POMS Reference

NL 00708: Letters and Paragraphs For Title II and Title XVIII

A. Introductory Paragraphs

  Paragraph Fill-ins

DIB and DWB

     
DWB and DIB—Affirmation of Denial, Cessation or Onset Date-Non-State-No Physician Participation 501 1
DWB and DIB Affirmation of Denial, Cessation or Onset Date—Non-State—Physician Participation 501A 1

DIB or Freeze

DWB and DIB Affirmation of Denial, Cessation or Onset Date—State—Physician Participation 501B 1
DIB or Freeze—Affirmation of Denial, Cessation or Onset Date—Non-State—No Physician Participation 504 None
DIB or Freeze—Affirmation of Denial, Cessation or Onset Date—Non-State—Physician Participation 504A None

CDB

DIB or Freeze—Affirmation of Denial, Cessation or Onset Date—State Physician Participation 504B None
CDB—Affirmation of Denial or Cessation—Non State—No Physician Participation 505 None
CDB Affirmation of Denial or Cessation—Non-State Physician Participation 505A None

DWB

CDB—Affirmation of Denial or Cessation—State—Physician Participation 505B None
DWB—Affirmation of Denial, Cessation or Onset Date—Non-State—No Physician Participation 570 None
DWB—Affirmation of Denial, Cessation or Onset Date—Non-State—Physician Participation 570.1 None

Miscellaneous

DWB—Affirmation of Denial, Cessation or Onset Date—State—Physician Participation 570.2 None
Title XVI Claims Escalated to Reconsideration Level 416 None
Reconsideration Affirmation Lead-in Paragraph 556 None
Escalated Title II Claim-Title XVI Claim at Reconsideration Level 585 None
Combined Initial - Reconsideration Determination 586 1
Escalated Title II Claim - Other Title II Claim at Reconsideration Level 587 2

B. Disability Requirement, Explanation of Disability Provisions

  Paragraph Fill-ins

DIB

     
DIB—Not Disabled—General 510 None
DIB—Not Disabled—Earnings Test Has Expired or Will Expire In or Before the Quarter Following the Date the Letter is Prepared 511 2
DIB—Not Disabled When Earnings Test Last Met—AOD Before Age 24 512 1
DIB—Not Disabled When Earnings Test Last Met—AOD Between Ages 24-31 512.1 1
DIB—Not Disabled When Earnings Test Last Met—AOD At or After Age 31—(Disability Not Due to Statutory Blindness) 512.2 None
DIB—Explanation of Disability Requirement 520 None
DIB—Explanation of Disability Requirement—Earnings Test Not Expired 520.1 1
DIB—Explanation of Disability Requirement—Earnings Test Expired—AOD Before Age 24 520.2 1
DIB—Explanation of Disability Requirement—Earnings Test Expired—AOD Between Ages 24-31 520.3 1
DIB—Explanation of Disability Requirement—Earnings Test Expired—AQD At or After Age 31—(Disability Not Due to Statutory Blindness) 520.4 1
DIB—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Earnings Requirement Not Met—EOD Before Age 24 521.3  
DIB—Disabled in Quarter Alleged or Onset Established Later Than Alleged—Earnings Requirement Not Met—EOD Between Ages 24-31 521A 3
Disabled in Quarter Alleged or Onset Established Established Later Than Alleged—Earnings Requirement Not Met—EOD At or After Age 31—(Disability Not Due to Statutory Blindness) 521B 4
DIB—Not Disabled in AOD or At Any Time Thereafter Up to and Including Last Quarter in Which Earnings Requirement Met—AOD Before Age 24 521.1.2  
DIB—Not Disabled in AOD or At Any Time Thereafter Up to and Including Last Quarter in Which Earnings Requirement Met—AOD Between Ages 24-31 521.11 2
DIB—Not Disabled in AOD or At Any Time Thereafter Up to and Including Last Quarter in Which Earnings Requirement Met—AOD At or After Age 31—(Disability Not Due to Statutory Blindness) 521.12 2
DIB—Not Disabled at Any Time Earnings Requirement Met—AOD Before Age 24 521.20 1
DIB—Not Disabled at Any Time Earnings Requirement Met—AOD Between Ages 24-31 521.21 1
DIB—Not Disabled at Any Time Earnings Requirement Met—AOD At or After Age 31—(Disability Not Due to Statutory Blindness) 521.22 1
Statutory Blindness—Not Disabled At Any Time Earnings Requirement Met—AOD 1973 or Later 521.23 1
Statutory Blindness (1972 Amendments)—Not Insured at AOD-AOD 1973 or Later 521.24 3

CDB

Statutory Blindness—Not Disabled When Earnings Requirement Test Last Met-AOD Before 1973 521.25 2
CDB—Explanation of Disability Requirement 522 None
CDB—Disability Must Start Before Age 22 522.1 None
CDB—Explanation of Claimant's Rights After Cessation 522.2  
CDB—7-Year Period for Reentitlement Ended Before EOD 522.3 2
CDB—Not Disabled At AOD or At Any Time Within 7-Year Period After End of Prior Entitlement 522.4 2
CDB—Reentitlement—Not Disabled At Any Time Before 7-Year Period Ended 522.5 1
CDB—Reentitlement—Disability More Than 7 Years After Prior Period Ended Cannot Serve to Qualify 522.6 None

DWB

CDB—Reentitlement—Advice Regarding Worsening of Condition 522.7 1
DWB—Explanation of Disability Requirement (Widow) 572 None
DWB—Explanation of Disability Requirement (Widower) 572.1 None
DWB—Explanation of Disability Requirement (Surviving Divorced Wife) 572.2 None

