DI 23570.000. This subchapter provides instructions that the Disability Determination Service (DDS) will follow when completing the continuing disability review (CDR) cases for children under age 18 and when completing an age-18 redetermination.

Summary of Changes

DI 23570.001 Public Law 104-193 - General

Some of the content in this section is now located in DI 23570.006. This section will become obsolete.

DI 23570.002 Glossary and General Explanation of Applicable Terms

Some of the content in this section is now located in DI 23570.006. This section will become obsolete.

DI 23570.006 Requirements for an Age-18 Redetermination

This is a new policy section. This section contains some of the content previously in DI 23570.001 and DI 23570.002. This section includes plain language writing and includes cross-references to instructions, where appropriate.

DI 23570.010 Disability Determination Services (DDS) Actions to Identify an Age-18 Redetermination Case

We revised the title of this section. This section includes plain language writing and to include cross-references to instructions, where appropriate.

DI 23570.015 Case Received From FO and Cases Pending in DDS - General Process

This section will become obsolete.

DI 23570.020 Disability Determination Services (DDS) Procedures for Processing an Age-18 Redetermination

We revised the title of this section. This section includes plain language writing and to cross-references to instructions, where appropriate.

DI 23570.025 Disability Determination Services (DDS) Development and Evaluation of an Age-18 Redetermination

We revised the title of this section. This sections includes plain language writing and to include cross-references to instructions, where appropriate.

DI 23570.030 Disability Determination Services (DDS) Procedures for Documenting an Age-18 Redetermination and Disabled Child (DC) Disability Determination

This is a new policy section. This section includes plain language writing and includes cross-references to instructions, where appropriate.

DI 23570.100 Age-18 Notice of Disability Redetermination — CDR to Disability Redetermination — Exhibit

In this section, we changed "Claim Number" to "Case Number".

DI 23570.110 Disability Redetermination Flag - Exhibit

In this section, we changed "Claim Number" to "Case Number.".

DI 23570.115 Age-18 Disability Redetermination – Continuance Notice Language

In this section, we changed "Claim Number" to "Case Number."

DI 23570.120 Age-18 Disability Redetermination – Cessation Notice Language

In this section, we changed "Claim Number" to "Case Number."

Conversion Table
Old POMS ReferenceNew POMS Reference
DI 23570.001DI 23570.006
DI 23570.002DI 23570.006
DI 23570.010DI 23570.010
DI 23570.015Archive
DI 23570.020DI 23570.020
DI 23570.025 DI 23570.025
DI 23570.030
DI 23570.100DI 23570.100
DI 23570.110DI 23570.110
DI 23570.115 DI 23570.115
DI 23570.120DI 23570.120

DI 23570.006 Requirements for an Age-18 Redetermination

A. Statutory requirement for an age-18 redetermination

Under Section 1614(a)(3)(H)(iii) of the Social Security Act, we must redetermine the eligibility of individuals who were eligible for Supplemental Security Income (SSI) based on disability in the month before the month in which they attained age 18. This redetermination occurs during the one-year period beginning on the individual’s 18th birthday. The age-18 redetermination uses the rules for determining initial eligibility for adults to make this determination, except the rules pertaining to substantial gainful activity (SGA) in DI 23570.001 and work incentive provisions of Section 1619(a) and 1619(b) in DI 28001.001. The medical improvement review standards (MIRS) used in a continuing disability review (CDR) does not apply to an age-18 redetermination.

B. Who is subject to an age-18 redetermination?

The requirement for an age-18 redetermination applies to anyone who attains age 18 on or after August 22, 1996. For additional information on the policy for attainment of age, see GN 00302.400.

C. When do we process an age-18 redetermination?

The law requires us to conduct a disability redetermination within one year of the SSI recipient's 18th birthday or, in lieu of a CDR, whenever we determine that an age-18 redetermination was required but was not performed.

The field office (FO) must make every effort to initiate an age-18 redetermination:

  • prior to the recipient’s attainment of age 19; or

  • later if an age-18 redetermination was not performed prior to the recipient’s attainment of age 19.

DI 23570.010 Disability Determination Services (DDS) Actions to Identify Age-18 Redetermination Cases

A. Identifying cases that require an age-18 redetermination

The DDS should use the procedures to identify cases that require an age-18 determination.

1. Field office (FO) and automated identifications

Each year, we identify cases of Title XVI recipients receiving disabled child benefits who are attaining age 18. Age-18 redetermination cases are initiated and controlled through the disability control file (DCF). When the case involves a paper folder, the DDS receives these cases from the FO identified as an age-18 redetermination.

2. DDS identification

The DDS uses the following guidelines when identifying and reviewing a case for an age-18 redetermination.

  1. a. 

    Age-18 flag in paper cases

    If the case involves a paper folder due to an electronic disability control system (EDCS) exclusion, review the current folder to see whether the case contains an age-18 disability redetermination flag. For an example of an age-18 redetermination flag, see DI 23570.110. For additional information on electronic age-18 redetermination cases, see DI 81010.232.

  2. b. 

    Review of the claim folder

    During the continuing disability review (CDR) process, the DDS may identify individuals who attained age 18 in the past, on or after August 22, 1996, are subject to an age-18 redetermination.

