TN 15 (11-02)

Include a summary of the evidence supporting the determination that the beneficiary was or was not engaged in substantial gainful activity (SGA) in the SSA-4268-U4. Also list TWP service months, if applicable. If eWork is used to prepare the determination, the SSA-4268 information will automatically be generated.

A. Procedure - Continuances

Show the rationale for a continuance in the SSA 4268. For example: work activity after the trial work period (TWP) did not represent substantial gainful activity (SGA); or although work was at a SGA level, it ended within 3 months of the end of the TWP due to the impairment.

B. Procedure - Cessation

In the rationale for a cessation show:

• that due process requirements are met (see DI 13010.185),

• that the beneficiary was or was not entitled to a TWP,

• what work activity is SGA and why, and

• the month of cessation.

  In a “Failure to Co-operate” or “Whereabouts Unknown” case document the efforts to locate the beneficiary or gain the beneficiary's cooperation, providing pertinent dates.

C. Procedure - Identifying Information

Enter the name of the beneficiary, the number-holder (in childhood disability claim (CDB) or disabled widow claims benefit (DWB)) and the social security number in the appropriate spaces at the top of the SSA-4268-U4.

D. Procedure - Signature And Date

Initial and date the SSA-4268-U4.