2

Enter the three digit Disability Determination Services (DDS) code.

3

Enter the date from the SSA-831 Disability Determination and Transmittal on which the original decision was recorded.

4

Enter social security number from folder tab.

5

Claimant's name and address.

a. Enter the name and most recent address of claimant, or

b. If claimant is now deceased, enter the claimant's name only and “claimant deceased.” No address is needed, or

c. If someone applied on behalf of a claimant, the applicant's name should be followed by “for” and the claimant's name. The applicant's address should be used. If the claimant is deceased, the claimant's name should be followed by “deceased” . The address of the applicant should also appear in this situation.

8

Indicate the type of claim as reflected on original SSA-831.

9

Use DOB from the SSA-831 used to record the original decision.

10

Check the “PD” block if decision was a denial.

11

When a title II reopening is also pending in the DDS, enter “Concurrent title II/title XVI.” Also, repeat any remarks appearing on the initial SSA-831 that are still pertinent.

11A-11B

Do not complete.

12

Complete field office (FO) address and code. Change from initial SSA-831 if the case was received from a different FO.

15-21

Complete in the same manner as for initial title XVI cases (see DI 26510.000).

22

Enter the Regulation-basis code that is applicable to the reopening determination. (See DI 26510.000).

23-24

Complete in the same manner as for initial title XVI cases (see DI 26510.000).

25

Check this block except on an escalated determination.

25A

Indicate the level of claim reflected on the original SSA-831.

26

Complete in the same manner as for initial title XVI cases (see DI 26510.000).

27

Complete in the same manner as for title II reopenings (see DI 27536.000).

29

Complete in accordance with DI 27540.000.

30-33

Complete in the same manner as for initial title XVI cases (see DI 26510.000).

34

In addition to the entries described in DI 26510.000, the following remarks should be entered, as applicable:

“Reopening Reversal (or Affirmation). Revises Previous Determination dated       .”

In informal remand cases, enter “Informal Remand Case.”