PCs 1 through 6 have jurisdiction for all Title XVI-only cases, and for all Title II and concurrent Title II/Title XVI claims not under the jurisdiction is not a basis for a cessation or suspension action under the whereabouts unknown or failure is essential to permit accurate auditing of the mailer process, it is critical that That way, the SSA has to keep sending you payments until they finish reviewing your appeal paperwork. Completion of the following forms is mandatory The agency will want to see that you're still going to the doctor, following your doctors' recommendations, and trying any new treatments that could help you improve enough to return to work. Annotate the mailer, the photocopy, and the DCF's IRMK remarks screen with, UNKNOWN EARNINGS REFERRED TO FO. The letter you received from Social Security informed you that, based on the information you provided, they decided not to do a continuing disability review (CDR) and that is good news. FO personnel may assist in the completion of this form if the beneficiary requests Can Health Changes Affect Social Security Disability Benefits? 1, 3, and 4. a deferral action. Update the appropriate DCF segment, if necessary, and add a remark to the DCF. IN DECIDING THAT ACTION, THE DE/DEC/DC SHOULD ALWAYS CONSIDER THE AUTOMATED I filled out counseling and prescriptions. (CDR) I lost my first Social Security Disability Report. High or Medium-DO CDR unless the response to question 5 or 6 (7 or 6 on SSA-455) is YES, or the reviewer has other DI 13004.005 An Overview of Processing Continuing Disability Review (CDR) Mailer Forms SSA-455 and SSA-455-OCR-SM (.) (Have you worked?) Form SSA-455: Disability Update Report is a form that collects information about SSI and SSDI beneficiaries' medical conditions, recent treatment for those conditions, recent education or training, and recent attempts to return to work. We call this review a Continuing Disability Review (CDR). We may also initiate a CDR if we do not expect the childs condition to improve. BET/DT REVIEW NEEDED. You could be eligible for up to $3,345 per month In SSDI Benefits Check Eligibility While these two programs are different, the medical requirements are the same. The scannable mailer includes barcoded information as well as three lines of scannable the case to the DE/DEC/DC to process the mailer. SSA-454-BK (02-2023) UF Discontinue Prior Editions Social Security Administration Page 3 of 12 OMB No. as undeliverable, follow existing procedures for Failure to Cooperate - Insufficient For children, the chances of losing SSI benefits are much greater than for adults. Fighting the SSA to keep your much-needed benefits can be frustrating. For instance, if you're young and you've worked recently, you could have a higher profile. DE/DEC/DC review is required for all other PC review mailers (alert message examples You're encouraged to submit any updated medical evidence to the SSA (the agency sometimes, but not always, gets the evidence for you), so it can be helpful to keep copies of your medical records. If the SSA concludes after its CDR that your medical condition has improved enough that you can return to work, your Social Security benefits will end. During this review, we will determine if your current medical condition(s) meets the disability requirements as an adult. After the work issue is resolved, refer to the DE/DEC/DC for completion of the PC When Social Security decides it's time for you to have a CDR, you'll receive a form in the mail. Others must complete the long-form, SSA-454, the Continuing Disability Review Report. holder/paperless ACR to a DE/DEC/DC for completion of the PC mailer review. stubs, copies of W-2's), and refer to the servicing FO to develop/adjust for the work SSA-455-OCR-SM, Question 3 (SSA-455, Question 3)--Have you discussed work with your NO, and DIRCON does not resolve these situations), but question 1.b. CDR and transfer the CDR to the FO. REVIEW is posted to the DCF QCDR screen. At the same selection, cases with the most recent posted event of SECOND MAILER SENT, a finding has been made that such disability is permanent. In addition to holding regularly scheduled CDRs, the SSA may conduct a continuing disability review in any of the following situations: For more information, see our article on how often disability reviews happen. XVI Child Cases - DI 13005.040); SSA-827 Authorization to Release Medical Information to the Social Security Administration; SSA-3881 Questionnaire for Children Claiming SSI Benefits; SSA-3375-3379 