UNDERSTANDING SSI Social Security Administration Office of Programs Office of Supplemental Security Income SSA Pub. No. 17-008 July 1994 Introduction...........................................3 SSI Overview...........................................5 Information About the Social Security Administration...7 Rights of SSI Applicants and Recipients................8 How Someone Can Help You with Your SSI.................9 SSI Eligibility Requirements..........................10 SSI Resources.........................................12 SSI Income............................................14 Living Arrangements...................................17 SSI for Children......................................18 SSI Application Process...............................21 Documents You May Need When You Apply.................23 If You Have a Disability or Are Blind.................25 SSI Work Incentives...................................29 Reporting Responsibilities of SSI Recipients..........32 Notices and Letters from SSA..........................33 SSI Redeterminations..................................34 SSI Overpayments......................................36 SSI Appeals Process...................................38 Expedited Payments....................................40 Representative Payee..................................42 SSI and Eligibility for Other Government Programs.....43 Social Security Entitlement Requirements..............45 SSI Spotlights........................................47 Trusts............................................48 Burial Funds......................................49 Resources.........................................50 Deeming Parental Income and Resources.............51 Special SSI Rules for Children of Military Personnel Living Overseas.........52 Student Earned Income Exclusion...................53 Continued Medicaid Eligibility for People Who Work......................................54 Special SSI Rule for Blind People Who Work........55 Impairment-Related Work Expenses..................56 Plans for Achieving Self-Support..................57 Property You Need for Self-Support................58 Continued Payment for Persons Who Are Temporarily Institutionalized................59 Living Arrangements...............................60 Getting SSI While You Try to Sell Excess Resources.....................................61 Payment for Travel to Medical Exams.............. 62 ---------------------------------------------------------- REMEMBER YOU CAN CALL SSA TOLL-FREE AT 1-800-772-1213 ---------------------------------------------------------- -3- INTRODUCTION ============ The purpose of "Understanding SSI" is to inform advocates and others in interested agencies and organizations about supplemental security income (SSI) eligibility requirements and processes. We hope this knowledge will, at a minimum, enable you to be our partners in identifying people who potentially are eligible for SSI. It may also assist you in helping people apply for, establish eligibility for, and continue to receive SSI benefits for as long as they remain eligible. The degree to which you help is up to you. "Understanding SSI" can be used as a training manual and as a reference tool. It is not necessary for you to know everything in "Understanding SSI." You may simply use and refer to those sections which are most useful to you. If you are using "Understanding SSI" as a reference tool without Social Security Administration (SSA) training, please contact your local Social Security office. They can answer your questions and give you current benefit amounts. "Understanding SSI" will tell you when you will need to refer to the "Understanding SSI Update" (SSA Pub. No. 17-010). Each year the "Understanding SSI Update" will contain current dollar amounts. You can and should refer any potentially eligible individuals to SSA to apply for SSI or to get an answer to any question about which you are unsure. "Understanding SSI" and any related instruction by SSA staff are not intended to replace the experts at Social Security. If you have any doubts about a person's eligibility, always refer him or her to Social Security. We thank the American Association of Retired Persons' (AARP's) Program Department for allowing us to adopt and modify the material they use to train their volunteers. Their training materials served as the basis for this document. The information in "Understanding SSI" is general and is not to be applied to individual case situations. You MUST contact Social Security for individual case information. -5- SUPPLEMENTAL SECURITY INCOME OVERVIEW ===================================== WHAT IS SSI? ----------- SSI stands for supplemental security income. SSI provides monthly payments to aged, blind, and disabled people with limited income and resources (assets). WHO IS ELIGIBLE FOR SSI? ------------------------ ANYONE WHO IS: Aged--65 or older or . Blind--adult or child or . Disabled--adult or child AND WHO: . Has limited income; and . Has limited resources; and . Is a U.S. citizen or lawfully admitted permanent resident or alien