1
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Does the aged alien claimant allege that they were lawfully residing in the U.S. on
8/22/96 or that they entered the U.S. before 8/22/96?
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•
If yes, continue with Step 2.
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•
If, no, STOP. Eligibility is not possible under the exception condition for qualified aliens who
are blind/disabled and were lawfully residing in the U.S. on 8/22/96.
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2
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Is the aged alien claimant potentially eligible under a time-limited category (e.g.,
refugee, asylee, etc.) in accordance with SI 00502.106B?
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•
If yes, continue with Step 3.
-
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3
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Did the alien submit acceptable documentary evidence that proves they are now in time-limited
alien category, or, if currently LAPR, was previously in a time-limited category?
(See SI 00502.130 for acceptable documentary evidence.)
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•
If yes, continue with Step 4.
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•
If no, obtain acceptable documentary evidence of status per SI 00502.130 and continue with step 4.
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4
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Is DHS verification of status in a time-limited status required?
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•
If yes, obtain verification of status in accordance with SI 00502.115 and continue with Step 5.
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•
If no, continue with Step 5.
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5
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If the aged alien claimant is potentially eligible for SSI because
they
meet one of
time limited categories based on documentary evidence and DHS verification (if required),
take the
following actions:
a. Adjudicate the application as an aged claim; and
b. If the aged alien claimant alleges disability /blindness, establish the systems record
as follows:
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•
Answer the appropriate disability/blindness questions on the Additional Client Data
(ACLD) screen in MSSICS with “Y.”
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•
MSSICS will build the type of claim as an Aged Individual (AI).
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•
The Development Worksheet (DW01) will control the receipt of the DDS decision.
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•
Send to the SSR via BTS (DSSR) and close the event. Payments will begin under the
applicable time-limited eligibility category.
The SSR can reflect only one alien eligibility (AER) code at a time (SM 01005.642).
The record of a refugee whose eligibility is limited to 7 years (AR code=”F”) will
show an AER code “1.” The record of an alien whose deportation or removal is being
withheld (AR=”J”) will show an AER code “2.” For aged aliens with eligibility limited
to 7 years, the system will automatically build an AER code “8” (“aged alien requiring
disability decision”) only for asylees (AR=”L”), Amerasian immigrants (AR=”3”), and Cuban/Haitian Entrants (AR=”X”)
who allege being blind or disabled.
c. Obtain the medical determination on a post-adjudicative basis using the following
guidelines:
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•
NOTE: If the individual who is age 65 or older is receiving Title II benefits, do not adopt
a prior Title II disability determination (if one was made in the case). Instead,
obtain a new disability decision for purposes of establishing alien eligibility under
the provision for blind/disabled qualified aliens who were lawfully residing in the
U.S. on 8/22/96.
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•
When sending the claim to the DDS for a medical decision, include the following notation
in the “Remarks” portion of the “Title II/Title XVI Information” screen in MSDCT or
SSA-831-U3: “Title XVI Aged Alien – Blindness/Disability Alleged – Systems Limitation.”
Refer to instructions in DI 11055.130 for preparing Form SSA-831-U3 (Disability Determination and Transmittal).
IMPORTANT: When the Aged Alien “System Limitation” annotation is included on the SSA-831-U3
and the DDS determines the individual is neither blind nor disabled, the DDS will
prepare a write-up entitled “Information About the Disability Decision” that will
provide the individual with a personalized explanation of the medical decision their
case. The DDS will place the write-up in the medical folder and return the folder
to the FO.
d. Continue with Step 6
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6
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After the initial claim based on the 7-year provision has processed, has the medical
determination for the aged alien been received?
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•
If yes, continue with step 7.
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•
If no, follow up on status of pending medical determination. When determination has been
received, continue with step 7.
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7
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Was the aged alien medically allowed by DDS?
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•
If yes, continue with Step 8.
-
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8
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Process medical allowance for aged alien who is currently eligible based on 7-year
provision as follows (post-entitlement):
a. If MSSICS case, input as follows:
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•
Update by establishing a “STAND ALONE PE EVENT.”
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•
Complete the Disability Clearance Data (CDIB) screen, including the appropriate Multi-category
Eligibility Code.
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•
Send to the SSR via BTS (DSSR) and close the event. This will build the transaction
that will establish the multi-category code, as well as other disability data, on
the SSR.
b. If non-MSSICS case, input as follows:
Transmit an SSA-1719B with the appropriate disability data per SM 01301.605 (Multi-category,
or “CM” field) and SM 01305.855 (Date of Onset field).
c. Prepare Manual Notice for MSSICS and Non-MSSICS cases as follows:
Prepare a manual SSA-L8166, “SSI Important Information,” using the Document Procession
System (DPS) if appropriate. Explain in the notice that:
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•
Although the prior notice (initial claim award) indicated that the individual’s eligibility
was limited to 7 years, the individual is now eligible to receive SSI benefits without
a time limit; (assuming all other factors of eligibility continue to be met); and
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•
This is the case because the individual has been determined to be blind or disabled
and was lawfully residing in the U.S. on 8/22/96.
