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A. PolicySection 221(i) of the Social Security Act, as amended, requires a periodic continuing eligibility review for disabled beneficiaries at least every 3 years except where a finding has been made that such disability is permanent. Reviews of cases involving permanent disability are made at such times as the Commissioner determines appropriate. This review is called a continuing disability review (CDR). Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental Security Income, based on disability or blindness. These reviews are either called CDRs or, in the case of the age 18 review, a redetermination. B. Process1. Mailer Form SSA-455 Disability Update ReportForm SSA-455 is a self-help mailer form designed to solicit key information from disabled beneficiaries about their medical conditions and recent treatment for same. "Recent" usually means within the last 2 years. The mailer form also asks for information about recent education or training, and recent attempts to (return to) work. 2. Who is Sent a Mailer FormThe mailer form is usually sent to beneficiaries who have a low probability of medical improvement were a full CDR done. Probability is determined on the basis of statistical analyses (called profiling ) of on-line beneficiary data. Data considered includes, but is not limited to: age; impairment(s); length of time in benefit status; basis (regulation-basis code and listing number, if applicable) for the initial determination; data on any prior CDR(s); recent earnings. Each case is assigned a score that reflects the results of the statistical analyses. The cases with scores indicative of a low probability of medical improvement are often described simply as “LOWs”. A LOW profile generally equates with the same adverse medical and/or vocational factors that result in a DDS CDR determination that disability continues. However, because the mailer form process is a folderless analysis, it is dependent on on-line data to document those factors. To avoid incorrect selection, when data are not available or the data are inconsistent, the resulting profile score will be higher, and selection of the case for mailer form processing may not be possible. In some instances, other groups of beneficiaries may be sent mailers. These groups are variously referred to as “HIGHs” or “MEDIUMs”, when differentiating between the “scores” of those who profile as potentially productive CDRs, or as a combined group may be referred to as “non-LOWs” or “not-LOWs”. 3. Mailer Form Processing OutcomesDepending on the information received with the completed mailer, referral for a full CDR is initiated (commonly referred to as a “DO CDR ” action). This occurs in about 2.5% of the mailer forms received for processing. Much more frequently, a deferral action is made to defer doing a full CDR. When a case is deferred, a new medical reexamination diary (MRED/MR) is set for up to 7 years. The medical diary reason (MDR) at the time the case was selected for mailer form processing is used to determine how long the new MRED/MR should be. If there is no MDR value, a default value of “3” is established for the MDR and the MRED/MR is reset for 36 months/3 years. 4. Mailer Form Processing is Not a CDRThe action to defer a CDR or refer a mailer case for a CDR is not a CDR and is not an initial determination subject to administrative review, nor is a new comparison point decision (CPD) established. 5. The Scannable Mailer FormAn optically scannable self-mailer variation of the mailer form, the SSA-455-OCR-SM, is most frequently used. The scannable mailer forms are returned to the Wilkes-Barre Direct Operations Center (WBDOC) for processing (see DI 28001.003E.). Since October 1995, the scannable mailer form SSA-455-OCR-SM is used most of the time, although the standard “hard paper” form may be used by the processing centers (PCs) or field offices (FOs). 