allowed to remain in the U.S.; and . Is a resident of the U.S., including the District of Columbia, and the Northern Mariana Islands; and . Agrees to apply for other benefits. HOW MUCH CAN YOU RECEIVE FROM SSI? ---------------------------------- The maximum Federal payment changes yearly. See the "Understanding SSI Update" for the current Federal payment. If you live in one the following States or territory, refer to the "Understanding SSI Update" for the maximum Federal payment as your State or territory does not pay a supplement: Arkansas N. Mariana Islands Georgia Tennessee Kansas Texas Mississippi West Virginia Some States add to the Federal SSI payment so that SSI payment levels may be higher in those States. Payment amounts vary based upon your income, living arrangements, and other factors. If you live in one of the States listed below, SSA administers the State supplement for your State. You may contact your Social Security office for the amount of your SSI payment. California Nevada Delaware New Jersey District of Columbia New York Hawaii Pennsylvania Iowa Rhode Island Maine Utah Massachusetts Vermont Michigan Washington Montana Wisconsin In you live in one of the States listed below, your State pays and administers supplemental payments and you may contact the State for payment information. Alabama Indiana North Carolina Alaska Kentucky North Dakota Arizona Louisiana Ohio Colorado Maryland Oklahoma Connecticut Minnesota Oregon Florida Missouri South Carolina Idaho Nebraska South Dakota Illinois New Hampshire Virginia New Mexico Wyoming NOTE: See page 20 for more information on States that supplement Federal SSI payments to children. HOW IS SSI DIFFERENT FROM SOCIAL SECURITY BENEFITS? --------------------------------------------------- SSI payments are not based on your prior work or a family member's prior work. To get SSI, you must have limited income and resources. In most States, SSI beneficiaries also can get Medicaid (Medical Assistance) to pay for hospital stays, doctor bills, prescription drugs, and other health costs. SSI beneficiaries may also be eligible for food stamps. (At this time this is not true of California residents.) To get SSI, you must be at least 65 years old, or blind, or disabled. There is no waiting period for SSI. HOW IS SSI LIKE SOCIAL SECURITY? -------------------------------- Both programs pay monthly benefits. Both are administered by SSA. NOTE: For more information on Social Security benefits, see page 45. -7- INFORMATION ABOUT THE SOCIAL SECURITY ADMINISTRATION ==================================================== SSA is part of the U.S. Department of Health and Human Services (DHHS). SSA has 10 regional offices. It also has 1,300 district and branch offices throughout the U.S. Additionally, there are 37 teleservice centers where toll-free calls are answered. SOCIAL SECURITY OFFICES ----------------------- Both the Social Security and SSI programs are administered by the same SSA offices. Social Security employees will answer questions about both programs on the telephone and in person at your local office. Informational booklets are available at all Social Security offices. A copy of the SSA policy manual (called Program Operations Manual System (POMS)) is available to the public at every SSA office. CONTACTING SOCIAL SECURITY -------------------------- SSA encourages people to do business by telephone. Advocates may contact Social Security by telephone, mail, or in person. Social Security's toll-free number is 1-800-772-1213. The public can use it to conduct most business. You can call between 7 a.m. and 7 p.m. Monday through Friday. For best service call before 9 a.m. or after 5 p.m. Avoid calling 1-800-772-1213: . On the first few days of each week; . On days after holidays; and . Between 10 a.m. and 3 p.m. These are the busiest times. SSA's toll free number for the deaf is 1-800-325-0778. Call this number from 7 a.m. to 7 p.m., Monday through Friday, for Technical Devices for the Deaf (TDD). Call WITHIN THE FIRST 10 DAYS OF THE MONTH if you are applying for benefits or reporting a change in circumstances. Take care of less urgent matters after the first week of the month. In most offices, you can make an appointment for a telephone or in-person interview. If you are not able to make an appointment convenient for you, you may visit any Social Security office. You will be served as quickly as possible. When you call or visit SSA, note the name of any staff member you speak with and the date of contact. Put your name and Social Security Number on written correspondence with SSA and keep a copy for your records. -8- RIGHTS OF SSI APPLICANTS AND RECIPIENTS ======================================= YOU HAVE THE RIGHT TO APPLY --------------------------- Anyone may apply for SSI. There is no charge to apply. YOU HAVE THE RIGHT TO HELP FROM SSA ----------------------------------- The Social Security Administration will complete the application forms for you based on information you give. SSA will help you get documents you need to show that you meet the SSI eligibility requirements. If