EDPNA PRACTICE TIPS EXAM QUESTIONS AND ANSWERS
RATED A+
✔✔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.
✔✔Statutorily Blindness - ✔✔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) - ✔✔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) - ✔✔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 - ✔✔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.
,To become eligible for Medicare a claimant has to have 24 months of disability
eligibility, meaning they have been paid 24 months of cash benefits. 24 months after
SSDI payments begin, the claimant will be automatically eligible for Medicare.
✔✔Disabled Adult Child (DAC) (SSDI Only) - ✔✔An adult who was disabled before age
22 may be eligible for child's benefits if a parent is deceased, or receiving Social
Security retirement, or receiving Social Security disability benefits. SSA considers this
Disabled Adult Child claim a "child's" benefit because it is paid on the parent's earnings
record. To meet requirements, the adult child -- including an adopted child, or, in some
cases, a stepchild, grandchild, or step grandchild - must
1. be unmarried;
2. be age 18 or older;
3. have a disability that started before age 22;
4. meet the SSA definition of disability for adults, and
5. not have substantial earnings to be insured for Title 2 on their own record.
✔✔Disabled Widow Benefits (DWB) - ✔✔Citation: 404.335
A widow or widower may be eligible for Disabled Widow(er)'s benefits if these
requirements are met:
1. The widow(er) is between 50 and 60 years old;
2. The widow(er) meets the SSA definition of disability for adults;
3. The widow(er)'s disability began before or within seven years after the spouse's
death.
4. The deceased spouse must have been on Title 2 disability or had Title 2 insured
status at death.
✔✔Substitution Of Party (SSDI) - ✔✔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) - ✔✔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 - ✔✔Test Tip: 60 days +5 days for mailing= 65 days to appeal!
, ✔✔Levels of Appeal - ✔✔The three levels of appeal relevant to non-attorney
representatives are:
· Reconsideration
· Administrative Hearing
· Appeals Council
✔✔Timely Appeals - ✔✔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) - ✔✔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) - ✔✔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 "in-
kind" 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) - ✔✔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.
RATED A+
✔✔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.
✔✔Statutorily Blindness - ✔✔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) - ✔✔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) - ✔✔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 - ✔✔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.
,To become eligible for Medicare a claimant has to have 24 months of disability
eligibility, meaning they have been paid 24 months of cash benefits. 24 months after
SSDI payments begin, the claimant will be automatically eligible for Medicare.
✔✔Disabled Adult Child (DAC) (SSDI Only) - ✔✔An adult who was disabled before age
22 may be eligible for child's benefits if a parent is deceased, or receiving Social
Security retirement, or receiving Social Security disability benefits. SSA considers this
Disabled Adult Child claim a "child's" benefit because it is paid on the parent's earnings
record. To meet requirements, the adult child -- including an adopted child, or, in some
cases, a stepchild, grandchild, or step grandchild - must
1. be unmarried;
2. be age 18 or older;
3. have a disability that started before age 22;
4. meet the SSA definition of disability for adults, and
5. not have substantial earnings to be insured for Title 2 on their own record.
✔✔Disabled Widow Benefits (DWB) - ✔✔Citation: 404.335
A widow or widower may be eligible for Disabled Widow(er)'s benefits if these
requirements are met:
1. The widow(er) is between 50 and 60 years old;
2. The widow(er) meets the SSA definition of disability for adults;
3. The widow(er)'s disability began before or within seven years after the spouse's
death.
4. The deceased spouse must have been on Title 2 disability or had Title 2 insured
status at death.
✔✔Substitution Of Party (SSDI) - ✔✔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) - ✔✔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 - ✔✔Test Tip: 60 days +5 days for mailing= 65 days to appeal!
, ✔✔Levels of Appeal - ✔✔The three levels of appeal relevant to non-attorney
representatives are:
· Reconsideration
· Administrative Hearing
· Appeals Council
✔✔Timely Appeals - ✔✔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) - ✔✔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) - ✔✔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 "in-
kind" 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) - ✔✔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.
