TN 10 (02-12)

DI 10505.003 Evaluating and Developing Earnings that Clearly are or are not Substantial Gainful Activity (SGA)

A. Defining clearly not SGA

We define “clearly not SGA” as earnings from employment that are clearly below the trial work period (TWP) service month threshold level (for the TWP service months amounts, see DI 13010.060). If a claimant or beneficiary alleges earnings from employment that are below the TWP service month threshold, and there is no evidence that conflicts with his or her allegation or indicates he or she may be in a position to control or suppress earnings, you do not need to complete an SSA-821-BK, Work Activity Report. You must continue to process the case without documenting the work activity with an SSA-821-BK.

B. Processing cases that are clearly not SGA cases

1. Initial entitlement or reconsideration cases

When the field office (FO) or disability determination services (DDS) receives clear evidence that the claimant’s monthly earnings are below the TWP service month threshold level (for the TWP service month amounts, see DI 13010.060) in an initial entitlement case, and we do not have evidence indicating that the claimant:

  • may actually engage in SGA, or

  • is in a position to defer or suppress earnings (see “NOTE” in DI 10505.003B.1. in this section).

Then:

  • do not re-contact the claimant on the work activity or complete a SSA-821-BK; and

  • do not determine the exact amount of monthly countable earnings.

  • accept the claimant’s allegation if his or her statement does not conflict with any other information in the file. Document your findings according to the instructions in this section.

When the FO receives a reconsideration on the initial claim determination, follow instructions in DI 12005.010.

EXAMPLE: A claimant files for disability 12/10/2011, and states that he or she stopped working due to his or her disability on 11/02/2011. The FO forwards the claim to the DDS, and documents the alleged onset date 11/02/2011. The DDS receives notification from the claimant that he or she started working one morning a week for her employer again (performing light clerical duties) in 01/2012, and is earning $200 a month. Since the claimant is earning below the TWP service amount, and he or she is not in any position to suppress or defer his or her earnings, AND the DDS does not have any evidence that conflicts with the claimant’s allegation, the DDS does not have to send this case to the FO to make an SGA decision. The DDS makes a determination that the earnings are clearly not SGA, and continues to process the case.

NOTE: Do not apply this policy to earnings amounts that are equal to or greater than the TWP service amounts, expedited reinstatement (EXR) cases, self-employed individuals, or for individuals who are in a position to control their earnings, such as closed family corporations. You must process self-employment cases and questionable work activity cases following the self-employment SGA guidelines in DI 10510.001.

a. FO procedure for developing and documenting work that is clearly not SGA

If alleged earnings are below the TWP threshold, and there is no conflict with earnings data in our records (i.e., queries such as the Office of Child Support and Enforcement (OSCE) query), stop development and follow these guidelines:

  • Document the monthly earnings allegations and write “clearly not SGA” on the Remarks section of the (Disability Report-Field Office) in the electronic disability claim system (EDCS). For instructions on how to document the SSA-3367, see DI 11005.045

  • In title XVI only cases, document your findings in EDCS and also on the INEQ screen (see MSOM MSSICS 016.005, Blind or Disabled Work Expenses (INEQ).

  • If you have transferred the case to the DDS, alert the examiner to your “clearly not SGA” determination in EDCS, via the update after transfer (UAT) , following instructions in DI 81010.095.

  • If an exclusion prevents you from documenting your determination in EDCS, write your determination on a SSA-5002 and fax it into the non-disability repository for evidentiary documents (NDRed), following the instructions in GN 00301.322. In addition, file your determination in the MDF.

See Also:

DI 13010.700 Office of Child Support and Enforcement Data Query

b. DDS procedure for developing and documenting work that is clearly not SGA

You have the authority to determine that earnings are clearly not SGA in initial entitlement cases, and continue case processing. Do not send a clearly not SGA case to the FO to process an SGA determination if the criteria in DI 10505.003A. applies. If you have any doubts about whether or not the earnings may represent SGA, send an action request (AR) to the FO for a determination on the work activity. Follow these guidelines to process “clearly not SGA” cases:

  • If you receive information that a claimant is working, and his or her work efforts result in earnings below the TWP threshold, and meets all other criteria of a “clearly not SGA” case as outlined in DI 10505.003A, do not return the case to the FO. For TWP service amounts, see DI 13010.060A.

