TN 35 (09-12)

A. Substantial gainful activity (SGA) during the extended period of eligibility (EPE)

If you receive a work report or learn about earnings for a beneficiary who is in the EPE, begin development immediately. If earnings are SGA, make a determination to suspend or terminate benefits and follow due process requirements, per DI 13010.185.

1. eWork processing the SGA decision

Use eWork to process the SGA determination. The system assists in the evaluation of work and earnings, and takes into consideration applicable work incentives. The eWork system:

• generates the appropriate notices, determination forms, routing sheet;

• makes the input to the post-entitlement system (POS); and

• establishes a future date for the end of the due process period.

2. eWork exclusions

If the case is an eWork exclusion, use the initial claim (IC) functionality in eWork to control development and produce all necessary forms for the determination.
eWork will store the determination, and although the decision displays “pending,” the decision will not pend on any lists, and will not prevent another work review from being established.

You must manually prepare the due process and final notices. For more information on due process notices, see DI 13010.185.

NOTE: An IC determination prevents another office from establishing another IC review. For detailed instructions on processing through IC, see DI 13010.026.

a. Disability cessation input

If the determination results in suspension of benefits, field offices (FOs) will use the eWork DECEFFECT bar code to FAX the information to paperless for processing. The processing center (PC) will refer the case to the benefit authorizers (BA) staff for processing. For IC procedure, see DI 13010.026.

b. Disability control file (DCF)

Use the DCF to:

• establish a title II work continuing disability review (CDR),

• post the verified monthly earnings,

• record the determination, and

• clear the title II work CDR.

For information on the DCF, see MSOM CDR Chapter 001, DI 13010.500, and DI 13010.600.

3. Due process for preparing and releasing the notice

eWork creates a due process notice and generates a tickle to allow the beneficiary time to respond. For eWork exclusions, follow instructions in DI 13010.026. When the time for responding to the due process notification expires, prepare a determination through eWork. Resolve any rebuttals prior to preparing the determination.

B. Reinstate or deny reinstatement of benefits during the EPE

1. Allow reinstatement

If earnings fall below SGA during the EPE, resume benefit payments if the beneficiary meets all other factors of entitlement. Use eWork to:

• Establish, control, document findings, and clear the CDR.

• Assist in the evaluation of earnings and any applicable work incentives.

• Input the decision to the post-entitlement system (POS). The system effectuates payment and non-payment months (if a DIBCESS exclusion prevents eWork from applying a direct input, follow instructions in DI 13010.215B.1.b. in this section).

a. eWork exclusion applies

If an eWork exclusion applies:

• You can still use eWork to develop, document and prepare an SSA-833-U3 (Cessation Or Continuance Of Disability Or Blindness Determination and Transmittal).

• Use the DCF to document findings, input earnings, and clear the CDR (for more information on the DCF, see DI 13010.500 The Disability Control File (DCF) and MSOM CDR 001.001).

• Clear the DCF as a cessation.

b. Effectuating the POS exclusion and Fax sheet procedure

Use the following procedure for any case that you cannot process using eWork:

• Use the paperless bar coding application to create the barcode “eWork DECEFFECT — Effectuation of eWork decision.” The fax creates an action control record (ACR) in the processing center action control system (PCACS) for the PC to resolve.

• Send the SSA-833-U3 and any supporting documentation associated with the case along with a FAX to the PC.

• After faxing work CDR information for action, also fax the documentation into the appropriate Repository (NDRed or eView), following instructions in GN 00301.325.

• If the decision was not effectuated, monitor by using the PCACS. Check PCACS or Paperless ROQS within 5 days to ensure that the PC has received the fax and PCACS (or PPL ROQS) shows an action pending.

• Check the MBR payment history, DIB line, and the SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) to determine if the PC updated the MBR. If the action has not processed, follow up with the PC of jurisdiction. PC contact information is located in KCNET.

For more information on DECEFFECT, go to the KCNet Handling eWork's DECEFFECT Tickle Guide.

In DI 13010.025 Field Office (FO) Responsibilities in Work Continuing Disability Reviews (CDRs) under B(4)

If the PC is unable to suspend, terminate, or reinstate benefits in POS, refer the case to the BA staff for processing.

eWork produces the following FAX COVER SHEET:

FAX COVER SHEET

DIB/CESS EXCLUSIONS

SSN: __ __ __ - __ __ - __ __ __ __ BIC(s): _____________

TOEL1 = STATUS

TOEL2 = DIBCESS

ROUTE TO BA PROC LOCATION

FAX TO PROCESSING CENTER:

___ (PC 1) NEPSC 877-385-0640

___ (PC 2) MATPSC 877-385-0644

___ (PC 3) SEPSC 877-310-6767

___ (PC 4) GLPSC 877-311-5797

___ (PC 5) WNPSC 877-310-7807

___ (PC 6) MAMPSC 877-311-8738

___ (PC 7) OCO 877-385-0643

___ (PC 8) OIO 877-385-0645

FROM FIELD OFFICE: (location) ______________________________

(code) ____________

For further information about this claim please contact:

(name) ____________________________

(phone) __ __ __ - __ __ __ - __ __ __ __

2. Deny reinstatement

If the beneficiary is still performing SGA, or stopped performing SGA outside of the EPE re-entitlement period, deny a request for reinstatement, and follow the same procedures as referenced in DI 13010.215B in this section.

If the beneficiary is outside of the EPE reinstatement period, he or she may file a new claim, or a claim for expedited reinstatement (EXR). For more information on filing considerations, see Filing Considerations–Expedited Reinstatement versus Initial Claim, DI 13050.020.

Do not provide due process if you are denying reinstatement, because the beneficiary is not currently receiving benefits. In addition, you are not required to complete a payment action. There is no need to complete a DIBCESS input.

We cannot reinstate benefits if earnings fall below SGA after the end of the EPE, unless a revision of a previous cessation to a continuance is appropriate.

Be alert to the possibility of an unsuccessful work attempt if SGA stops after a short period, or in situations where the MBR has erroneously terminated: verification of employment confirms that SGA ended before the DBC on the MBR. The decision to terminate should be reopened if it is erroneous.

C. Diary cases with impairment related work expenses (IRWE) or a likely change in status

Procedure for dairying IRWEs:

1. Establish a one-year follow-up diary (or earlier, if necessary) in eWork or on the DCF CDRW screen when

   • processing a CDR action that involves IRWE, subsidies, special conditions, or

   • there is a reason to believe that the level of the beneficiary’s work activity is likely to change within a year.

2. Take manual action to establish the diary date. Choose a date you determine work activity may change the SGA determination. In IRWE cases, this date should not extend beyond 12 months.