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Form SSA454BK Report of Continuing Disability Interview

If the SSA chooses a full CDR, you will be sent SSA-454-BK: Report of Continuing Disability Interview to complete. (You can also obtain this form anytime you want simply by calling the SSA and asking for it.) Along with the form will be a notice inviting you to contact a Social Security representative at your local Field Office. Such contact is meant to protect your rights and assure that you fully understand the questions on the form. It will also give you the opportunity to ask questions that you might have about your CDR. You can complete the form and mail it back to your local Field Office. The SSA prefers face-to-face contact, but you can do it by telephone if you wish. It is also possible for you to waive personal contact under certain conditions:

• the relationship between you and your representative payee is an official one (for example, an institution, government agency)

• you or your representative payee agrees or requests that the CDR be conducted by mail

• contact must be made, but is not practical at the present time (for example, because of weather or travel considerations) and you or your representative payee agrees to waive the personal contact and have the CDR conducted by mail instead, or

• you reside in a foreign country, unless you are in a U.S. District Office.

Form SSA-454-BK is 11 pages long, but filling it out is more time-consuming than difficult. In addition to the help available at the SSA Field Office, an attorney or other representative can fill out much of the form for you. A copy of the form and instructions on how to complete it follow. For all questions, the SSA wants to know what has happened since the time you filed your original disability application or had your last CDR.

Don't worry about the little code boxes asking for the Types of Entitlement. The SSA Field Office representative can complete that information. If the beneficiary is not doing the reporting, note the name, address and relationship of the other person reporting. This other person would be someone like a guardian or representative. Also state why the beneficiary is not reporting.

1 a. Describe in your own words the disabling conditions for which you receive benefits. Don't list new impairments that have appeared since you were granted benefits or since your last CDR.

b. If your disabling impairment has changed in severity, check Yes and describe the changes. Otherwise, check No.

c. If you have new impairments, check Yes and describe the new conditions. Otherwise, check No.

2 a. If you feel you can return to work, check Yes. Then turn to page 6, Item 14, and explain why you think you can work and any limitations on your work. If you don't think you can work, check No and turn to Item 14 and explain why you can't work. Try to be specific and concise in your explanation, and stick to the important points.

EXAMPLE 1: Pete was considered disabled because of heart disease and arthritis. He checked No and wrote in Item 14 the following: "My doctor says the blockages in my heart arteries are still there. I have just as many chest pains—on average, twice a day—as I had the last time my claim was reviewed. I still get chest pain walking a half-block slowly on level ground and sometimes I am short of breath. I have not had heart surgery and must take the same amount of medications. I've had no surgery for the arthritis in my knees; if anything, I can't stand as long as before. I have to sit down because of knee pain after standing more than about 30 minutes. My ability to do daily activities

Form SSA-454-BK: Sample Report of Continuing Disability Interview (Page 1)

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