POMS Reference

DI 26010: Completion of Form SSA-831-U5 in Blindness Cases

TN 2 (10-08)

A. Claimant is not statutorily blind

Complete only the following items (in addition to the identifying items that the field office (FO) routinely completes):

  1. Item 16A (Primary Diagnosis)—show “Not Statutorily Blind.”

  2. Items 30, 31, 32, 33, 32A, and 32B—signature blocks.

  3. Item 34 (Remarks)—show “SGA-Statutorily Blind decision only.”

NOTE: The FO incorporates the Disability Determination Services (DDS) determination in a denial or cessation based on the non-blind SGA level.

B. Claimant is statutorily blind

  1. Item 16A (Primary Diagnosis)—show “Statutory Blindness” as the primary diagnosis per DI 26510.015C.2.b.

  2. Complete the forms as normally required for an allowance or continuance for DWB and CDB (other than issues of comparability) claimants.

NOTE: The FO effectuates an allowance or continuance, as usual.