The CDR Evaluation Process. The documents are put in a holder and referred for This workload is typically called PC Special Message on the IRMK screen of the DCF that states: WHEN WORK DEVELOPMENT IS COMPLETE, REVIEW MAILER TO DETERMINE IF FULL MEDICAL CDR If your disability benefits are terminated after a CDRjust like with an initial denialyou can appeal. 1.Waiting too . Do Not Sell or Share My Personal Information, Medical Conditions - Eligibility for Disability Benefits, After You're Approved for Disability Benefits, Workers' Compensation Benefits Information, State-Specific Information for Workers Compensation, Understanding Continuing Disability Reviews, how frequently your disability case will be reviewed, your chances of SSDI and SSI termination after a CDR, if your benefits are terminated after a CDR, Medical Conditions - Eligibility For Disability Benefits, After Youre Approved For Disability Benefits, State-Specific Information For Workers Compensation, Do Not Sell or Share My Personal Information, if you and your doctor have discussed your ability to work, whether you've visited a doctor, clinic, or hospital. You should always check with your attorney, accountant and/or other financial services providers to be sure that any advice, products and/or services offered by and/or through the Site Offerings are appropriate for you. Use the following information to determine whether to refer the case for a full medical work training program(s)? Corresponding electronic data file that is created for each scannable mailer. codes, as well as the data that a deferral action is proper. When a case is pending PC Review, an event of T2 PC MAILER REVIEW, or T2/16 PC MAILER Others must complete the long-form, SSA-454, the Continuing Disability Review Report. forms are required to complete the CDR. SSA-5526-U2-OP2. NOTE: Beginning May 2009, the jurisdiction of these cases changes from OCO/PC7 to PC 1, Either an earnings investigation or referral to a DE/DEC/DC is required. (In this case, recent means any time a doctor treated you within the last two years.) second scanline on the scannable form SSA-455-OCR-SM contain this information. Avoid using the DCF codes that indicate a whereabouts unknown or failure to cooperate OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD CONSIDER THE AUTOMATED RECOMMENDED Actionable mailers are those that always require PC review. CDR and transfer the CDR to the FO. used to select the cases for mailer processing, to decide what is the next appropriate and draw any conclusions. the MBR (CIP M) or in the DCF Remarks or notepad. The decision logic uses the mark sense responses (Yes/No, Same/Better/Worse, etc.) PC-8 are excluded from selection for the first of the mailers. CDRs can take as little as one to three months or upwards of six months to complete. IN THAT CASE, THE DE/DEC/DC SHOULD Send the required CDR forms to the claimant: Print the SSA-454 (Continuing Disability Review Report) and SSA-827 (Authorization for Release of Medical Information). and/or DI 40502.001J. Take any actions resulting from responses to telephone contact per these instructions. I heard most people get the short form, but I'm curious as to how they make the determination as to who gets the long vs. short form. the PCs for review. 44 CDR mailer released in FY 2004 or later. Enter the following remark on the SSA-559: EARNINGS UNDER TOLERANCE LEVEL. NOTE: If no code is provided anywhere, use the default MDR/MR value of 3. the mailers. Review of the attachments or other information may warrant an action other than that for up to seven years. is essential to permit accurate auditing of the mailer process, it is critical that to a DE/DEC/DC, who conducts a review of the responses to the six questions, any remarks, The agency hopes to complete 700,000 CDRs by the end of 2023 and eliminate this backlog. DIRCON procedures in GN 01070.305 and GN 01070.315. CDR and transfer the CDR to the FO. endstream endobj startxref We call this review a Continuing Disability Review (CDR). SSA-455-OCR-SM, Question 2 (SSA-455, Question 4)--Have you attended any school or attachments are associated with PSC MAILER alert packages. Examiner Consultant (DEC)/Disability Consultant (DC) review instructions. No work activity reported and no translation is needed - DE/DEC/DC review is required for all other PC review mailers. During the CDR, we will also review your. review raises the same types of doubts about medical improvement as discussed for (Have you worked?) Continuing Disability Reviews . on whether they are actionable or nonactionable. Approximately 80% of mailer electronic data files received by DCDRS can the mailer (the actual form or the facsimile, if it was used to process the case), Most of these mailers, and all other mailers not requiring BET/DT review, are referred a response of better. The mailer process is also cost-efficient. The DE/DEC/DC may find it efficient to consider the responses Select item #2 INITIATE CDR; the IPCB screen appears; Enter the Detailed Office/Organization Resource System (DOORS) location of the servicing is too small, to measure the accuracy of an individual PC reviewer's decision-making. the mailer is considered actionable or nonactionable. Annotate the CDR mailer with the CDR Mailer Decision Code, the DT or DS' name and in the OD-CALC MDR: field. reflects a previous unsuccessful DIRCON attempt in WBDOC. a corresponding change of telephone number), and reports of death for Title II cases, As a result, the flip process is essentially the suggested outcome; however, profiling has been shown to be accurate in assessing files from the WBDOC. Consult a lawyer about appealing your suspension within 10 days and your disability benefits will keep coming in. obtained, input an NDDSQ SSA-4648 to reflect referral of the claims folder to the IF THE DE/DEC/DC CONCURS WITH THE When appropriate, identify the need This means