Effective Dates: 05/13/2014 - Present Previous | Next

Basic (03-86)

DI 41005.035 Exhibits

Exhibit 1 Title II Cessation Basis Codes (Item 11 of SSA-833-U5)
Exhibit 2 Title II Continuance Basis Codes (Item 12 of SSA-833-U5)
Exhibit 3 Occupation Codes (Item 15 of SSA-833-U5
Exhibit 4 Industry Codes (Item 15 of SSA-833-U5)
Exhibit 5 Why Review Was Made (WRM) (Item 20 of SSA-833-U5
Exhibit 6 International Classification of Diseases (ICD) Codes for Visual Impairments (Items 21 and 22 of SSA-833-U5)
Exhibit 7 SSA-833-U5 Completed for DIB Attainment, DIB Allowed
Exhibit 8 SSA-833-U5 Completed for DIB Attainment Freeze Continuance, DIB Denied
Exhibit 9 Notice for Freeze Continuance, DIB Denied Cases - Statutorily Blind Individual Under Age 55 and Engaging in SGA
Exhibit 10 Model Language for Freeze Continuance, DIB Denial Cases - Statutorily Blind Individual Age 55 or Over and Engaging in Comparable SGA
Exhibit 11 SSA-833-U5 Completed for Statutorily Blind Individual, Work Continuance
Exhibit 12 SSA-833-U5 Completed for Statutorily Blind Individual, Entitled to a TWP, (1) Under Age 55 and Engaging in SGA or (2) DIB or CDB Beneficiary Age 55 or Over and Engaging in Comparable SGA
Exhibit 13 SSA-833-U5 Completed for Statutorily Blind Individual, Not Entitled to a TWP, (1) Under Age 55 and Engaging in SGA or (2) DIB or CDB Beneficiary Age 55 or Over and Engaging in Comparable SGA
Exhibit 14 SSA-833-U5 Completed for Statutorily Blind DIB or CDB Beneficiary Age 55 or Over, Entitled to a TWP, Engaging in Noncomparable SGA
Exhibit 15 Model Letter “W” - Redetermination Under 1972 Amendments - No Increase in PIA

Exhibit 1 - Title II cessation basis codes (Item 11 of SSA-833-U5)

Title II cessation basis codes (Item 11 of SSA-833-U5)

01 Medical Condition Not Disabling—Medical Improvement Demonstrated—Able to Engage in SGA
02 Medical Condition Not Disabling—Medical Improvement Not Demonstrated but Individual Has Benefited from Advances in Medical or Vocational Therapy or Technology—Able to Engage in SGA
03 Medical Condition Not Disabling—Medical Improvement Not Demonstrated but Vocational Profile Enhanced by Vocational Therapy—Able to Engage in SGA
04 Medical Condition Not Disabling—New or Improved Diagnostic Techniques or Evaluation Show Impairment(s) Not as Disabling as Considered to be at Time of Most Recent Prior Favorable Medical Determination—Able to Engage in SGA
05 Medical Condition Not Disabling—Substantial Evidence that Any Prior Favorable Medical Determination of Entitlement to Benefits was Based on Error—Now Able to Engage in SGA
06 Future Use
07 Prior Determination was Fraudulently Obtained
08 Widow(er)'s Impairment No Longer Meets or Equals the Listing of Impairments—Medical Improvement Demonstrated
09 Widow(er)'s Impairment No Longer Meets or Equals the Listing of Impairments—Medical Improvement Not Demonstrated, but Individual Has Benefited from Advances in Medical Therapy or Technology
10 Widow(er)'s Impairment No Longer Meets or Equals the Lisitng of Impairments—New or Improved Diagnostic Techniques or Evaluation Show Impairment(s) Not as Disabling as Considered to be at Time of Most Recent Prior Favorable Medical Determination
11 Future Use
12 Widow(er)'s Impairment No Longer Meets or Equals the Listing of Impairments—Substantial Evidence that Any Prior Favorable Medical Determination of Entitlement to Benefits Was Based on Error
13 Failure to Cooperate
14 Whereabouts Unknow
15 Failure to Follow Prescribed Treatment
16 Improvement Expected—Work SGA (Clear-Cut)
17 TWP Completed—Work SGA—No Medical Issue
18 TWP Completed—Work SGA—Medical Issue
19 Not Entitled to a TWP—Work SGA
20 EPE Reinstatement Denied—Work SGA
21 EPE Suspension After Reinstatement—Work SGA
22 EPE Termination—SGA After Reentitlement Period
​       ESRD
26 ESRD - Dialysis Ceased
27 ESRD - Transplant, No Dialysis