STOP! No further action is necessary.
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9
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Process medical denial for aged alien who is currently eligible based on 7-year
provision as follows (post-entitlement):
a. If MSSICS case, input as follows:
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•
Update MSSICS by establishing a “STAND ALONE PE EVENT.”
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•
Record in SSR Remarks (CRMK) the date and denial code of the DDS decision.
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•
Receipt the DW01 for the medical decision.
b. If non-MSSICS case, input as follows:
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•
Transmit the date and denial code of the DDS decision via SSA-1719B in the Remarks
field.
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•
NOTE: No other systems input is needed. The aged alien recipient’s SSI benefits will be
suspended (N13) when the 7-year period expires, assuming the alien coding on the record
shows no basis for eligibility past the 7-year period.
c. Prepare a manual notice for both MSSICS and Non-MSSICS cases as follows:
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•
Use an SSA-L8166-U-2, “SSI Important Information” from DPS.
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•
Include the following special language in the notice:
“We looked at your claim to see if you were disabled under our rules. We have decided
that you are not disabled under our rules. Detailed information about our decision
is shown on the
attachment called “Information About the Disability Decision.” If you disagree with
the disability
decision, please read the information later in this notice about filing an appeal.”
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•
Explain in the SSA-L8166 that the recipient’s current eligibility is not affected
by the medical denial and can continue based on their current alien status through
the end of the applicable 7-year period.
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•
Mail the notice, along with the DDS write-up entitled “Information About the Disability
Decision” (see “IMPORTANT” in Step 5c.) to the aged alien recipient.
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•
Since the medical decision is an initial determination, the decision is appealable.
The DPS version of the SSA-L8166 has preprinted appeal rights.
STOP! No further action is necessary.
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10
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For aged alien claimant where alien eligibility is not possible without disability
allowance (i.e., alien cannot be eligible based on status in a 7-year category):
Is the aged alien presumptively blind or disabled in accordance with the lists of
impairment categories in DI 23535.010. (FO is authorized to make PD/PB decision) or DI 23535.010B.
(DDS is authorized to make a PD/PB decision)?
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•
If yes, continue with Step 11
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•
If no, skip to Step 13.
NOTE: In general, an SSI claimant may receive 6 months of payments before the final determination
of disability or blindness is made if
-
•
They are determined to be presumptively disabled or blind; and
-
•
They meet all other non-disability eligibility requirements.
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11
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For aged alien who meets presumptive disability or blindness impairment from Step
10:
Does the aged alien meet all of the non-disability eligibility requirements?
-
•
If yes, continue with Step 12.
-
IMPORTANT: For the purpose of determining whether an aged alien can get PD or PB payments, consider
the aged alien to meet all of the non-disability eligibility requirements” if—
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•
They are currently a qualified alien based on appropriate documentary evidence of
alien status (SI 00502.130) and DHS verification (if required in accordance with SI 00502.115); and
-
•
DHS verified that the aged alien was lawfully residing in the U.S. on 8/22/96 (item
5.f of the Supplement to the G-845 described in SI 00502.115E.5.b.); and
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•
The aged alien meets all of the other non-disability factors of eligibility (e.g.,
income, resources, residency, etc.).
NOTE: Place the case in H80 until development for all factors is complete.
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12
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Aged alien who needs medical allowance to be eligible meets the requirements for payment
based on presumptive disability/blindness:
a. If MSSICS case:
-
•
Answer the appropriate disability/blindness question on the Additional Client Data
(ACLD) screen.
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•
Complete the Disability Data (ADIB) screen showing “2” for Presumptive Disability
and the appropriate Presumptive Onset Date.
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•
Complete the Adjudicative Decision (DADJ) screen, send to the SSR via BTS (DSSR),
and close the event.
b. If non-MSSICS case, code the SSA-450SI input as follows:
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•
TP of “AI” for age 65 or older;
-
-
•
The appropriate AR (SM 01005.632), AQ (SM 01005.642), and ZX (SM 01005.645) fields;
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•
Input a “DO” (Date of Onset) with “P” for presumptive disability;
-
STOP! No further action is necessary.
