Author: Revisions contributed by, Katie Shelton, LAF
Last updated: April 2012

Federal Statutes and Regulations
Eligibility for Disability Insurance Benefits (DIB) under Retirement, Survivors, and Disability Insurance (RSDI) 
Eligibility for Retirement Benefits 
Eligibility for Survivors Benefits
Amount of Benefits
Application Procedure
Access to Records
Underpayments
Lost or Stolen Checks 
Reduced or Terminated Benefits
Effect of Employment on Benefits

Federal Statutes and Regulations

42 U.S.C. §402 et seq.
20 C.F.R. Part 404 et seq.

Eligibility for Disability Insurance Benefits (DIB) under Retirement, Survivors, and Disability Insurance (RSDI)

To qualify, an applicant must be:

• 62 or older; or
• A dependent in a family with a retired or disabled worker; or
• A child in a family with a retired or disabled worker; or
• A survivor in a family of a deceased worker; or
• A spouse taking care of a minor or disabled child; or
• Disabled (see Evaluation of Disability for SSI and RSDI cases); and have:
  • Earnings from work for the number of quarters (one quarter for each year between 21 and the year you become disabled) required by the Social Security Act (i.e., "fully insured" status);
  • Work earnings (i.e., quarters of coverage) for 20 of the 40 quarters before becoming disabled (i.e., "disability insured" status).

A claimant ages 24-31 must have at least 6 quarters of coverage (QCs) in the 12 quarter period before becoming disabled and 3 of these 6 QCs must occur after the claimant reaches age 21.

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Eligibility for Retirement Benefits

Retired worker: A person 62 years old or older and fully insured.

Spouse or divorced spouse: A person 62 years old or older; if divorced, the marriage must have lasted at least 10 years. The worker must be fully insured and retired or disabled. 20 CFR § 404.330-339.

Note: If the divorced spouse had been divorced from the worker for at least two years (after a marriage of at least ten years), she may receive benefits even if the worker has not stopped working, as long as she is at least 62 years-of-age. Also, a remarriage could affect the spouse’s entitlement to benefits.

Child or Grandchild: A person under 18 or any age if disabled since childhood and prior to age 22.  (In most cases, the child or grandchild must be dependent on the worker). The worker must be fully insured and retired/disabled or deceased. 20 CFR § 404.350-368.

Dependent Parent: A person 62 years old or older who received support from the deceased worker at time of her death. The worker must be fully insured. 20 CFR § 404.370-374.

Lump-Sum Death Benefit: A widow(er) either living with worker at the time of her death, or eligible for benefits, or child entitled to benefits at the time of the worker’s death.  The worker must be fully or currently insured. 20 CFR § 404.390-392.

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Eligibility for Survivors Benefits

Widow(er) or Divorced Person: A person 60 years old or older or 50-65 and disabled. The worker must be fully insured. 20 CFR § 404.1577-1579.

Widow(er) or Divorced Person Caring for Worker’s Child: A person any age, if caring for a child who is either under 16 or disabled, and who is entitled to "child’s" benefits. 20 CFR § 404.348-349.

Note: Remarriage of a widow(er) after age 59, the date on which he or she became entitled to disabled widow(er)’s benefit, or the date he or she met the disability requirements will not affect entitlement to widow(er) benefits.

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Amount of Benefits

A recipient’s benefit amount depends on his "Primary Insurance Amount" (PIA), which depends on how much the worker earned while paying Social Security taxes into the Social Security system, and the time of retirement:

• Age 65: A person will get full retirement benefit. However, it is important to note that the age of full retirement is increasing. See the Find Your Retirement Age chart;
• Age 62-64: A person's benefit amount is reduced by 5/9 of 1% for every month under 65 years-of-age. Note that reduction amount is increasing. See the Find Your Retirement Age chart; 
• Disabled worker: A person generally receives a full benefit regardless of age.

Note: The Social Security taxes (or Federal Insurance Contribution Act deductions) vary annually and between employees and the self-employed.

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Application Procedure

Where to Apply

Apply at the local Social Security Office or online. Also, if requested, applications may be made by mail or via a home interview.

Signature

Applications may be signed by the following individuals:

• The applicant; or
• The applicant’s legal guardian; or
• The head of an institution where the applicant lives; or
• A person who takes care of the applicant.

Note: A person who signs for the applicant must include a statement that the applicant is under his or her care, or show proof that he or she is the applicant’s legal guardian.

Application Date

This is the date used to determine when benefits begin. It is either:

• The date the Social Security office receives the application; or
• The date the Social Security office receives a letter stating the applicant’s intention to submit an application within six months.  This letter must include the following:

• Applicant’s name;
• Applicant’s address;
• Applicant’s telephone number;
• Applicant’s Social Security number;
• Social Security number on which the benefits are being claimed;
• Date the applicant telephones the Social Security office to "preserve his Social Security Administration (SSA) application date" (after which an application must be filed within six months);
• The date the applicant went into SSA to apply, but was dissuaded by worker from applying.