Exhibit 2 - Title II continuance basis codes (Item 12 of SSA-833-U5)

30 Impairment Meets Listings
31 Impairment Meets Listings (DWB)
32 Impairments Equals Listings
33 Impairment Equals Listings (DWB)
34 Impairment Plus Vocational Factors
35 35-40 Years of Arduous Work
36 Disability Continues—Medical Improvement Not Demonstrated and No Exception Applies
37 Disability Continues—Data from Most Recent Prior Favorable Medical Determination Insufficient to Assess Medical Improvement
38 EPE Reinstatement—Work Not SGA
39 TWP Not Completed
40 TWP Completed—Work Not SGA
43 Periodic Review Pre-CDR Review Rediary (ODO, PSC-DRS and INTPSC)
44 Reported Income Does Not Constitute Service Months
45 Not Entitled to a TWP—Work Doesn't Demonstrate Ability for SGA
​       ESRD
47 Dialysis
48 Transplant—Severity Continues

Exhibit 3 - Occupation codes (Item 15 of SSA-833-U5)

PROFESSIONAL TECHNICAL AND MANAGERIAL OCCUPATIONS
01 Occupation in architecture, engineering, and surveying
02 Occupation in mathematics and physical sciences
04 Occupation in life sciences
07 Occupation in medicine and health
09 Occupation in education
10 Occupation in museum, library, and archival sciences
11 Occupation in law and jurisprudence
12 Occupation in religion and theology
13 Occupation in writing
14 Occupation in art
15 Occupation in entertainment and recreation
16 Occupation in administrative specializations
18 Managers and officials

CLERICAL AND SALES OCCUPATIONS
19 Other professional, technical, and managerial occupations
20 Stenography, typing, filing, and related occupations
21 Computing and account-recording occupations
22 Production and stock clerks and related occupations
23 Information and message distribution occupation
25 Sales occupation, services
26 Sales occupation, consumable commodities
27 Sales occupation, commodites other than consumable
28 Other clerical occupation

SERVICE OCCUPATIONS
29 Other sales occupation
30 Domestic service occupations
31 Food and beverage prepartion and service occupation
32 Lodging and related service occupation
33 Barbering, cosmetology, and related service occupation
34 Amusement and recreation service occupation
35 Other personal service occupation (e.g., hostesses, stewards, hospital attendants, practical nurses, etc.)
36 Apparel and furnishings service occupation
37 Protective service occupation
38 Office service occupation

AGRICULTURAL, FISHERY, FORESTRY, AND RELATED OCCUPATIONS
39 Other nonpersonnel service occupation
40 Plant farming occupation
41 Animal farming occupation
44 Fishery and related occupation
45 Forestry occupation
46 Hunting, trapping, and related occupation

PROCESSING OCCUPATIONS
47 Other agricultural, fishery, forestry and related occupation
50 Occupation in processing of metal
51 Ore refining and foundry occupation
52 Occupation in processing of food, tobacco, and related products
53 Occupation in processing of paper and related materials
54 Occupation in processing of petroleum, coal, natural and manufactured gas, and related products
55 Occupation in processing of chemicals, plastics, synthetics, rubber, paint, and related products
56 Occupation in processing of wood and wood products
57 Occupation in processing of stone, clay, glass, and related products
58 Occupation in processing of leather, textiles, and related products

MACHINE TRADES OCCUPATIONS
59 Other processing occupation
60 Metal machining occupation
61 Metalworking occupation
62 Mechanics and machinery repairers
64 Paperworking occupation
65 Printing occupation
66 Wood machining occupation
67 Occupation in machining stone, clay, glass, and related materials
68 Textile occupation