you are applying on the basis of disability or blindness, and SSA decides that the medical information needed to make a decision is not available from existing sources, SSA will pay for you to see a doctor. If a medical exam is needed, you must go to the exam in order to receive benefits. SSA may also pay your travel costs to get to this exam. NOTE: For information on when SSA pays for travel to medical exams, see the SSI Spotlight on Payment for Travel to Medical Exams. YOU HAVE THE RIGHT TO A REPRESENTATIVE -------------------------------------- You may appoint someone to help you with your SSI claim and go with you to meetings with SSA. NOTE: See How Someone Can Help You With Your SSI, page 9. YOU HAVE THE RIGHT TO A NOTICE ------------------------------ SSA will notify you in writing of any decision about your eligibility or any change in your payment amount. SSA will also send copies of all notices to your representative if you have one. Each notice will explain your appeal rights. YOU HAVE THE RIGHT TO EXAMINE YOUR FILE --------------------------------------- You or your representative may examine the information in your case file, upon request. YOU HAVE THE RIGHT TO APPEAL ---------------------------- You may appeal most decisions SSA makes about your eligibility for SSI, or if SSA decides to stop your check. SSA's administrative appeals process has three levels. NOTE: See SSI Appeals Process (page 38) for further information. -9- HOW SOMEONE CAN HELP YOU WITH YOUR SSI ====================================== ANYONE YOU CHOOSE CAN HELP YOU BY: ---------------------------------- Completing forms. Going with you to meetings with Social Security. Interpreting for you. Helping you gather and give information. Taking you to medical examinations or to the SSA office. Receiving mail for you at his or her address. IF YOU WANT MORE HELP, YOU MAY APPOINT A REPRESENTATIVE WHO CAN --------------------------------------------------------------- DO ALL OF THE ABOVE PLUS: ------------------------- Sign an application on your behalf. Review your file at the Social Security office. Get information from SSA about your claim, including notices and letters, just as you would. Represent you at informal or formal hearings. Give SSA evidence for you. Help you with appeals. (See SSI Appeals Process, page 38.) HOW DO YOU BECOME A REPRESENTATIVE? ----------------------------------- You must sign a statement naming your representative. Social Security has an "Appointment of Representative" form which you can use. Call your local Social Security office and ask for Form SSA-1696. Your representative does not have to be a lawyer. A representative's duties are different from those of a representative payee. NOTE: See page 42 for further information. -10- SSI ELIGIBILITY REQUIREMENTS ============================ TO BE ELIGIBLE FOR SSI BENEFITS YOU MUST: ----------------------------------------- BE AGED OR BLIND OR DISABLED AND MEET CITIZENSHIP AND RESIDENCY REQUIREMENTS AND HAVE LIMITED INCOME AND HAVE LIMITED RESOURCES GENERAL DEFINITIONS: -------------------- AGED ---- . Age 65 or older BLIND--Any Age ----- . 20/200 vision or less in your better eye with best correction; or . Your visual field is 20 degrees or less, even with a corrective lens. DISABLED--Child --------------- . Under 18, or 18 - 22 and a student; and . If under 18 - substantially reduced ability to function independently, appropriately, and effectively in a manner children of a similar age would due to a physical or mental impairment(s) which has lasted or which is expected to last at least 12 months or end in death; or . If 18 - 22, the ADULT disability definition explained below applies. See SSI for Children on page 18 and page 27 for more information on childhood disability evaluation. NOTE: As a result of the Zebley court case, SSA changed its rules for evaluating disability in children under age 18. The new rules are reflected in the above definition of childhood disability. Zebley class members: All children who had SSI benefits denied or terminated for medical reasons, between 1/1/80 and 2/11/91 are members of the Zebley class. For more information about the processing of Zebley class member cases, please contact your local Social Security office or the Zebley class lawyer-sponsored hotline, 1-800-523-0000. DISABLED--Adult --------------- . Unable to work due to a physical or mental impairment which has lasted or is expected to last at least 12 months or result in death. CITIZENSHIP/ALIEN STATUS ------------------------ . U.S. citizen; or . Lawfully admitted permanent resident; or . Alien allowed to remain in U.S. RESIDENCY --------- . Must live in the United States, including the 50 States, the District of Columbia, and the Northern Mariana Islands; or . Be a child living with a parent in the military service assigned to permanent duty ashore overseas. NOTE: See SSI Spotlight on Special SSI Rules for Children of Military Personnel Living Overseas. LIMITED INCOME -------------- Income includes: . Money you earn from work; . Money you receive from other sources, such