    An age-18 redetermination is required if, the DDS examiner finds that the Title XVI recipient was:

    • eligible in the month before the month of attainment of age 18; and

    • an age-18 medical redetermination or a determination under the adult initial claims standard was never done.

    Before initiating an age-18 redetermination, the DDS must send notices to the disabled individual and representative payee that an age-18 redetermination will be done rather than a CDR. The DDS must send this notice as soon as possible after the DDS recognizes that a medical redetermination is appropriate. For an example of an age-18 redetermination notice, see DI 23570.100.

  3. c. 

    Prior determination made using the adult criteria

    An age-18 redetermination is not appropriate if the individual has otherwise had a favorable determination under the adult initial claims standard after attainment of age 18.

    Examples of cases that do not require an age-18 redetermination:

    • an age-18 redetermination has already been done;

    • a favorable Title II adult determination (child disability benefits (CDB), disability insurance benefits (DIB) claims), that was processed after the individual attained 18, but if the prior determination was based on collateral estoppel, see DI 27515.001F; or

    • a CDR after age 18 resulted in a continuance based on meeting or equaling an adult listing, or on a residual functional capacity (RFC) assessment plus consideration of vocational factors. However, if the comparison point decision (CPD) was a child determination and the case was continued based on no medical improvement (MI), or no MI related to the ability to work, the determination as not a determination under the adult initial claim standards and the case still requires an age-18 redetermination.

    NOTE: For cases that meet the above criteria, complete the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal- Title XVI) as usual with a favorable determination.

  4. d. 

    Screening out a CDR after an age-18 redetermination

If an age-18 redetermination was completed within the last 12 months and soon afterward a new CDR is found pending, the DDS examiner should apply a “no determination” (ND) decision to the CDR case providing that the medical diary has not matured and will not mature in the next 3 months. If the case meets these conditions, the DDS must return the folder to the FO requesting an update to the record to reflect the diary period established by the DDS at the time the age-18 redetermination was processed. For additional information on the screen out process, see DI 28003.005.

B. Notification for an age-18 redetermination

The FO must provide a notice initiating the medical redetermination in cases identified as they attain age 18. The agency requires a special notice for those cases identified by the DDS during a CDR as requiring a medical redetermination or in situations in which a CDR was erroneously developed within 12 months after the age-18 medical redetermination was made (and the medical diary has not matured or will not mature in the next 3 months). The DDS must send the special notice prior to the issuance of a medical determination and must inform both the individual and representative payee that a medical determination will be processed using the initial adult standard. For an example of the medical redetermination notice, see DI 23570.100.

NOTE: The DDS must send a separate notice to the disabled individual and their representative payee.

DI 23570.020 Disability Determination Services (DDS) Procedures for Processing an Age-18 Redetermination

When the DDS processes an age-18 redetermination, the DDS must follow the guidelines in the policy below.

A. Timeliness of processing an age-18 redetermination

The law requires the Social Security Administration (SSA) to conduct an age-18 redetermination within one year of the Title XVI recipient's 18th birthday or, in lieu of a continuing disability review (CDR), whenever we determine that an age-18 redetermination was required and had not been initiated. The field offices (FO) and DDS must initiate and complete the actions timely. The FO and DDS will diligently pursue development and age-18 redetermination on any case identified as being subject to an age-18 redetermination.

B. Procedures for processing an age-18 redetermination

1. FO actions

The FO will complete the following actions when processing an age-18 redetermination:

  • conduct the disability interview in the same manner as an initial claim;

  • will not take a new application;

  • will not develop medical information back to the original onset date; and

  • will obtain completed disability reports and functional reports appropriately to initiate the disability determinations.

2. DDS actions

The DDS will complete the following actions when processing an age-18 redetermination.

  1. a. 

    Evaluate the individual’s disability using the initial disability standard for adults.

  2. b. 

    Do not apply Step 1 substantial gainful activity (SGA) of the sequential evaluation process.

  3. c. 

    Do not apply the medical improvement review standards (MIRS) in an age-18 redetermination.

  4. d. 

    Although the cases will be evaluated using the rules for initial adult claims (except for Step 1(SGA)), they will be processed in a manner similar to a CDR.

  5. e. 

    Document and input the age-18 redetermination in the same manner as a CDR using the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal- Title XVI).

C. Receipting an age-18 redetermination in the DDS

The DDS must complete the following procedures when receiving an age-18 redetermination.

1. Receiving the case in the DDS

The FO will send create and transfer electronic cases in the Electronic Disability Collect System (EDCS) to the DDS and should be identified as an age-18 redetermination, see DI 81020.205. However, some cases age 18 and over, may be received as CDRs and then identified by the DDS as requiring an age-18 redetermination instead of a CDR. For additional information on cases that require a disability redetermination instead of a CDR, see DI 28005.003. In paper cases, if the prior paper folder is not available, the FO should place the new disability material in a yellow MDF folder and staple the flag to the top of the folder. When the DDS receives a paper case, the DDS will receive the age 18 case from the FO with the Disability Redetermination Flag, per DI 23570.110.