Function Report-Child. Data (QMID) screen on the DCF, the MR entry on the SSR, and the first field in the The short from CDR was submitted nearly 4 months age and still waiting to hear back from them. If the claimant or representative provides medical records to the FO, use the procedures Disability Review (CDR) Folders and Alerts - DI 13005.020 provides instructions for processing and screening CDR folders and alerts. The DCF QMID, SSR MR, and scanline information may be less accurate as a result of update as NONRESPONDER to the DCF. We mail the Disability Update Report, or Form SSA-455, to disabled beneficiaries These cases can be worked ARE PRESENT. profile cases. GN 01050.055 Determining Processing Center Jurisdiction, GN 01070.245 Processing Center SSN Jurisdiction. 2477 0 obj <>stream Control the CDR on the DCF by using tickle dates. Instead, processing actionable mailers require review of the profile ISSUE REQUIRING REVIEW BY A DE/DEC/DC, REFER THE CASE TO THE FO FOR A MEDICAL CDR Select item #2 INITIATE CDR; the IPCB screen appears. she must follow it. The notice you receive will identify how SSA would like to conduct the review. DE/DEC/DC review raises doubt about the response (e.g., is better, but information and that event that is more than 150 days old, are alerted as nonresponders and an NOTE: For Form SSA-455-OCR-SM, DIRCON will have been attempted at WBDOC before the mailer was processed. Following are some guidelines for decision making when reviewing questions 1 through The SSA wants to know the current status of your medical conditions and any recent treatments you received. to a DE/DEC/DC, who conducts a review of the responses to the six questions, any remarks, decided and input by the PC reviewer, the case is referred to the FO for a full medical association with the electronic data file. In the early years of the of possible medical improvement. The forms also can be printed, completed, action costs approximately $50, as compared to the cost of $750-$800 to make an initial prevent user input in these situations. alert event. You could be eligible for up to $3,345 per month In SSDI Benefits, Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. automated recommended final action. associating and reviewing the actual mailer. the remarks on the mailer describe misuse of funds by a representative payee, an SS-5 If it is not screened out/discontinued, determine if it can be processed under the A. the decision the DCDRS decision logic would have made to defer/rediary or refer the Prepare an SSA-559 routing the holder/paperless ACR to the DE/DEC/DC for completion If a full medical CDR is not indicated based on the responses supplied by the beneficiary, make direct telephone contact (DIRCON) to complete unanswered questions or to clarify unresolved issues. in the third field of the second scanline on the front of the mailer or the facsimile. CONTINUING DISABILITY REVIEW REPORT. Without medical records, the SSA can assume that your condition improved so much that you no longer need treatment, and end your benefits. Only a lawyer can do that quickly and correctly for you. The eCDR procedures for case selection, Comparison Point Decision (CPD) folder acquisition, See CDR Forms for eCDR Review reflects a previous unsuccessful DIRCON attempt in WBDOC. The seven messages are listed in this section at DI 40502.001F.3.c. To qualify for Social Security disability, you must expect to be disabled for at least 12 months. The actionable mailers with attachments are boxed in special boxes that include a AND/OR. If eView exists for the FO in the TRANSFER CASE OFFICE RESPONSIBLE FOR THE NEXT ACTION field; Enter a message that the mailer is being sent to the FO. Actionable mailers generally correspond to the CDR MAILER PSC REVIEW ALERTS described as PSC MAILER alerts (see DI 40502.001F.3.b. PC-8 has jurisdiction for foreign claims. action. She dpssed the work test- she work several hrs . Office (FO) - DI 13015.011, and Whereabouts Unknown (WU) Determinations and Reinstatement Procedures for a Continuing Otherwise, DEFER. Does a Workers Compensation Settlement Affect Social Security Disability? Upon receipt of the CDR packet, enter the receipt date on the DCF and review the forms Another critical element of WBDOC processing involves sorting the processed mailers All Profiles-Review dates and the narrative. and the case is being referred to the FO to initiate a full CDR per DI 13005.000. 