Effective Dates: 12/05/2023 - Present Previous | Next

TN 25 (12-23)

DI 13005.025 Field Office (FO) Actions to Initiate a Continuing Disability Review (CDR)

To initiate a medical CDR, the FO must follow the instructions in this section.

A. Initial request to initiate a CDR

The FO must send an initial notice for the CDR and request the completion of the required forms for each case, see DI 13005.040C. Use the Workload Action Center (WAC) program to send a notice with the appropriate CDR Type Notice language (for example, face-to-face, by mail).

The initial CDR notice gives the individual or representative payee 30 calendar days to respond to the request (either by mail with completed paperwork or to come-in or call-in to the local office). For example, if the initial CDR notice date is 4/15/2019, the individual or representative payee must comply by 5/15/2019. An adult beneficiary or recipient without a representative payee may also have the option to complete and submit the SSA-454 online by accessing the link on their mySSA account by using an i454 application.

The individual must provide the information and evidence needed to determine if their disability continues. If the individual or representative payee does not respond within 15 days after the date on the initial notice, review the case to determine if any special handling considerations apply.

B. Special handling considerations

The FO must provide additional assistance when the FO identifies that the individual has one of the special handling considerations as listed in this chart.

Special Handling Considerations

Reference

Appointed Representative
  • •

    GN 03910.040 Appointment and Revocation of Appointment of Representative

  • •

    GN 03910.050 Contacting a Represented Claimant

Representative Payee

Title XVI Disabled Child (DC)

Age-18 Redeterminations and Individuals aged out of Foster Care in the last 2 years.
  • •

    DI 13006.000 Title XVI Age 18 Medical Redeterminations

Homeless

Mental Impairment
  • •

    GN 00301.180 Identifying Claimants Who May Need Assistance

Limited English Proficiency (LEP) or Hearing-Impaired
  • •

    GN 00203.011 Special Interviewing Situations: Limited English Proficiency (LEP) or Language Assistance Required

  • •

    GN 00203.012 Special Interviewing Situations for Deaf or Hard-of-Hearing Customers

  • •

    GN 00301.180 Identifying Claimants Who May Need Assistance

C. Follow-up to the initial request

If there is no response within 15 days of the date on the initial notice and there are no special handling considerations, use the chart below to complete the following actions:

CDR Follow-up Process - No Special Handling Considerations

Step 1

15 calendar days after the date on the initial notice:

Attempt contact by telephone.

If the telephone contact is successful – Remind the individual or representative payee to return the requested documentation or forms for the CDR. Document the outcome of the telephone contact in the disability control file (DCF). Proceed to Step 2 and there is no need to complete Step 3.

If the telephone contact is not successful – In the DCF document the outcome of the telephone contact. Proceed to Step 2.

Step 2

15 calendar days after the date on the initial notice:

Send a follow-up notice using WAC. Document the DCF with the date that the follow-up notice was sent. If telephone contact was not successful, proceed to Step 3. If telephone contact was successful, proceed to Step 4.

Step 3

 Complete any additional development as stated in DI 13005.025D.1, then 35 days after the date on the initial notice; proceed to Step 4.

Step 4

35 days after the date on the initial notice:

NOTE: If you have not made contact or followed up with the recipient, representative payee, or legal guardian, and more than 75 calendar days have elapsed since the last date of activity (i.e., date of the initial request, date of the follow-up notice or date of the documented telephone call), issue a new initial written request. The new initial request must have a new due date that allows the person 30 calendar days plus 5 days for mailing to comply.

If the FO does NOT receive the completed CDR forms – Make a failure to cooperation – insufficient evidence decision (FTC) determination, document the FTC status in the DCF and put the individual in non-payment status.

NOTE: Do not suspend the benefits prior to 35 days from the date of the initial request. For additional information on suspending the individual’s benefits, see DI 13015.001 or DI 13015.011.

NOTE: The follow-up notice gives the individual or representative payee 15 days to comply. The FO cannot proceed with the FTC or whereabouts unknown (WU) procedures until 35 calendar days after the date of the initial notice. If the individual or representative payee has less than 5 calendar days to comply and contacts the FO they state they are providing the requested information; grant an additional 10 calendar days after the initial due date to comply. For additional information on WU procedures, see DI 13015.011. For example, if the initial CDR notice date is 1/1/2019 and the follow-up notice is 1/16/2019, the FO cannot suspend the monthly benefits until 2/4/2019.

In foreign cases, the FO does not make personal contact by telephone. The Office of Earnings and International Operations (OEIO) will send a notice to the individual or representative payee and request completion of Form SSA-454-BK Continuing Disability Review Report as follows:

Reason for the CDR

Title

Notice

Medical Improvement Expected (MIE) diary

Title II Only

SSA-L1190-U2

Medical Improvement Possible (MIP) diary

Title II Only

SSA-L1219-U2

NONDIARIED review

Title II Only

SSA-L293-U2

D. Individual fails to respond to the follow-up notice

The FO must make every effort to contact the individual or representative payee to follow-up on all requests.

NOTE: If the case meets the special handling considerations listed in DI 13005.025A in this section, follow the procedures in DI 13005.025D2 in this section.

1. Efforts to locate and contact the individual

The FO must contact any party that may have contact with the individual who could provide information such as:

  • •

    a third-party contact,

  • •

    a financial institution (FI),

  • •

    a post office (PO), or

  • •

    an employer(s).

If the individual or representative payee does not respond within 15 days of the follow-up notice, develop and consider:

  • •

    capability, if it appears the individual may not be capable according to GN 00502.020; or

  • •

    the possibility of a new representative payee when the representative payee no longer wishes to serve or is uncooperative according to GN 00504.100.

