PRESCRIBED PERIOD:
Prescribed period begins with the latest of:
|
|
a.
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_______ Month of number
holder’s
(NH’s) death
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b.
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_______ Last month of previous entitlement to DWB that terminated
because disability
ceased
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c.
|
_______ Last month of entitlement to E (Mother's) benefits
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Prescribed period ends with the earliest of:
|
|
a.
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_______ Month before the month widow(er) attains age 60. (In Medicare -
only cases, leave blank.)
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b.
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_______ If filing for Medicare only, the month before the month widow(er)
attains age 65
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c.
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_______ Last day of 84th month following the month the prescribed period
began
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CONTROLLING DATE
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|
1.
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Select the latest of:
|
a.
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_______ 12 months retroactive from filing date1
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b.
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_______ NH's month of death
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c.
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_______ Month widow attains age 50
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d.
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_______ Month after the last month of entitlement to E or
DWB
|
|
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2.
|
_________ Indicate 1st day of 5th month before date selected in
1. above
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3.
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_________ Indicate the alleged onset date or the potential onset date, (see the chart in DI 25501.220C.1.b.
for POD instructions)
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4.
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_________ Indicate the later date of 2. and 3. above
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5.
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_________ Indicate the date the prescribed period ends
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6.
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_________ Indicate the earlier of 4 and 5 above
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7.
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_________ In a remarried widow(er)’s claim, indicate the date of
remarriage; otherwise, leave blank.
|
8.
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_________ Indicate the earlier of 6 and 7 above.
This
date is the CONTROLLING DATE
|
1 For DWB Medicare-only claims in which the widow(er) alleges amyotrophic lateral sclerosis,
enter the month of entitlement to “D” or “E” benefits.
In a remarried widow(er)'s claim, the controlling date will be established as of the
date of remarriage (line 7), if the remarriage occurred after the attainment of age
50, and the date of remarriage is earlier than the controlling date that would otherwise
be derived from calculations in the guide (line 6). This is because one of the requirements
for entitlement as a remarried widow(er) is that the widow(er) was disabled at the
time of remarriage. In such situations, the remarriage is deemed not to exist. See
RS 00207.003.
Remarriage may also be deemed not to exist in a subsequent DWB claim if the disabled
widow(er) was previously entitled to DWB at the time of remarriage and then subsequently
had entitlement terminated due to, for example, SGA. In this situation, leave item
7 in the guide blank.