Note: A letter constitutes proof of the date the Social Security Office was contacted.

Proof of Eligibility

The supporting documents that should accompany an application are as follows:

• Social Security card (or a record of the number)
• Birth certificate or other proof of age (such as school and census records or other childhood records)
• Children's birth certificates, if applying for benefits for them, or if applying for mother's or father's benefits
• Marriage certificate, if applying for benefits on a spouse's work record
• A divorce record, if divorced from the worker and applying on his or her work record
• A death certificate or other proof of a death, if the worker is deceased
• Evidence of financial dependence on the worker, if applying for child's or parent's benefits
• W-2 forms for the past two years or copies of last two federal income tax returns, if self-employed

Applicants' Rights

Applicants have a right to fill out an application form even if:

• The SSA worker believes the applicant is ineligible; 
• The Applicant does not have all required proof available; or
• The Applicant does not know the Social Security number of the person on whose work record benefits are claimed. 

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Access to Records

Applicants (or their authorized representatives) have a right to see all of their records at the Social Security office. 20 CFR § 401.35.

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Underpayments

Use form SSA-L137 to obtain a copy of SSA's records of employment history.

Note: SSA generally will not correct errors in wage records after three years, three months, and 15 days have elapsed since the wages were paid. There is no time limit for correcting SSA records if earnings were omitted in error.

To prove SSA omitted earnings, it is necessary to supply:

• Statement by the employer
• Pay stubs
• Form SSA-7013, "Statement Regarding Wages by Person Having Knowledge Thereof" or
• Signed, written statement by a co-worker

If SSA rejects applicant's proof, a "reconsideration" may be requested, as further described herein.

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Lost or Stolen Checks

If the check does not arrive by the sixth of the month:

• Check with post office;
• File form SSA-735 with the Social Security office (which will check at the Regional Disbursing Center);
• If the check was mailed, but not cashed, SSA will issue a new check as a "substitute" within 15 days; or, if "substitute" check is not issued, recipient should submit form SSA-1138 requesting "expedited payment;"
• If check was cashed by someone else, request form GFO-1133 from the Treasury Department;
• If check was not mailed, SSA should have sent a notice explaining why benefits were suspended or terminated. Recipient may request a "reconsideration."

Replacement Payments

• A "critical payment" can be made within 7-10 days;
• A request for expedited payment can be made within 45 days after a current benefit was due, or within 90 days after all information that SSA requested is furnished. Benefits will be sent within 15 days of the end of these periods.

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Reduced or Terminated Benefits

SSA may stop or reduce benefits if they believe the recipient:

• Is not cooperating
• Received too many benefits
• Is currently ineligible (e.g., alien who leaves country for more than 6 months ) or 
• Is no longer eligible

If the SSA stops or reduces benefits, the recipient should:

• Ask Social Security office for an explanation; and
• Request a "Reconsideration" if the recipient believes there is an error.

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Effect of Employment on Benefits

Working and Retirement Benefits
Individuals receiving SSDI benefits have a series of stages in which a recipient may “test” their ability to work.  

Trial Work Period

The first stage of the SSDI work rules is a 9-month “Trial Work Period” which begins the month you become entitled to SSDI benefits. 20 CFR § 404.1592. The months are counted non-consecutively within a 5-year period. This means that any month within a 5-year range in which the individual earns more than the Trial Work Period threshold ($720 in 2012) counts as a trial work month. During this period, the individual may earn any amount of money and those earnings will not be deducted from their SSDI benefits.

Note: An individual is not entitled to a trial work period if they engage in Substantial Gainful Activity ("SGA") during the required waiting period for benefits, or within 12 months of the onset of their disability and before the decision finding them disabled. 20 CFR § 404.1592(d).

Extended Period of Eligibility
After the Trial Work Period ends, a 36 consecutive month “extended period of eligibility” begins. During this time, if the individual continues to work, they will not be entitled to an SSDI monthly payment for any month in which they earn more than the SGA level ($1010/month in 2012). However, the individual is still entitled to receive full SSDI benefits during this period for any month that their earnings are below SGA. 20 CFR § 404.1592a.

Expedited Reinstatement for SSDI

After the extended period of eligibility, an individual’s SSDI benefits will be ceased if they have one month’s earnings over SGA. However, if the individual becomes unable to perform SGA within 5 years from the end of their extended period of eligibility, they may apply for expedited reinstatement of their benefits. This means that SSA will award provisional benefits for up to six months while they redetermine your eligibility for benefits. Expedited Reinstatement is awarded only when an individual is disabled due to the same or related impairments for which they were originally awarded benefits, and the individual is currently unable to perform SGA. 20 CFR § 404.1592f.

Note: If an individual is approved for disability through expedited reinstatement, a 24-month reinstatement period applies. During this period, SSA will not pay any benefits for months for which there is SGA. None of the trial work period or extended period of eligibility provisions apply during this time. After the reinstatement period is complete, any subsequent work by the individual will start the process again, beginning with a new 9-month trial work period. 20 CFR §404.1592f(d)-(e).

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