BASIC (03-86)

The SSA-4268-U4 should contain a summary of the evidence supporting the conclusion that the beneficiary was or was not engaged in SGA. If the TWP applied and there were TWP service months, they should be enumerated.

If comparability of work activity for DIB, CDB, and DWB individuals age 55 and over is at issue, the SSA-4268-U4 should contain a summary of the evidence supporting the conclusion.

A. Continuances

The rationale for continuances should fully explain the basis for the continuance determination.

B. Cessations

The rationale for cessations should show that the due process requirements are met (see DI 13010.185 ff.) and that the beneficiary was or was not entitled to a TWP; that the work activity was determined to be SGA; that the month of cessation was determined to be (state month and year).

In “Failure To Cooperate” cases, the efforts to gain the beneficiary's cooperation should be cited, giving pertinent dates.

C. Identifying information

The name of the beneficiary, the wage earner (in CDB or DWB claims) and the SSN should be entered in the appropriate spaces at the top of the SSA-4268-U4.

D. Signature and date

Initial and date the SSA-4268-U4.