SSA - POMS: DI 40502.001 - Processing Center Instructions for the Continuing Disability Review Mailer Forms SSA-455 and SSA-455-OCR-SM (2024)

The BET/DT develops the work on mailer alerts with a BET/DT remark/message, and the DE/DEC/DC develops the work on any alerts with a DE/DEC/DC remark/message.

DCDRS decision logic uses the same criteria used by the WBDOC to determine if the response(s) to question 1 are actionable (DI 40502.001E.4.b.). DCDRS alerts the following cases for BET/DT review:

  • all mailers with a “YES” response to question 1.a. (Have you worked?) AND/OR

  • in response to question 1.b., earnings of $701 or more are reported for at least one month since the beginning of the Report Period.

If question 1.a. is answered “Yes” (or is not answered or is answered BOTH Yes and NO, and DIRCON does not resolve these situations), but question 1.b. is blank/no earnings are reported, the mailer is actionable.

If there is insufficient WORK BEGAN and/or WORK ENDED information in question 1.b. to determine when the earnings occurred, but the reported MONTHLY EARNINGS in 1.b. are $701 or more in any of the three entries, the mailer is actionable.

NOTE: If only work and earnings prior to the report period are described, the mailer is not considered an actionable mailer.

DCDRS decision logic also alerts “nonactionable” mailers for PC review when it detects a code of “1” in position 1 or 2 of the ANY CODES? codes. These cases can be worked from the facsimile.

Local procedures may have the DE/DEC/DC refer cases involving work and earnings for BET/DT review.

The BET/DT procedures, as described herein, are generalized and may not precisely describe the local process.

NOTE: Under no circumstances should the BET/DT “NAN” the mailer after review of question 1. Either an earnings investigation or referral to a DE/DEC/DC is required.

Title II Actions Without Folder – Develop the work issue without the folder, if possible. Take the following actions based on receipt of a BET/DT REVIEW alert:

  • Folderless Actions – Check the T2 WORK and EARNINGS Segments of the DCF. If alleged work falls within the dates of the work information posted to the T2 WORK and/or EARNINGS segments of the DCF annotate the mailer with “WORK ON THE DCF”

  • Prepare an SSA-559 routing the holder/paperless ACR to the DE/DEC/DC for completion of the PC review.

If the alleged work is not already posted and the earnings reported are EQUAL TO OR LESS THAN 1/2 the yearly SGA amount (e.g., for 2008, equal to or less than $217 weekly, or $940 monthly, or $11,280 annually), do not develop the work issues at this time. Instead, prepare an SSA-559 to refer the case to the DE/DEC/DC to process the mailer.

Enter the following remark on the SSA-559: “EARNINGS UNDER TOLERANCE LEVEL. RETURN TO BET/DT AFTER DE/DEC/DC REVIEW.”

When the mailer processing is completed, return those cases not referred by the DE/DEC/DC to the FO for a CDR, and not selected for a CDR as integrity sample cases, to the BET/DT to complete the development of the unposted earnings in accordance with DI 40510.000.

If the alleged work is not already posted and the earnings reported EXCEED 1/2 the yearly SGA amount (e.g., for 2008, more than $217 weekly, or $940 monthly, or $11,280 annually), develop the work issues per DI 40510.000, update the DCF to show an earnings investigation is being initiated, and enter a Special Message on the IRMK screen of the DCF that states:

“WHEN WORK DEVELOPMENT IS COMPLETE, REVIEW MAILER TO DETERMINE IF FULL MEDICAL CDR IS NECESSARY, AND REPLACE WORK AND EARNINGS INVESTIGATION WITH APPROPRIATE IPCA EVENT CODE”.

Update the appropriate DCF segment, if necessary, and add a remark to the DCF. After the work issue is resolved, refer to the DE/DEC/DC for completion of the PC mailer review.

Title II Actions with Folder – Determine whether the alleged work and earnings have already been resolved. If resolved, annotate the mailer holder/paperless ARC with, “WORK RESOLVED”, and prepare an SSA-559 referring the case to the DE/DEC/DC to complete the PC mailer review.

If the alleged work is not already posted and the earnings reported are EQUAL TO OR LESS THAN 1/2 the yearly SGA, do not develop the work issues at this time. Instead, prepare an SSA-559 to refer the case to the DE/DEC/DC for processing of the mailer. Enter the following remark on the SSA-559:

“EARNINGS UNDER TOLERANCE LEVEL. RETURN TO BET/DT AFTER DE/DEC/DC REVIEW.”

When the mailer processing is completed, return those cases not referred by the DE/DEC/DC to the FO for a CDR, and not selected for a CDR as integrity sample cases, to the BET/DT to complete the development of the unposted earnings in accordance with DI 40510.000.

If the alleged work is not already posted and the earnings reported EXCEED 1/2 the yearly SGA amount, develop the work issues per DI 40510.000, update the DCF to show that an earnings investigation is being initiated, and enter a Special Message on the DCF's IRMK screen that states:

“WHEN WORK DEVELOPMENT IS COMPLETE, REVIEW MAILER TO DETERMINE IF FULL MEDICAL CDR IS NECESSARY, AND REPLACE WORK AND EARNINGS INVESTIGATION WITH APPROPRIATE IPCA EVENTCODE”.

Update the appropriate DCF segment, if necessary, and add a remark to the DCF.

After the work issue is resolved, refer to the DE/DEC/DC for completion of the PC mailer review.

Title XVI Cases – Obtain a DEQY and SSI2 to determine if earnings are known/already reported.

If earnings are known, annotate the mailer with, “EARNINGS KNOWN”, and prepare an SSA-559 referring the holder/paperless ACR to a DE/DEC/DC for completion of the PC mailer review.

If earnings are not known/previously reported, do not apply the Title II earnings tolerance. Make a photocopy of the mailer/facsimile and any relevant attachment (e.g., pay stubs, copies of W-2's), and refer to the servicing FO to develop/adjust for the work and earnings.

Annotate the mailer, the photocopy, and the DCF's IRMK remarks screen with, “UNKNOWN EARNINGS REFERRED TO FO”.

Complete the clerical and DE/DEC/DC review. On the copy of the mailer referred to the FO, advise the FO that no referral to PC-7 is necessary.

SSA - POMS: DI 40502.001 - Processing Center Instructions for the Continuing Disability Review Mailer Forms SSA-455 and SSA-455-OCR-SM (2024)
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