TN 1 (01-11)

A. Requirements for extending the application cutoff date

The 1965 amendments removed the requirement that the claimant’s condition is disabling at the time the claimant files the application, and allowed for a closed period of disability if the disability ceased no earlier than 12 months before the month of the application file date.

The 1967 amendments provided for the extension of the 12-month requirement to 36 months in situations where the claimant was physically or mentally incapable of filing the claim in the 12-month period after his disability ceased. Since the number holder (NH) was not under a disability during the 12-month retroactivity limitation for monthly benefits, a denial of the disability insurance benefits (DIB) claim is appropriate. Under this section, a closed period of disability freeze might be established.

Disability Determination Services (DDS) jurisdiction cases referred to the examiner where the DDS does not determine whether the claimant’s failure to file a timely application (within 12 months of disability cessation) was due to physical or mental incapacity the Disability Examiner /Disability Processing Specialist (DE/DPS) will make the determination.

The field office may route the case directly to the Office of Disability Operations/Processing Center-Disability Processing Branch (ODO/PC-DPB) in which the claimant filed after 12 months but within 36 months of the month of the alleged cessation.

If it is determined that the claimant's failure to file a timely application was not due to physical or mental incapacity, prepare a determination of denial and personalized letter to the claimant.

If it is determined that the claimant's failure to file a timely application was due to physical or mental incapacity, route the case to the DDS using Form SSA-847 (SSA Request for Case Action), for preparation of the determination.

If the case is electronic, the PCs DE/DPS will input a “No Determination” decision code in MIDAS using the instructions in DI 81020.127 and route the claim to the appropriate DDS, using the instructions found in Electronic Case Routing before Final Determination in DI 81020.125.

B. Preparation of the SSA-831 and notices

1. DIB denied, closed period of freeze allowed

When it is determined, that the claimant's failure to file a timely application was due to a physical or mental incapacity, a determination of a closed period of freeze will be prepared.

Prepare Form SSA-831 (Disability Determination and Transmittal) to reflect a closed period of freeze. The rationale (on the SSA-4268) should address both the closure of the period of disability and the non-entitlement to DIB during the retroactive life of the application.

The DE/DPS will route the case to a Claims Authorizer (CA)/Claims Technical Examiner (CTE) to process the denial.

The CA/CTE must enter denial code “A1” to annotate the freeze to the MBR (SM 00380.100).

The CA/CTE will also prepare and release the notice, and include the following language:

“We have reviewed your Social Security claim and find that you are entitled to a period of disability but you are not entitled to disability insurance benefits. We have established a period of disability for you beginning    (1)   and ending   (2)   .

The period of disability now established for you is important. It protects your right to insurance benefits and the benefit rights of your dependents and survivors. However, in cases where a disabled worker was furnishing one-half support to a parent when the period of disability began, proof of this support must be submitted immediately. Failure to do so may cause such parent to be ineligible for benefits at a later date.

—Reason DIB is denied

Attached to this letter is an explanation of the decision we made on your claim and how we arrived at it.

- G75

- G11

- G21

Fill-ins:

1. Date of onset of period of disability (MM/DD/YY).

2. Date of termination of period of disability (MM/DD/YY).

2. DIB and freeze

An SSA-831 will be prepared to deny the monthly benefits.

If it is determined that the claimant's failure to file a timely application was not due to physical or mental incapacity, the DE/DPS will also enter this determination in the rationale of the DIB denial SSA-831 or on an SSA-4268.

The claimant must receive a personalized disability notice. The notice should include personalized language explaining why extension of the 12-month period for filing for a period of disability cannot be granted.

Add the following suggested language to the DIB denial notice when it is not automatically generated:

DIB and freeze denied – paragraph to be added to whatever DIB denial is appropriate

Under the law a period of disability cannot be established which ends more than 12 months before the month the claim was filed. The 12-month period can be extended to 36 months if you were physically or mentally incapable of filing the claim within the 12-month period. We have determined that your impairment did not, physically or mentally, prevent you from filing a claim within the time limits. Therefore, you are not entitled to a period of disability.