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EDPNA Exam 2023 Technical and Procedural.
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EDPNA Exam 2023 Technical andProcedural
Social Security Disability Insurance SSDI Citation - CORRECT ANSWER-CFR
20 Section 404
Good Cause for Late Filing (Citations: 404.911, 416.1411) - CORRECT
ANSWER-If an appeal deadline is missed, and the claimant wants to appeal, he
or she must show "good cause" for late filing.
Examples of good cause are described in 404.911: - CORRECT ANSWER-• You
were seriously ill and were prevented from contacting us in person, by phone, in
writing, or through a friend, relative, or other person;
• There was a death or serious illness in your immediate family;
• Important records were destroyed or damaged by fire or other accidental cause;
• You were making serious efforts to find necessary information to support the
claim but had not been able to obtain it within the stated time periods;
• You requested additional information from us explaining this action within the
time limit. Within 60 days of receiving the explanation you requested
reconsideration or a hearing, or within 30 days of receiving the explanation you
requested Appeals Council review or filed a civil suit;
• We gave you misleading, incorrect or incomplete information about when and
how to request administrative review or to file a civil suit;
• You did not receive notice of the determination or decision;
• You sent the request to another government agency in good faith within the time
limit and the request did not reach us until after the time period had expired; or
• Unusual or unavoidable circumstances exist, which show that you could not
have known of the need to file timely, or which prevented you from filing timely.
SSA will consider the following for deciding whether a claimant had good cause -
CORRECT ANSWER-• What circumstances kept the claimant from making the
request on time;
• Whether SSA's action mislead the claimant;
• Whether the claimant did not understand the requirements;
,• Whether the claimant had any physical, mental, educational, or linguistic
limitations which prevented them from making a timely request or from
understanding or knowing about the need to file a timely request for review.
Social Security Disability Insurance SSDI - CORRECT ANSWER-Title XVI
SSDI Eligibility - CORRECT ANSWER-1. Is the applicant under full retirement
age (66)?
2. Is the applicant fully insured?
3. Is the applicant insured for disability?
Auxiliary Benefits - CORRECT ANSWER-Benefits can be paid to the disabled
worker's family in some cases. Benefits can be paid to dependent children under
the age of 18 or a spouse (or divorced spouse if married for 10 years) under the
age of 62 who has joint care of the children.
Supplemental Security Insurance SSI - CORRECT ANSWER-Title II
Supplemental Security Insurance SSI Citation - CORRECT ANSWER-CFR 20
Section 416
SSI - CORRECT ANSWER-No work requirement
Children can qualify as disabled
No retroactive benefits earlier than filing date
Strict income and resource provisions
Definition of Disability - CORRECT ANSWER-Citations: 404.1505, 416.905
The inability to do any substantial gainful activity (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.
Insured Status - CORRECT ANSWER-1. An individual must be fully insured
2. as a general rule they must meet to 20/40 requirement. (5 of last 10 years)
Insured status - CORRECT ANSWER-Quarters of Coverage at least 6 Quarters
,One of Four For every year beginning with the year after attainment of age 21 up
until the age you turn 62 or you die
Rules of Disability Insured Status (SSDI Only) - CORRECT ANSWER-Citations:
404.130, 404.131, and 404.140
Rule 1 - 20/40:You have to have 20 quarters of coverage in the 40-quarter period
ending with the quarter that you became disabled. This is called the 20/40 rule.
Or essentially, you have worked five years out of the last ten years, before you
became disabled.
Rule 2 - Special Insured Status:
Rule 3: You had a period of disability before age 31.You are insured in a quarter
for purposes of establishing a period of disability or becoming entitled to disability
insurance benefits if in that quarter-
(1) You are disabled again at age 31 or later after having had a prior period of
disability established which began before age 31 and for which you were only
insured under paragraph (c) of this section; and
(2) You are fully insured and have QCs in at least one-half the calendar quarters
in the period beginning with the quarter after the quarter you became age 21 and
through the quarter in which the later period of disability begins, up to a
maximum of 20 QCs out of 40 calendar quarters; however-
(i) If the number of quarters during this period is an odd number, we reduce the
number by one;
(ii) If the period has less than 12 quarters, you must have at least 6 QCs in the
12-quarter period ending with that quarter; and
(iii) No monthly benefits may be paid or increased under Rule Ill before May
1983.
Rule 4: You are statutorily blind.
(1) You are disabled by blindness as defined in § 404.1581; and
(2) You are fully insured.
Special Insured Status (SSDI Only) - CORRECT ANSWER-Disable before the
age of 31
20 CFR 404.130: You are insured in a quarter for purposes of establishing a
period of disability or becoming entitled to disability insurance benefits if in that
quarter-
(1) You have not become (or would not become) age 31;
(2) You are fully insured (next chapter); and
, (3) You have Quarters of Coverage (QCs) in at least one-half of the quarters
during the period ending with that quarter after the quarter you became age 21;
however-
(i) If the number of quarters during this period is an odd number, we reduce the
number by one; and
(ii) If the period has less than 12 quarters, you must have at least 6 QCs in the
12- quarter period ending with that quarter.
Insured Status - Statutorily Blind - CORRECT ANSWER-Citation: 404.130(e)
Statutorily blind individuals must only meet the fully disability insured status.
Statutorily Blindness - CORRECT ANSWER-Defined in the law as central visual
acuity of 20/200 or less in the better eye with the use of correcting lens. An eye
which has a limitation in the field of vision so that the widest diameter of the
visual field subtends an angle no greater than 20 degrees is considered to have
a central acuity of 20/200 or less. (404.1581)
Fully Insured Status (SSDI Only) - CORRECT ANSWER-404.110
You need at least one QC (Quarter of Coverage) for each calendar year after you
turned 21 and the earliest of the following:
• The year before you attain age 62,
• The year before you die, or
• The year before you become disabled.
The minimum number of QCs needed is 6. The maximum number needed is 40.
Any year (all or part of a year) that was included in a period of disability is not
included in determining the number of QCs you need.
Waiting Period (SSDI Only) - CORRECT ANSWER-There is a 5-month period in
which a claimant must have been disabled for 5 full consecutive months,
beginning with the month that they were both insured and disabled, before cash
benefits can begin. Your waiting period can begin no earlier than the 17th month
before the month you apply-no matter how long you were disabled before then.
Medicare Waiting Period - CORRECT ANSWER-Test Tip: Include the 5-month
waiting period in your calculation and count 29 months forward from established
onset date to get the date the Medicare eligibility would begin.
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