2. Reviewing the prior folder

An age-18 redetermination is a new determination using the initial standards of disability for adults. If the case has a prior paper folder create the age-18 redetermination in EDCS, see DI 81010.232. The DDS will develop the current evidence as though it is a new claim and make a disability determination without regard to the previous determination.

The DDS may decide that a child case initiated as a CDR should have an age-18 redetermination after reviewing the prior folder. Generally, the prior folder is not as critical as it is in a normal CDR; however, scan all relevant school and medical records into the current age-18 redetermination folder. For additional information on documenting and copying relevant evidence, see DI 81020.230 and DI 22501.001.

3. When a case initiated as a CDR requires an age-18 determination

An age-18 redetermination decision is appropriate instead of a CDR if:

  • the coding shows that a CDR or age-18 redetermination was not done after age 18; or

  • if a CDR was done after age 18, it is clear from the coding that the prior continuance was not based on consideration of the adult standard applicable to initial claims. The additional information on system coding identification, see DI 23570.010B.1.

Receipt the case as a CDR using the following codes:

  • CDT:

    • 02 - Childhood Disability Redetermination Case

      NOTE: Once the original child redetermination workload is completed, it will be unusual to receive a case from the FO identified as a child disability redetermination.

    • 04 - Age 18 Disability Redetermination Case

  • SLC: 8

D. Processing a pending CDR

The DDS must use the following procedures when processing a pending CDR by each case type.

1. Child under age 18

Review the case to see if the CDR meets the child disability redetermination requirements, if a CDR is pending on a child under age 18, see DI 25201.001. If so, process the case as a DC redetermination, see DI 28005.020. If the disabled child turns age 18 prior to a determination, notify the individual and the representative payee of the disability standards using the special notice provided as mentioned in DI 23570.100 and make an age-18 redetermination. For additional information on a case that require a disability redetermination instead of a CDR, see DI 28005.003.

2. Child attained age 18

An age-18 redetermination is required, if a CDR is pending on any individual who attained age 18:

  • who was eligible as a child in the month before the month of attainment of age 18; and

  • who has not had a medical determination under the initial adult standard after attaining age 18, see DI 23570.010A.

If the disabled child turns age 18 prior to a disability determination, send a notice of the medical redetermination using the special notice provided in DI 23570.100.

3. Pending CDR for a child age 18 or who will attain age 18 within 2 months

The FO may initiate an initial level CDR in EDCS when the claimant is age 17 and 10 months until the day before the claimant reaches age 19, the information is collected in EDCS as an age-18 redetermination. The DDS must process the case as an age-18 redetermination, if a CDR is pending on a child, and the child is now or will attain age 18 within 2 months. However, do not make an age-18 determination on the case until the child attains age 18. The DDS must verify eligibility and provide a notice of the need for an age-18 redetermination before rendering the disability determination since the case was sent to the DDS as a child CDR. The DDS must hold the case and make the age-18 redetermination after the disabled individual attains age 18.

DI 23570.025 Disability Determination Services (DDS) Development and Evaluation of an Age-18 Redetermination

A. Developing evidence for an age-18 redetermination

The DDS must develop evidence under the existing procedures for initial claims. If the field office (FO) potentially identifies the case to involve vocational rehabilitation (VR) or similar program or Section 301, see DI 14510.010.

B. Evaluating evidence for an age-18 redetermination

The DDS should evaluate each case based on the case type as described below.

1. Age-18 redetermination

The adult standards for initial claims will apply to an age-18 redetermination for individuals who have attained age 18, except the Step 1 substantial gainful activity (SGA) of the sequential evaluation process will not apply, see DI 22001.001B, DI 22001.001C, and DI 24505.001. These are new initial disability determinations. The DDS will consider all current impairments, including any new impairments even if they do not meet the duration requirement, see DI 28005.210B.1.

2. Failure to cooperate (FTC) cases

For an age-18 redetermination case involving FTC, follow the instructions in DI 28075.005.

3. Concurrent cases (adoptions)

The DDS may not adopt a Title II medical determination made before the individual attains age 18 for a Title XVI age-18 redetermination. The DDS may use the reduced development process regarding prior Title II determinations as outlined in DI 23570.025B.5. in this section.

For Title II medical determinations made after the individual attains age 18, the DDS will follow existing adoption policies, see DI 27515.000.

4. Concurrent cases (unfavorable medical determination)

An unfavorable decision on a Title XVI age-18 redetermination could be reason to initiate a continuing disability review (CDR) on the Title II claim. The evidence used could also establish a reason to consider reopening the Title II disability determination. For additional information on when to raise a CDR issue, see DI 27515.050.

However, because the initial standard employed in an age-18 redetermination differs from the MIRS employed in determining continuing disability, it is possible that entitlement could continue the Title II claim. For Title II cases not initiated as a CDR, the DDS must send notification prior to initiating the Title II CDR.

NOTE: The DDS must send a separate notice to the disabled individual and his or her representative payee.

For concurrent cases initiated as a CDR, process the age-18 redetermination and the Title II CDR actions at the same time. However, if a new notice is required, send notification prior to processing the CDR. This means that there could be a later cessation date on the Title II claim. Do not attempt to reconcile the dates and do not delay action on the Title XVI age-18 redetermination. For additional information on conflicting determinations or decisions, see DI 27520.030.

