Write the appropriate name and address. For a deceased beneficiary, write the name only, and write “DECEASED” in the address area. Write the Social Security Number (SSN), date of birth, and if appropriate, the name of the wage earner (if this is an auxiliary case).

In the blank following “Period From” show the latest of the date:

• •

  of filing a SSA-16-F6 (Title II supplemental application); and

• •

  of the disability examiner’s (DE) or claim representative’s (CRs) signature on the latest SSA-833-U5 continuance or SSA-899-U2 in file.

Item A.2.(a) or (b)

If termination was due to death or attainment of full retirement age (FRA), write the month and year death occurred, or when the beneficiary attained FRA.

Show the month and year following the month of the last due check (e.g., cessation date was 01/2010, beneficiary received checks through 03/2010), write 04/2010 in item A.2.(c).

Write one “X” only in the appropriate blocks in each of the items, B., Part I and II and C.

Do not write in this block. If necessary, enter any needed TWP or medical improvement expected (MIE), medical improvement possible (MIP), medical improvement not expected (MINE) diaries on the disability control file (DCF).

Do not check either the “ODO” or “PSC” block and check the category of case involved.

Fax all eWork documentation and any supporting work development into eView or NDRed. For a list of documents see DI 13010.025B.