BASIC (03-86)

Notices of work activity for statutorily blind individuals age 55 and over will continue to be received in the usual manner, i.e., voluntary reports, reports of earnings from OCRO, etc. If a work report or evidence of earnings is received, a work review should be established in eWork. If the FO receives the report, the work review and the T2 Work CDR in the DCF should be transferred to the proper PC of jurisdiction. Place a remark on the IRMK screen of the DCF documenting the reason for transfer (age 55 stat blind case). See DI 13010.025B.2. The current action to be taken will depend on the factors in each case. However, several additional situations may arise.

If the latest determination contains the remark “Stat blind-WK (designated months),” then benefits have been withheld on the basis on noncomparable SGA for the months shown. Therefore, if earnings appear on a Continuing Disability Review Enforcement Output (CDREO) for a period for which benefits have already been withheld, annotate the output “NAN DI 41005.020,” sign and date it, place it inside the folder and return the case to files. For Certified Electronic File (CEF) cases, fax a copy into the CEF.

If a notice of work activity is received determine whether the individual is entitled to a TWP (see DI 41001.025B.).

A. Individual entitled to a TWP - TWP not expired

If a continuance SSA-833-U5 is needed, see DI 41005.015B.1., DI 41005.015B.2. and DI 41005.015B.3.

B. Individual entitled to a TWP - TWP has expired

Evaluate the work activity following the guides in DI 41001.025 to determine whether the work is SGA.

1. Processing a continuance determination. Follow the instructions in DI 41005.015B.1., DI 41005.015B.2., and DI 41005.015B.3.

2. Processing a cessation determination - Individual engages in comparable SGA. Use the instructions in DI 41005.001. (see DI 41005.035, Exhibit 12 for an example of a completed SSA-833-U5.)

   1. On the SSA-833-U5, Item 24, Remarks, enter “Beneficiary Engaging in Comparable SGA.” (See DI 41005.001V.2.)

   2. On the SSA-833-U5, Item 29, show “DL” and prepare the following language on an SSA-865 (SSA-573 in PSC-DRS):

      “The law provides that the disability insurance benefits of an individual who has attained the age of 55 and is statutorily blind shall end if he or she becomes able to engage in substantial gainful activity requiring skills or abilities comparable to those of any gainful activity in which he or she has previously engaged with some regularity and over a substantial period of time. The law also provides that an individual will receive his or her benefit payments for the month in which he or she becomes able to do such substantial work and the following 2 months. Not until a person has worked in at least 9 months is a decision made as to whether he or she has become able to do substantial work. The evidence in your case shows that you have worked in at least 9 months and that in (      ) you became able to engage in substantial gainful activity requiring skills or abilities comparable to those of gainful activity in which you previously engaged with some regularity and over a substantial period of time. Accordingly, the last disability benefit check to which you are entitled is for the month of (     ). However, your period of disability will continue until you reach full retirement age (FRA) or you no longer meet the definition of blindness contained in the law.”

      “If you stop working or if your earnings are significantly reduced, you should contact your Social Security office.”

      NOTE: If the individual is not entitled to a TWP, delete the italicized portions of the notice referring to the 9-month trial work period.

      Prepare a personalized explanation of the decision on an SSA-4268-U4 (see DI 13095.150) and ask the typist to attach it to the notice to the beneficiary.

      The technical rationale should be prepared on a separate SSA-4268-U4. See DI 41005.005. Make sure a copy of the notice with the personalized attachment is in the folder. For CEF cases, fax a copy into the CEF.

   3. For cases where cessation and reinstatement months are involved, follow instructions in DI 13010.170B.6. for documenting the multiple determinations.

3. Processing a cessation determination - Individual engages in noncomparable SGA and did not become entitled to benefits while engaging in noncomparable SGA. Use the instructions in DI 41005.015 C.1.a. above with the following differences. (See DI 41005.035, Exhibit 14.)

   1. On the SSA-833-U5, Item 24, enter the remarks “Stat Blind Noncomparable SGA” and “Stat Blind WK - (Mo./Yr.)” (show month and year individual engaged in SGA). If work is continuous above the SGA level show “Mo./Yr. - On.” If work is not continuous above the SGA level, show each month and year of SGA.