Always use the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal - Title XVI) to document the CDR medical determination for the concurrent Title II claim if the Title XVI age-18 redetermination results in an unfavorable determination.

5. Reduced development cases

The DDS may receive cases from the FO without the usual forms because the nature of the impairment is such that the FO felt that the interview would not be necessary. The reduced development process is to alleviate the burden on severely disabled individuals. However, the DDS can request the FO to fully develop and document these types of cases when it is not evident that the case meets the requirements for disability.

Cases that fall under the medical improvement not expected (MINE) or MINE-equivalent criteria may use the reduced development process. These are cases:

  • that involve a very severe impairment that could be considered a permanent impairment in terms of duration of the condition and the unlikelihood that medical improvement will occur (for example, total blindness; cases involving amputation of more than one limb, or amputation of a leg at the hip; a longstanding condition which has resulted in bed confinement or the need for a walker or crutches); or

  • the DDS may incorporate and use the findings of a prior Title XVI medical determination if the individual has a very severe impairment (as described above) that meets the adult criteria and there is no expectation or evidence of improvement. In these situations, the DDS need only confirm the individual's status with the treating source and document the folder. The documentation requirements are the same as those normally employed in MINE or MINE-equivalent cases. For additional information on documenting and copying relevant evidence, see DI 81020.230 and DI 22501.001.

    Cases excluded from the reduced development process are any cases that involve the following:

    • any discrepancy between any current allegations and evidence and the evidence used in the prior determination;

    • any reason exist that questions the earlier determination; or

    • the presence of a medical improvement expected (MIE) or medical improvement possible (MIP) diary.

C. Unfavorable age-18 determinations

The law does not provide any special rules for the termination of benefits to individuals affected by the age-18 redetermination. The normal cessation and termination rules apply. Disability ceases as of the date of the age-18 redetermination decision unless there is a reason for a retroactive cessation date, such as FTC. Eligibility ends the last day of the second month following the month of cessation. As usual, the individual will continue to receive benefits for two months following the month of cessation if the individual meets all other eligibility criteria. Continued payment of disability or blindness benefits after an unfavorable age18 redetermination may occur if the individual is participating in a VR or similar program, see DI 14505.010.

DI 23570.030 Disability Determination Services (DDS) Procedures for Documenting an Age-18 Redetermination and Disabled Child (DC) Disability Determination

A. Fully favorable age-18 determinations

The DDS must complete all actions below (for example, completion of the Form SSA-538 (Childhood Disability Evaluation Form) for child cases, release of notices, etc.) using the existing procedures for processing continuances in a continuing disability review (CDR).

1. Notices for favorable disability determinations

Use the special notices and language format designated for this workload (for example, “Notice of Continuation”).

2. Completing the Form SSA-832 for a continuance

Complete the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal- Title XVI) as normal in DI 28084.020 for each item with the following exceptions.

  1. a. 

    Item 12

    Use the following continuance codes as appropriate.

    1. 1. 

      For a disability redetermination when the child is under age 18, use the existing “Reason for Continuance” codes:

      • Code 71 (Impairment Meets the Listing (DC, BC)),

      • Code 73 (Impairment Medically Equals Listing (DC, BC)), or

      • Code 78 (Impairment Functionally Equals Listing (DC, BC)).

        NOTE: Do not use Code 79 (Individualized Functional Assessment (IFA)-Comparable Severity) as the IFA is no longer an appropriate basis for fully favorable determination. Do not use codes based on lack of medical improvement (for example, Code 76 for “No Medical Improvement”) because medical improvement is not the issue for disability redetermination cases.

    2. 2. 

      For an age-18 redetermination, use the existing “Reason for Continuance” codes:

      • Code 70 (Impairment Meets Listing),

      • Code 72 (Impairment Equals Listing), or

      • Code 74 (Impairment Plus Vocational Factors).

        NOTE: Do not use codes based on lack of medical improvement (for example, Code 76 for “No Medical Improvement”) because medical improvement is not the issue for disability redetermination cases.

  2. b. 

    Item 20

    Use the following Why Review Was Made (WRM) codes as appropriate.

    1. 1. 

      For a disability redetermination when the child is under age 18, enter Code 27 (IFA Disability Redetermination, P.L. 104-193). Always use this code for a childhood medical redetermination if the original determination involved an IFA, or enter Code 28 (Maladaptive Behavior Disability Redetermination, P.L. 104-193).

    2. 2. 

      For an age-18 redetermination, enter Code 29 (Age 18 Disability Redetermination P.L. 104-193).

  3. c. 

    Item 24

    For a child and an age-18 redetermination, enter in the Remark section, “P.L. 104-193.”

B. Unfavorable age-18 determinations

Follow the existing procedures except as indicated in DI 23570.030B.2. and DI 23570.030B.3. in this section. For additional information on unfavorable an age-18 redetermination, see DI 23570.025C.

1. Notices for unfavorable disability determinations

The DDS must prepare and release the notice for an unfavorable age-18 redetermination decision. Use the special cessation notice designated for this workload, see DI 23570.120 Age 18 Disability Redetermination – Cessation Notice Language.