as Social Security, pensions, Veterans' benefits, friends or relatives; and . Free food, clothing, or shelter you receive. NOTE: Not all income counts for SSI. Income that counts reduces your SSI payment amount. (See SSI Income on page 14.) LIMITED RESOURCES ----------------- Resources are things you own such as: . Cash/bank accounts; . Land; . Personal property; and . Life insurance. NOTE: Not all resources count for SSI. (See SSI Resources on page 12.) The SSI limits for resources that SSA counts are: . Individual -- $2,000; and . Couple -- $3,000. Congress may authorize changes in the SSI resource limits. Any changes are in the "Understanding SSI Update." OTHER REQUIREMENTS ------------------ . You must apply for all other benefits for which you may be eligible; e.g., pensions, Social Security. . In some cases, you must accept vocational rehabilitation services if you are blind or disabled and under age 65. . You will have to accept treatment for alcoholism or drug addiction if either one is found to be a cause of your disability. -12- SSI RESOURCES ============= WHAT ARE RESOURCES? ------------------- Resources are things you own such as: . Cash . Bank accounts, stocks, U.S. savings bonds . Land . Life insurance . Personal property . Automobile(s) . Anything else you own which could be changed to cash and used for food, clothing, or shelter . Deemed resources Sometimes we count a portion of the resources of a spouse, parent, or sponsor of an alien. If a child under 18 lives with one parent, $2,000 of the parent's resources do not count. If the child lives with two parents, $3,000 does not count. Amounts over these limits are counted as the child's resources. WHAT IS THE IMPORTANCE OF RESOURCES IN THE SSI PROGRAM? ------------------------------------------------------- . The value of your resources is one of the factors which determines whether or not you are eligible for SSI payments. . But remember, not all resources count for SSI. . If the value of your resources that SSA counts is over the allowable limit at the beginning of the month, you cannot receive SSI for that month. WHAT IS THE ALLOWABLE RESOURCE LIMIT? ------------------------------------- The limit for countable resources is: . $2,000 for an individual; and . $3,000 for a couple. WHAT RESOURCES DO NOT COUNT FOR SSI? ------------------------------------ For SSI, SSA does not count: . The home you live in and the land it is on (SSA does not place a lien on your home.) . Household goods and personal property that are not worth more than $2,000 . One wedding ring and one engagement ring . Burial spaces for you or your immediate family . Burial funds for you and your spouse, each valued at $1,500 or less (See SSI Spotlight on Burial Funds.) . Life insurance policies with a combined face value of $1,500 or less . Retroactive SSI or Social Security checks for up to 6 months after you receive them . One car, regardless of value, if it is: . Necessary for employment or medical treatment; or . Modified for use by a disabled person; or, . Necessary because of climate, terrain, distance or similar factors to perform essential daily activities. If your use of the car does not meet one of these conditions, then up to $4,500 of its market value is excluded. The remaining value is counted against the resource limit. OTHER RESOURCES WHICH DO NOT COUNT FOR SSI: ------------------------------------------- . Property essential to self-support. (See SSI Spotlight on Property You Need for Self-Support.) . Resources that a blind or disabled person needs for an approved plan for achieving self-support. (See SSI Spotlight on Plans for Achieving Self-Support.) . Support and maintenance assistance and home energy assistance that we do not count as income are not resources. . Cash received for medical or social services that we do not count as income is not a resource for 1 month. (EXCEPTION: Cash reimbursement of expenses already paid for by the person is counted under the regular income and resources rules.) NOTE: See page 12 for the regular resource counting rules and page 14 for the regular income counting rules. . Disaster relief assistance which we do not count as income. . Cash received for the purpose of replacing an excluded resource (e.g., a house) that is lost, damaged, or stolen. . Property in a trust set up according to State law--to which the SSI beneficiary has no access. NOTE: There are different Medicaid rules on trusts. See SSI Spotlight on Trusts. WHAT IF I WANT TO SELL A RESOURCE? ---------------------------------- If you own real property or other resources that you are trying to sell, you may be able to get SSI while you are trying to sell them. When the resource is sold, you must pay back the SSI payments. These are called "conditional payments." NOTE: See SSI Spotlight on Getting SSI While You Try to Sell Excess Resources. -14- SSI INCOME ========== WHAT IS INCOME? --------------- Earned Income -- money you receive from wages or earnings from self-employment. Unearned Income -- money you receive from other sources, such as Social