TN 10 (04-09)

A. Overview

The Disability Determination Services (DDSs) are responsible for completing part of the SSA-831, Disability Determination and Transmittal form. (For instructions specific to blindness cases, see “Completion of Form SSA-831 in Blindness Cases,” DI 26010.000.) A paper SSA-831 will only be completed for any claims that are MCS or MSSICS exclusions and cannot be created in the Electronic Disability Collect System (EDCS). See "Certified Electronic Folder (CEF) Exclusions and Limitations," DI 81010.030A.

Completing items 1-14 is primarily a field office (FO) responsibility, see (DI 11055.120 through DI 11055.135). However, the DDS is responsible for reviewing the FO-completed items on the SSA-831 for possible discrepancies. Contact the FO to resolve discrepancies such as name, SSN, or type of claim on the SSA-831 (or other FO-completed transmittal).

NOTE: In a Title XVI claim, if a disabled child (DC) claimant attains age 18 while the claim is in DDS jurisdiction, do not change the entry in item 8 (Type of Claim). See (DI 25201.010) for details. For more information on completing item 34 (Remarks), see DI 26510.095 Completing Item 34 (Remarks) on the SSA-831.

This subchapter covers completion of items 15-38 for Title II, Title XVI and concurrent claims for paper and electronic cases. It also covers completion of items 11A and 11B for Title XVI claims. Appropriate items are broken down into separate headings for Disability Insurance Benefits (DIB), Disabled Widow(er) Benefits (DWB), DWB Medicare, and Childhood Disability Benefits (CDB), as well as Title XVI.

NOTE: If the FO does not give special DWB-Medicare instructions, use regular DWB procedures. Similarly, if the FO does not give special parent claim instructions, use CDB procedures.

B. Exhibit - Form SSA-831-C3/U3, Disability Determination

To view this form, go to SSA-831 C3/U3.