BENCHWORK OCCUPATIONS
69 Other machine trades occupation
70 Occupation in fabrication, assembly, and repair of metal products
71 Occupation in fabrication and repair of scientific, medical, photographic, optical horological, and related products
72 Occupation in assembly and repair of electrical equipment
73 Occupation in fabrication and repair of products made from assorted materials
74 Painting, decorating, or related occupation
75 Occupation in fabrication and repair of plastics, synthetics, rubber and related products
76 Occupation in fabrication and repair of wood products
77 Occupation in fabrication and repair of sand, stone, clay, and glass products
78 Occupation in fabrication and repair of textile, leather, and related products

STRUCTURAL WORK OCCUPATIONS
79 Other benchwork occupation
80 Occupation in metal fabricating
81 Welder, cutter, or related occupation
82 Electrical assembling, installing, and repairing occupation
84 Painting, plastering, waterproofing, cementing, or related occupation
85 Excavating, grading, paving, or related occupation
86 Construction occupation

MISCELLANEOUS OCCUPATIONS
89 Other structural work occupation
90 Motor freight occupation
91 Transportation occupation
92 Packaging and materials handling occupation
93 Occupation in extraction of minerals
95 Occupation in production an distribution of utilities (e.g., energy, water, sewage)
96 Amusement, recreation, motion picture, radio and television occupations not included in the proceedings

Exhibit 4 - Industry codes (Item 15 of SSA-833-U5)

AGRICULTURE, FORESTRY, FISHING, HUNTING AND TRAPPING
01 Agricultural production - crops
02 Agricultural production - livestock
07 Agricultural services
08 Forestry

MINING AND COAL AND GAS EXTRACTION (INCLUDING URANIUM
09 Fishing, hunting, and trapping
10 Metal mining
11 Anthractie mining
12 Bituminous coal and lignite mining
13 Oil and gas extraction

CONSTRUCTION
14 Mining and quarrying of nonmetallic minerals, except fuels
15 Building construction - general contractors and operative builders
16 Construction other than building construction - general contributors
17 Construction - special trade contracts (e.g., plumbing, heating, electrical, carpentry, etc.)

MANUFACTURING
18 Other construction
20 Food and kindred products
21 Tobacco manufacturers
22 Textile mill products
23 Apparel and other finished products made from fabrics and similar materials
24 Lumber and wood products, except furniture.
25 Furniture and fixtures
26 Paper and allied products
27 Printing, publishing and allied industries
28 Chemicals and allied products
29 Petroleum refining and related industrices
30 Rubber and miscellaneous plastic products
31 Leather and leather products
32 Stone, clay, glass, and concrete products
33 Primary metal industries
34 Fabricated metal products, except machinery and transportation equipment
35 Machinery, except electrical
36 Electrical and electronic machinery, equipment, and supplies
37 Transportation equipment
38 Measuring, analyzing, and controlling instruments; photographic, medical, and optical goods; watches and clocks

NON-MANUFACTURING
39 Other manufacturing industries
40 Railroad transportation
41 Local and suburban transit and interurban highway passenger transportation
42 Motor freight transportation and warehousing
43 U.S. postal service
44 Water transportation
45 Transportation by air
46 Pipe lines, except natural gas
47 Transportation services
48 Communication
49 Electric, gas, and sanitary services
50 Wholesale trade - durable goods
51 Wholesale trade - nondurable goods
52 Building materials, hardware, garden supply, and mobile home dealers
53 General merchandise stores
54 Food stores
55 Automotive dealers and gasoline service stations
56 Apparel and accessory stores
57 Furniture, home furnishings and equipment stores
58 Eating and drinking places
59 Miscellaneous Retail
60 Banking
61 Credit agencies other than banks
62 Security and commodity brokers, dealers, exchanges, and services
63 Insurance companies
64 Insurance agents, brokers, and service
65 Real estate
66 Combinations of real estate, insurance, loans, law offices
67 Holding and other investment offices
70 Hotels, rooming houses, camps, and other lodging places
72 Personal services
73 Business services
75 Automotive repair, services, and garages
76 Miscellaneous repair services
78 Motion pictures
79 Amusement and recreation services, except motion pictures
80 Health services
81 Legal services
82 Educational services
83 Social Services
84 Museum, art gallaries, botanical and zoological gardens
86 Membership organizations
88 Private households
89 Miscellaneous services
91 Executive, legislative, and general government, except finance
92 Justice, public order, and safety
93 Public finance, taxation, and monetary policy
94 Administration of human resources programs
95 Administration of environmental quality and housing programs
96 Administration of economic programs
97 National security and international affairs
99 Nonclassifiable establishments

