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Social Security Disability Insurance SSDI Citation ✔✔CFR 20 Section 404
Good Cause for Late Filing (Citations: 404.911, 416.1411) ✔✔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: ✔✔• 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 ✔✔• 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 ✔✔Title XVI
SSDI Eligibility ✔✔1. Is the applicant under full retirement age (66)?
2. Is the applicant fully insured?
3. Is the applicant insured for disability?
Auxiliary Benefits ✔✔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 ✔✔Title II
Supplemental Security Insurance SSI Citation ✔✔CFR 20 Section 416
SSI ✔✔No work requirement
Children can qualify as disabled
,No retroactive benefits earlier than filing date
Strict income and resource provisions
Definition of Disability ✔✔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 ✔✔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 ✔✔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) ✔✔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) ✔✔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 ✔✔Citation: 404.130(e)
Statutorily blind individuals must only meet the fully disability insured status.
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Social Security Disability Insurance SSDI Citation ✔✔CFR 20 Section 404
Good Cause for Late Filing (Citations: 404.911, 416.1411) ✔✔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: ✔✔• 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 ✔✔• 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 ✔✔Title XVI
SSDI Eligibility ✔✔1. Is the applicant under full retirement age (66)?
2. Is the applicant fully insured?
3. Is the applicant insured for disability?
Auxiliary Benefits ✔✔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 ✔✔Title II
Supplemental Security Insurance SSI Citation ✔✔CFR 20 Section 416
SSI ✔✔No work requirement
Children can qualify as disabled
,No retroactive benefits earlier than filing date
Strict income and resource provisions
Definition of Disability ✔✔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 ✔✔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 ✔✔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) ✔✔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) ✔✔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 ✔✔Citation: 404.130(e)
Statutorily blind individuals must only meet the fully disability insured status.