Security, Veterans' benefits, pensions, State disability, unemployment benefits, interest income, and cash from friends and relatives. In-Kind Income -- free food, clothing, or shelter. Deemed Income -- the part of the income of your spouse, parent with whom you live, or sponsor (of an alien), which SSA uses to compute your SSI payment amount. WHY IS INCOME IMPORTANT IN THE SSI PROGRAM? ------------------------------------------- Generally, the more income you have, the less your SSI payment will be. If your income is over the allowable limit, you cannot receive SSI. WHAT INCOME DOES NOT COUNT FOR SSI? ----------------------------------- Payments or services that are not counted as income for the SSI program include: . The first $20 of most income received in a month . The first $65 of earnings and one-half of earnings over $65 received in a month . The value of food stamps . Income tax refunds . Home energy assistance . Assistance based on need funded by a State or local government . Small amounts of income received irregularly or infrequently . Food, clothing, or shelter based on need provided by private nonprofit agencies . Loans to you (cash or in-kind) that you have to repay . Payments from a trust account for items other than food, clothing, or shelter (See SSI Spotlight on Trusts.) . Money someone else spends to pay your expenses for items other than food, clothing, or shelter (e.g., someone pays your telephone or medical bills.) . Income set aside under a plan for achieving self-support (PASS) HOW DOES YOUR INCOME AFFECT YOUR SSI PAYMENT? --------------------------------------------- Step 1: SSA subtracts any income that is not counted from your total income. This figure is your "countable income." Step 2: SSA subtracts this "countable income" from the SSI Federal benefit rate. The result is your monthly SSI payment as follows: 1) Total income 2) SSI Federal benefit rate - Income that is not counted - Countable income ---------------------------- ------------------------- = Countable income = SSI payment THE FOLLOWING EXAMPLES ARE BASED ON 1992 DOLLAR AMOUNTS. FOR CURRENT DOLLAR AMOUNTS, PLEASE REFER TO THE "UNDERSTANDING SSI UPDATE." IF YOU HAVE ANY QUESTIONS, CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE. EXAMPLE A -- UNEARNED INCOME Total monthly income = $300 (Social Security check) 1) $300 (Social Security check) 2) $422 (SSI Fed. benefit) - 20 (Not counted) -280 (Countable income) --------------------------- ----------------------- $280 (Countable income) $142 (SSI payment) EXAMPLE B -- EARNED INCOME Total monthly income = wages of $317 1) $317 (Wages) - 20 (Not counted) ------------------- $297 - 65 (Not counted) ------------------- $232 divided by 1/2 = $116 (Countable income) 2) $422 (SSI Federal benefit rate) -116 (Countable income) ------------------------ $306 (SSI payment) EXAMPLE C -- SAMPLE STATE SUPPLEMENT The facts are the same as example A, but State supplementation is involved. 1) $300 (Social Security check) - 20 (Not counted) --------------------------- $280 (Countable income) 2) $422 (SSI Federal benefit rate) -280 (Countable income) ------------------------------ $142 (SSI Federal payment) 3) $142 (SSI Federal payment) + 15 (Sample State supplement payment for an individual living alone) ------------------------------------- $157 (Total SSI payment) NOTE: For information on how your living arrangement affects your SSI payment, see Living Arrangements on page 17. WHEN DOES DEEMED INCOME APPLY? ------------------------------ . When a person who is eligible for SSI lives with a spouse who is not eligible for SSI, SSA may count some of the spouse's income in figuring the SSI payment. . When a disabled child under age 18 lives with parents who do not receive SSI, SSA may count the parents' income in figuring the SSI payment. . When an alien has a sponsor, SSA may count the sponsor's income in figuring the SSI payment. From January 1, 1994 through September 30, 1996, SSA may count a sponsor's income for 5 years after an alien was admitted to the United States for permanent residence. (Before that, SSA counted a sponsor's income for 3 years.) WHEN DOES DEEMED INCOME NOT APPLY? ---------------------------------- . When you no longer live with a spouse or parent. . When a disabled or blind child reaches age 18. . When an alien's sponsoring period is over. . When a sponsored alien becomes disabled or blind after admission into the U.S. for permanent residence. . When an alien's sponsor dies. NOTE: See the section, "What Are Resources?," on page 12 and the section, "How Does Deeming Work for a Child?," on page 18, for more information on deeming to children. Also see the SSI Spotlight on Deeming Parental Income and Resources. -17- LIVING ARRANGEMENTS =================== WHY IS MY LIVING ARRANGEMENT IMPORTANT? --------------------------------------- Your living arrangement determines how much SSI you can get. This means your SSI benefits may vary depending on where you live: . In your own place such as a house, apartment, or trailer; or . In someone else's household; or . In a congregate care or board and care