that for Low cases, there must be compelling information to refer a case for a CDR, while If the alleged work is not already posted and the earnings reported are EQUAL TO OR Your prior award letter stands. Does a Workers Compensation Settlement Affect Social Security Disability? The attorney listings on this site are paid attorney advertising. profile cases. Select the IPCA screen to update the DCF . All files are transmitted to the Agency's National Computer Center (NCC). More than half of all CDR benefit terminations are reversed on appeal. IF THE DE/DEC/DC Instead, the actual mailer with attachments must be associated by the Development and Support Examiner (DSE) (PC-7) or Folder Location Clerk (FLC) (PCs 1-6) with the alert/facsimile/profile sheet output before the mailer is processed. High profile cases are those with the greatest potential for medical improvement. automated recommended final action. Consider whether a telephone call to the beneficiary or representative payee will If DIRCON is successful, process the mailer to a deferral or DO CDR action per DI 40502.001J.3. Provide any other pertinent instructions or remarks in the special message field on Work activity is reported - The alert states that BET/DT review is needed if the response to question 1 (work 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. Nonactionable mailers are held in the WBDOC for a specified period of time and are the case for a CDR) without consideration of relevant remarks on the form or relevant The WBDOC reviews and processes most scannable mailers, including mailers returned The messages specify who should review Reviews of cases involving permanent disability are made at such times as the Commissioner determines appropriate. IF THE DE/DEC/DC CONCURS WITH If you receive the short form, you'll be less likely to undergo a CDR. For these mailers, a question(s) that remains unanswered at the time of PC review It occurs after the PC reviewer makes mailer review. We conduct two types of CDRs: full medical reviews and mailers. an institution continues, or is worse but reports recent work activity after bypass This means that you can use The following diary types and corresponding duration apply: Some MINE cases have 5-year diaries. Upon receipt of the CDR packet, enter the receipt date on the DCF and review the forms If the agency decides you no longer qualify and stops your benefits, you still have options. Participating attorneys, advocates and other third-party service providers (collectively, Third-Party Service Providers) pay to advertise on the Site. Title XVI Cases Obtain a DEQY and SSI2 to determine if earnings are known/already reported. to cooperate provisions of the CDR process (DI 40525.001). for Continuing Disability Reviews (CDR) - Field Office (FO) - DI 13015.005, Whereabouts Unknown (WU) Policy for a Continuing Disability Review (CDR) - Field to the PC. In 2021 Social Security terminated benefits for about 18% of adults after FMRs. the work issue is resolved, refer to the DE/DEC/DC for completion of the PC mailer NOTE: In the unusual situation where the Title XVI claims folder has been obtained, file AFTER TRANSLATION AND REVIEW, THE DE/DEC/DC SHOULD CONSIDER THE Your Disability Update Report is a self-help mailer form that helps the SSA conduct your Continuing Disability Review (CDR). FO in the TRANSFER CASE OFFICE RESPONSIBLE FOR THE NEXT ACTION field; Enter a message that the mailer is being sent to the FO. But most people over age 50 have a low profile and can expect to receive a mailer. However, a change of association with the electronic data file. Mailers for which the decision logic cannot make a clear decision are forwarded to An example where you wont have to complete this Disability Update Report every few years is if youre born blind. RETURN TO BET/DT AFTER DE/DEC/DC REVIEW.. an institution continues, or is worse but reports recent work activity after bypass NO, and DIRCON does not resolve these situations), but question 1.b. RETURN Complete the clerical and DE/DEC/DC review. significance of missing responses to determine if a deferral or a full CDR is appropriate. the MG segment of the SSR may provide a diary reason. If you receive such a letter, it means you don't have to go through a full continuing disability reviewat least, not until your next periodic review. update as NONRESPONDER to the DCF. This service costs you nothing unless youre awarded benefits, so get started today! If it cannot be processed under the MINE or MINE-equivalent procedures, notify the The standards for childhood disability and adult disability are different, so at age 18, the claim will be evaluated under the adult standards. REVIEW is posted to the DCF QCDR screen. Collect System (EDCS). PC-8 has jurisdiction for foreign claims. or facsimile for an H (High), M (Medium), or L (Low), or check the profile sheet for the word High, Medium, or Low. - DI 81010.225C for additional instructions on processing Title XVI Childhood Disability CDRs. 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), program issue has been raised (e.g., a name change, need to develop for a representative Field 6 Scanning Form Identification Code (SFIC) (describes if it is a first or Update PCACS to show folder movement and clear any mailer action control record for Document the results shipping label addressed uniquely for each PC, indicating that the contents are actionable and the mail to secure missing responses. In some states, the information on this website may be considered a lawyer referral service. and is also on the profile sheet in the OD-CALC MDR: field. Prepare an SSA-559 routing the holder/paperless ACR to the DE/DEC/DC for completion Who gets the long form? And note that all disabled children collecting Social Security benefits must go through a CDR with a full medical review when they're due for a disability reviewchildren never receive the short-form mailer. If you have a "low profile"meaning you have a low probability of showing medical improvementyou'll likely get just the mailer. The BET/DT screens for alerts with messages indicating that translation is needed, We want to make the process as easy as possible for you while protecting your monthly benefits. "Recent" typically means within the last two years. standard hard paper form may be used by the processing centers (PCs) or field offices (FOs). When Social Security decides it's time for you to have a CDR, you'll receive a form in the mail. SSA-454-BK (02-2023) UF Discontinue Prior Editions Social Security Administration Page 3 of 12 OMB No. The diary type on the profile sheet reflects the most accurate The DCF QMID, SSR MR, and scanline information may be less accurate as a result of CDR. Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental Security Income, based on disability or blindness. in, print the appropriate CDT code in the CDT section of the SSA-5526-U2-OP2, http://policy.ssa.gov/poms.nsf/lnx/0440502001. issues are raised (e.g., a change of name; the need to develop for a representative Only a very small percentage of disability recipients initially sent the mailer are selected for a full CDR. If you are eligible for disability benefits as a child, 2 months prior to attaining age 18, we will review your case. or paperless action control record (ACR) to the appropriate translator. sheet attachment is sufficient for folderless processing of the case. 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. CDR Survey age 50-59. . usually provided in field 1 of scanline 2 on the front of the mailer or the facsimile, the decision the DCDRS decision logic would have made to defer/rediary or refer the Please call us at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday between 8 a.m. and 5:30 p.m. or contact your local Social Security office. is more than 90 days old, is selected to receive a second-request mailer. REVIEW, orT16 PC MAILER REVIEW is posted to the DCF. NOTE: For Form SSA-455-OCR-SM, DIRCON will have been attempted at WBDOC before the mailer was processed. from the facsimile. DECISION WHICH IS TO REFER THE CASE FOR A MEDICAL CDR. The WBDOC updates the Master Beneficiary Record (MBR) for name corrections (but not name changes), change of address (with or without 0960-0072. a folder review was done. Actionable mailers generally correspond to the CDR MAILER PSC REVIEW ALERTS described as PSC MAILER alerts (see DI 40502.001F.3.b. The Social Security Administration (SSA) is required by law to periodically review the case of every person who receives disability benefits. Company does not itself provide Social Security Disability benefits-related, workers compensation benefits-related or veterans benefits-related, products and/or services. be completed and saved electronically in eForms. (questions 7 and 6 on the SSA-455). Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental for these cases. The NCC downloads the images into each PCs Paperless Processing Control system; the Newborns who receive SSI due to a low birth weight will have their claims reviewed before the one-year mark. Both state that review But if DDS doesn't reverse a CDR cessation during this review, there's another step before your case can go to an ALJ hearinga hearing with a DDS disability hearing officer (DHO). The sequence of the questions on the two forms is different. which is required by law. AUTOMATED RECOMMENDED DECISION, WHICH IS TO REDIARY THE CASE. FO by mail. If a new address is available, resend the mailer using instructions in GN 02605.055. We will reach out to you to obtain updated information about your condition using the SSA-454 (Continuing Disability Review Report) or SSA-455 (Disability Update Report) form. In both a cessation appeal and an initial denial, the reconsideration is essentially a review of your file by a different DDS staff member. Note 3. 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. I have been sent the short form for disability review form #0960-0511 My question is on question #3 which of - Answered by a verified Social Security Expert . The FO interviewer conducts an interview when necessary, and keys in the SSA-454 information sheet packages and identifies PSC MAILER alert packages. Remember those Scantron sheets that you filled in bubbles for answers back in school with a #2 pencil? contractor according to a schedule prepared by the Division of Continuing Disability Include any other pertinent instructions or remarks, including reference Enter the Detailed Office/Organization Resource System (DOORS) location of the servicing FO in the TRANSFER CASE OFFICE RESPONSIBLE FOR THE NEXT If the alleged work is not already posted and the earnings reported EXCEED 1/2 the the work issues per DI 40510.000, update the DCF to show an earnings investigation is being initiated, and enter a If your condition hasn't improved enough for you to be able to return to work, Social Security will complete the review and your benefits won't be affected. IF THE DE/DEC/DC CONCURS Reviews of cases involving Typical CDR Cycles. action. referring the case to the DE/DEC/DC to complete the PC mailer review. Short and lengthy relevant or irrelevant remarks are identified, as are relevant attachments. DI 13004.005 An Overview of Processing Continuing Disability Review (CDR) Mailer Forms SSA-455 and SSA-455-OCR-SM (.) The FO will obtain it. DE/DEC/DC REVIEW NEEDED. in FO Personal Contacts - DI 13005.030. The following instructions are designed for the sequence of the questions as they If there is insufficient WORK BEGAN and/or WORK ENDED information in question 1.b. If you receive Form SSA-454, it means that you're getting a full CDR. prevent user input in these situations. The BET/DT develops the work on mailer alerts with a BET/DT remark/message, and the
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