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DI 13010.023: Processing Center (PC) Responsibilities for Continuing Disability Reviews (CDRs) involving Work Activity

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  • Effective Dates: 06/14/2017 - Present
  • Effective Dates: 06/28/2018 - Present
  • TN 39 (09-16)
  • DI 13010.023 Processing Center (PC) Responsibilities for Continuing Disability Reviews (CDRs) involving Work Activity
  • A. PC responsibilities for CDRs involving Work Activity
  • The PC is responsible for the evaluation of CDR cases when work activity is involved to determine if eligibility for disability benefits continues. PC responsibilities include:
  • * processing PC jurisdiction work activity cases;
  • * developing evidence of earnings and appropriate work incentive information;
  • * performing a medical folder review (MFR) when the information in the system is insufficient. For more information on medical folder reviews, see DI 40510.040;
  • * maintaining jurisdiction for the adjudication of age 55 or older title II statutory blind work issue cases (for more information on blind work issue cases, see DI 13010.135);
  • * maintaining jurisdiction of railroad cases (Great Lakes PSC only). Also, see DI 44001.140
  • * processing claims for Medicare for disabled individual who work, as outlined in DI 40510.140 through DI 40510.185 Office of Central Operations (OCO) only;
  • * providing due process and appeal rights;
  • * preparing the determination and appropriate notice(s);
  • * effectuating the determination through direct input if possible, or following established procedures to request manual action in the appropriate component on cases that are direct input exclusions; and
  • * developing failure to cooperate (FTC) and whereabouts unknown (WU) cases.
  • B. PC development guidelines and procedures
  • 1. Documenting and verifying earnings
  • Follow procedures DI 10505.005C.
  • 2. Documenting all contact attempts
  • When documenting contacting attempts:
  • * Fully document all contact attempts and the results of your attempts on the eWork development worksheet or the DCF development worksheet (CDRW) screen, as appropriate.
  • * Receipt in the development you receive or closeout the issue by checking the non-receipt check box if you do not receive requested development.
  • * Use the eWork general remarks section to document information that could assist others in subsequent work reviews.
  • * Fax all documentation into eView or NDRed. Documents include forms SSA-833 (Cessation or Continuance of Disability of Blindness Determination and Transmittal) or SSA-899 (Continuing Disability Review), SSA-4268 (Explanation of Determination), SSA-821 (Work Activity Report - Employee) or SSA-820 (Work Activity Report Self-Employment), SSA-823 (Report of SGA Determination – For SSA Use Only), earnings verifications and any other supporting documents.
  • * Fax all documentation into eView. If there is no eView, fax into NDRed. Documents include forms SSA-833 (Cessation or Continuance of Disability of Blindness Determination and Transmittal) or SSA-899 (Continuing Disability Review), SSA-4268 (Explanation of Determination), SSA-821 (Work Activity Report - Employee) or SSA-820 (Work Activity Report Self-Employment), SSA-823 (Report of SGA Determination – For SSA Use Only), earnings verifications and any other supporting documents.
  • C. PC requests for field office (FO) assistance
  • In limited situations, the PC may request FO assistance to process a work CDR.
  • 1. Situations in which FO assistance may apply
  • FO assistance may apply in these situations:
  • * beneficiary states that he or she prefers to work directly with the FO;
  • * a third party or anonymous party alleges fraud;
  • * the beneficiary disputes posted self-employment income;
  • * there is evidence of possible homicidal or suicidal behavior; or
  • * the Disability Determination Service (DDS) needs to make a statutory blindness determination that will affect the substantial gainful activity (SGA) decision. For more information on statutory blind cases, see DI 13010.135, Continuing Disability Considerations in Blindness Cases - Title II Only.
  • NOTE: Failure to cooperate (FTC) procedures may apply when a beneficiary has self-employment income, or appears to be in a situation to control or suppress earnings, such as a family corporation, and is uncooperative (i.e., will not provide information about work activity or form SSA-820-F4 (Work Activity Report- Self-Employment). For more information on FTC, see DI 13015.005A.5.a.
  • 2. Procedure for contacting the FO for assistance
  • Be very specific when you request FO assistance, fully explain why you are sending the request, and state the action you would like for them to take. Follow these guidelines when requesting assistance:
  • * Document the request on the DCF CDRW screen and the eWork Development Worksheet (DW) Remarks screen.
  • * Document that there is additional information in eWork, eView, Paperless Read Only Query System (ROQS) or the Claims File Records Management System (CFRMS).
  • * Transfer the case in eWork to the servicing FO by using the Case Movement function in eWork.
  • * Fax all documentation into eView for certified electronic folder (CEF) cases, or into the Non-Disability Repository for Evidentiary Records (NDRed) for non CEFs if the documentation is not available in Paperless ROQS. To determine if a folder is a CEF, see DI 81001.015.
  • D. PC processing of work CDRs
  • The PC uses eWork to develop and adjudicate work reviews, just as the FO does, per the procedures in DI 13010.025. The PC also uses the processing center action control system (PCACS) to establish workload controls. Most work reviews in the PC result from alerts produced by the Continuing Disability Review Enforcement Operation (CDREO). The PC may also become aware of work activity through other sources such as the CDR Mailer (SSA-455 - Disability Update Report).
  • 1. CDREO alert procedure
  • The CDREO alerts records of title II and concurrent beneficiaries with potentially uninvestigated substantial earnings after disability onset. The CDREO alerts post to the DCF as T2 Work CDRs. Process CDREO alerts according to instructions in DI 13010.027.
  • 2. Dual or multiple entitlement guidelines
  • The PC that maintains jurisdiction of the social security number (SSN) on the primary record (beneficiary’s own SSN) must take the necessary action(s) on all entitlements. If the PC with the non-primary SSN becomes aware of a work issue, they will:
  • * establish the T2 Work CDR on the DCF (if not already established);
  • * add a remark to the DCF that the case is being transferred to the primary SSN PC; and
  • * transfer the DCF to the PC with jurisdiction of the primary SSN.
  • A weekly program run in the PCs establishes the action control request for the work issue.
  • 3. Homicidal or suicidal issues
  • Identify and flag cases when there is evidence of potential suicidal or homicidal behavior. For more information on suicidal or homicidal cases, see DI 13005.070.
  • 4. Work reports procedure
  • The FO or teleservice center (TSC) usually processes work reports, but you may also receive them. For detailed instructions on processing work reports, see DI 13010.020.
  • 5. CDR mailer forms
  • When we initiate a periodic medical CDR, we may send form SSA-455 (Self-help Mailer) to the beneficiary. Question 1 of the form asks if the beneficiary has worked in the past 2 years; and if so, when did the work begin, end, and what are his or her monthly earnings. Evaluate and process this report following the guidelines in DI 40502.001J.
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