EDPNA Exam Test Questions And Answers
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Substitution Of Party (SSDI) - ANSWER POMS DI 23510.035
Substitution of Party is limited to a surviving spouse who was living with the decedent at
the time of death or within six months immediately preceding death, or to the parent or
parents of a disabled or blind child who was living with the parent or parents at the time
of death or within six months immediately preceding the month of death. Title XVI may
also be pursued on a deceased claimant if Medicaid benefits had been paid on the
claimant's behalf.
Substitution Of Party (SSI) - ANSWER 1. Surviving spouse living with claimant or
entitled to benefits on the claimant's account in the month of death;
2. Any child entitled to monthly benefits on the claimant's SSN for the month in
which the claimant died;
3. Parent(s) of the claimant entitled to monthly benefits on the claimant's SSN for
the month in which the claimant died; 4. Surviving spouse of the claimant;
5. Child(ren) of the claimant;
6. Parent(s) of the claimant;
7. Legal representative of the estate of the claimant.
Appeal Deadlines - ANSWER Test Tip: 60 days +5 days for mailing= 65 days to
appeal!
Levels of Appeal - ANSWER The three levels of appeal relevant to non-attorney
representatives are:
· Reconsideration
· Administrative Hearing
· Appeals Council
Timely Appeals - ANSWER Important to file because administrative finality.
A determination or decision becomes final and binding if it is not appealed timely.
Trial Work Period (SSDI Only) - ANSWER Citation: 404.1592, (no equivalent in 416)
The worker does have a period of time during which they can work without risk of losing
their benefits.
The trial work period is 9 months and it can be 9 different months so it doesn't have to
be consecutive. A beneficiary can work in January and then again in May and then
again in September and that's only three months of their trial work period (TWP) the trial
,work period cannot begin in a month that cannot be considered TWP month if the work
occurred during the waiting period.
There are dollar amounts that Social Security applies to decide if you use one of your
TWP months. In 2017 that was $840.00 in 2018 it is $850.00. If a person works and
earns $500, they have not used one of their 9 trial work period months but if they work
and earn $900 in a month then 1 of their 9 TWP months has been used.
Rules: 9 months within a 60 month rolling period
Income (SSI Only) - ANSWER test tip: Income does not have to be cash to be counted
against a claimant.
Income is defined in the regulations at 20 CFR 416.1104. You will find that income is
anything that you received during a calendar month, that can be used to meet your
needs for food or shelter. It may be cash or non-cash. Non-cash items they consider
"inkind" income. "In-kind" income is an item of food or shelter or something that you can
use to get food or shelter. Additionally, Social Security breaks all income down into two
categories; either earned income or unearned income.
Earned Income (SSI Only) - ANSWER Citations: 416.1112 "Earned Income We Do Not
Count"
Test Tip: Remember the two disregards are $20.00 no matter what, and $65.00
additionally, if the income is considered "earned income."
Wages OR net profit from self-employment are both considered under this provision.
Wages are counted when they are received and credited to the claimant or recipient.
Self-employment net earnings are counted by a taxable year, where they take the net
profit, divided by 12 months - 1 /12th of the net profit is counted as income in each of
those twelve months.
The first deduction is a twenty-dollar disregard, which is taken from all the income
received in a month. If the income is considered earned income, SSA will additionally
take a second deduction of $65.00 disregard. The computation continues by SSA
counting half of the remaining earned income, after these deductions.
Unearned Income (SSI Only) - ANSWER One important example is cash, Other
examples of unearned income include, but are not limited to: annuities, pensions, SSDI
benefits, or other periodic payments like alimony, support payments, dividends, interest,
some royalties, rental income, prizes, awards, gifts, inheritances, etc. Support and
maintenance in-kind, can also be considered unearned income
In Kind Support (SSI Only) - ANSWER Citations: 416.1102, 416.1130 -416.1148
anything that you received used to meet your needs for food or shelter. Almost always
unearned income
, There are special rules as to how the value of this food or shelter is treated and
received in a month. You should really be familiar with 20 CFR 416.1130 through 1148
for the detailed information about those rules.
One Third Reduction Rule (VTR) - ANSWER Test Tip: If the claimant is not receiving
both food AND shelter, the 1/3 reduction rule does not apply. Instead SSA uses the
presumed value rule as described in 416.1140.
