• •

  Entitlement terminates

  If entitlement terminates before the month the claimant can be re-entitled, the individual must file an application to become entitled again.

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  Deemed filing

  A deemed spouse must file a new application to become re-entitled if the entitlement was previously terminated because of the entitlement of a legal spouse (see RS 00202.040).

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  Eligibility after ALJ decision

  If the claimant first meets all factors of eligibility after the date of the ALJ decision, a new application is necessary. Eligibility will be determined based on the filing date of the second application and would not be retroactive. (See Example 3 in SI 00601.010C.2.)

  NOTE: If the claimant meets all factors of eligibility in any month during the life of the application, the claimant can receive payment without filing a new application.

• •

  Eligibility after suspension

  Refer to SI 02301.205 for when a new application is required to reestablish eligibility after a suspension.

1. a. 

   Entitlement Conversions

   A beneficiary’s entitlement from one class of benefits to another will automatically occur without the beneficiary having to file an application for the other benefit. Beneficiaries may also have the option to retain their entitlement to specific class of benefits (i.e., child insurance benefits) based on meeting a new entitlement factor (i.e., full time student) without filing an application. We refer to these actions as “Entitlement Conversions.” In some cases, they may need to submit additional evidence or complete a certificate of election for the benefits to start. The following is a list of situations in which entitlement covers without an application with references to the policy for more information:

   • •

     DIB to RIB conversions – RS 00201.001 through RS 00201.003 NOTE: If the DIB NH is at FRA when a subsequent disability determination (i.e., medical or SGA) shows that DIB ceased prior to the conversion, the DIB to RIB conversion will remain valid, the conversion of entitled auxiliaries will also remain valid, and no new application is required.

   • •

     Conversion from auxiliary child's benefits to surviving child's benefits – RS 00203.040.

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     Conversion to widow(er)'s benefits – RS 00207.004 through RS 00207.005

   • •

     Conversion from auxiliary child's benefits to surviving child's benefits – RS 00203.040.

   • •

     Conversion of mother’s/father’s benefits to widow(er)s benefits at FRA – RS 00208.085.

   • •

     Conversion of spouse’s benefits to mother's/father's benefits – RS 00208.001, RS 00208.040, and RS 00208.090.

   • •

     Retaining entitlement to child benefits: A child entitled to child's insurance benefits for the month before attainment of age 18, is eligible for benefit continuation, with no break in entitlement, based on disability or school attendance. (See RS 00205.001 for eligibility criteria for a student and RS 00205.400E.2. for completion requirements for the SSA-1372 (Student's Statement Regarding School Attendance).

     NOTE: Refer to DI 10115.001 through DI 10115.050 for eligibility requirements for a childhood disability beneficiary and RS 00203.080 for application guidelines for childhood disability benefits (CDB)).

   • •

     A disabled surviving spouse who is age 60, but not yet FRA, may elect to receive an aged widow(er)'s benefit if they are in suspense during the EPE because of SGA and payment of an aged widow(er)'s benefit though subject to the annual earnings test may still be advantageous. The individual can submit a signed written statement (e.g., letter, SSA-795, etc.,) to elect an aged widow(er)'s benefit for any month in which the individual was an aged surviving spouse. See RS 00615.315 for policy and procedure for simultaneous entitlement to a widow(er) and disabled widow(er)'s benefit.

2. b. 

   Reinstatements

   A disabled individual whose earnings fall below substantial gainful activity (SGA) during the extended period of eligibility (EPE) after they complete the trial work period (TWP) is automatically reinstated to DIB, CDB or disabled widow(er)'s benefits (DWB). (See DI 13010.210G.) These reinstatements are for cash benefits or freeze and apply only to disability benefits that did not cease prior to 12/01/80.

3. c. 

   Expedited Reinstatement

   An application may not be required if expedited reinstatement of disability benefits is requested under the Ticket to Work and Work Incentives Improvement Act of 1999 (see GN 00204.001F for the policy on using a reinstatement request as an application and DI 13050.000 for procedures on expedited reinstatement

1. a. 

   An existing determination is reopened under the rules of administrative finality (see SI 04070.001 - SI 04070.080 for the policy on Title XVI administrative finality).

2. b. 

   Eligibility was established by conversion from a former State program unless eligibility was subsequently terminated (see SI 01410.001A.3. for the policy on conversion cases).