NOTE: When a legally competent adult disabled individual has a representative payee, the DDS should send the cessation notice to competent adult disabled individuals. Also, send a modified copy of the cessation notice to his or her representative payee. The representative payee's notice should not contain personal information. Include the decision paragraph and the sentence “(Beneficiary Name) has been given a more detailed explanation of our decision” on the personalized attachment.

2. Completing the Form SSA-832 for a cessation

Complete Form SSA-832 as normal in DI 28084.015 with the following exceptions.

  1. a. 

    Item 9

    Use the following cessation codes as appropriate.

    1. 1. 

      For a disability redetermination when the child is under age 18, complete as normal.

    2. 2. 

      For an age-18 redetermination, complete as normal.

  2. b. 

    Item 11

    Use the following cessation codes as appropriate.

    1. 1. 

      For a disability redetermination when the child is under age 18, enter Code 95 IFA medical redetermination does not meet new definition of disability. Always use this code on a child disability redetermination if the initial determination was based on an IFA; or enter Code 96 for Maladaptive Behavior Disability Redetermination, does not meet new definition of disability.

    2. 2. 

      For an age-18 redetermination, enter Code 97 (Age-18 Disability Redetermination, Impairment(s) Does Not Meet Definition of Disability for Adults).

      NOTE: If the benefits will cease due to failure to cooperate (FTC), use Code 62 (Failure to Cooperate).

  3. c. 

    Item 20

    Use the following cessation codes as appropriate.

    1. 1. 

      For a disability redetermination when the child is under age 18, enter Code 27 (IFA Disability Redetermination, P.L. 104-193) Always use this code for a childhood disability redetermination if the original determination involved an IFA; or enter Code 28 (Maladaptive Behavior Disability Redetermination, P.L. 104-193).

    2. 2. 

      For an age-18 redetermination, enter Code 29 (Age 18 Disability Redetermination P.L. 104-193).

  4. d. 

    Item 24

    For a disability redetermination when the child is under age 18 and an age-18 redetermination, enter in the Remark section, “P.L. 104-193.” If the case is a potential “Section 301” case, see DI 14510.010B.2.c.

3. National Disability Determination Services System (NDDSS) input

Complete all inputs in the NDDSS and complete other actions as normal in the same manner as a cessation or continuance for normal a CDR. If the case is a potential “Section 301” case, see DI 14510.010C.2.

DI 23570.100 Age 18 Notice of Disability Redetermination — CDR to Disability Redetermination — Exhibit

Social Security Administration
Supplemental Security Income
Important Information

Date:
Case Number: XXXXXXXXX

 

John Payee for
Jane G. Beneficiary
101 Main Street
My City, ST 00001

 

This letter is about your SSI. You do not need to call us.

Earlier we wrote to tell you that we would review your Supplemental Security Income (SSI) disability case to decide if you were still disabled. We are writing now to tell you that because you are over age 18, we will use the same disability rules we use for adults who file new claims to decide your case. However, we will not apply the rule that says we must deny your claim if you are working.

We Will Let You Know What We Decide

See Next Page

  •  

    Doctors and other trained staff will decide if you are disabled under the disability rules for adults.

    We may decide that you are not disabled under the disability rules for adults and your SSI payments could stop. The disability rules for adults are different than the disability rules for children we used when we last looked at your case. So we may find you are not disabled now even though we found you disabled before.

    When we decide we will let you know our decision. Our letter will explain your right to appeal the decision. If you appeal the decision you can also choose to have us continue to make payments until we decide the appeal.

     

     

XXXXXXXXX                                         Page 2 of 2

Information About Work

  •  

    If you work or want to work but are concerned about losing your SSI or medical assistance, your local Social Security office can tell you more about work incentives and how work and earnings can affect your SSI.

If You Have Any Questions

  •  

    If you have any questions, you may call us toll free at 1-800-772-1213, 7 a.m. to 7 p.m. Monday through Friday. We can answer most of your questions over the phone. Our busiest times are the first week of the month and Mondays. So, we may be able to handle your call more quickly if you can call us at other times.

    You can write or visit any Social Security office. The address of the office that serves your area is:

    123 Main Street
    Anywhere, USA 00000

    If you call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

     

Regional Commissioner

DI 23570.110 Disability Redetermination Flag - Exhibit

DISABILITY REDETERMINATION FLAG

 

TO  : Disability Determination Services
FROM : SSA Field Office #

DISABILITY
REDETERMINATION CASE
(P.L. 104-193)

 

 

 

CHECK ONE:

 

CHILDHOOD        DDS: Upon receipt, enter CDT 02

 

AGE 18       DDS: Upon receipt, enter CDT 04

 

Disability Redetermination Needed

DI 23570.115 Age 18 Disability Redetermination – Continuance Notice Language

A. Exhibit

Social Security Administration

Supplemental Security Income

Important Information

Date:

Case Number:

 

JOHN SMITH

STREET ADDRESS

CITY ST ZIP

 

Earlier we told you that we would review your case to decide if you are disabled under the disability rules for adults. We are writing to tell you that you will continue to receive Supplemental Security Income payments if you still meet all the other eligibility requirements. This is because you are disabled under the disability rules for adults. Also, if you are getting medical assistance based on SSI, your coverage should continue.

