RS 00203: Child's Benefits
TN 14 (10-07)
A. Procedure - general
1. Disability development
Complete development instructions for childhood disability benefit (CDB) cases are located in DI 11020.000.
Consider re-entitlement via expedited reinstatement (DI 13050.000) if the child’s previous CDB entitlement ended due to his or her own work activity.
CAUTION: Disability development does not have to be undertaken if the dependency or relationship requirements are not met or the number holder (NH) was not insured. Follow DI 11020.050, Field Office (FO) Authorization of Childhood Disability Benefits (CDB) Involving Substantial Gainful Activity (SGA), and Technical Denials, when the CDB claim does not require a disability determination.
REMINDER: Follow GN 00204.022 on when to explore entitlement on another earnings record and DI 13010.500 on when to use the Disability Control File (DCF).
2. Electronic Disability Collect System (EDCS) Processing
The FO will complete the case in EDCS unless an exclusion exists and will transfer the claim to the Disability Determination Services (DDS). See DI 81010.030A. The claim will be accessible in eView. The eView program allows the user to check the status of the claim. Messages and case updates can be added through the EDCS program and will be posted in eView. For example, “claimant can only be reached after 5 p.m.”
3. Insured status
Always consider the possibility of entitlement on the CDB’s own SSN if he or she worked. Use the Disability Insured Status Calculator Online (DISCO) or the Informational Certified Earnings Record System (ICERS) to verify possible insured status.
NOTE: Remarks can be entered in EDCS so they are readily available to the DDS in eView.
IMPORTANT: DISCO cannot be used to document non-insured status on any SSN since a certified earnings record (CER), such as a CER from ICERS, is required per GN 01010.440.
4. FO routing
a. General
All CDB cases which need a determination of disability will be transferred to the appropriate DDS or other adjudicating component. Follow instructions in:
DI 11020.000 on jurisdiction, routing and transmitting cases to DDS or the Program Center (PC); and
DI 81010.085B regarding the transfer of the Certified Electronic Folder (CEF).
NOTE: GLPSC – Disability Process Branch (DPB) has jurisdiction of Title II disability determinations for career annuitant and career railroad dependent survivor claims. (See DI 11010.262 and DI 20101.040A.1. for additional instructions.)
b. Exceptions
See DI 11020.060 for exceptions to the general routing procedures.
5. Disability determination for child to entitle or to continue benefits to a mother/father or young spouse
If a disability determination is necessary for a child age 15 ½ or older in order to entitle or continue benefits to a mother/father or young spouse, follow DI 11020.060 and DI 23505.001.
If both a physical and mental impairment are alleged, enter “child-in-care” in the remarks section of the EDCS 3367. This will alert the DDS to identify in remarks a documented mental impairment which is not shown as the primary or secondary impairment.
6. Disability determination for disabled minor child to enable continuation of child's benefits at age 18
CDB payments cannot begin prior to age 18. While the disability determination is being developed, ensure that the appropriate system input is made to enable automatic conversion when the child attains age 18. (See MSOM COMMON 005.017.)
B. Procedure – pending childhood disability action
If other claimants are simultaneously filing, process the disability claim as a delayed claim (see GN 01010.140). If the child is also claiming benefits as a full-time student, see RS 00203.090.
1. Child already entitled (post-entitlement action)
Suspension actions for developing childhood disability determinations are processed by Title II Redesign (T2RD). Follow processing instructions in MSOM COMMON 005.017 for the appropriate systems input.
IMPORTANT: If the child is entitled as a student, a suspension action is not appropriate.
2. Child entitled prior to age 18 (initial award)
a. Partial award
The claim can be processed as a partial award in the FO (see GN 01010.110 - GN 01010.120). Advise in the award notice that the claim for CDB benefits is pending. See NL 00725.005 for the appropriate Universal Text Identifiers (UTI).
b. Develop for Child Disability Determination (DDIB) Process
The DDIB screen can be entered for the child beneficiary as early as age 17 ½ to prevent termination at age 18. Follow RS 00203.090 Exception and DI 11020.005 if the child could be found entitled as a full-time student.
