BASIC (05-02)

Regardless of whether screening is performed by Disability Determination Services (DDS) examiners or a special VR screening unit, it is essential that the screening decision be recorded on the disability determination form (SSA-831-U5 or SSA-833-U5.)

NOTE: Referrals must also be reported on the State Agency Operations Report (SAOR).

A. Procedure - title ii claim only or title xvi claim only

1. Applicant Referred

Check the Sc. In (Screened-In) box on the SSA-831-U5 or on the SSA-833-U5 or SSA-832-U5. Enter “Blind” above “Screened In” if referral will be to a blind agency.

2. Applicant Previously Referred by the DDS

Check the “Previously Referred” box on the SSA-831-U5 or the SSA-833-U5 or SSA-832-U5 if there is an SSA-831-U5 or SSA-833-U5 or SSA-832-U5 in file showing that the person was referred (screen-in) at an earlier time by the DDS.

B. Procedure - concurrent titleii/title xvi claims

Whether the claims are processed in the DDS simultaneously or separately, in most cases the DDS should show the same referral action on both determination forms and report that action twice on the SAOR (once for title II purposes and once for title XVI purposes). There will be exceptions, however, if an individual's concurrent claims are processed at different times, the fact that there is no referral to VR when the first determination is prepared does not preclude referral when the second determination is prepared. Therefore, the DDS may, in some infrequent instances, report a screen-out for the first determination and referral with the second. Both determination forms (title II and title XVI) should be annotated as noted above, whichever is appropriate.