DI 11055: Supplemental Security Income (SSI) Disability Cases
TN 64 (09-09)
A. Introduction
A Title XVI disability claim may occur in combination with one or more of the Title II disability or nondisability claim categories.
1. Title II disability categories
The types of claims in the Title II disability categories:
Disability Insurance Benefits (DIB) or DIB Freeze
Disabled Widow(er) Benefits (DWB)
Childhood Disability Benefits (CDB)
Medicare Qualified Government Employees (MQGE)
Medicare Only
2. Title II non-disability categories
The types of claims in the Title II non-disability categories:
Retirement Insurance Benefits (RIB)
Auxiliary Child
Auxiliary Spouse
Auxiliary Divorced Spouse
Widow(er)’s Insurance Benefits (WIB)
3. The claim type in multiple claims situations in which the field office (FO) should send to the disability determination services (DDS)
Send any Title XVI and Title II claim type that requires a disability determination to the DDS.
4. The claim type in the multiple claims situations in which the FO does NOT send to the DDS
Do not send any Title XVI or Title II claim type that does not require a medical determination to the DDS. The FO processes all non-medical determinations.
B. Procedure for processing concurrent title II and title XVI claims
When multiple claims consist of concurrent Title XVI/Title II, disability claims:
For MSSICS and MCS claims, use Electronic Disability Collect System (EDCS) to transmit the concurrent case to the component making the medical determination.
For non-MSSICS or non-MCS claims, use a separate SSA-831 (Disability Determination and Transmittal form) for the Title XVI and the Title II claims to transmit the concurrent case to the component making the medical determination.
NOTE: Disability forms, such as the SSA-3368 (Disability Report - Adult), the SSA-3367 (Disability Report – Field Office), and SSA-827s (Authorization to Disclose Information to the Social Security Administration), serve a common purpose for the concurrent disability claims. This means that, although the claimant filed both Title XVI and Title II claims (multiple applications, one under each program), there is only one set of disability forms for the concurrent case.
1. DDS determination is not necessary
In SGA denial situations:
If the claimant is working at the SGA level and a visual impairment is not alleged, the FO follows procedures per DI 11055.075 through DI 11055.100. For Title XVI only, or concurrent Title II and Title XVI claims, prepare the SSA-831 per DI 11055.135 for Title XVI and DI 11010.055 for Title II.
If the FO determines SGA involvement in concurrent Title XVI/Title II claim situations, make SGA denial determinations, adjudicating both claims, completing Form(s) SSA-820 or SSA-821, as appropriate. When claims are associated with a CEF, see Processing SGA denials using the FO denial function DI 81010.140C.
NOTE: If earned income is above the break-even point after considering all income exclusions, deny the Title XVI claim for excess income (N01); do not develop SGA.
If the claims are associated with a paper modular disability folder (MDF), retain the Title XVI denial along with the completed SSA-831 and all Title XVI non-medical material in the FO. See Claims Involving Work Activity DI 11055.045 and Claimant Engaging in SGA DI 11055.095.
In non-medical denial situations:
If only one claim of a concurrent case involves a non-medical denial, only transfer the claim(s) needing a medical determination to DDS.
2. DDS determination is necessary
Send the disability materials for both claims to the DDS. However, where critical non-medical requirements are in question on the Title II claim and a disability determination is required on the Title XVI claim, create a case on EDCS (per Preparation of the Official Disability Folder DI 11055.150), containing the disability material on the Title XVI claim and transmit it to the DDS. Advise the DDS on an electronic or a paper SSA-3367 in Section 5, Section 10, or in the Remarks Section, as appropriate, with the status of the Title II action.
REMINDER: Enter "Concurrent Title II and Title XVI claims" in Item 11 of each SSA-831 if a systems limitation or exclusion exists or code the disability transmittal forms with the concurrent claim status.
a. Title II claim in the FO
Create an EDCS case for the Title XVI claim, SSA-831, and other applicable disability material (e.g., disability report, medical release forms, etc.). On the SSA-831 or the SSA-3367, Remarks section to the DDS, ADD: "Title II claim pending in FO." Upon transmitting the Title II portion of the concurrent claim, enter “SSI claim and disability material on SSN forwarded (date first claims material was forwarded to the DDS)” on the SSA-831, Remarks section. Prepare an SSA-5002, report of contact (RPOC) INFORMING DDS of the resolution of all critical non-medical requirements on the Title II claim and that a DDS determination is necessary.
b. Title XVI claim in the FO
If you transmitted the Title XVI claim to the DDS after the Title II claim, see Using the Update-After-Transfer Utility DI 81010.095.