We Will Review Your Case Again

The doctors and other trained staff who decided that you are still disabled believe that your health may improve. Therefore, we will review your case again in about 3 years. We will send you a letter before we start your review.

Things To Remember

The decision we made on your case is based on information we have now. If this information changes, it could affect your SSI. For this reason, it is important that you report changes right away. Be sure to tell us about any of the following changes:

  • You go to work.

  • Your job, pay or work expenses change, if you are working now.

  • Your doctor says your health is better.

  • Your income, livings arrangements, or resources change.

If You Disagree With The Decision

If you disagree with the decision, you have the right to appeal. We will review your case again and consider any new facts you have. A person who did not make the first decision will decide your case.

  • You have 60 days to ask for any appeal.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for any appeal.

  • You have to ask for an appeal in writing. We will ask you to sign Form SSA-561-U2, called “Request for Reconsideration.” Contact one of our offices if you want help.

How the Appeal Works

You have the right to review the facts in your case. You can give us more facts to add to your file. Then we will decide your case again. You will not meet the person who will decide your case.

If You Want Help With Your Appeal

You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

If You Have Any Questions

If you have any questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at XXX-XXX-XXXX. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

Street Address

City, ST ZIP

If you do call or visit an office, please have this letter with you. It will help us answer your questions.

 

Regional Commissioner

 

B. Paragraphs with fill-ins

1. Paragraph 1 (Lead-in Paragraph)

Earlier we wrote to tell you that we would review (1) disability case to decide if (2) disabled under the disability rules for adults. We are writing to tell you that (3) will continue to receive Supplemental Security Income payments if (4) all the other eligibility requirements. This is because (5) disabled under the disability rules for adults. Also if (6) getting (7) based on SSI, (8) coverage should continue.

Fill-ins

  1. (1) 

    Choice 1: your

    Choice 2: recipient's name

  2. (2) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  3. (3) 

    Choice 1: you

    Choice 2: he

    Choice 2: she

  4. (4) 

    Choice 1: you still meet

    Choice 2: she still meets

    Choice 3: he still meets

  5. (5) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  6. (6) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  7. (7) 

    Choice 1: medical assistance

    Choice 2: Medicaid

    Choice 3: AHCCCS (for Arizona)

    Choice 4: MediCal (for California)

  8. (8) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

2. Paragraph 2 (Medical Reexamination Diary)

We Will Review [Your/Recipient name, possessive] Case Again

Option 1 (MIE diary established)

The doctors and other trained staff who decided that (1) still disabled expect (2) health to improve. Therefore, we will review (3) case again in (4). We will send you a letter before we start the review.

Fill-ins

  1. (1) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  2. (2) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

  3. (3) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

  4. (4) 

    Month/Year

Option 2 (MINE diary established)

Doctors and other trained staff decided that (1) still disabled. And we realize that (2) health may not improve. But we must review all disability cases. Therefore, we will review (3) case again in 5 to 7 years. We will send you a letter before we start the review.

Fill-ins

  1. (1) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  2. (2) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

  3. (3) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

Option 3 (MIP diary established)

The doctors and other trained staff who decided that (1) still disabled believe that (2) health may improve. Therefore, we will review (3) case again in about 3 years. We will send you a letter before we start the review.

Fill-ins

  1. (1) 

    Choice 1: you are
    Choice 2: she is
    Choice 3: he is

  2. (2) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

  3. (3) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

3. Paragraph 3 (Reporting Reminders)

Things To Remember

The decision we made on (1) case is based on information we have now. If this information changes, it could affect (2) SSI. For this reason, it is important that you report changes right away. Be sure to tell us about any of the following changes.

  • (3) to work.

  • (4) job, pay or work expenses change, if (5) working now.

  • (6) doctor says ( 7 ) health is better.

  • (8) income or resources change.

    Fill-ins:

    1. (1) 

      Choice 1: your

      Choice 2: her

      Choice 3: his

    2. (2) 

      Choice 1: your

      Choice 2: her

      Choice 3: his

    3. (3) 

      Choice 1: You go

      Choice 2: She goes

      Choice 3: He goes

    4. (4) 

      Choice 1: Your

      Choice 2: Her

      Choice 3: His

    5. (5) 

      Choice 1: you are

      Choice 2: she is

      Choice 3: he is

    6. (6) 

      Choice 1: Your

      Choice 2: Her

      Choice 3: His

    7. (7) 

      Choice 1: your

      Choice 2: her

      Choice 3: his

    8. (8) 

      Choice 1: Your

      Choice 2: Her

      Choice 3: His

4. Paragraph 4 (Appeal Rights)

If You Disagree With The Decision

 

If you disagree with the decision, you have the right to appeal. We will review your case again and consider any new facts you have. A person who did not make the first decision will decide your case.

  • You have 60 days to ask for any appeal.

  • The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason if you wait more than 60 days to ask for any appeal.

  • You have to ask for an appeal in writing. We will ask you to sign Form SSA-561-U2, called “Request for Reconsideration.” Contact one of our offices if you want help.

5. Paragraph 5 (Reconsideration Process)

How the Appeal Works

You have the right to review the facts in your case. You can give us more facts to add to your file. Then we will decide your case again. You will not meet the person who will decide your case.