6. Question Sequencing on the Mailer Formsa. GeneralThe responses to the questions on the mailer form, as well as information and evidence submitted with the form, may be of use to the DDS adjudicator in the event the case is subsequently referred to the DDS for a full medical CDR. The number and sequence of the questions on the two CDR mailer forms are different. b. Questions on the SSA-455 "Hard Paper" Mailer FormThe hard paper form has a fixed report period format (the last 2 years). The questions were taken from the version of form SSA-454-BK, Report of Continuing Disability Interview, then in use, and were then modified to fit a self-mailer form design. Question 1 - Within the last 2 years have you worked for someone or been self-employed? Question 2 - Check the block which best describes your health within the last 2 years (Better, Same or Worse). Question 3 - Within the last 2 years has your doctor told you that you can return to work? Question 4 - Within the last 2 years have you attended any school or work training programs(s)? Question 5 - Would you be interested in receiving rehabilitation or other services that could help you get back to work? Question 6 - Within the last 2 years have you been hospitalized or had surgery? Question 7 - Within the last 2 years have you gone to a doctor or clinic for your condition? c. Questions on the SSA-455-OCR-SM Scannable Mailer FormEach question on the scannable mailer is referenced to a specific time period unique to that mailer. This "report period" usually begins with the 24th month prior to the month the mailer is sent and continues to the present, but may be a longer or shorter time period. Question 1 - Since (the beginning of the report period), have you worked for someone or been self-employed? Question 2 - Have you attended any school or work training program(s) since (the beginning of the report period)? Question 3 - Since (the beginning of the report period), have you and your doctor discussed whether you can work, and if so, what did the doctor tell you? Question 4 - Place an "X" in only one box (labeled Better, Same, and Worse) which best describes your health now as compared to (the beginning of the report period). Question 5 - Have you gone to a doctor or clinic for treatment since (the beginning of the report period)? Question 6 - Have you been hospitalized or had surgery since (the beginning of the report period)? Note that the scannable mailer does not include a question regarding interest in referral for rehabilitation or other vocational services. d. What Is the Significance of the Difference Between the Two Versions of the Mailer Form?The hard paper mailer form was the only CDR mailer form prior to fiscal year 1996. The sequence and wording of questions on form SSA-455-OCR-SM were modified from the original SSA-455 to reflect our experiences with the mailer form process from 1993 onward. The SSA-455-OCR-SM reflects the most current design and processing policies; however, the older form SSA-455 may be used. Both versions are under review by private contractors; a single sequence of questions and matching hard paper and scannable mailer forms will be prepared following completion of this review. C. Procedure -- Sending Out the Mailer Form and Establishing Systems Controls1. Sending Out the Mailer FormThe mailer form, a generic cover notice and instruction insert, and a reply envelope are sent to the beneficiary or representative payee. An initial mailer form or "1st-request" form is sent. If it is not returned and receipted within a specific time frame, a "2nd-request" mailer form is sent. If neither mailer is returned and receipted within a specific time frame, a nonresponder alert is generated to the servicing PC. The four-page generic cover notice and instruction insert explains the mailer process and what outcomes may result when the Agency processes the mailer. The insert also stresses the importance of responding and specifies time frames for responding. The insert includes telephone numbers for contacting SSA if the individual has additional questions. The insert also includes two pages of instructions on how to complete the form, including sections on each question that provide more in-depth explanations (than can be included on the mailer form) as to what information is being requested. 2. When Mailer Forms Are Senta. Scannable Mailer Form SSA-455-OCR-SMCentral Office initiates five scheduled releases of large numbers of scannable mailer forms SSA-455-OCR-SM during the Agency's fiscal year (FY), which begins on October 1 and ends on September 30 of the following calendar year. Scannable mailer forms SSA-455-OCR-SM are sent to Title II-only and concurrently entitled beneficiaries or their representative payees in October, February and June of the FY. Scannable mailer forms SSA-455-OCR-SM are sent to Title XVI-only recipients or their representative payees in February and August of the FY. The five scheduled mailings of scannable mailer forms in a FY, including 1st-request and 2nd-request mailer forms, often total in excess of 1,000,000 forms. b. Hard Paper Mailer Forms SSA-455Since FY 1996, SSA has not used the hard paper form for the large scheduled mailings. These forms are used on an as-needed basis by the PCs and FOs. 3. Establishing Systems Controls for Receipt of the CDR Mailer FormWhen a case is selected to receive a Title II-only, concurrent Title II/Title XVI, or Title XVI-only mailer, time-sensitive controls are established on the Disability Control File (DCF) by means of posting an EVENT 001 - “T2 INITIAL MAILER SENT, T2/16 INITIAL MAILER SENT or T16 INITIAL MAILER SENT” or EVENT 002 - “T2 SECOND MAILER SENT, T2/16 SECOND MAILER SENT or T16 SECOND MAILER SENT” which can be viewed by querying the QCDR screen in the DCF. For a detailed explanation of this process, see DI 13004.005C.3. 