Follow the FTC or WU procedures in DI 13015.001 or DI 13015.011.

2. When the individual fails to cooperate or cannot be located, and meets the special handling considerations

If there is no response within 15 days of the date on the initial notice, and there are special handling considerations as described in DI 13005.025A, complete the following steps:

CDR Follow-up Process - Special Handling Considerations

Step 1

15 calendar days after the date on the initial notice - Attempt to contact the individual or representative payee by telephone. Make two attempts by telephone on different days and different times.

NOTE: A busy signal does not constitute as a successful attempt.

If the telephone contact is successful - Remind the individual or the representative payee to return the requested documentation or CDR forms. In the DCF, document the outcome of the telephone contact. Proceed to Step 3.

NOTE: There is no need to complete Step 2.

If the telephone contact is not successful - Proceed to Step 2.

Step 2

Query the Supplemental Security Record (SSR), Master Beneficiary Record (MBR) and the Modernized Development Worksheet (MDW) for a current address or telephone number. If a newer address or telephone number is not available, document the DCF. In the DCF, document any forms of development completed for each case. After completing the development, proceed to Step 3.

Step 3

15 calendar days after the date on the initial notice - Send a follow-up notice using WAC to request compliance within 15 calendar days. If the telephone contact was successful, proceed to Step 5.

Step 4 If there is still no response, 15 calendar days after the date on the follow-up notice - The FO must complete the procedures found in DI 13005.025D.1. In the DCF, document any forms of development completed for each case. After completing the development, proceed to Step 5.

Step 5

30 calendar days after the date on the initial notice - Send a come-in or call-in notice using WAC to request compliance within 15 calendar days. Proceed to Step 6.

Step 6

45 days after the date on the initial notice:

NOTE: If you have not made contact or followed up with the recipient, representative payee, or legal guardian, and more than 75 calendar days have elapsed since the last date of activity (i.e., date of the initial request, date of the follow-up notice or date of the documented telephone call), issue a new initial written request. The new initial request must have a new due date that allows the person 30 calendar days plus 5 days for mailing to comply.

If the FO does NOT receive the completed CDR forms– In the DCF, document the FTC or WU status and put the individual in non-payment status.

NOTE: Do not suspend the benefits prior to 45 days from the date of the initial notice. For additional guidance on suspending the individual’s benefits, see DI 13015.001 or DI 13015.011.

Do not consider FTC or WU procedures when the individual:

  • •

    is incapable, unless the representative payee is the legal guardian;

  • •

    requires a representative payee change; or

  • •

    the third party (such as a neighbor, household family member or financial institution) fails to comply and is acting on their behalf. For additional information on direct payment to incapable beneficiaries, see GN 00504.105.

E. Exceptions to initiating a medical CDR

Do not conduct a medical CDR in the following situations:

  • •

    For a Title XVI recipient who is ineligible for Section 1611 or Section 1619 benefits; or

  • •

    A Title XVI or concurrent (Title II and Title XVI) individual who is in current suspense or non-pay status (unless the DDS field on the SSR reflects an initial denial); the individual is entitled to Title XVI due process.

For additional information on the conditions to screen out a medical CDR, see DI 13005.020D.

NOTE: For medical CDR processing instructions for beneficiaries whose ticket to work status is “Assigned” or “In Use SVR”, see DI 55025.001 and DI 55025.010.

If the payment status (PSY) field reflects the codes “N07,” “N08,” “N30”-“N54,” “T31,” or “T51,” the individual is not eligible for payment under Title XVI. Consider the case a Title II case only. With the establishment of the Section 1619 provisions, certain suspense and termination codes took on a revised meaning, see SI 02302.030.

Further development is necessary to determine if a case has become Title II only. Document on an SSA-5002 (Report of Contact) the determination, including the rationale. For example, a case that has the following status:

  • •

    “T5” or “T3” for 12 months,

  • •

    “N04” due to an initial excess resources denial, or

  • •

    “M01” but we will not reestablish the record. Attach all documentation to the completed SSA-5002 (Report of Contact).

NOTE: The FO will include an SSA-5002 (Report of Contact) in every folder transmitted to any component including the DDS, which explicitly states whatever disability entitlement exists (for example, Title II only, Supplemental Security Income (SSI) disabled child (DC), etc.).

F. References

  • •

    DI 13015.001 Failure to Cooperate- Insufficient Evidence Decision (FTC) Policy for Continuing Disability Reviews (CDRs) – Field Office (FO)

  • •

    DI 13015.005 Failure to Cooperate- Insufficient Evidence Decision (FTC) Suspension Procedures for Continuing Disability Reviews (CDRs) – Field Office (FO)

  • •

    DI 13015.007 Failure to Cooperate- Insufficient Evidence Decision (FTC) Reinstatement Procedures for Continuing Disability Reviews (CDRs) - Field Office

  • •

    DI 13015.011 Whereabouts Unknown (WU) Policy for Continuing Disability Reviews (CDRs) – Field Office (FO)

  • •

    DI 13015.013 Whereabouts Unknown (WU) Determinations and Reinstatement Procedures for Continuing Disability Reviews (CDR) – Field Office

  • •

    DI 13015.025 Field Office (FO) Assistance in Medical Continuing Disability Reviews (CDRs) and Failure to Cooperate- Insufficient Evidence Decision (FTC) or Whereabouts Unknown (WU) Cases

  • •

    DI 25205.020 Failure Issues

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0413005025
DI 13005.025 - Field Office (FO) Actions to Initiate a Continuing Disability Review (CDR) - 12/05/2023
Batch run: 10/21/2024
Rev:12/05/2023