TN 6 (02-18)

A. Procedure for screening for Title XVI EXR eligibility

To be eligible for EXR, a Title XVI claimant must meet the eligibility requirements listed in DI 13050.001B.1. The disability must have terminated due to earned income, or a combination of earned and unearned income.

1. Supplemental security record (SSR)

Review the following elements of the SSR of to determine if disability ended due to work:

• CMPH segment - the last entry in the Payment Status (PS) field is T31;

• CMPH segment - there is an entry of N01 in the PS field in the month before the T31 month; and

• ENIH segment - there is earned income in the month before the T31 month.

2. Other corroborating information

Review the following additional sources of information to verify that termination was due to work:

• Notice - the claimant may have a notice stored in the online notice retrieval system (ORS) that explains the basis for termination, and

• Other records such as a Modernized Development Worksheet (MDW).

3. EXR filing period

Determine if the EXR request is within 60 months of the previous termination (T31) month. Add 59 months to the T31 month reflected on the SSR to determine the end of the 60-month period. For further information about the EXR request period and consideration of good cause for late filing, refer to DI 13050.010. Also, consider the protective filing guidelines in DI 13050.015.

4. Establish protective writing

If it is not possible to complete an EXR interview immediately, establish a protective writing through the 800 Number System, and schedule an appointment on the claims leads/protective filing appointment calendar of the claimant’s servicing field office (FO). Enter “EXPEDITED REINSTATEMENT” in the remarks section of the DIB appointment lead. Advise the claimant that provisional benefits cannot begin until the claimant submits the completed EXR request package.

B. Procedure for Title XVI EXR interview

1. Explain EXR provisions

The FO technicians must screen cases for EXR eligibility per DI 13050.001A, DI 13050.050A and discuss filing a new claim versus an EXR with the claimant per DI 13050.020.

• If the claimant is not eligible for expedited reinstatement for not meeting the technical requirements for EXR and insists on filing for EXR, the FO must deny the request per procedures in DI 13050.065D.

• If the claimant chooses to file a new initial claim for disability benefits, you may use the request for reinstatement as a protective filing. Close out the protective writing per DI 13050.015E and GN 00204.012. Document the reason the claimant chose to file a new claim instead of an EXR in the remarks section of the new initial application.

• If the claimant is eligible for EXR and decides to file an EXR request, follow the instructions below to complete the EXR package and process the request.

2. Complete EXR package

The EXR package includes:

• SSA-372 - Request for Reinstatement - Title XVI. Staple this to the front of the SSA-8000-BK;

• SSA-8000-BK-Application for Supplemental Security Income;

  NOTE: Complete the SSA-8000-BK in the same manner as for a pre-effectuation review contact (PERC). Develop all factors of eligibility immediately

• SSA-454-BK - Continuing Disability Review Report;

• SSA-3367- Disability Report-Field Office;

• SSA-827 - Authorization to Disclose Information to the Social Security Administration;

• SSA-820-BK or SSA-821-BK - Work Activity Report (Self-Employment) or Work Activity Report (Employee); and

• SSA-823 - Report of SGA Determination

Request wage and employment information authorization and record it in the Wage and Employment Information Authorization (WEIA) application per, GN 00204.150C.

NOTE: If the interview is by telephone, send the EXR forms for signature, along with the 60-day EXR close-out notice per DI 13050.015E. Explain that the claimant must sign and return the forms before we can pay provisional benefits.

3. Eligible spouse

If there is a previously eligible spouse, you may also reinstate the spouse if he or she requests reinstatement and meets the EXR requirements.

• If the spouse is blind or disabled, worked, and meets EXR screening requirements in DI 13050.050A in this section, complete an SSA-372 for the spouse.

• Complete an SSA-454-BK and SSA-827.

4. Aged spouse

If there is an aged spouse, obtain an initial application for SSI Aged and establish entitlement using normal requirements for entitlement.

5. Establish EXR on DCF

Establish an EXR event on the DCF following these steps:

• On the MCDR screen, select 8=Establish Disability Review.

• On the ECDR screen, select 2=EXR.

• Complete the DRES screen to establish the EXR event.

6. Request prior file

Take the following steps to retrieve the prior folder:

• Request the prior claim folder to confirm eligibility for EXR and to provide the comparison point decision (CPD) medical records the disability determination services (DDS) will need to make the medical determination.

• Follow the instructions for retrieving a folder in the medical CDR instructions, see DI 13015.030 through DI 13015.250 and DI 40525.020 through DI 40525.150.

• If you cannot find the CPD folder, follow the procedures in DI 13015.080 and DI 13015.090.

7. Representative payee

If, during the interview you determine that the claimant is incapable of managing his or her own provisional benefits, develop for a representative payee. If the claimant had a representative payee in the previous entitlement period, determine if the claimant still needs a representative payee. For more instructions about payee development, refer to DI 13050.075.

8. Provisional benefits

Start provisional benefits when appropriate. For more information about provisional benefits, see DI 13050.030.

9. Prepare and send the case to the DDS

Include all forms in the EXR request package listed in 13050.045B.2 in this section, in the paper file. In addition, take the following actions:

1. SSA-820-BK or SSA-821-BK – Use these forms to develop and document all work activity beginning with the month of filing; and

2. SSA-823-­­­ In Item 2C under Continuing Disability Review/Post-Entitlement (CDR/PE), document the following:

   • the month of EXR filing, and

   • the SGA determination for the month of EXR filing to present. If there is SGA in the month of filing, add the remark “SGA in the month of filing. First possible MOE is MM/YY”.

Before sending the case to DDS, fax the documents in the EXR request package to:

• eView – use the MDF E barcode and annotate the “Note” field with “EXR Documentation,” or

• Claims File Records Maintenance System (CFRMS) – use the document type of “Other,” and annotate the “Remarks” field with “EXR Documentation.”

Send the case to the DDS:

• Pair the completed EXR packet with the prior decision folder. If the prior decision was an electronic file it must be converted to paper, see DI 81010.030C and;

• Attach the EXR Case Flag to the paper medical folder and;

• Mail the paper folder to the appropriate DDS

10. Update the DCF

Update the DCF taking the following steps:

• Transfer the event to the servicing DDS per DI 13010.620.

• Establish an issue (for example, EXRDDS) on the DCF development worksheet (CDRW) to control for the DDS decision. For more information about the CDRW, see DI 13010.605