4. Responding to the Mailer FormThe mailer form is completed by the beneficiary or representative payee and returned to the WBDOC (form SSA-455-OCR-SM), or to the PC or FO (form SSA-455). The address of the SSA component to who the mailer form should be returned is printed on the reply envelope provided with the mailer form. D. Procedure -- FO and DDS Involvement in the Mailer Process1. FO Assistance in Completing Mailer FormsFO assistance may include:
For more detailed information on FO actions, see DI 13004.005. 2. DDS Contact With Mailer RecipientsIn the rare event that an individual contacts the DDS about a mailer form, the DDS should refer the individual to the generic insert and the toll free telephone numbers provided therein for calling SSA. If the individual indicates that personal contact is necessary, the DDS should encourage the individual to visit a local Social Security Administration field office. 3. Forwarding Mailer Forms (and Any Attachments)a. Forward Scannable Mailer Forms SSA-455-OCR-SM to the Wilkes-Barre Direct Operations Center (WBDOC)The FO or DDS forwards all scannable mailer forms SSA-455-OCR-SM (and any attachments) to the WBDOC for processing. Although mailer forms should only rarely be misrouted to the DDS, it is very important that the mailer forms are sent to the correct processing component as soon as possible. The mailing address for the WBDOC is provided at the top of the front side of every form SSA-455-OCR-SM. NOTE that SSA-455-OCR-SMs sent to Title II/concurrently entitled beneficiaries have a different Post Office Box number than do mailer forms sent to Title XVI-only recipients. The address to send Title II-only and concurrent Title II/Title XVI scannable mailer forms SSA-455-OCR-SM to is: SOCIAL SECURITY ADMINISTRATIONWILKES BARRE DIRECT OPERATIONS CENTER PO BOX 4550 WILKES BARRE PA 18767-4550 NOTE that one way to identify SSA-455-OCR-SM mailer forms that have been sent to Title II-only or concurrently entitled beneficiaries is that the five numbers in the red box at top of the front of the form will be 11111, 22222, 33333, or 44444. In addition, a Title II claim number is on the front of the form. A Title II claim number consists of a Social Security Number followed by a Beneficiary Identification Code (BIC) (e.g., 999-99-9999A, or 888-88-8888C2, or 777-77-7777W). The address to send Title XVI-only scannable mailer forms SSA-455-OCR-SM to is: SOCIAL SECURITY ADMINISTRATIONWILKES BARRE DIRECT OPERATIONS CENTER PO BOX 4556 WILKES BARRE PA 18767-4556 NOTE that one way to identify SSA-455-OCR-SM mailer forms that have been sent to Title XVI-only recipients have numbers 55555, 66666, 77777, or 88888 in the red box at the top of the front of the mailer form. In addition, a Title XVI claim number is on the front of the form. A Title XVI claim number consists of a Social Security Number followed by an Individual Beneficiary Identification code (ID) (e.g., 999-99-9999DI, or 888-88-8888BI, or 777-77-7777DC). b. Forward Hard Paper Mailer Forms SSA-455 to the Servicing Processing Center (PC)The FO or DDS forwards “hard paper” SSA-455s (and any attachments) to the servicing PC for processing. Title XVI-only hard paper SSA-455 mailer forms are sent to PC-1 though PC-6 only, while Title II-only and Title II/concurrent hard paper forms are sent to PC-1 through PC-7. To determine type of entitlement and the servicing PC, it may be necessary to query the DCF, MBR or Supplemental Security Record (SSR). PC jurisdiction is described in GN 01050.055 and GN 01070.245. The addresses for sending hard paper mailer forms SSA-455 to the PCs are: NEPSC/PC-1: SOCIAL SECURITY ADMINISTRATIONNEPSC DISABILITY REVIEW SECTION 155-10 JAMAICA AVE 2ND FLOOR JAMAICA NY 11432 MATPSC/PC-2: SOCIAL SECURITY ADMINISTRATIONMATPSC DISABILITY REVIEW SECTION PO BOX 2857 PHILADELPHIA PA 19122 SEPSC/PC-3: ATTN DRS MANAGERSOCIAL SECURITY ADMINISTRATION PO BOX 830589 BIRMINGHAM AL 35283 GLPSC/PC-4: SOCIAL SECURITY