Applies when a claimant is living with someone else who is providing them with food
and shelter.
Social Security reduces the SSI monthly amount in that situation by one third. There is
also a provision where any other income in the household, or that the recipient receives,
is additionally subtracted from that 113rd lower SSI payment amount.
Presumed Max Value (SSI) - ANSWER Citation: 416.1140
This is similar to the 1/3 reduction rule, but it is applied in a situation where claimant
normally lives in their own home but still gets help in the form of food and shelter or from
another individual. In that situation Social Security deducts the current market value of
the item from the monthly benefit subject to a maximum 1/3 of the FBR.
The presumed maximum value rule is rebuttable and if the recipient feels that the help
that they are getting is not worth 1/3 of $841 (for 2022), then they can submit evidence
to establish that the help they receive is worth less.
Income Deeming - ANSWER Citation: 416.1160
Income deeming is the process of considering another person's income and/or
resources to be available for meeting the basic needs of a disabled SSI claimant or
recipient. Deemed income is a major class of income where the actual disabled
individual is not receiving the income, but another person's income is deemed to be
used for the individual's benefit. To understand deeming, you must first understand the
term "ineligible individual" which is a person who is ineligible for SSI benefits due to
income and/or resources.
Deeming relationship include:
• Parent-to-Child Deeming:
Parent-to-child deeming only applies to deeming of income and resources from
ineligible parent(s) to an SSI eligible child under the age of 18. Once the child reaches
age 18, deeming of income and resources from the parent(s) no longer applies.
Generally, for parent-to-child deeming to apply, the child needs to be living with the
parent(s). However, there are certain instances when a child who lives away from the
parental home is still subject to parent to-child deeming. A common example of this
would be when a child under age 18 is away at school, but is still under parental control.
There are also several very limited situations in which SSA may waive deeming of
parental income and/or resources.
• Spouse-to-Spouse Deeming:
Spouse-to-spouse deeming only applies when an SSI eligible individual is married to an
ineligible spouse. If both members of a married couple are SSI eligible, another set of
Verified 100% Correct
Substitution Of Party (SSDI) - ANSWER POMS DI 23510.035
Substitution of Party is limited to a surviving spouse who was living with the decedent at
the time of death or within six months immediately preceding death, or to the parent or
parents of a disabled or blind child who was living with the parent or parents at the time
of death or within six months immediately preceding the month of death. Title XVI may
also be pursued on a deceased claimant if Medicaid benefits had been paid on the
claimant's behalf.
Substitution Of Party (SSI) - ANSWER 1. Surviving spouse living with claimant or
entitled to benefits on the claimant's account in the month of death;
2. Any child entitled to monthly benefits on the claimant's SSN for the month in
which the claimant died;
3. Parent(s) of the claimant entitled to monthly benefits on the claimant's SSN for
the month in which the claimant died; 4. Surviving spouse of the claimant;
5. Child(ren) of the claimant;
6. Parent(s) of the claimant;
7. Legal representative of the estate of the claimant.
Appeal Deadlines - ANSWER Test Tip: 60 days +5 days for mailing= 65 days to
appeal!
Levels of Appeal - ANSWER The three levels of appeal relevant to non-attorney
representatives are:
· Reconsideration
· Administrative Hearing
· Appeals Council
Timely Appeals - ANSWER Important to file because administrative finality.
A determination or decision becomes final and binding if it is not appealed timely.
Trial Work Period (SSDI Only) - ANSWER Citation: 404.1592, (no equivalent in 416)
The worker does have a period of time during which they can work without risk of losing
their benefits.
The trial work period is 9 months and it can be 9 different months so it doesn't have to
be consecutive. A beneficiary can work in January and then again in May and then
again in September and that's only three months of their trial work period (TWP) the trial
,work period cannot begin in a month that cannot be considered TWP month if the work
occurred during the waiting period.
There are dollar amounts that Social Security applies to decide if you use one of your
TWP months. In 2017 that was $840.00 in 2018 it is $850.00. If a person works and
earns $500, they have not used one of their 9 trial work period months but if they work
and earn $900 in a month then 1 of their 9 TWP months has been used.
