DI 28095: CDR Notice Instructions
TN 1 (10-15)
When preparing a manual notice for Title II, Title XVI and concurrent Title II and Title XVI continuances, use this chart:
|
|
Notices and Fill-ins |
Add Suffix to the Notice * |
|
|---|---|---|---|
|
Type of Case |
Title II |
Title XVI |
|
|
Disability Continues--No Work Activity--No Medical Reexamination Scheduled (SSI and Title II DIB, CDB and DWB Claims) |
Check Block None |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Disability Continues--No Work Activity--Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims) |
Check Block 6 |
Fill-in (Disabled) Check Block 6 |
“A”-“Z”-“C25” |
|
Disability Continues--Trial Work Period Less Than 9 Months--Work Stopped--Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims) |
Check Block 2, 6 |
Fill-in (Disabled) Check Block 2, 6 |
“A”-“Z”-“C25” |
|
Disability Continues--Trial Work Period Less Than 9 Months--Work Stopped--No Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims) |
Check Block 2 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Disability Continues--Trial Work Period Less Than 9 Months--Work Continuing--No Medical Reexamination Scheduled (SSI and Title II DIB and CDB Claims) |
Check Block 3 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Disability Continues--Trial Work Period Completed--Work Stopped--Medical Re-exam Scheduled (SSI and Title II DIB, CDB Claims) |
Check Block 2, 6 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Disability Continues--Trial Work Period Completed--Work Stopped-No Medical Re-exam Scheduled (SSI and Title II DIB and CDB Claims) |
Check Block 2 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Disability Continues--Trial Work Period Completed--Currently Working (Work Not SGA)--Medical Reexamination Scheduled (SSI and Title II DIB and CDB Claims) |
Check Block 4, 6 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Disability Continues--Trial Work Period Completed--Currently Working (Work Not SGA)--No Medical Reexamination Scheduled (SSI and Title II DIB and CDB Claims) |
Check Block 4 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Blindness Continues--Medical Reexamination Scheduled (SSI and Title II DIB, DWB, CDB Claims) |
Check Block 6 |
Fill-In (Blind) |
“A”-“Z”-“C25” |
|
Blindness Continues--No Medical Reexamination Scheduled (SSI and Title II DIB, DWB, CDB Claims) |
Check Block None |
Fill-In (Blind) |
“A”-“Z”-“C25” |
|
Blindness Ends - Disability Continues - Follow DI 28080.065 for additional language needed. (SSI and Title II DIB, DWB, CDB Claims) |
Check Block 6 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
|
Disability Continues--Not Entitled to a Trial Work Period--Currently Working (Work Not SGA)--No Medical Re-exam Scheduled (Title II DIB, CDB, and DWB Claims) |
Check Block 5 |
Fill-in (Disabled) |
“A”-“Z”-“C25” |
Title XVI procedures and Title XVI-Title II notices
Legend of fill-ins for check blocks:
1 Check Block 6--No fill-ins.
Check Block 2--Number of trial work service months tallied. (Never indicate more than nine months)
Check Block 3--Number of months worked in the trial work period, and months counting toward the trial work period.
Check Blocks 4--Month and year of review at end of trial work period.
Check Blocks 5--Trial work period months.
*NOTE: Suffix “A”--Indicates a copy of the notice that will be sent to the representative identified in the Remarks portion of the SSA-832.
Suffix “Z”--Indicates a copy of the notice that will be sent to the authorized organization who requested a copy.
Suffix “C25”--Indicates the beneficiary or recipient requests the return of a document that he or she submitted.
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DI 28090: CDR Rationale Preparation
DI 28090: CDR Rationale Preparation
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