6. Paragraph 6 (Right to Representation)

If You Want Help With Your Appeal

You can have a friend, lawyer, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. Your local Social Security office has a list of groups that can help you with your appeal.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

7. Paragraph 7 (FO Referral)

If You Have Any Questions

If you have any questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (1). We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

(2)

If you do call or visit an office, please have this letter with you. It will help us answer your questions.

Fill-ins:

  1. (1) 

    FO Phone Number from DOORS

  2. (2) 

    FO Street Address from DOORS

8. Name, Title, and Signature Requirements

Follow NL 00601.003.

DI 23570.120 Age 18 Disability Redetermination – Cessation Notice Language

A. Exhibit

Social Security Administration

Supplemental Security Income

Disability Redetermination Decision

Date:

Case Number:

 

JOHN SMITH

STREET ADDRESS

CITY ST ZIP

 

Important Notice—Your SSI Will Stop

 

Earlier we told you that we were reviewing your case to see if you are disabled under the definition of disability for adults. After reviewing all of the information carefully, we have decided that you no longer qualify for Supplemental Security Income (SSI).

 

We urge you to read this entire letter. It includes important information about appeal rights and Medicaid eligibility. It also explains how you can continue to receive benefits if you appeal.

 

The Decision on Your Case

[Personalized Case Language (“PDN”)]

 

When Payments Will Stop

Under the disability rules for adults, you are no longer disabled as of (Month/Day/Year). You will get SSI for that month and the next two months. Your last SSI payment will be for (Month/Year) as long as you continue to meet all other eligibility requirements until then.

Information About Medicaid

For information about any change in your Medicaid eligibility caused by this action, you should get in touch with the county welfare office or social service agency.

You Have Important Appeal Rights

If you disagree with the decision, you have the right to appeal. We will review the case and consider any new facts you have. A person who did not make the first decision will decide the case.

  • You can ask for an appeal anytime within 60 days. But if you want to keep getting payments while we decide the case you must ask for an appeal within the first 10 days.

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to sign a form SSA-789-U4 called “Request for Reconsideration—Disability Cessation.” To get this form, contact one of our offices. Address(es) and phone number(s) are shown on the last page of this letter. We can help you fill out the form.

 

Please read the enclosed pamphlet, “Your Right To Question The Decision Made on Your Claim.” It contains more information about the appeal.

Appeal in 10 Days To Keep Getting Your Payment

  • The 10 days also start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • If you lose the appeal, you might have to pay back some or all of this money. However, we may decide that you do not have to pay the money back.

How An Appeal Works

A Disability Hearing Officer will decide your SSI appeal. We will call this person a DHO in the rest of our letter. The DHO will meet with you before making the decision on the appeal. The meeting works like this.

  • The DHO will mail you a letter at least 20 days before the meeting to tell you its date, time and place.

  • You can look at your file before the meeting.

  • You can tell the DHO the reasons you think you are still disabled. You should give the DHO any information you think is missing from your file. You can bring someone to represent you at the meeting. And you can bring people to explain the reasons you are disabled.

  • You can have the DHO ask people to come to the meeting to speak about your disability and bring important papers. You can question these people at the meeting.

  • You do not have to go the meeting in person. If you do not want to go, you can still give the DHO more facts that you have. The DHO will decide the case using these facts, and what is now in the file. But if you go to the meeting, it may help the DHO to decide the case.

If You Want Help With Your Appeal

You can have a lawyer, friend, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. The local Social Security office has a list of groups that can help you with your appeal.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

If Your Health Gets Worse

If your health gets worse, please get in touch with us. You may be able to get SSI again. We can help you file a new application for SSI.

You have the right to file a new application at any time, but filing a new application is not the same as appealing this decision. So, if you disagree with this decision, you should ask for an appeal within 60 days.

If You Have Any Questions

If you have any questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at XXX-XXX-XXXX. We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

Street Address

City, ST ZIP

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

 

Regional Commissioner

 

Enclosure:

SSA Pub. No. 05-10058

B. Paragraphs with Fill-ins

1. Paragraph 1 (Lead-in)

Important Notice- (1) SSI Will Stop

 

Earlier we told you that we were reviewing (2) case to see if (3) disabled under the definition of disability for adults. After reviewing all the information carefully, we have decided that (4) no longer (5) for Supplemental Security Income (SSI).

We urge you to read this entire letter. It includes important information about appeal rights and Medicaid eligibility. It also explains how you can continue to receive benefits if you appeal.

Fill-ins

  1. (1) 

    Choice 1: Your

    Choice 2: Recipient's Name (possessive)

  2. (2) 

    Choice 1: your

    Choice 2: recipient's name (possessive)

  3. (3) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  4. (4) 

    Choice 1: you

    Choice 2: she

    Choice 3: he

  5. (5) 

    Choice 1: qualify

    Choice 2: qualifies

2. Paragraph 2 (Personalized Denial Language)

The Decision On (1) Case

[Insert required Personalized Case Language (“PDN”) or reference to the personalized attachment. See DI 26530.010.]

