The instructions in this section apply when an FTC issue occurs during the medical CDR process while the case is at a State disability determination services (DDS). If work activity is the sole issue, the field office (FO) has jurisdiction see DI 28020.050 and DI 28030.025.

The disability adjudicator must follow the guidelines for general development of CDR cases in DI 28030.000. For pre-hearing (PH) or Disability Hearing Unit (DHU) FTC cases follow CDR case processing instructions described in this section.

FTC occurs when an individual fails, without good cause, to do by a certain date what the Social Security Administration (SSA) or the DDS has asked them to do.

That is, the individual fails to:

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  Provide medical or other evidence; or

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  Attend a scheduled consultative examination (CE); or

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  Take any other required action that SSA or the DDS has requested.

SSA considers an FTC cessation by the DDS to be a medical determination.

IMPORTANT: While an individual may fail to cooperate with a request for information or action, we have a responsibility to provide a medical determination based on the available evidence. Even when the individual fails to cooperate with an initial request for evidence or action, we may find that disability continues when supported by the case evidence.

The adult individual and their representative payee have a responsibility to cooperate with, and to take any action requested by, SSA or the DDS to complete the medical CDR. For a Title II disabled minor child and a Title XVI disabled child, this responsibility ultimately rests with adult responsible for the child (i.e., parent, guardian, relative, or other person acting on the child's behalf).

For additional information concerning Title II disabled minor children, see DI 23505.001.

For additional information concerning Title XVI disabled children and FTC, see DI 25205.020.

FTC is a Group II exception to the MIRS see DI 28020.900. Group II exceptions do not require a finding that the:

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  Individual is not currently disabled; i.e., do not require a finding of ability to engage in Substantial Gainful Activity (SGA) or,

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  Child's impairment(s) no longer causes marked and severe functional limitations for Title XVI child cases.

When the individual fails to cooperate with an initial request, the adjudicator must make a reasonable effort to develop all the evidence that does not require the individual's cooperation and make a determination using the CDR sequential evaluation process, as set forth in DI 28005.015. For explanation of "reasonable effort," see DI 22505.001A.2.

When the individual does not provide good cause for failing to comply with the DDSs request and the evidence is insufficient to support a continuance, the DDS will apply the Group II exception to the determination and terminate Title II benefits or Title XVI payments.

When the evidence is sufficient to make a continuance determination, FTC does not apply, see DI 28020.900 B.2.

When the individual fails to cooperate with a request for evidence or action, use the follow-up procedures for adult Title II and Title XVI initial and reconsideration cases explained in DI 23007.000.

For more information about procedures when FTC occurs in a Title XVI disabled child case, see DI 25205.020.

NOTE: Allow 10 days for the due date, plus 5 days for mailing before processing a cessation due to a failure to cooperate situation.

If the DDS receives a case where the FO identified FTC but did not do required FTC development before sending it to the DDS, the DDS adjudicator must return the case(s) to the FO for the required development in DI 13005.025, i.e., obtain interview forms and releases.

When a Title II individual is in terminated status due to work and does not cooperate with the FO during the medical CDR, the DDS must make a medical CDR determination to determine if entitlement or eligibility for extended Medicare benefits should continue, see Policy-Extended Medicare Eligibility DI 28055.001B.

When the individual does not provide good cause for failing to comply with the DDSs request and the evidence is insufficient to support a continuance, the DDS will apply the Group II exception, as explained in DI 28075.005D in this section. The DDS must follow up on the initial request as explained in DI 22505.014.

Disability ends the first month in which the individual:

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  Failed to comply with the initial request by a certain date,

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  Did not provide a good cause, and

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  Was informed their benefits may cease as an effect of not cooperating.

The cessation date will be the date the requested action or information was due.

Follow the FTC development procedures Failure to Cooperate in DI 23007.000 and document all efforts made to resolve the issues on an SSA-5002 (Report of Contact), or on a Case Note in the Disability Case Processing System (DCPS) and "write to" the case development worksheet (CDW). Include the following:

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  Efforts to resolve the issue(s), and the dates,

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  Results of the efforts, and

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  Justification for a cessation.

The DDS makes the FTC determination. For all FTC situations, the cessation date cannot be earlier than the first month in which the individual failed to do what we asked.

Prepare the Form

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  SSA-832-U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) or

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  SSA-833-U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title II)

Follow the instructions Completion of Continuing Disability Review Determination Forms (SSA-832 and SSA-833)in DI 28084.000.

Also prepare any other relevant forms which explain the determinations.

Upload the completed forms to the certified electronic folder (CEF) or place the completed paper forms into the paper folder and forward the folder(s) to the FO.

See also:

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  DI 28080.110 Processing Medical Cessation Cases for Disability Determination Services (DDS)

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  DI 28095.105 Title II Medical Cessation Notices Chart

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  DI 28095.110 Title XVI Medical Cessation Notices Chart

A cessation determination due to FTC, is eligible to receive, statutory benefit continuation (SBC) because it is a medical determination.

The individual has 60 days to appeal a cessation determination. The usual CDR appeal procedures apply. For Standards and Development Guidelines for the Reconsideration CDR Process, see DI 29005.001. If applicable, the DDS hearing officer will revise the cessation date. To determine the cessation month, see DI 28005.205C.1.

When the appeal period has expired, the DDS may only consider reopening if the rules of administrative finality allow (See Conditions for Reopening a Final Determination or Decision, DI 27505.001).

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  DI 22505.014 Requesting Evidence or Action from the Claimant or Third Party

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  DI 22510.016 Claimant Consultative Examination (CE) Notice and Confirmation Procedures

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  DI 22510.019 Consultative Examination (CE) Appointment Notice Follow-up and Reminder

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  DI 23007.000 Failure to Cooperate

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  DI 25205.020 Failure to Cooperate and Insufficient Evidence in Title XVI Disabled Child (DC) Cases

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  DI 28005.205 Determining the Cessation Month in Continuing Disability Review (CDR) Cases

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  DI 28020.001 General -- Groups I and II Exceptions to Medical Improvement (MI)

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  DI 28080.110 Process Medical Cessation Cases for Disability Determination Services (DDS)

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  DI 28084.000 Completion of Continuing Review Determination Forms (SSA-832 and SSA-833) - Table of Contents

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  DI 28095.105 Title II Medical Cessation Notices Chart

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  DI 28095.110 Title XVI Medical Cessation Notices Chart