If the official folder is a paper MDF, prepare and forward an SSA-5002, (RPOC), (or the SSA-831, for the Title XVI claim, annotating in Remarks "Title II claim and disability material under SSN XXX-XX-XXXX, previously forwarded (specify date),” and any additional medical evidence, if available, to the DDS. Transmit the material, affixing an SSA-408 (Route Slip) to the front cover of a prepared two-part brown claim folder housing the Title XVI claim and related Title XVI claim material. Upon receipt of this claim, the DDS associates it with the MDF housing the Title II claim previously transmitted.
Title XVI technical denial - It is not necessary to notify the DDS. Retain the Title XVI claim in the FO if the official folder is paper, and if the Title II claim folder and transmittal.
Title II claim in FO - If the claim meets the critical non-medical requirements, see Adding a Claim to a Case DI 81010.095D. Use the UAT Utility to add the Title II portion of the claim to the case. If the official folder is paper, prepare another folder housing the Title II claim, per Multiple Claims – Supplemental Security Income (SSI) Claim Involved DI 11010.090 and the initial Title II disability transmittal or SSA-831, being sure to indicate the case is concurrent (Title II and Title XVI). Forward an SSA-5002 with the folder, and any additional disability evidence, if available, to the DDS. Hold the Title II non-medical material in the FO. The DDS associates the previously received Title XVI claim and disability material with the Title II folder upon receipt.
c. Non-medical requirements not met
If the FO originally notified the DDS of concurrent claim status with the other claim forthcoming, and it is later determined that the claimant did not meet the non-medical requirements for the other claim, notify the DDS of that change. Otherwise, process the claim in accordance with DI 11055.055B.1. in this section and Notifying the FO of Potential Allowance Cases by the DDS DI 11010.340.
C. Procedure when a prior title II denial or cessation folder is not in an FO
When processing a Title XVI claim subsequent to a Title II denial or cessation, follow these steps:
Do not request the prior folder if it is not located in a field office.
Document the SSA-3367, giving the DDS as much information about the prior claim(s) as is available from FO records.
If there is not a concurrent filing for Title II due to non-medical reasons, document the Title XVI case as to the reason.
Send the Title XVI disability materials to the DDS.
NOTE: If the prior denial was on a non-medical basis and there is an indication of meeting the Title II non-medical requirements, obtain a Title II claim and process as a concurrent (Title II and Title XVI) case.
D. Procedure when a title II allowance is pending in the FO or was previously forwarded for payment action
If the DDS or DQB returns a Title II medical allowance to the FO indicating a continuing period of disability, a closed period of disability, or an alleged visual impairment without statutory blindness established, follow these instructions:
1. Continuous period of disability
If the Title XVI non-medical requirements are met, and the Title II allowance can be treated as the final determination in accordance with Adoption of Title II Disability Decisions DI 11055.075 through DI 11055.100, do not send the Title XVI claim to the DDS. Adopt the Title II determination and input the Title XVI allowance.
If the Title II claim is still pending in the FO, complete the necessary action and route the Title II claim to the appropriate processing center.
2. Closed period of disability
If the claim cannot be processed electronically, prepare a folder and an SSA-831 for the Title XVI claim and send it to the DDS for a determination. Include a photocopy of the Title II SSA-831 and disability material from the Title II file. For the definition and criteria for a closed period of disability, see DI 25510.001 through DI 25510.015.
If the Title II claim is still pending in the FO, complete the necessary action and route the Title II claim to the appropriate processing center.
3. Visual impairment alleged but statutory blindness not established
If the Title XVI claimant alleges a visual impairment and statutory blindness was not established in connection with the Title II allowance, send the Title XVI claim to the DDS for a determination on the issue of statutory blindness. Annotate the SSA-3367 to explain to the DDS the reason why a determination is necessary.
E. Procedure when there was a prior title II denial and the title II folder is in an FO
If the claim is an MSSICS exclusion, prepare an SSA-831 for the Title XVI claim.
If the official folder is a paper MDF, place the disability transmittal and any new disability material in the Title II folder and send the folder enclosed with the Title XVI claim to the DDS for a disability determination on the Title XVI claim.
F. Procedure when a title XVI claim is filed while an appeal is pending at the ALJ, AC, or Court level on a prior title II disability claim
Process and route the Title XVI claim per
DI 11055.025 - Pending Title XVI and Title II Claims at Different Levels of Appeal in Common-Issue Cases
DI 12045.010 - Processing Disability Claims at Different Levels of Appeal, Title II and Title XVI – Common-Issue Cases