Glossary of Terms Related to SSDI and SSI
| Term |
Description |
Agency Links[1] |
| Continuing Disability Review (CDR) |
After deciding that an individual is disabled, SSA periodically evaluates the
impairment to determine whether or not the disability continues, conducting a
continuing disability review. When a review is scheduled, the individual
is notified, offered the opportunity to submit medical or other evidence
regarding his/her health, and informed that the review could result in the
termination of benefits.
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| Date of Onset (Onset Date, Alleged Onset Date, AOD) |
The first day a person meets SSA's definition of
disability:
the last day of
significant work (SGA) due to a medically
determinable severe impairment,
which has lasted or is expected to last 12 months or result in death. The onset
date triggers the 5-month waiting period for SSDI
eligibility and it is used by
SSA and the DDS to determine the earliest possible date a
claimant can become
eligible for SSDI benefits.
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| Disability Determination Services (DDS) |
A Division of Utah State Office of Rehabilitation, a state agency. DDS is
responsible for determinations of medical eligibility for federal
SSDI and SSI claims at the initial and
reconsideration
stages of disability claims. DDS is established by Section 221(b) of the Social
Security Act. DDS for the
State of Utah is located at 555 East 300 South, Salt Lake City, UT 84102.
Phone: (801) 321-6500
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| Disability |
SSA defines 'disability' generally as the "inability to
engage in any
SGA by
reason of any medically determinable physical or mental impairment(s) which can
be expected to result in death or which has lasted or can be expected to last
for a continuous period of not less than 12 months".
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| Impairment-Related Work Expenses (IRWE) |
SSA defines this as "impairment-related expenses for things needed by the
self-employed person in order to work". The "countable income" level for
SGA
determinations deduct impairment-related work expenses from income, unless they
were already deducted as business expenses.
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| Internet Social Security Benefits Application (ISBA) |
SSA allows SSDI claimants to complete and electronically sign an application on
the Internet. The SSA-3368, Disability Report Adult which is required for all
disability applications may also be completed on the Internet. A partially
completed ISBA establishes a protective filing date as of the
date the claimant
first completes the ISBA Personal Identification Information page and selects
the "Next Page" button which provides the claimant with a "Confirmation Number".
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| Listed Impairments |
SSA provides a "Listing of Impairments" which describes, for each of the major
body systems, impairments that are considered severe enough to prevent an adult
from doing any gainful activity regardless of his age, education, or work
experience. All of the Listed Impairments have specific criteria for "meeting"
the Listing and most are permanent or expected to result in death. An impairment
may also be "medically equivalent" to a Listing, even if it does not meet the
specific criteria provided in the Listings. An impairment(s) is medically
equivalent to a listed impairment in the Listing of Impairments if it is at
least "equal in severity and duration to the criteria of any listed impairment".
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| Medically Determinable Severe Impairment |
SSA considers this to be a "medically determinable impairment of serious
proportions . . . of a nature and degree of severity sufficient to justify its
consideration as the cause of failure to obtain any substantial gainful work". A
claimant's inability to engage in SGA must be based on his or
her inability to
perform "basic work activities as required in most jobs". Examples of basic work
activities are walking, standing, sitting, lifting, pushing, pulling, reaching,
carrying, handling, seeing, hearing, speaking, understanding, carrying out and
remembering simple instructions, use of judgment, responding appropriately to
supervision, coworkers, and usual work situations, and dealing with changes in a
routine work setting.
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| Past Relevant Work (PRW) |
Work that was performed within the 15 years before adjudication, was substantial
gainful activity (SGA), and lasted long enough for the person
to learn the job
requirements, i.e., long enough to learn the techniques, acquire the necessary
information, and develop the facilities needed for average performance of the
job situation. The length of time required to learn the job requirements depends
of the nature and complexity of the work.
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| Program Operations Manual System (POMS) |
Procedures and instructions for adjudicating and processing disability claims,
developed by SSA for state agencies (DDS)
and SSA field office personnel. Where
relevant to a term in this glossary, a link to the corresponding public POMS
entry is provided in the right column.
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| Protective Filing Date |
The date SSA first receives a written statement of intent to file for SSDI (or
also the date of an oral inquiry about benefits for SSI) as long as there is an
application completed and submitted within 6 months for SSDI (paper or
electronic), or 60 days for SSI.
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| Reconsideration |
The first level of appeal following an initial denial by DDS.
After being denied
initially by DDS, disabled claimants should file an appeal or a "Request for
Reconsideration" with their local Social Security field office withing the
60-day time limit. A Request for Reconsideration form can be downloaded and
printed as a PDF file from the SSA website (see righthand column for external
links).
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| Residual Functional Capacity (RFC) |
Describes "the most an individual is able to do, despite functional limitations
resulting from a medically determinable impairment(s) and impairment-related
symptoms". A claimant may be limited in their ability to perform their past
work, or in their ability to perform the physical demands of general work
activity, such as sitting, standing, walking, lifting, carrying, pushing,
pulling, reaching, handling, stooping, or crouching. A claimant may also be
limited in their ability to perform certain mental activities such as
understanding, remembering, carrying out instructions, and in responding
appropriately to supervision, co-workers, and work pressures in a work setting.
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| Social Security Administration (SSA) |
An agency of the United States government established by a law codified at 42
U.S.C. § 901. The SSA manages the United States' social insurance program,
consisting of retirement, disability, and survivors' benefits. The programs are
financed by mandatory contributions which employers, employees, and self-insured
persons pay. SSA governs and processes all federal disability
claims established under the Social Security Act (such as SSDI and SSI). |
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| Social Security Disability Insurance (SSDI) |
A payroll tax-funded, federal insurance program provided under
Title II of the
Social Security Act. It is designed to provide income to people unable to work
because of a disability until their condition improves and
guarantees income if
their condition does not improve. It is associated with medical coverage
programs such as Medicare and Medicaid.