3. c. 

   Eligibility is reestablished within 12 months following a suspension or 24 months following a suspension only for blind and disabled children of military personnel stationed overseas (see SI 02301.205 for the policy on reinstatement).

4. d. 

   Members of an eligible couple separate or divorce (see SI 02005.030 for the policy requirements).

5. e. 

   One member of an eligible couple:

   • •

     becomes ineligible (see SI 02005.030 for the policy requirements) or dies (see SI 02005.030 for the policy requirements).

   • •

     A disabled or blind recipient attains age 65.

   • •

     A disabled or blind recipient ceases to be disabled or blind after attaining age 65 (see SI 00501.300 for the policy on multicategory eligibility).

   • •

     An aged or disabled recipient becomes blind and the individual lives in a multicategory State where the blind rate is higher (see SI 00501.300 for the policy on multicategory eligibility).

   • •

     An aged individual becomes disabled or blind and is potentially eligible under section 1619(b) of the Social Security Act (see SI 02302.030C.5. for the policy on disability determinations for aged individuals).

   • •

     An individual's request for reinstatement of SSI disability benefits is denied because the individual is found medically improved and able to perform substantial gainful activity

   • •

     Reopening of a Title II determination. For more information on reopening see GN 04001.010.

1. a. 

   Retirement or survivor applications

   • •

     A retirement or survivor application can be filed and awarded, up to 4 months before the month of entitlement a as long as the claimant meets the entitlement factors (like age or insured status).

   • •

     If the claimant wants to file the application earlier than 4 months before meeting the entitlement factors, you must accept the application but deny it. For more on denying applications for lack of insured status, see GN 01010.440.

2. b. 

   Disability applications

   A disability application can be filed and upon receiving the medical determination, it can be awarded if the number holder meets insured status in a future month within the same calendar year. However, you cannot pay benefits until all entitlement factors are met. For details on disability entitlement factors, see DI 10105.005B.

The earliest point at which an application may be taken before eligibility, and effectuated as an allowance, is in the month before the month of eligibility (see SI 00520.900 - SI 00520.930 for the exception related to pre-release cases and SI 00601.011 for the exception related to disabled youth transitioning out of foster care). No payment is due for the first month of eligibility. (See SI 00601.009 for the policy on application effective date.)

EXAMPLE 1 – Ineligible in the month of filing due to resources

Tae Jones, age 66, applies for SSI at the field office on 9/10. The claims interviewer enters 9/10 for the PROTECTIVE FILING DATE and EFFECTIVE FILING DATE on the Supplemental Security Income Application page.

Tae’s has too many resources on September 1, making him ineligible for September. He provides a bank statement dated September 9 showing his resources are now below the limit. Tae meets all other eligibility requirements.

The claims interviewer approves Tae’s application. Tae’s payment status is set as N04 (ineligible) for September and C01 (eligible) for October. The system will update the status from C01 to E02, and payments will start on November 1.

EXAMPLE 2 – Filing prior to attainment of age 65

Hobi Stone will attain age 65 on October 29th. He visits the local Social Security office on September 1st and files for SSI. The claims interviewer enters 9/1 as the PROTECTIVE FILING DATE and 10/29 as the EFFECTIVE FILING DATE on the Supplemental Security Income Application page.

The claim technician is able to adjudicate the SSI application as an allowance because the application was filed in the month before the month of eligibility. Based on Hobi's EFFECTIVE FILING DATE of 10/29 (E02 month), payments will begin 11/1.

NOTE: The age 65 exception discussed in SI 00601.009C.2. applies to this example.

The life of a Title II and Title XVI application starts when the application is filed and extends from the filing date through the date a determination becomes final. See GN 00204.007 for determining the application filing date, and GN 03101.060 for when a determination becomes final.

The life of an application continues based on a timely appeal, or if good cause is established for late filing of an appeal request, but only through the date of the administrative law judge (ALJ) decision. The life of an application also continues when it is remanded to an ALJ by the Appeals Council (AC) or court. (See SI 00601.020A.2. for establishing a protective filing based on a request for AC review and DI 12045.027 when a new claim is filed while an appeal is pending before the ALJ or AC.) The appeal information must be annotated on the Supplemental Security Record (SSR) to keep the record current.