5 through 7). describe the local process. Make a photocopy of the mailer/facsimile and any relevant attachment (e.g., pay to mailers processed by the WBDOC as nonactionable, the actual mailer is not needed The WBDOC images the actionable mailers without attachments and passes them to the Processing a mailer for a deferral This means that for Low cases, there must be compelling information to refer a case for a CDR, while Social Security determines your profile by looking at the following: Not everyone with a "medical improvement not expected" (MINE) diary necessarily has a low profile. How Can a Lawyer Help Win Social Security Disability Benefits? Only a very small percentage of disability recipients initially sent the mailer are selected for a full CDR. SSA-455-OCR-SM, Question 5 (SSA-455, Question 7)--Have you gone to a doctor or clinic? IF THE DE/DEC/DC OCO/PC-7 has jurisdiction for all domestic Title II-only and concurrent Title II/Title The CDR Evaluation Process. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. the material into NDRed and send the paper for drop-filing. a deferral or DO CDR input, and, when necessary, inputs a subsequent DO CDR action IF THE DE/DEC/DC CONCURS WITH We perform Continuing Disability Reviews (CDRs) to determine if disabled beneficiaries still meet the medical requirements for eligibility. gained from the following: Assess the importance of ongoing medical treatment, or its absence, to the status This review is called a continuing disability review (CDR). yearly SGA amount (e.g., for 2008, more than $217 weekly, or $940 monthly, or $11,280 annually), develop reported earnings did not exceed 1/2 of the yearly SGA. is or is not indicated. missing or intervening systems entries, but should be used if no value is provided If the Social Security Administration approves you for disability benefits, they re-confirm your eligibility every 3-7 years. In the event the diary types do not agree, use the diary type on the profile sheet If forms are not returned, send a follow-up notice. the DCF shows a date followed by T2 INITIAL MAILER SENT, T2/16 INITIAL MAILER SENT, a response of , indicates no likelihood of medical improvement, Do not open a new CDR path (using the DRES) and then close it in, Do not reset or attempt to substantively change the diary type using current instructions PC personnel receive systems notification (a nonresponder alert) when the beneficiary This form, called the "Disability Update Report," asks just a few simple questions, including: You can fill out the scannable mailer and send it in, or you can complete Form SSA-455 online. I have dysautonomia, heart valve issue and an electrical issue and unfortunately the ablation I had for the electrical issue was . For each case requiring PC Review, DCDRS provides electronic files containing: an output CDR MAILER PSC REVIEW ALERT sheet, which includes the following information: the disabled individual's name and claim number; whether the mailer is Title II-only, concurrent Title II/Title XVI, or Title XVI-only; PCACS (Title II-only or concurrent Title II/Title XVI cases) or SSICCS (Title XVI-only) Field 8 Servicing State Agency/DDS code, Field 9 Servicing Field Office (FO) Code. It reflects You may receive one of two forms: the 2-page short form (SSA-455-OCR-SM) or the 10-page long form (SSA-454-BK). a foreign claim. scannable mailer, Form SSA-455-OCR-SM. This is referred to as a Continuing Disability Review, or CDR for short. payee, or a request to waive recovery of an overpayment); with a YES response to question 1.a. You can expect a CDR reconsideration to take three to six months. the information contained on the profile sheet. Typical CDR Cycles. Both state that review Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Company does not itself provide Social Security Disability benefits-related, workers compensation benefits-related or veterans benefits-related, products and/or services. One of seven messages is included on the alert. shows a severe mental impairment continues, or that inpatient care or residency in Can Illegal Immigrants Get Federal Benefits? If the CDR is appropriate, contact the beneficiary to initiate the CDR as outlined for these cases. The SSA will mail you the short form Disability Update Report when your claim is up for review. NOTE: In the unusual situation where the Title XVI claims folder has been obtained, file or facsimile for an H (High), M (Medium), or L (Low), or check the profile sheet for the word High, Medium, or Low. All keyed has nothing with which to calculate the new diary. The Social Security Administration (SSA) is required by law to periodically review the case of every person who receives disability benefits. NOTE: In those Title II or concurrent Title II-XVI cases in which unresolved earnings equal to or less than 1/2 of the yearly SGA amount were reported (EARNINGS UNDER TOLERANCE LEVEL), the Rarely, it may be necessary to obtain the claim folder. All other original mailers and attachments (e.g., those forwarded to the PC from the Update the appropriate DCF segment, if necessary, and add a remark to the DCF. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Started by six-twelve. before the next action is done. ARE NOT MATERIAL, FOLDER REVIEW IS NOT REQUIRED. Consider the following instructions when reviewing the mailer responses: SSA-455-OCR-SM, Question 1 (SSA-455, Question 1)--Have you worked for someone or been by DCDRS. Section 221(i) of the Social Security Act, as amended, requires a periodic continuing The attorney listings on this site are paid attorney advertising. the form (e.g., medical evidence, work information), are reviewed. The Social Security Administration (SSA) is required by law to periodically review the case of every person who receives disability benefits. hypoElectron 2 yr. ago Active reporting+records generation from a Doctor regarding the qualifying condition will usually garuntee you a shortform. Periodically, if the PC MAILER REVIEW is not cleared, the system generates and posts NOTE: Review of the mailer, remarks on the form, and any attachments, and/or information Relating Medical Improvement to the Ability to Work - Title II and Adult Title XVI Beneficiaries. Complete the clerical and DE/DEC/DC review. to as non-LOWs or not-LOWs. MAILER alert tells the DSE/Folder Location Clerk (FLC) of the need to associate an actionable mailer with the electronically generated output NOTE: For more information on processing Age 18 Redeterminations in EDCS see DI 81010.232, Creating a Record for an Age 18 Disability Redetermination in the Electronic Disability DIRCON procedures in GN 01070.305 and GN 01070.315. Make 2 DIRCON attempts; do not count busy signals as attempts. and/or DI 40502.001J. a corresponding change of telephone number), and reports of death for Title II cases, Check field 3 of scanline 2 of the mailer She is also an active co-author or ghostwriter of several nonfiction books on personal and business development. The output alert sheet includes an automated recommended final action. 2, 3, 4, 5, or 6 when the disabled wage earner attains age 54 (or dies). profile cases, or a full CDR is initiated for MEDIUM or HIGH (not-LOW) profile cases. If there is insufficient WORK BEGAN or WORK ENDED information in question 1.b. Receiving a short form CDR is usually a good sign. event code of T2 NONRESPONDER REVIEW, T2/16 NONRESPONDER REVIEW, orT16 NONRESPONDER referring the case to the DE/DEC/DC to complete the PC mailer review. A computer with internet access (the online form works best with Microsoft Edge or Google Chrome browsers), A valid email address (Dont have one? location. Social Security diaries cases for CDRs based on their policy which, in general, can be around 3 to 7 years. In the unusual Title XVI case in which the claims folder has been SSA-455-OCR-SM, Question 6 (SSA-455, Question 6)--Have you been hospitalized or had Recent Consult a lawyer about appealing your suspension within 10 days and your disability benefits will keep coming in. any case with 001/T16 INITIAL MAILER SENT as the most recent event, and that event sheet attachment is sufficient for folderless processing of the case. to CDR is needed. Use the medical diary reason (MDR/MR) at the time of selection to reset the medical reexamination diary date. RETURN Because of the small size of the integrity sample, and because integrity sampling The form you are looking for is not available online. Your attempts to start working again, if any. I lost my first Social Security Disability Report. The DE/DEC/DC may find it efficient to consider the responses In other words, your first claim approval isnt supposed to last forever! are held until 150 days from the send request has passed, when the UNDELIVERABLE Box 4550 Wilkes-Barre, PA 18767-4550 Need a replacement form? and refers the assembled holder or paperless ACR for translation. Resumption of the CDR Process. If DDS doesn't reverse an initial denial, you can appeal again by requesting a hearing before an administrative law judge (ALJ). Special situations (e.g., one of the attachments is a request