Form Ssa 831 C3 U3 – Fill Out and Use This PDF

The SSA-831 C3/U3 form, officially titled "Disability Determination and Transmittal," is pivotal in the Social Security Administration’s process to determine eligibility for disability benefits. Endorsed by the Office of Management and Budget with OMB No. 0960-0437, this form captures detailed claimant information, disability diagnosis, and determinations necessary for adjudicating disability claims under the Social Security Act. For individuals seeking disability benefits, accurately completing and submitting this form is a crucial step towards receiving assistance. Click the button below to learn more about filling out the form.

Get Form Now Download PDF

Form Ssa 831 C3 U3 PDF Details

The Social Security Administration's Form SSA-831 C3/U3 is a critical document in determining eligibility for disability benefits. It is used to relay findings from the Disability Determination Services (DDS) to the SSA for a final decision on a claimant's disability status. This comprehensive form covers a wide range of information, including the claimant's personal details, type of claim, date of onset of disability, diagnoses, vocational background, and any previous determinations regarding the disability. Importantly, it delineates whether a claimant is considered disabled under the strict guidelines established by the Social Security Act, as amended. The form also addresses cases of blindness specifically defined within the Act, providing a structured format for examiners and medical professionals to offer their insights. It includes sections for remarks on the claimant's condition, including any multiple impairments and their severity. The SSA-831 form encapsulates a thorough process designed to ensure that decisions on disability claims are grounded in detailed evaluations and official standards. Its role is vital not just in determining immediate eligibility for benefits, but also in the broader scope of program evaluation and management, maintaining the delicate balance between necessary support for individuals and the integrity of the Social Security system.

Question	Answer
Form Name	Form Ssa 831 C3 U3
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	requestment, SSA-831, DPB, SSN

Form Preview Example

Form Approved

SOCIAL SECURITY ADMINISTRATION

OMB No. 0960-0437

DISABILITY DETERMINATION AND TRANSMITTAL

1. DESTINATION

2. DDS CODE

3. FILING DATE

4. SSN

BIC (if CDB or DWB CLAIM)

DDS ODO DPB DQB

OIO

5. NAME AND ADDRESS OF CLAIMANT (include ZIP Code)

6. WE'S NAME (IF CDB OR DWB CLAIM)

7. TYPE CLAIM (Title II)

DIB FZ

DWB

CDB-R

CDB-D RD-R

RD-D RD

P-R

P-D MQFE

8. TYPE CLAIM (Title XVI)

9. DATE OF BIRTH

10. PRIOR ACTION

11. REMARKS

12. DISTRICT-BRANCH OFFICE ADDRESS (include ZIP Code)

DO-BO

CODE

13. DO-BO REPRESENTATIVE

14. DATE

11A. Presumptive

Disability

11B.

Impairment

DETERMINATION PURSUANT TO THE SOCIAL SECURITY ACT, AS AMENDED

15. CLAIMANT DISABLED

A. Disability

Began

B. Disability

Ceased

17. DIARY TYPE MO./YR. REASON

16A. PRIMARY DIAGNOSIS

BODY SYS.

CODE NO.

16B. SECONDARY DIAGNOSIS

CODE NO.

18. CASE OF BLINDNESS AS DEFINED IN SEC. 1614(a)(2)/(216)(i)

19. CLAIMANT NOT DISABLED

Not Disab. for Cash

Disab. for Cash Benefit Purp.

Through Date of

Before Age 22

Current Determination

B. Through

(CDB only)

Bene. Purp.

Beg.

20. VOCATIONAL BACKGROUND

OCC YRS.

ED YRS.

21. VR ACTION

SC IN

SC OUT Prev Ref

22. REG-BASIS CODE

23. MED LIST NO.

24. MOB CODE

25. REVISED

25A.

Initial

Recon

Recon DHU

ALJ Hearing

Appeals Council

U.S. District Court

DET

26.

LIST

NO.

27. RATIONALE

See Attached

Check if Vocational

SSA-4268-U4/C4

Rule Met. Cite Rule

28.

Continues

Period of Disability

Disability Period C.

Estab Beg

AND D.

Term

29. LTR/PAR NO.

30. DISABILITY EXAMINER-DDS

31. DATE

32. PHYSICIAN OR MEDICAL SPEC. SIGNATURE

33. DATE

32A. PHYSICIAN OR MEDICAL SPEC. NAME (Stamp, Print or Type)

32B. SPEC. CODE

34. REMARKS

MULTIPLE IMPAIRMENTS

CONSIDERED

34A.

COMBINED MULTIPLE

NONSEVERE-SEVERE

34B.

COMBINED MULTIPLE

NONSEVERE-

NONSEVERE

35. BASIS CODE

36. REV. DET.

37. SSA REPRESENTATIVE

SSA

38. DATE

CODES

CODE

Form SSA-831 C3/U3 (12-2001) ef (07-2006)

Electronic Input:

DECISION

CASE CONTROL

(3 copies - Folder, VR, State Agency)

Form Ssa 831 C3 U3 – Fill Out and Use This PDF

Form Ssa 831 C3 U3 PDF Details

Form Preview Example

Form Ssa 831 C3 U3 isn’t the one you’re looking for?

Related Documents