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13
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Take the following actions if alien eligibility is not possible without a disability
allowance and presumptive disability/blindness is not involved:
a. Obtain medical decision according to the following guidelines:
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•
NOTE: If the individual who is age 65 or older is receiving Title II benefits, do not adopt a prior Title II disability determination (if one was made in the case). Instead,
obtain a new disability decision for purposes of the provision described in this section.
-
•
When sending the claim to the DDS for a medical decision, include the following notation
in the “Remarks” portion of the “Title II/Title XVI Information” screen in MSDCT or
SSA-831-U3: “Title XVI Aged Alien – Blindness/Disability Alleged – Systems Limitation.”
Refer to instructions in DI 11055.130 for preparing Form SSA-831-U3.
NOTE: When this annotation is included on the SSA-831-U3 and the DDS determines the individual
is neither blind nor disabled, the DDS will prepare a write-up entitled “Information
About the Disability Decision” that will provide the individual with a personalized
explanation of the medical decision in their case. The DDS will place the write-up
in the medical folder and return the folder to the FO.
b. Undertake simultaneous development of non-disability factors of eligibility:
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•
Obtain documentary evidence of current qualified alien status in accordance with SI 00502.130; and
-
•
Verify current qualified alien status as appropriate in accordance with SI 00502.115; and
-
•
Verify whether the alien was lawfully residing in the U.S. on 8/22/96 using the G-845
process (item 5.f of the Supplement to the G-845 described in SI 00502.115E.5.b.); and
-
•
Develop whether the claimant meets all of the other non-disability factors of eligibility
(e.g., income, resources, residency, etc.).
-
•
Do not defer development of the non-disability factors of eligibility in an aged alien’s
case while the medical decision is pending.
c. If MSSICS, establish the systems record as follows:
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•
Answer the appropriate DISABLED/BLIND question on the Additional Client Data (ACLD)
screen with “Y.”
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•
Complete the Disability Data (ADIB) and other screens in MSSICS.
-
•
Build the SSR but do not close the event. (If you close the event before a medical
decision is posted, MSSICS will build an erroneous N13 denial.)
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•
MSSICS will set up the case as an Aged Individual (AI) in H80 status.
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•
MSSICS will automatically build the AER code of “8” (“aged alien requiring a disability
determination”) on the SSR.
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•
Hold the case until the disability decision is returned from the DDS.
d. If non-MSSICS case, establish the systems record as follows:
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•
Complete the SSA-450SI as usual, including TP of “AI,” AQ with code “8,” and PS of
“H80.”
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•
Do not include the DO, SA, or CM fields
Continue with Step 14.
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14
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Upon receipt of the medical decision from the DDS:
Was the aged alien medically allowed by DDS?
-
•
If yes, continue with Step 15.
-
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15
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For aged alien claimant who was medically allowed, and medical allowance is needed
for
eligibility, do systems input as follows:
a. If MSSICS case:
-
•
Update the existing MSSICS pending file with any new data.
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•
Complete the Disability Clearance Data (CDIB) screen if the DDS decision is not already
recorded there, including the appropriate Multi-category Eligibility Code.
-
•
Send to the SSR via BTS (DSSR) and close the event.
b. If non-MSSICS case, transmit an SSA-450SI with:
-
•
DLPS (to delete H80); and
-
•
Date of onset (SM 01305.855), medical data (SM 01305.900), and multi-category code
(SM 01301.605).
STOP! No further action is necessary.
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16
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For aged alien claimant who was medically denied, and a medical allowance was needed
for eligibility, take the following actions to process the N13 denial:
a. If MSSICS case:
-
•
Close the open event on the Build SSR (DSSR) screen.
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•
Suppress the automated denial notice via the Update Notice Suppression (UNSP) in Direct
SSR Update. (See instructions in MSOM BUSSR 002.018 for completion of the UNSP screen).
-
•
Since no information was entered on the CDIB, MSSICS will build the N13 denial on
the DADJ.
b. If non-MSSICS case:
-
•
Transmit a PR9 with DS N13.
-
•
Suppress the automated denial notice (NP field).
c. Prepare a manual (N13) denial notice for both MSSICS and non-MSSICS
cases using DPS as follows:
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•
Complete the client information, then click “Document Selection” in the left-hand
navigation window.
-
•
Search for the “SSA-L8030-U2 – ALIEN02 – MANUAL DENIAL – NOT ELIGIBLE ALIEN” or select
“Initial Claims” and navigate to the notice.
-
•
When prompted, select the paragraph designated as “AGED PERSON DENIED – NOT DISABLED.”
-
•
From the “Group Selection” screen select “enclosure” and attach the DDS write-up entitled
“Information About the Disability Decision” (see “IMPORTANT” under Step 5c of this
table) to the notice.
-
•
Mail the notice and the write-up to the claimant.
STOP! No further action is necessary.
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