DI 13510: Vocational Rehabilitation Reimbursements
BASIC (07-11)
A. Field Office (FO) disclosures of medical information to State VR agencies for return-to-work purposes
FOs receive requests from State VR agencies for medical and other claims-related information. We may honor these requests only if we are not already providing the information via an automated data exchange with the requesting agency. If necessary, consult with the Regional Office (RO) Data Exchange Coordinator to verify if we have an existing automated data exchange for the information with the requesting agency.
VR agencies use the information they obtain from us to assist them in planning the beneficiary’s vocational rehabilitation and return to work, including developing an Individualized Plan for Employment. We do not require consent in this instance because these programs meet the criteria for health and income-maintenance programs. For more information about automated data exchanges, see GN 03314.155.
1. Determining if a request is related to SSA’s return-to-work programs
We may disclose medical information without consent to State VR agencies upon request when the request is for a program-related purpose. Consider requests directly related to the administration of our VR Cost Reimbursement or Ticket to Work programs to be program related and do not charge a fee. You may grant non-program related requests, but they are subject to a fee. For more information on fees, see GN 03314.001I.
To receive medical records without a fee, State VR agencies must submit requests in writing on agency letterhead and include the signature of a VR agency official. The request must clearly state that:
the person is eligible for the State VR program because he or she receives Social Security Disability Insurance (SSDI) benefits or Supplemental Security Income (SSI) payments; and
the State VR agency will use the medical information we provide to determine the person’s priority for service and plan the person’s vocational rehabilitation and return to work.
The Social Security Administration’s Vocational Rehabilitation Provider Handbook contains a template for this letter that State VR agencies may use for this purpose. (For a facsimile of this template, see DI 13510.030C.)
Before releasing the medical information, check the General Ticket Query (TKQY) in the Disability Control File (DCF) to determine if we selected the beneficiary to receive a ticket. If we have selected the beneficiary, there is a date in the selected field. The ticket does not have to be assigned or in use. (For instructions on accessing the TKQY screen, see MSOM CDR 004.003).
2. Determining what medical information to disclose
Disclose only the minimum amount of information necessary to satisfy a request, as described in GN 03314.001E. Consider the last type of medical determination or decision and provide the information specified in DI 13510.030A.3. in this section to satisfy requests related to the VR cost reimbursement or Ticket to Work Program. For example, if a medical continuing disability review (CDR) was the last medical determination, provide the State VR agency with the specified forms from the medical CDR. Medical information other than the documents identified in these instructions is not required for return-to-work program purposes. Remind requesters that we charge fees for providing information for non-program related purposes.
If a State VR agency disagrees with the information we released or the fees we charged, refer disputes to your RO disclosure liaison. RO disclosure liaisons may refer questions to their central office contacts.
3. Documents to disclose based on last type of medical determination or decision
Provide the appropriate medical documentation as described below within 30 days. If it will take longer than 30 days to complete the request, please provide an interim response using the phone number shown on the incoming request.
a. Initial claims
Provide the State VR agency with the following existing medical information:
Disability Determination Explanation
SSA-416 (Case Analysis)
SSA-4734-BK (Physical Residual Functional Capacity Assessment)
SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment)
b. Reconsideration on initial claim
Provide the State VR agency with the following most recent existing medical information:
Disability Determination Explanation
SSA-416 (Case Analysis)
SSA-4734-BK (Physical Residual Functional Capacity Assessment)
SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment)
c. Administrative Law Judge (ALJ) hearing, Appeals Council (AC) review, U.S. district court review on initial claim
Provide the State VR agency with the ALJ decision, AC decision, or applicable federal court decision.
d. Medical Continuing Disability Reviews (CDRs)
Provide the State VR agency with the most recent report of the following forms:
SSA-416 (Case Analysis)
SSA-4734-BK (Physical Residual Functional Capacity Assessment)
SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment)
If the above forms do not exist for the medical CDR, provide the SSA-454-BK ( Report of Continuing Disability Interview).
e. Disability hearing unit decision on medical cessation
Provide the State VR agency with the following existing medical information:
SSA-1207 (Disability Hearing Officer’s Decision)
SSA-1207-SUP1 (Disability Hearing Officer’s Decision CDB DI DS)
f. ALJ hearing, Appeals Council review, or U.S. district court review on medical cessation
Provide the State VR agency with the ALJ decision, Appeals Council decision, or applicable federal court decision.
g. Disability Service Improvement (DSI) initial claim
Provide the State VR agency with the documents described in DI 13510.030A.3.a. in this section.
h. Federal Reviewing Official (FedRO), ALJ hearing, Decision Review Board review, or U.S. district court review on a DSI initial claim
Provide the State VR agency with the applicable decision document.
B. Do not disclose the following information to State agencies providing VR services
Prior to disclosing information to State or local agencies providing VR services, you must mask (redact) or delete:
all personally identifiable information (PII) about living persons who are not the subject of the record;
any information that may have an effect on another living person on the record; and
all tax return information. (For examples of tax return information, see GN 03320.001D.1.)
Refer questions about redacting PII to the RO Privacy Act Coordinator (PAC). RO PACs may refer questions to their central office contacts.
C. Exhibit of State VR Agency Template to Request Medical Records
State VR Agency Template to Request Medical Records
(Place Letter on State Vocational Rehabilitation Agency Letterhead)
Date:
To:
From:
Subject: State Vocational Rehabilitation (VR) Agency Request for Medical Information
(VR Cost Reimbursement or Ticket to Work Program Purposes)
Beneficiary’s Name: Beneficiary’s SSN:
This is a Vocational Rehabilitation (VR) Cost Reimbursement or Ticket to Work program related request for medical information unavailable through my State’s automated data exchange with the Social Security Administration. This request is for medical information on the beneficiary named above, free of charge, to assist us in determining this person’s eligibility for the vocational rehabilitation and return to work services we provide.
I certify the following:
The person identified in this request is eligible for my state’s VR program because he or she is a Social Security Disability Insurance and/or Supplemental Security Income beneficiary based on blindness or disability; and
I will use the medical information requested to determine the beneficiary’s priority for service and plan the beneficiary’s vocational rehabilitation and return to work.
___________________________________ ___________________________________
VR Agency Official’s Signature Phone Number
D. References
GN 03314.130, Disclosure Without Consent to State or Local Agencies Providing Vocational Rehabilitation Services
GN 03314.001, Disclosure Without Consent to State and Local Agencies and Native American Tribal Authorities
GN 03320.015, Disclosure of Tax Return Information Without Consent
GN 03325.003, Verification of the Social Security Number (SSN) Without Consent
Guide for Determining When to Disclose Medical Information to State VR Agencies for VR Cost Reimbursement or Ticket to Work Program Purposes