facility; or . In an institution. NOTE: For more information on living arrangements, see the SSI Spotlight on Living Arrangements. Some living arrangements reduce your SSI: . When you live in another person's house, apartment, or trailer, and you pay only a part of your share of your food or housing costs; . When you live in a house, apartment, or trailer, and someone else pays for all or part of your food, rent, or mortgage and other things like electricity and garbage removal. . When you are in a hospital or nursing home for the whole month and Medicaid pays for over one-half of the bill. . When you are in an institution run by a Federal, State, or local government for the whole month. (In most government institutions, you cannot get any SSI unless Medicaid is paying more than one-half of your bills.) NOTE: If you will be in a medical institution for 90 days or less, you may receive SSI. See the SSI Spotlight on Continued Payments for Persons Who Are Temporarily Institutionalized. If you live in a State that does not supplement the SSI benefit rate, refer to the "Understanding SSI Update" for the current Federal SSI payment if you have no other countable income and live alone or pay your share of food and household costs, or live in the household of another person, or live in a Medicaid institution. If you live in a State that does supplement the SSI benefit rate, refer to page 6 for more information. Contact your local Social Security office for the amount of SSI you will receive based on your living arrangements. WHAT IF YOU ARE HOMELESS? ------------------------- Your payment is figured the same as a person who lives in his own house, apartment, or trailer. CAN YOU RECEIVE SSI WHILE LIVING IN A PUBLIC SHELTER FOR THE HOMELESS? Yes. You can receive up to the maximum SSI payable in your State while living in a public shelter for up to 6 months out of any 9-month period. WHERE WILL YOU GET YOUR SSI IF YOU DON'T HAVE AN ADDRESS? --------------------------------------------------------- You don't need an address to get SSI. SSA will make arrangements to pay you. 18 SSI FOR CHILDREN ================ WHO IS A "CHILD" FOR SSI? ------------------------- A person who is neither married nor head of the household and: . Is under age 18; or . Is under age 22 and is a student regularly attending school or college or training that is designed to prepare the person for a paying job. NOTE: There is no minimum age requirement for SSI eligibility. WHAT IS "DISABLED OR BLIND" FOR A CHILD? ---------------------------------------- Disabled . If under 18--substantially reduced ability to function independently, appropriately, and effectively in a manner children of a similar age would due to a physical or mental impairment(s) which has lasted or which is expected to last at least 12 months or end in death. . If 18--22, the Adult disability definition on page 10 applies. Blind . 20/200 vision or less in your better eye with best correction; or . Your visual field is 20 degrees or less, even with a corrective lens. HOW DOES DEEMING WORK FOR A CHILD? ---------------------------------- If a child is under age 18, not married, and lives at home with parents who do not receive SSI payments, the parents' income or resources may be counted as being available to the child. This is called "deeming." There are deductions for parents and for other children living in the home. After these deductions are subtracted, the amount remaining is used to decide if the child meets the SSI income requirements for a monthly payment. NOTE: For more information, see the SSI Spotlight on Deeming Parental Income and Resources. WHEN DOES DEEMING NOT APPLY? ---------------------------- Deeming stops when a child reaches age 18 or no longer lives with a parent. Deeming does not apply, and SSA may pay up to $30 plus the applicable State supplement when: . A disabled child who received SSI while in an institution goes to live at home; and . The child is eligible for Medicaid under a State home care plan; and . Deeming would otherwise cause ineligibility for SSI. SSA does not consider the income of a parent for deeming purposes if the parent receives a public income maintenance payment, such as Aid to Families with Dependent Children (AFDC). CAN A CHILD GET MEDICAID? ------------------------- In most States, a child who gets SSI can get Medicaid to help pay medical bills. In some cases, a child may be eligible for Medicaid while in an institution, but not be eligible when living at home either because of the parents' income and resources or because the child receives in-kind help or other income. At the States' option, children under age 18 who live at home may keep Medicaid eligibility while getting home care if that care is less costly to the government. Even if not eligible for Medicaid due to SSI, a child still may be eligible for Medicaid under other State rules. Always check with the State. Other State services may also be available. CHILDREN OF ARMED FORCES PERSONNEL LIVING OVERSEAS -------------------------------------------------- Children living with a parent