EXCEPTION: When the DDIB process cannot be used, the Program Center (PC) diaries for the first day of the month prior to the month of attainment of age 18, for possible payment of CDB benefits. Annotate the diary screen: “CDB” determination pending (month, year), “age 18 attainment.”
3. Child reapplying within 4 years of termination and alleges disability prior to termination
The FO will notify the PC via the appropriate method, i.e., Modernized Development Worksheet (MDW) or faxing into the PC paperless queue, that a disability determination is pending. See also RS 00203.080B.
4. Child entitled age 18 or later as full-time student (initial award)
Entitle the child to student benefits pending a CDB determination. See SM 03020.320E for detailed instructions regarding T2RD processing.
If there are other beneficiaries, do not adjust benefits upward pending the disability determination. (Do not notify the payee if the amount of the benefits paid will not be affected by the suspension because of the number of beneficiaries in the household.)
If the case is a Modernized Claims System (MCS) exclusion, instruct the benefit authorizer (BA)/benefit technical examiner (BTE) to:
place the child in suspense status rather than terminated pending the disability determination; and
input the appropriate reason for suspension/termination (RFST) (see procedure in SM 00848.425).
REMINDER: See DI 11020.085 for a list of claims excluded from District Office Final Authorization (DOFA) processing.
5. Child’s benefits erroneously terminated
a. FO action
Notify the PC and instruct the BA/BTE to place the child in suspense status effective with the age 18 attainment month pending the disability determination.
b. PC action
The BA/BTE will input the suspension action, appropriate RFST and prepare any necessary diary.
If there are other beneficiaries, do not adjust benefits upward pending the disability determination. (Do not notify the payee if the amount of the benefits paid will not be affected by the suspension because of the number of beneficiaries in the household.)
6. Payee development
Follow GN 00502.075 for determining when payee development is required.
C. Procedure – status check on DDS or DPB determination
Use the DDS Service Query (DDSQ) or eView to check the progress of DDS case or DPB processing.
D. Procedure – FO action following disability determination
1. General
After the DDS or DPB makes a disability determination and the case is transferred to the FO, follow:
DI 11020.135 through DI 11020.140;
DI 11010.265 regarding case control inputs.
This reference list is for claims that cannot be processed for non-DOFA reasons.
See DI 11020.085 for claims excluded from DOFA processing.
2. Disability established
The following chart provides case scenarios and processing instructions. The chart is not all inclusive:
|
If the child is: |
Action: |
|---|---|
|
Age 16 and entitled to child’s benefits (CDB claim to continue benefits to child-in-care (CIC) beneficiary) |
Use an SSA-3601 to fax actionable material into the PC’s paperless queue. See GN 01020.265 for completion of the Action Required block on the SSA-3601. Annotate Remarks “CDB claim to continue mother/father’s or spouse’s benefits” if CIC beneficiary entitled. Provide the disability onset date and other coding if necessary, i.e., rep payee. In EDCS, the claims material is faxed to the EF. If the official folder is CEF, fax all claims material to the EF. |
|
Age 17 ½ to age 18 |
Update DDIB screen and make appropriate systems input to update the Master Beneficiary Record (MBR) for the child and any CIC beneficiary. |
|
Over 18 (and not receiving student benefits) |
If Supplemental Security Income (SSI) is involved, use an SSA-3601 to fax the actionable material into the PC’s paperless queue. See GN 01020.265 for completion of the Action Required block on the SSA-3601. Provide the disability onset date and other coding if necessary, i.e., rep payee. In EDCS, the claims material is faxed to the EF. If the official folder is the CEF, fax all claims material to the EF.
|
|
Over 18 (receiving student benefits) |
Use an SSA-3601 to fax the actionable material into the PC’s paperless queue. See GN 01020.265 for completion of the Action Required block on the SSA-3601. Provide the disability onset date and other coding if necessary, i.e., rep payee. In EDCS, the claims material is faxed to the EF. If the official folder is the CEF, fax all claims material to the EF. |
|
Over age 18 and benefits are terminated |
Use an SSA-3601 to fax the actionable material into the PC’s paperless queue. See GN 01020.265 for completion of the Action Required block on the SSA-3601. Provide the disability onset date and other coding if necessary, i.e., rep payee. |
Refer to:
GN 01010.140C if claimant was in delayed status;
DI 26535.036 if capability or payee is in question and an interim notice is required.