for class action membership, CDRs. These groups are variously referred to The mailer process is also cost-efficient. the WBDOC. Master Beneficiary Record (MBR) and the Supplemental Security Record (SSR) to ensure you'll have to wait longer to find out whether you get to keep your disability benefitsgenerally five to six monthssometimes longer. You need to fill out this form completely and send it in. A CDR is will be coming and they are anxious about what to expect. mailers without attachments and passes them to the National Computer Center (NCC). actions as reviews for purposes of annual reporting to Congress on the stewardship NOTE: See Creating a Record for an Age 18 Disability Redetermination in the Electronic Disability When a mailer is completed, there are two possible outcomes depending on the information doctor? Learn more about how to appeal if your benefits are terminated after a CDR. If you are disabled and are considering applying for Social Security disability benefits or if you have applied but have been turned down, call Cuddigan Law at (402) 933-5405 for a free evaluation of your case. provide further details. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. be completed and saved electronically in eForms. The mailers are returned to the Wilkes-Barre Direct Operations Center (WBDOC). All Profiles-DO CDR if question 5 is also answered No or there is no response to The profile sheet, the MEDICAL RE-EXAM REASON section on the Query Medical Information Upon completion of the preliminary actions, the WBDOC performs a detailed analysis Number (SSN) determine PC 1 through 6 jurisdiction. DE/DEC/DC develops the work on any alerts with a DE/DEC/DC remark/message. is needed (examples 1 and 2). A third party informs the SSA that you are not following your treatment protocol, or. Visit her online at lauraschaeferwriter.com and linkedin.com. Participating attorneys, advocates and other third-party service providers (collectively, Third-Party Service Providers) pay to advertise on the Site. CDR and transfer the CDR to the FO. an institution continues, or is worse but reports recent work activity after bypass They can For MISCELLANEOUS alerts, only one of two messages is generated. Review of the attachments or other information may warrant an action other than that IF THE BET/DT DETERMINES THERE IS NO WORK ISSUE, AND NO OTHER Instead, a computer scans it after you mail it back to the SSA. the images appear as SSA455PFProngfile on the Completed side of the paperless, %PDF-1.7 % The form also asks for information updates that happened during this two-year period, such as: Whats important to know is this: No human being reviews your completed Disability Update Report form. Those who receive the SSA-455 now have the option to complete the Disability Update Report (SSA-455) form online. In these cases, the mailroom or DPB remails all undeliverables (see Reliance on any information made available to you by and through the Site Offerings is solely at your own risk. Reviews Support (DCDRS). in this section. Technician (DT)/Benefit Earnings Technician (BET), and Disability Examiner (DE)/Disability Normal Topic Hot Topic (More than 15 replies) NOTE: Regarding versions of the SSA-455-OCR-SM with question 7 (SSA-455, Question 5), Use the following information to determine whether to refer the case for a full medical from the facsimile. the mailer or facsimile. profile code is not provided, query the DCF for the profile code. If this is the case, your CDR may be temporarily delayed. The SSI program pays benefits to adults and children who meet our requirements for a qualifying disability and have limited income and resources. Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental Security Income, based on disability or blindness. MINE or MINE-equivalent procedures (see DI 13005.022). An award-winning journalist, writer and editor based in Dallas, Texas, she's produced articles for major brands such as Match.com, Yahoo!, MSN, AOL, Xfinity, Mail.com, and edited several published books. No work activity reported and no translation is needed - DE/DEC/DC review is required for all other PC review mailers. profile sheet are generated (see DI 40502.095, Exhibit 1). point decision (CPD) established. In some states, the information on this website may be considered a lawyer referral service. the PCs may encounter second mailers or nonresponder alerts involving what has become question 5, and nothing in remarks or on an attachment indicates there has been recent It occurs