2

Enter the three-digit DDS code.

3

Enter the date from the SSA-831 the FO recorded the original decision.

4

Enter the Social Security number (SSN) from folder tab.

5

Claimant's name and address.

a. Enter the name and most recent address of claimant, or

b. If claimant is now deceased, enter the claimant's name only and “claimant deceased.” You do not need an address, or

c. If someone applied on behalf of a claimant, follow the applicant's name with “for” and the claimant's name. If the claimant is deceased, follow the claimant's name with “deceased”. Use the applicant's address for both of these situations.

6

Enter the name of the SSN holder on whose earnings record the claim is filed for childhood disability benefit (CDB) claims, disabled widow/widower benefit (DWB) claims, and parent determinations.

7

Indicate the type of claim as reflected on the original SSA-831.

9

Use date of birth (DOB) from the SSA-831 used to record the original decision.

10

Check the “PD” block if decision was a denial.

11

When a title XVI reopening is also pending in the DDS, enter “Concurrent title II/title XVI.” Also, repeat any remarks appearing on the original SSA-831 that are still pertinent.

11A-11B

Do not complete since presumptive disability does not apply to reopening cases.

12

Complete FO address and code. Enter current FO information if changed from the initial SSA-831.

15-21

See DI 26510.010 through DI 26510.040.

22

Enter the Regulation—Basis code that is applicable to the reopening determination. See DI 26510.045.

23

See DI 26510.050.

25

Check this block except in an escalated claim.

25A

Indicate the level of claim reflected on the most recent SSA-831-U5.

26

See DI 26510.070.

Check block for SSA-4268-U4/C4 if applicable.

27

If an Appendix 2 rule (See DI 25025.001 and DI 25025.005) is met at the time of adjudication in either an allowance, denial, or closed period case, cite the rule after the arrow, e.g., 20201. (You no longer need to check the vocational rule block.)

For complete instructions on rationale preparation, refer to DI 27536.000.

28

See DI 26510.080.

29

Completion of this block is optional when the DDS prepares and releases a notice. In affirmations of denials complete this item in accordance with DI 27540.000.

a. In cases where Office of Disability Operations (ODO) or the Disability Analysis Branch (DAB) prepares and release the denial letter, enter ODO-D/L in this item.

b. If ODO or the Office of Quality Performance only reviews and releases the letter, enter whatever notice the DDS prepares.

30-33

See DI 26510.090.

34

In addition to the entries outlined in DI 26510.095, the following remarks should be entered, as applicable:

“Reopening Reversal (or Affirmation). This Revises Previous Determination dated      .”

In informal remand cases, enter “Informal Remand Case.”