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| Supplemental Security Income (SSI) |
A federal needs-based program provided under Title XVI of
the Social Security
Act assisting elderly, blind, or disabled persons. Provides
cash assistance
($603 per month in 2006) for an individual to help meet the costs of basic needs
of food, shelter and clothing and assures concurrent access to Medicaid.
Individuals must prove to the Social Security Administration that they are
blind, disabled or over the age 65 with limited income and resources to receive
SSI benefits. See the Agency Links (at right) for CFR-defined income and
resource limitations and basic eligibility provisions in
POMS.
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| Substantial Gainful Activity (SGA) |
SSA defines SGA as "the performance of significant physical and/or mental
activities in work for pay or profit, or in work of a type generally performed
for pay or profit, regardless of the legality of the work... Work may be
'substantial' even if it is performed on a part-time basis... Work activity is
gainful if it is the kind of work usually done for pay, whether in cash or in
kind, or for profit, whether or not a profit is realized". "Countable earnings"
of employees indicate SGA and "countable income" of the self-employed is
"substantial" if the amount averages more per month than the following amounts:
$810 in the calendar year of 2004, $830 in 2005, $860 in 2006. For blind
individuals the SGA amounts are $1350 in 2004, $1380 in 2005, and $1450 in 2006.
When calculating SGA, the worker's IRWE reduces countable
earnings and income.
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| Special Work Conditions |
Under SSA policy, an unsuccessful work attempt may involve
circumstances where
work at the SGA level ends or is reduced below the SGA level
due to the removal
of special conditions which are related to the person's impairment and which are
essential to their further performance of work. That is, a severely impaired
person may have worked under conditions especially arranged to accommodate his
or her impairment or may have worked through an unusual job opportunity, such as
in a sheltered workshop. These special conditions may include that a worker:
- Required and received special assistance from other employees in performing
the job;
- Was allowed to work irregular hours or take frequent rest periods;
- Was provided with special equipment or was assigned work especially suited
to the impairment;
- Was able to work only within a framework of specially arranged
circumstances, such as where other persons helped him or her prepare for or get
to and from work;
- Was permitted to perform at a lower standard of productivity or efficiency
than other employees; or
- Was granted the opportunity to work, despite his or her handicap, because of
family relationship, past association with the firm, or other altruistic
reason.
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| Title II (see also SSDI) |
References Title II of the Social Security Act, formally known as the Federal
Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance
Trust Fund program (OASDI), in reference to its three components (OA for
retirement, S for widows and survivors income, D for disability income). Federal
Social Security laws are compiled on the SSA website (see column at right for
agency links).
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| Title XVI (see also SSI) |
References Title XVI of the Social Security Act. Provides monthly cash
assistance ($603 in 2006) for an individual to help meet the costs of basic
needs of food, shelter and clothing. Individuals must prove to the Social
Security Administration that they are blind, disabled or over
the age 65 with
limited income and resources to receive SSI benefits. In Utah, as in most
states, SSI eligibility assures concurrent access to important medical coverage
under state Medicaid programs.
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| Trial Work Period (TWP) |
The trial work period provision is intended to give an SSDI beneficiary
the opportunity to test his/her ability to work and hold a job without the
threat of loss of benefits. Disability can not be ceased during the TWP based on
an individual's work activity. The trial work period consists of 9 service
months (which do not need to be consecutive) in a rolling 60 month period. SSA
requires the SSDI beneficiary to report promptly when there is a return to work
Effective January 1, 2002, SSDI beneficiaries who have been entitled to benefits
for at least 24 months, will not have a medical CDR triggered
solely as result
of work activity. This new work incentive is called a "Section 111 protection".
However, SSA policy states that "even with Section 111 protection, work activity
will still be investigated, with Trial Work Period (TWP) months being documented
and Substantial Gainful Activity (SGA) determinations still
being performed at
the conclusion of the TWP". A TWP is triggered with monthly earnings of $580 in
2004, $590 in 2005, and $620 in 2006 (for self-employment activity, TWP is
triggered with the same dollar amounts or 80 hours of self-employment activity).
SSA does not reduce its calculations of TWP earnings by
IRWE.
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| Unsuccessful Work Attempt (UWA) |
Before a period defined as a UWA can begin there must be a significant "break in
the continuity" of a person's work, one example sited by SSA is "being out of
work for at least 30 consecutive days". SSA policy states, "An unsuccessful work
attempt is an effort to do substantial work in employment or self-employment
which was discontinued or reduced to the non-SGA level after
a short time (no
more than 6 months) because of the individual's impairment or the removal of
special conditions related to the impairment that are essential to the further
performance of work". UWA can be an important issue when establishing the
onset date of a disability. If a claimant has engaged in
significant work
after the alleged onset date, but subsequently works at under SGA, the
work may be considered an unsuccessful work attempt by SSA. If a worker returns
to work after a substantial absence (ex. 30 or more days) due to an impairment,
but that effort ends or is reduced below the SGA level within 6 months, SSA is
required to consider why the SGA-level work was interrupted, reduced, or
stopped. For example, were special working conditions
removed, were there
frequent absences from work, was job performance unsatisfactory, did the
employer reduce the duties, responsibilities, or earnings because of the
impairment? According to SSA policy, "If the work effort does not exceed 3
months and the alleged reason work ended or was reduced has a reasonable
relationship to the impairment, then verification of the reason work ended or
was reduced is not required. If this requirement is not met or if the work
effort was more than 3 months but less than 6 months . . . evidence must be
obtained establishing the claimant's conditions of work". An unsuccessful work
attempt does not negatively impact the claimant's onset date, which remains
prior to the UWA.
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