3. Disability not established
Take the following actions:
Process the disallowance/denial through the MACADE Disallowance Function if the disallowance cannot be processed through MCS EC.
Make appropriate systems input to update the MBR.
Prepare an MDW or appropriate paperless directive for the PC to inform them that the CDB claim is denied.
Release the disability denial notice, if not released by the DDS.
Follow DI 11020.135 if DDS denied based on res judicata.
IMPORTANT: If the child’s benefit termination event has a collateral effect on the entitlement of a child-in-care beneficiary, refer to SM 03020.100.
E. Procedure – PC action following disability determination
1. Disability denied
Take the following actions:
Terminate benefits if benefits have not already been terminated (unless student entitlement is applicable),
Adjust other benefits affected by such termination, and
Send a notice of adjustment to the auxiliaries and a termination notice to the CDB if in suspense status.
2. Disability established
The following is a brief overview and is not all inclusive.
a. General
When a disability determination for a child is received:
Resume the payment of benefits (including mother’s, father’s and spouse’s benefits if CDB is in their care) if they had been suspended;
Make appropriate systems inputs (i.e., post the disability determination in the BENE ENT line on the MBR to enable automatic conversion);
Reinstate benefits to the CDB if they had been terminated at age 18;
Cancel any diary established according to RS 00203.085B.2.
b. Disability determination made to entitle mother/father, young spouse or to continue child's benefits past age 18 as CDB
Benefits will automatically be continued to the child upon attainment of age 18 if disability is indicated in the BENE ENT line on the MBR. No special notices are required when the child attains age 18. Send the appropriate notice in NL 00703.000. See SM 03020.100 and SM 00883.125 regarding any systems input required.
c. Direct payment
Direct payment will be made to a CDB beneficiary who is capable of managing payments in his or her own interest.
If capability is raised by medical or other evidence, follow development instructions in GN 00502.025.
F. Procedure – PC action – child not previously entitled or prior entitlement terminated
1. Disability denied
Take the following actions:
Process the disallowance using the MACADE Disallowance function (see SM 00380.500) if MCS EC cannot be used.
Take any necessary action to adjust benefits to any other beneficiaries affected by the denial of the CDB claim.
Ensure that the denial is posted to the MBR.
If the case was returned to the PC from ODO, or if the DDS did not prepare and release the denial notice, send a disallowance letter (see NL 00701.000).
2. Disability and other requirements established
If all requirements for entitlement are satisfied, the child was not previously entitled, and automated processing is not possible, prepare and review the EF-101 in accordance with existing procedures if necessary. See MSOM T2PE 009.001. If the child was previously entitled, convert benefits to CDB benefits.
Direct payment will be made to a CDB beneficiary who is capable of managing payments in his or her own interest. If capability is raised by medical or other evidence, follow the development instructions in GN 00502.025.
G. References
FO-DDS Exchange of Information and Coordination of Actions (DI 10005.010)
Completion of Item 34 (Remarks) (DI 26510.095)
eView (DI 81005.000)
Creating an EDCS Case (DI 81010.020)
Certified Electronic Folder (CEF) Exclusions and Limitations (DI 81010.030)
Development for Disabled Child Prior to Age 16 – Procedure (RS 00208.070)
Conditions for Entitlement and Definitions (RS 01310.001)
ICER Background/Introduction (SM 00349.001)
Develop for Child Disability (DDIB) (SM 03020.120)