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 |
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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 |
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Form Approved |
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SOCIAL SECURITY ADMINISTRATION |
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OMB No. |
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DISABILITY DETERMINATION AND TRANSMITTAL |
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1. DESTINATION |
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2. DDS CODE |
3. FILING DATE |
4. SSN |
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BIC (if CDB or DWB CLAIM) |
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DDS ODO DPB DQB |
OIO |
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- |
- |
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5. NAME AND ADDRESS OF CLAIMANT (include ZIP Code) |
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6. WE'S NAME (IF CDB OR DWB CLAIM) |
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7. TYPE CLAIM (Title II) |
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DIB FZ |
DWB |
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8. TYPE CLAIM (Title XVI) |
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DI |
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DS |
DC |
BI |
BS |
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BC |
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9. DATE OF BIRTH |
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10. PRIOR ACTION |
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11. REMARKS |
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PD |
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PT |
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12. |
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CODE |
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13.
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) |
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19. CLAIMANT NOT DISABLED |
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A. |
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Not Disab. for Cash |
B. |
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Disab. for Cash Benefit Purp. |
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Through Date of |
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Before Age 22 |
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A. |
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Current Determination |
B. Through |
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C. |
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(CDB only) |
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Bene. Purp. |
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Beg. |
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20. VOCATIONAL BACKGROUND |
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OCC YRS. |
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21. VR ACTION |
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SC IN |
SC OUT Prev Ref |
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A. |
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B. |
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C. |
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22. |
23. MED LIST NO. |
24. MOB CODE |
25. REVISED |
25A. |
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Initial |
Recon |
Recon DHU |
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ALJ Hearing |
Appeals Council |
U.S. District Court |
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DET |
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A. |
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D. |
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E. |
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F. |
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26. |
LIST |
A. |
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B. |
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C. |
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D. |
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NO. |
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27. RATIONALE |
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See Attached |
Check if Vocational |
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Rule Met. Cite Rule |
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28. |
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Continues |
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A. |
Period of Disability |
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Disability Period C. |
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AND D. |
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29. LTR/PAR NO. |
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30. DISABILITY |
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31. DATE |
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32. PHYSICIAN OR MEDICAL SPEC. SIGNATURE |
33. DATE |
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32A. PHYSICIAN OR MEDICAL SPEC. NAME (Stamp, Print or Type) |
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32B. SPEC. CODE |
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34. REMARKS |
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MULTIPLE IMPAIRMENTS |
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CONSIDERED |
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34A. |
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COMBINED MULTIPLE |
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34B. |
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COMBINED MULTIPLE |
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NONSEVERE- |
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NONSEVERE |
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35. BASIS CODE |
36. REV. DET. |
37. SSA REPRESENTATIVE |
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SSA |
38. DATE |
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CODES |
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CODE |
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Form
Electronic Input:
DECISION
CASE CONTROL
(3 copies - Folder, VR, State Agency)
PRIVACY ACT/PAPERWORK ACT NOTICE
We are authorized to collect this information under Sections 221 (a) and (b) of the Social Security Act and Sections 404.1615(d) and 416.1015 (d) of the Code of Federal Regulations. The information will be used to determine eligibility for benefits and for program evaluation and management. You are not required to complete this form, however, failure to do so could affect the claimants eligibility for benefits.
We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, State, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it.
Explanations about these and other reasons why information you provide us may be used or given out are available in Social Security Offices. If you want to learn more about this, contact any Social Security Office.
PAPERWORK REDUCTION ACT STATEMENT - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 15 minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate above to: SSA, 1338 Annex Building, Baltimore, MD
Form