  • Instead, document your determination that the work is clearly not SGA using the following tools:

    1. Report of contact (SSA-5002);

    2. eCAT (if available); or

    3. The electronic case worksheet.

NOTE: Do not apply this policy to EXR cases, self-employed claimants, or for claimants who are in a position to control their earnings, such as a closed family corporation.

2. Continuing disability reviews (CDRs)

The DDS does not make SGA decisions in CDRs. Refer all work issues to the FO or PC, following procedure in DI 28050.010A.4.

When the FO or PC receives information from the beneficiary that he or she works, and his or her monthly earnings meet all of the following:

  • the total earnings match those in the master earnings file (MEF) total earnings (or the discrepancy is not significant to the determination per DI 10505.005C.3); and

  • there is no discrepancy with earnings posted in the Office of Child Support Enforcement (OCSE) query; and

  • all earnings postings are clearly below the TWP level (even when considering possible reallocation); and

  • there is no other evidence (e.g., 3rd party report, or PM verified earnings on the Shared Process) indicating that the individual may be engaging in SGA or in a position to defer or suppress earnings.

Then:

Do not re-contact the beneficiary regarding the work activity, or complete a work activity report. You do not need to determine the exact amount of monthly countable earnings. Instead, follow these guidelines:

  • determine that the work activity is not SGA, because earnings are clearly below the TWP level; and

  • document the file with your findings on the eWork remarks screen, by documenting the earnings amount and verifying by allegation. Also, document your findings on an SSA-5002, and fax the form into the electronic folder. If the case is a not a certified electronic folder, fax the form into the NDRed, and insert it into the modular disability folder (MDF).

C. FO and PC responsibility when earnings are clearly SGA

1. Initial entitlement

When a claimant alleges working at levels that are clearly above the SGA level and there is no reason to question the accuracy of his or her statements and information on the SSA-821 or SSA-820 indicate that:

  • there is no evidence of subsidy, special conditions or impairment related work expenses (IRWE); and

  • the claimant verified that there is no subsidy, special conditions, or IRWE involved; or

  • the evidence is clear that subsidy, special conditions, or IRWE will not reduce earnings below the SGA level; and

Then:

Do not re-contact the claimant regarding the work activity or determine the exact amount of countable earnings. Instead, follow these guidelines:

  • determine that the work activity is SGA, as it is clearly above the SGA level; and

  • document your findings on an SSA-823 (Report of SGA Determination-For SSA Use Only); and

  • document EDCS, following the instructions in DI 81010.140.

For more information on documenting employment cases, see DI 10505.035. For instructions on how to process title XVI initial SGA denials, follow instructions in SI 00602.001.

2. Continuing disability

If information on the SSA-821 and alleged monthly earnings meet all of the following:

  • the total earnings match those in the MEF total earnings (or if the discrepancy is not significant to the determination per DI 10505.005C.3.);

  • there is no evidence or allegation of subsidy or special conditions, IRWE, or the evidence is clear that the alleged subsidy, special condition, or IRWE would not reduce countable earnings below the SGA level; and

  • all earnings postings are clearly above the SGA level (even when considering possible reallocation).

Then:

You do not need to re-contact the beneficiary regarding the work activity or determine the exact amount of monthly countable earning. Instead, follow these guidelines:

  • determine that the work activity is SGA as it is clearly above the SGA level; and

  • continue processing the CDR using eWork. For more information on processing work CDRs, see DI 13010.025.


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DI 10505.003 - Evaluating and Developing Earnings that Clearly are or are not Substantial Gainful Activity (SGA) - 05/07/2013
Batch run: 05/07/2013
Rev:05/07/2013