C. Disability Requirement, Explanation of Disability Provisions, Insert Guides

  Paragraph Fill-ins
DIB or Freeze-Termination Due to Work Activity 530 5
DIB or Freeze—Disability Must Exist When Earnings Requirement is Met 533 None
DIB or Freeze—Disability After Earnings Requirement Last Met Cannot Serve to Qualify 533A None
DIB or Freeze—Condition Not Severe When Earnings Requirement Met 533B None
DIB or Freeze—Disability Must Start At Least 5 Months Before Full Retirement Age 534 None
DIB or Freeze 534A None
DIB or Freeze—Disability Must Start At Least 5 Months Before the Month of Attaining Full Retirement Age and When Earnings Requirement Met 535 None
Definition of SGA 536 1
DWB—Disability Must Exist When Specified 7-Year Period Requirement Met 577 None
DWB—Disability After Specified 7-Year Period Cannot Serve to Qualify 577.1 None
DWB—Condition Not Severe When Specified 7-Year Requirement Last Met 577.2 None
DWB—Disability Must Start At Least 5 Months Before Age 60—Widow 578 None
DWB—Disability That Starts Less Than 5 Months Before Age 60—Cannot Serve to Qualify—Widow 578.1 None
DWB—Disability Must Start At Least 5 Months Before Age 60—Widower 578.2 None
DWB—Disability That Starts Less Than 5 Months Before Age 60—Cannot Serve to Qualify—Widower 578.3 None

D. Earnings Requirement, Explanation of Earnings Provisions

  Paragraph Fill-ins

DIB or Freeze

     
DIB or Freeze—Meeting Earnings Requirement After Onset Date 541 None
DIB or Freeze—Date Earnings Requirement Was Last Met 542 1
DIB or Freeze—Claimant Aged 62-65—Possible Entitlement to Reduced RIB 543 None
DIB or Freeze—Not Disabled—Claimant Will Attain Retirement Age Before Earnings Test Expires 544 None
DIB or Freeze—General Description of Earnings Requirement 546 None
DIB or Freeze—Description of 6/12 Test—Disability Before Age 24 546.1 None
DIB or Freeze—Description of Earnings Requirement—Disability Between the Ages 24-31 546.2 None
DIB or Freeze—Description of Earnings Requirement—Disability Age 31 or Later 546.3 None
Description of Earnings Requirement—Statutory Blindness—AOD 1973 or Later 547 None
Description of Old and New Earnings Requirement—Statutory Blindness 548 None

DWB

DIB—Allowance Under 1972 Amendments—StatutoryBlindness 549 3
DWB—Explanation of Specified 7-Year Period (Widow) 573 None
DWB—Explanation of Specified 7-Year Period (Widower) 573.1 None
DWB—Explanation of Specified 7-Year Period (Surviving Divorced Wife) 573.2 None
DWB—Date Specified 7-Year Period Last Met 575 1
DWB—Seven Year Period Ended Before EOD 575.3 2
DWB—Not Disabled at AOD or at Any Time Within 7-Year Period 575.5 2

E. Disability Requirement, Explanation of Disability Provisions, Cessation

  Paragraph Fill-ins

DIB or FREEZE

     
Freeze Cessation 523A 2
DIB Cessation—Work Activity—Trial Work Period 524 None
Freeze Cessation—Work Activity 524A None

CDB

DIB Cessation—Work Activity—No Waiting Period Served 524B None
CDB Cessation—Work Activity—TWP Previously Used 525(B) None

DWB

CDB—Denied Before Age 22—Possible Worsening of Condition 525(C) 2
DWB Cessation—Medical Improvement—Widow 576 None
DWB Cessation—Medical Improvement—Widower 576.1 None
DWB Cessation—Medical Improvement—Surviving Divorced Wife 576.2 None
DWB Cessation—Work Activity—Widow 576.3 None
DWB—Cessation—Work Activity—Widower 576.4 None

Miscellaneous

DWB Cessation—Work Activity—Surviving Divorced Wife 576.5 None
DIB or Freeze—Determination Concerns Only Disability Application 544(A) None
Favorable Disability Determination by Veterans Administration—General 550 None
P&T Pension Award by Veterans Administration 551 None
Disability Benefits by Other Than Veterans Administration 552 None
Partial Allowance in Freeze Cases 553 2
Conclusion of Disability by Attending Physician 554 None
DIB—Explanation of Claimant's Rights After Cessation 555 None

F. Reconsideration and Hearing Standard Paragraphs

  Paragraph Fill-ins
Previous Action Revised Upon Reconsideration Not Primarily Due to Additional Evidence 136(A) None
Previous Action Revised Upon Reconsideration—Primarily Due to Additional Evidence 136(C) None
Previous Action Revised Upon Reconsideration—(For Residents Other Than U.S., Guam, American Samoa, Philippines, Canada, Mexico, Western Samoa and British Virgin Islands) 136(D)F None
Previous Action Revised Upon Reconsideration—After Implied Request (For Residents Other Than U.S., Guam, American Samoa, Philippines, Canada, Mexico, Western Samoa and British Virgin Islands) 136(E)F None
Program Service Center Reconsiders Case Remanded Prior to a Hearing 137 None
Hearing Paragraph for Reconsidered Disability Cases 140 None
Hearing Paragraph Used in Reconsideration Notice Where Claim is Denied on the Basis of Res Judicata 140(A) None
Reconsideration Paragraph - Disability Ceases - Payments Continue 142 None
Reconsideration Paragraph - Disability Ceases - Payments Terminate 143 1
Appeals Paragraph - Disability Ceases - Payments Continue 149 None
Appeals Paragraph - Disability Ceases - Payments Terminate 150 1
Title II Medical Cessation Appeals Language - Advance Notice Required - SSI Payments Being Made 305 None
Expedited Appeals Process 941 None