Rules: 9 months within a 60 month rolling period
Income (SSI Only) - ANSWER test tip: Income does not have to be cash to be counted
against a claimant.
Income is defined in the regulations at 20 CFR 416.1104. You will find that income is
anything that you received during a calendar month, that can be used to meet your
needs for food or shelter. It may be cash or non-cash. Non-cash items they consider
"inkind" income. "In-kind" income is an item of food or shelter or something that you can
use to get food or shelter. Additionally, Social Security breaks all income down into two
categories; either earned income or unearned income.
Earned Income (SSI Only) - ANSWER Citations: 416.1112 "Earned Income We Do Not
Count"
Test Tip: Remember the two disregards are $20.00 no matter what, and $65.00
additionally, if the income is considered "earned income."
Wages OR net profit from self-employment are both considered under this provision.
Wages are counted when they are received and credited to the claimant or recipient.
Self-employment net earnings are counted by a taxable year, where they take the net
profit, divided by 12 months - 1 /12th of the net profit is counted as income in each of
those twelve months.
The first deduction is a twenty-dollar disregard, which is taken from all the income
received in a month. If the income is considered earned income, SSA will additionally
take a second deduction of $65.00 disregard. The computation continues by SSA
counting half of the remaining earned income, after these deductions.
Unearned Income (SSI Only) - ANSWER One important example is cash, Other
examples of unearned income include, but are not limited to: annuities, pensions, SSDI
benefits, or other periodic payments like alimony, support payments, dividends, interest,
some royalties, rental income, prizes, awards, gifts, inheritances, etc. Support and
maintenance in-kind, can also be considered unearned income
In Kind Support (SSI Only) - ANSWER Citations: 416.1102, 416.1130 -416.1148
anything that you received used to meet your needs for food or shelter. Almost always
unearned income
, There are special rules as to how the value of this food or shelter is treated and
received in a month. You should really be familiar with 20 CFR 416.1130 through 1148
for the detailed information about those rules.
One Third Reduction Rule (VTR) - ANSWER Test Tip: If the claimant is not receiving
both food AND shelter, the 1/3 reduction rule does not apply. Instead SSA uses the
presumed value rule as described in 416.1140.
Applies when a claimant is living with someone else who is providing them with food
and shelter.
Social Security reduces the SSI monthly amount in that situation by one third. There is
also a provision where any other income in the household, or that the recipient receives,
is additionally subtracted from that 113rd lower SSI payment amount.
Presumed Max Value (SSI) - ANSWER Citation: 416.1140
This is similar to the 1/3 reduction rule, but it is applied in a situation where claimant
normally lives in their own home but still gets help in the form of food and shelter or from
another individual. In that situation Social Security deducts the current market value of
the item from the monthly benefit subject to a maximum 1/3 of the FBR.
The presumed maximum value rule is rebuttable and if the recipient feels that the help
that they are getting is not worth 1/3 of $841 (for 2022), then they can submit evidence
to establish that the help they receive is worth less.
Income Deeming - ANSWER Citation: 416.1160
Income deeming is the process of considering another person's income and/or
resources to be available for meeting the basic needs of a disabled SSI claimant or
recipient. Deemed income is a major class of income where the actual disabled
individual is not receiving the income, but another person's income is deemed to be
used for the individual's benefit. To understand deeming, you must first understand the
term "ineligible individual" which is a person who is ineligible for SSI benefits due to
income and/or resources.
Deeming relationship include:
• Parent-to-Child Deeming:
Parent-to-child deeming only applies to deeming of income and resources from
ineligible parent(s) to an SSI eligible child under the age of 18. Once the child reaches
age 18, deeming of income and resources from the parent(s) no longer applies.
Generally, for parent-to-child deeming to apply, the child needs to be living with the
parent(s). However, there are certain instances when a child who lives away from the
parental home is still subject to parent to-child deeming. A common example of this
would be when a child under age 18 is away at school, but is still under parental control.
There are also several very limited situations in which SSA may waive deeming of
parental income and/or resources.
• Spouse-to-Spouse Deeming:
Spouse-to-spouse deeming only applies when an SSI eligible individual is married to an
ineligible spouse. If both members of a married couple are SSI eligible, another set of