Fill-in:

  1. (1) 

    Choice 1: Your

    Choice 2: Recipient's Name (possessive)

3. Paragraph 3 (Benefits Stop)

When Payments Will Stop

Under the disability rules for adults (1) no longer disabled as of (2). (3) will get SSI for that month and the next 2 months. (4) last SSI payment will be for (5) as long as (6) to meet all other eligibility requirements until then.

Fill-ins

  1. (1) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  2. (2) 

    Month/day/year (in the format, “January 12, 1998”)

  3. (3) 

    Choice 1: You

    Choice 2: She

    Choice 3: He

  4. (4) 

    Choice 1:Your

    Choice 2: Her

    Choice 3: His

  5. (5) 

    Month/year (in the format, “January 1998”)

  6. (6) 

    Choice 1: you continue

    Choice 2: she continues

    Choice 3: he continues

4. Paragraph 4 (Medicaid Information)

Information About Your Medicaid

For information about any change in your Medicaid eligibility caused by this action, you should get in touch with (1).

Fill-in:

  1. (1) 

    See NL 00804.110 paragraph 1144 for the fill–in language.

    NOTE: Do NOT use the language in paragraph 1144 — only the fill-in.

5. Paragraph 5 (Appeal Rights)

You Have Important Appeal Rights

If you disagree with the decision, you have the right to appeal. We will review the case and consider any new facts you have. A person who did not make the first decision will decide the case.

  • You can ask for an appeal anytime within 60 days. But if you want to keep getting payments while we decide the case, you must ask for an appeal within the first 10 days.

  • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • You must have a good reason for waiting more than 60 days to ask for an appeal.

  • You have to ask for an appeal in writing. We will ask you to sign a form SSA-789-U4, called “Request for Reconsideration-Disability Cessation.” To get this form, contact one of our offices. Address(es) and phone number(s) are shown on the last page of this letter. We can help you fill out the form.

Please read the enclosed pamphlet, “Your Right To Question The Decision Made on Your Claim.” It contains more information about the appeal.

6. Paragraph 6 (Benefit Continuation Rights)

Appeal In 10 Days To Keep Getting Your Payment

  • The 10 days also start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.

  • If you lose the appeal, you might have to pay back some or all of this money. However, we may decide that you do not have to pay the money back.

7. Paragraph 7 (Disability Hearing)

How An Appeal Works

A Disability Hearing Officer will decide (1) SSI appeal. We will call this person a DHO in the rest of our letter. The DHO will meet with you before making the decision on the appeal. The meeting works like this.

  • The DHO will mail you a letter at least 20 days before the meeting to tell you its date, time and place.

  • You can look at (2) file before the meeting.

  • You can tell the DHO the reasons you think (3) still disabled. You should give the DHO any information you think is missing from (4) file. You can bring someone to represent you at the meeting. And you can bring people to explain the reasons (5) disabled.

  • You can have the DHO ask people to come to the meeting to speak about (6) disability and bring important papers. You can question these people at the meeting.

  • You do not have to go to the meeting in person. If you do not want to go, you can still give the DHO more facts you may have. The DHO will decide the case using these facts, and what is now in the file. But if you go to the meeting, it may help the DHO decide the case.

Fill-ins:

  1. (1) 

    Choice 1: your

    Choice 2: (recipient's name, possessive)

  2. (2) 

    Choice 1: your

    Choice 2: (recipient's name, possessive)

  3. (3) 

    Choice 1: you are

    Choice 2: (recipient's name) is

  4. (4) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

  5. (5) 

    Choice 1: you are

    Choice 2: she is

    Choice 3: he is

  6. (6) 

    Choice 1: your

    Choice 2: (recipient's name, possessive)

8. Paragraph 8 (Help With the Appeal)

If You Want Help With Your Appeal

You can have a lawyer, friend, or someone else help you. There are groups that can help you find a lawyer or give you free legal services if you qualify. There are also lawyers who do not charge unless you win your appeal. The local Social Security office has a list of groups that can help you with your appeal.

If you get someone to help you, you should let us know. If you hire someone, we must approve the fee before he or she can collect it.

9. Paragraph 9 (Things to Remember)

If (1) Health Gets Worse

If (2) health gets worse, please get in touch with us. (3) may be able to get SSI again. We can help you file a new application for SSI.

You have the right to file a new application at any time, but filing a new application is not the same as appealing this decision. So, if you disagree with this decision, you should ask for an appeal within 60 days.

Fill-ins:

  1. (1) 

    Choice 1: Your

    Choice 2: (Recipient's Name, possessive)

  2. (2) 

    Choice 1: your

    Choice 2: her

    Choice 3: his

  3. (3) 

    Choice 1: You

    Choice 2: She

    Choice 3: He

10. Paragraph 10 (FO Referral)

If You Have Any Questions

If you have any questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at (1). We can answer most questions over the phone. You can also write or visit any Social Security office. The office that serves your area is located at:

(2)

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly.

Fill-ins:

  1. (1) 

    FO Phone Number from DOORS

  2. (2) 

    FO Street Address from DOORS

11. Name, Title, and Signature Requirements

Follow NL 00601.003.


DI 23570 TN 34 - Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law (P.L.) 104-193 as Modified by P.L. 105-33) - DDS - 11/30/2021