TN 10 (04-09)

A. Disability Insurance Benefit (DIB) claims

1. Complete Item 28 for disability and disability freeze allowances.

2. Do not complete Item 28 for denials and parent claim determinations.

B. Completing Item 28 in DIB claims

1. Check Block A “Period of Disability” in DIB claims.

2. Do not check Block B “Disability Period” in DIB claims.

3. Block C “Estab. Beg.”

   • Check this block when the claimant is found disabled on or before the date the earnings requirement is last met in DIB claims.

   • Make no further entries in block C in DIB claims.

C. Disabled Widow(er) Benefit (DWB) claims

1. Complete Item 28 for “Closed period” DWB claims only.

2. Do NOT complete Item 28 “open period” allowance or denial claims.

D. Completing Item 28 in DWB claims

1. Do not check Block A in DWB claims.

2. Check Block B for DWB “closed period” allowances.

3. Block C

   • Check this block for DWB claimants found disabled on or before the date the prescribed period requirement is last met.

   • Enter, on the line following Block C, the date shown in Item 15A in DWB claims.

4. In DWB closed period claims, check Block E, and enter the last day of the second month after the month disability ceased (the date shown in Item 15B).

E. Childhood Disability Benefit (CDB) claims

1. Complete Item 28 for “Closed period” CDB claims only.

2. Do Not Complete Item 28 in “open period” allowance or denial CDB claims.

F. Completing Item 28 in CDB claims

1. Do not check Block A in CDB claims.

2. Check Block B for CDB “closed period” allowances only

3. Check Block C for CDB claimants found disabled. On the line following Block C, enter the date shown in Item 15A for CDB claims.

4. Check Block E in CDB closed period claims, and on the line following Block E, enter the last day of the second month after the month the disability ceased (the date shown in Item 15B).

G. Title XVI claims

Do not complete Item 28 for Title XVI cases.