Exhibit 5 - Why review was made (WRM) (Item 20 of SSA-833-U5)

01 Court Remand (Based on Social Security Disability Benefits Reform Act of 1984)
02 Reopened Mental Impairment Case (Based on Social Security Disability Benefits Reform Act of 1984)
03 Decision Reviews Required by the Social Security Disability Benefits Reform Act of 1984. Other than those included in 01 and 02 above.
04 Medical Improvement Expected (Medical Reexamination Diary)
05 Medical Improvement Possible (3 Year Periodic Review Diary)
06 Medical Improvement Not Expected (5 Year Periodic Review Diary)
07 Medical Improvement Not Expected (7 Year Periodic Review Diary)
08 EPE Medical Review
09 Adoption Issue
10 TWP Diary Matured
11 Voluntary Report of Medical Improvement
12 Earnings Posted—Medical Reexamination Set
13 Earnings Posted—No Medical Reexamination Set
14 Voluntary Report of Work—Medical Reexamination Set
15 Voluntary Report of Work—Medical Reexamination Not Set
16 Third Party Report
17 State VR Report
18 Court Order (Other Than Medical Improvement—Individual or Class Member)
19 Post Transplant ESRD
20 Special (Use only when specifically instructed)
21 Other (If “Other” code used, indicate why review was made (WRM) in item 24)
22 “301” Case Review Diary
00 Vocational Rehabilitation Diary Maturity (not “301” case)
​ For Possible Future Use (DO NOT USE UNLESS SPECIFICALLY INSTRUCTED)
23 Medical Improvement Expected (Medical Reexamination Diary)—Moratorium Case
24 Medical Improvement Possible (3 Year Periodic Review Diary)—Moratorium Case
25 Medical Improvement Not Expected (7 Year Periodic Review Diary)—Moratorium Case
26 EPE Medical Review—Moratorium Case
27 Voluntary Report of Medical Improvement—Moratorium Case
28 Third Party Report—Moratorium Case
29 State VR Report—Moratorium Case
30 “Clear Cut” Case—Moratorium Case
31 Mental Impairment—Moratorium Case

Exhibit 6 - Impairment codes for visual impairments (Items 21 and 22 of SSA-833-U5)

Listing Diagnostic
Category 		Impairment
Code
2.02 Retinal Detachments and Defects 3610
2.02 Glaucoma 3650
2.02 Cataract 3660
2.02 Low Vision 3690
2.02 Statutory Blindness 3694
2.03A Statutory Blindness 3694
2.03 Visual Disturbances 3680
2.04 Visual Disturbances 3680
9.08D Other Retinal Disorder (Diabetic Retinopathy) 3620

Exhibit 7 - SSA-833-U5 Completed for DIB Attainment, DIB Allowed

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Exhibit 8 - SSA-833-U5 Completed for DIB Attainment, Freeze Continuance, DIB Denied

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Exhibit 9 - Notice for Freeze Continuance, DIB Denial Cases - Statutorily Blind Individual Under Age 55 and Engaging in SGA

See NL 00705.330A

Exhibit 10 - Model Language for Freeze Continuance, DIB Denied Cases - Statutorily Blind Individual Age 55 or Over and Engaging in Comparable SGA

Exhibit 11 - SSA-833-U5 Completed for Statutorily Blind Individual, Work Continuance

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Exhibit 12 - SSA-833-U5 Completed for Statutorily Blind Individual, Entitled to a TWP, (1) Under Age 55 and Engaging in SGA or (2) DIB or CDB Beneficiary Age 55 or Over and Engaging in Comparable SGA

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Exhibit 13 - SSA-833-U5 Completed for Statutorily Blind Individual, Not Entitled to TWP, (1) Under Age 55 and Engaging in SGA or (2) DIB or CDB Age 55 or Over and Engaging in Comparable SGA

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Exhibit 14 - SSA-833-U5 Completed for Statutorily Blind DIB or CDB Beneficiary Entitled to a TWP Age 55 or Over, Engaging in Noncomparable SGA

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To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0441005035
DI 41005.035 - Exhibits - 05/13/2014
Batch run: 05/13/2014
Rev:05/13/2014