TN 35 (09-12)

A. eWork exclusions

Some of the eWork exclusions include, but are not limited to:

• non-entitlement or terminated cases;

• reconsiderations of work issue continuing disability reviews (CDRs) and initial reinstatement period (IRP) determinations made outside of eWork;

• BICs of E, T1-9, TC, TV, TW, TX, TY, and TZ;

• expedited reinstatement (EXR) cases with months of non-payment within the initial reinstatement period (IRP) due to reasons other than substantial gainful activity (SGA). For example, a beneficiary who is in prisoner suspense, or was deported;

• concurrent retirement and disability cases where the beneficiary remains entitled to disability but has elected to receive reduced retirement;

• beneficiaries in statutory benefit continuation (SBC) pending appeal of a medical cessation;

• reopenings based on return to work within one year of onset for statutorily blind beneficiaries who remain entitled to disability freeze;

• statutorily blind disability attainment cases where the beneficiary’s benefits was previously ceased or terminated due to SGA, and already completed a trial work period (TWP).

1. eWork exclusion case procedure

Although you cannot effectuate exclusion cases in eWork, you can use the initial claim (IC) functionality feature within eWork to assist you in making an SGA decision, and to obtain certain necessary adjudicative documents (e.g., SSA-821 (Work Activity Report-Employee), L-725 (Employer Verification of Monthly Wages), and the SSA-833-U5 (Cessation or Continuance of Disability or Blindness Determination and Transmittal).

2. IC functionality procedure

Since you cannot use eWork to effectuate the case, the earnings information cannot “push” to the DCF. Follow the instructions below to use the IC functionality in eWork exclusion cases:

1. Access the IC functionality in eWork by selecting “Initiate/Update IC Evaluation” on the eWork Main Menu screen.

2. Establish a work review, and enter the date of onset, date of filing, and the date of entitlement.

3. Select “IC” case, then click on “Establish Work Review.”

4. From the Work Review Summary Screen, post any earnings for employers and generate your development forms.

5. Process your decision, clicking on the “Preview/Process Decision” button.

6. Use the document processing system (DPS) to prepare due process (or manually produce them, if needed) and final notices.

7. Save the determination in eWork.

8. Manually input earnings and work determination information to the verify earnings (VERN) screen of the disability control file (DCF).

9. Clear the work CDR in the DCF.

10. Route the documents following the instructions in DI 13010.026B in this section.

IMPORTANT: Using the IC functionality will not allow you to produce notices. You must manually prepare the due process or final notice in DPS. For due process and notice procedure, see DI 13010.185 and NL 00701.000.

3. Manual process procedure

If you cannot use eWork to adjudicate the work CDR, follow this procedure:

• Manually input the monthly earnings and WORK DET (Work Determination) code for each month of earnings in the review period to the VERN screen of the DCF;

• Clear the work CDR in the DCF;

• Prepare the DIB CESS Exclusion Fax cover sheet document using the paperless barcode fax for “eWork DECEFFECT – Effectuation of eWork decision,” the SSA-833-U5, the SSA-4268-C4 (Explanation of Determination), and the earnings and event report to the PC of jurisdiction;

• Annotate what the exclusion is, and provide clear instructions on what you need the PC to do (e.g., notice language, MBR coding, etc.); and

• Route the documents following the instructions in DI 13010.026B in this section.

For the eWork DECEFFECT Tickle Guide, go to the KCNET Site.

See also:

• DI 13010.145 Reconsideration or Reopening of Continuing Disability Work Issue Cases – title II

• DI 13010.610 The Disability Review Establishment Screen (DRES)

• DI 13010.675 The Verify/Update Earnings Screen (VERN)

• DI 41005.010 Claimant in Freeze Status Files for DIB

B. Routing title II work CDR documentation

For direct input exclusion cases:

• Prepare and send the final notice advising the beneficiary that we will send him or her information about any overpayment issues in a separate notice. Fax the DIB CESS Exclusion Fax cover sheet document using the paperless barcode fax for “eWork DECEFFECT – Effectuation of eWork decision,” the SSA-833-U5, the SSA-4268-C4 (Explanation of Determination), and the earnings and event report to the PC of jurisdiction.

• Write what the exclusion is, and provide clear instructions on what you need the PC to do (e.g., notice language, MBR coding, etc.).

• Fax the documents into eView, or if non-electronic, the claims folder (using NDRed), per GN 00301.322.

The claims folder should contain:

• copies of any determinations: SSA-899-U2 (Continuing Disability Review), SSA-833-U5, and SSA-4268-C4;

• copies of notices sent;

• impairment-related work expenses (IRWE) documentation or subsidy or special condition computations;

• any other information, such as relevant reports of contact, necessary to expedite the reinstatement or suspension of benefits;

• SSA-820, SSA-821, and SSA-823 (Report of SGA Determination-For SSA Use Only); and

• any evidence that supports the determination.