   2. On the SSA-833-U5, Item 29, indicate “DL” and show the following language on an SSA-865 (SSA-573 in PSC-DRS):

      “The law provides that, based on your impairment, you are entitled to disability insurance benefits. However, no payment may be made for any month in which you engage in substantial gainful activity that does not require skills or abilities comparable to those of any gainful activity in which you previously engaged with some regularity and over a substantial period of time. Not until a person has worked in at least 9 months is a decision made as to whether he or she has become able to do substantial work. The evidence in your case shows that you have worked in at least 9 months and that your work has been substantial gainful activity since (     ). Therefore, it is necessary to withhold your benefits beginning with the month of (      ).”

      “You should notify your Social Security office promptly if you stop working or if your earnings are significantly reduced since benefits may be payable to you.”

      NOTE: If the individual is not entitled to a TWP, delete the italicized portions of the notice referring to the 9-month trial work period.

      Prepare a personalized explanation of the decision on an SSA-4268-U4 and ask the typist to attach it to the notice to the beneficiary. Make sure a copy of the notice with the personalized attachment is in the folder. For CEF cases, fax a copy into the CEF.

      The technical rationale should be prepared on a separate SSA-4268-U4. Identify those months in which the work is noncomparable SGA. See DI 41005.005.

   3. For cases where cessation and reinstatement months are involved, follow instructions in DI 13010.170B.6. for documenting the multiple determinations.

C. Individual not entitled to a TWP or TWP previously expired

Evaluate the work activity following the guides in DI 41001.001 ff. to determine whether the work is SGA.

1. If it is not SGA, process a continuance per DI 41005.015 B.1.2. and 3.

2. If the work is SGA, determine whether the work is comparable or noncomparable.

   1. If there is insufficient information to show whether the work is noncomparable or comparable, initiate a CDR.

   2. If there is sufficient information to show that the work is comparable, complete the SSA-833-U5 notice and rationale per DI 41005.015C.1.b., DI 41005.015C.2.d. and DI 41005.015C.3. Also follow DI 41005.020B.2.a. and DI 41005.020B.2.b. The example in DI 41005.035, Exhibit 13 shows a completed SSA-833-U5.

   3. If there is sufficient information to show that the work is noncomparable SGA prepare an SSA-553 (Special Determination) to this effect, identify the months of SGA and indicate the first month for which benefits should be withheld. Place the SSA-553 on the left side of the folder. Route the case to a benefit authorizer (BA) by SSA-559 with instructions to withhold benefits in accordance with the SSA-553. Furnish the BA with the following paragraph to use in the notice to the individual:

      “The law provides that, based on your impairment, you are entitled to disability insurance benefits. However, no payment may be made for any month in which you engage in substantial gainful activity that does not require skills or abilities comparable to those of any gainful activity in which you previously engaged with some regularity and over a substantial period of time. Not until a person has worked in at least 9 months is a decision made as to whether he or she has become able to do substantial work. The evidence in your case shows that you have worked in at least 9 months and that your work has been substantial gainful activity since (      ). Therefore, it is necessary to withhold your benefits beginning with the month of (      ).”

      You should notify your Social Security office promptly if you stop working or if your earnings are significantly reduced since benefits may be payable to you.”

      If appropriate, include an impairment related work expense paragraph per DI 13095.140. If the individual is not entitled to a TWP, delete the italicized portion of the notice referring to the trial work period.

   4. For cases where cessation and reinstatement months are involved, follow instructions in DI 13010.170B.6. for documenting the multiple determinations.

3. Processing Notices of Work Cessation or Reduction in Earnings Below the SGA Level

   If the last determination or other information in file shows that benefits have been withheld on the basis of noncomparable SGA and a notice of work cessation or reduction in earnings below the SGA level is received, prepare an SSA-559 to a BA. Indicate the first month the claimant did not engage in SGA and that benefits should be reinstated beginning with such month.