ADMINISTRATIONGLPSC DISABILITY REVIEW SECTION PO BOX 87755 CHICAGO IL 60680-8915 WNPSC/PC-5: SOCIAL SECURITY ADMINISTRATIONWNPSC DISABILITY REVIEW SECTION PO BOX 2427 RICHMOND CA 94802 MAMPSC/PC-6: SOCIAL SECURITY ADMINISTRATIONMAMPSC DISABILITY REVIEW SECTION 601 EAST 12 ST KANSAS CITY MO 64106 ODO OCO/PC-7: ATTN: PROGRAM ANALYSTSSA OCO CPS Room 7324 SWT 1500 WOODLAWN DRIVE BALTIMORE MD 21241-1500 c. Send Mailer Forms and Any Related Materials Only to the WBDOC or a PCIt is important that the completed mailer forms, and any information that may be submitted with the form, be sent only to either the WBDOC (all scannable mailer forms SSA-455-OCR-SM) or the servicing PC (all hard paper forms SSA-455) as soon as possible. Misrouted or late-forwarded forms can cause substantial delays in processing the form, result in the generation of a 2nd-request mailer (see DI 28001.003C.1.), and may cause a nonresponder alert to be generated on a case. Do not send mailer forms to:
E. Procedure -- Wilkes-Barre Direct Operations Center (WBDOC) ProcessingThe WBDOC reviews and processes most scannable CDR mailer forms. The WBDOC:
For a more detailed description of WBDOC actions, see DI 13004.005E. or DI 40502.001E. F. Procedure -- National Computer Center (NCC) Processing of Confirmation Files and Data FilesThe NCC:
G. Procedure -- Office of Continuing Disability Reviews Support (OCDRS) Decision Logic ActionsAs part of OCDRS decision logic processing, OCDRS:
For a very detailed description of OCDRS decision logic, see DI 40502.001F. H. Procedure -- Processing Center (PC) Processing of the Mailer FormThe following is an abbreviated description of PC processing of the mailer form. For a thorough description, see DI 40502.001, especially DI 40502.001I. and DI 40502.001J. The PC:
I. Procedure -- CDT Coding on the SSA-5526-U2-OP2The current version of the SSA-5526-U2-OP2 does not have pre-printed Continuing Disability Review Type (CDT) codes for mailer form cases that were initiated after fiscal year (FY) 1999. For DO CDR actions involving mailer forms initiated FY 2000 or later, print the appropriate CDT code in the CDT section of the SSA-5526-U2-OP2 or route slip. The possible CDT codes are:
A complete list of CDT codes is in SM 06001.120B.11. It is important that the PC use the correct CDT code when referring the DO CDR action to the FO. It is equally important that the FO use the correct CDT code when the FO refers the CDR to the DDS, and that the correct CDT is entered by the DDS when input is made to the National Disability Determination Services System (NDDSS) DDS Receipt (DREC) data input screen (see SM 06001.000 and SM 06001.120). J. Procedure -- FO Action Upon Receipt of the DO CDR ReferralThe FO:
Why am I getting a letter from Social Security central operations?Whenever we send you a notice, it is because there is something you should know or do about your claim, benefit status or benefit amount. We send you a notice before we make a change to your benefit amount or eligibility. We will send a notice whenever we must tell you about activity on your case.
What is Wilkes Barre data Operations Center?An Office of Central Operations is a data processing center maintained by the Social Security Administration. The SSA maintains two such offices, with one Office of Central Operations in Wilkes-Barre, Pennsylvania; and the other in Salinas, California.
How do I know if a letter from Social Security is real?If you receive a letter from Social Security and are not sure if it is real or not, you can verify it by calling 1-800-772-1213. SSA also encourages people to set up an account at My Social Security to be able to check notices and your benefits at any time.
Does Social Security still send out letters?We will mail your benefit verification letter to the address we have on file. If your address is incorrect in our records and you get Social Security benefits, you should update your address through your personal my Social Security account, or by contacting us to update your address.
Does Social Security tell you when you are being investigated?The SSA will not tell you that you are under investigation. Find out more about SSA investigations and Cooperative Disability Investigations (CDI) here.
What does it mean when Social Security is reviewing your case?The law requires that we review your case from time to time to verify that you are still disabled. Generally, if your health hasn't improved, or if your disability still keeps you from working, you'll continue to receive your benefits.
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