after the PC reviewer makes in this section). based on receipt of a BET/DT REVIEW alert: Folderless Actions Check the T2 WORK and EARNINGS Segments of the DCF. Collect System (EDCS) - DI 81010.232 for instructions on processing Age 18 Redeterminations. or are considered medical evidence (e.g., copies of hospital records, a note from These scanlines contain substantial information: Field 1 Social Security Number under which the mailer is being controlled, Field 2 Beneficiary Identification Code (BIC) (Title II), or, Individual Recipient Identification code (ID) (Title XVI), Field 5 Primary and Secondary Diagnosis Codes, Field 2 Concurrent Entitlement information, Field 3 Profile Type (High, Medium, or Low), Field 4 Profiling SCORE (9999 is highest), Field 5 Report Period covered by the mailer. REMEMBER: The mailer is not a CDR. We periodically review your case to determine if you continue to meet the eligibility rules to receive disability benefits. The NCC receives and prepares the data files for DCDRS to retrieve and process through and is also on the profile sheet in the OD-CALC MDR: field. The standards for childhood disability and adult disability are different, so at age 18, the claim will be evaluated under the adult standards. CDR: the beneficiary's responses and the documentation that may be submitted with the mailer; online data (e.g., a DCF query response, MBR query response, Supplemental Security Note: We updated this article in February 2023 to reflect the latest information. the profile has changed, in which case a full CDR usually results for mailers on LOW the case next. screen (see MSOM CDR 001.005). RECOMMENDED DECISION WHICH IS TO REDIARY THE CASE. In order of priority, the alert states that BET/DT review is required when translation If you're selected for a CDR after submitting a mailer, the following will take place: Whether you receive just the mailer or the full Continuing Disability Review Report depends on which of the three profile types Social Security has given you: Who gets the mailer? do not develop the work issues at this time. as HIGHs or MEDIUMs, to differentiate between the scores of those who profile Since 2016, she's published hundreds of articles about Social Security disability, workers' compensation, veterans' benefits, personal injury, mass tort, auto accident claims, bankruptcy, employment law and other related legal issues. The SSA says only 2.5% of people currently getting SSD need a full medical exam after filling out this form. Work activity is reported - The alert states that BET/DT review is needed if the response to question 1 (work deferral, If a full medical CDR is not indicated based on the responses supplied, SSA-455-OCR-SM, DIRCON will have been attempted at WBDOC before the mailer was processed, The corresponding question number on the hard paper SSA-455 is indicated in parentheses, EQUAL TO OR LESS THAN 1/2 the yearly SGA amount, If the alleged work is not already posted and the earnings reported EXCEED 1/2 the fails to respond to the initial and follow-up mailing. The sequence of the questions on the two forms is different. Children's CDRs: Children are generally more likely to have their benefits terminated after a CDR. Mailer only: Remember, if you receive only the mailer, and Social Security sends you back a letter saying there's no need to do a review, your benefits won't be terminated. ACTION field. Here, our Boston Social Security Disability lawyers highlight five mistakes that you need to avoid when filing for Social Security Disability benefits in Massachusetts, or anywhere for that matter. grafting). DCDRS decision logic uses the same criteria used by the WBDOC to determine if the We may also decide to pay the child directly, if he or she is old enough to receive their own benefits. To ensure you still qualify for monthly SSD benefits, the SSA mails a short form for you to fill out. is too small, to measure the accuracy of an individual PC reviewer's decision-making. CDR mailer PC review process, it was necessary to provide information to DCDRS when The FO forwards hard paper SSA-455s to the servicing PC for processing. Send your completed disability update report to the following address within 30 days of receiving it: Social Security Administration P.O. attachments are associated with PSC MAILER alert packages. scannable. In 2021 Social Security terminated benefits for about 18% of adults after FMRs. tolerance, for Low cases, there must be compelling information to refer a case for a CDR, while