in the military service overseas may receive SSI but are not eligible for Medicaid. Medicaid eligibility is based on an individual physically living in a State with the intention of remaining there permanently or for an indefinite period. NOTE: For more information, see the SSI Spotlight on Special SSI Rules for Children of Military Personnel Living Overseas. DEEMING ELIGIBILITY GUIDELINES ------------------------------ The Deeming Eligibility Chart for Children in the "Understanding SSI Update" gives the highest amount of gross monthly income for this year (before taxes are withheld) which parent(s) can earn or receive and still have a child qualify for SSI. Note that some types of income that a parent may receive are not counted; e.g., money received for providing foster care to an ineligible child. NOTE: For more information on income, see SSI Income on page 14. USE CAUTION WHEN USING THE DEEMING ELIGIBILITY CHART FOR DEEMING OF INCOME TO CHILDREN. IF THERE IS ANY DOUBT WHETHER A CHILD IS ELIGIBLE, CONTACT YOUR SOCIAL SECURITY OFFICE FOR HELP. The Deeming Eligibility Chart for Children in the "Understanding SSI Update" DOES NOT APPLY when: . The parent(s) receive both earned income (e.g., wages or net earnings from self-employment) and unearned income (e.g., Social Security benefits, pensions, unemployment compensation, interest income, State disability, and Veterans' benefits). . The parent receives a public income maintenance payment such as Aid to Families with Dependent Children (AFDC) or a needs-based pension from the Department of Veterans Affairs. . The parent pays court-ordered support payments. . The child has income of his own. . There is more than one disabled child applying for or receiving SSI. Use the Deeming Eligibility Chart for Children in the "Understanding SSI Update" for children in the following States or territory, which do not supplement the Federal payment: Alaska Kansas North Carolina Arkansas Maryland South Carolina Delaware Mississippi Tennessee Georgia Missouri Texas Indiana N. Mariana Islands Virginia Ohio West Virginia If you live in one of the States listed below, SSA administers the State supplement for children. Call your Social Security office for deeming eligibility information. California Michigan Rhode Island District of Columbia Montana* Utah Hawaii Nevada* Vermont Iowa New Jersey Washington Maine New York Wisconsin Massachusetts Pennsylvania * Nevada supplements blind children only. Montana supplements disabled and blind children in certified foster homes only. If you live in one of the States listed below, your State administers the State supplement for children. Contact the State for information. Alabama Illinois New Mexico Arizona Kentucky North Dakota Colorado Louisiana Oklahoma Connecticut* Nebraska Oregon Florida* Minnesota* South Dakota Idaho New Hampshire* Wyoming * Connecticut, Minnesota, New Hampshire, and Oregon only supplement payments to blind children. Florida supplements disabled children only under the long-term care residential program. South Dakota supplements disabled and blind children in residential care facilities. -21- SSI APPLICATION PROCESS ======================= HOW TO APPLY FOR SSI -------------------- You can call Social Security and make an appointment to apply for benefits. You can have an appointment on the telephone or in person at your Social Security office. Someone else can call for you. You can visit a Social Security office to apply without making an appointment, but you may have to wait awhile. You will have to provide information and work with us to get documents concerning SSI eligibility. You or your representative will have to sign an application. Most of the forms to apply for SSI are not designed for self-completion. An SSA claims representative interviews you and completes the forms with information you give. WHEN TO APPLY ------------- Apply as soon as possible so that you do not lose benefits. The first date you contact SSA about applying for SSI is the earliest date from which benefits can be paid. If you call SSA to make an appointment to apply, SSA will use the date of your call as your application date. If you do not keep this appointment, SSA will send you a letter saying you must apply within 60 days (from the date of the letter) to use the date of your original call as your SSI application date. If you are in a public institution but you will be leaving within a few months, you may not be eligible for SSI until you leave. You may, however, be able to apply before you leave so that SSI benefits can begin quickly after you leave. Check with the institution and the local Social Security office about filing an application under the "prerelease procedures." IF YOU DO NOT SPEAK ENGLISH OR YOU NEED AN INTERPRETER BECAUSE OF ----------------------------------------------------------------- DEAFNESS -------- . Have a translator or interpreter with you during the interview; or . When you make your appointment, ask SSA if they can find someone to translate or interpret for you. WHAT SSA WILL ASK YOU ABOUT --------------------------- To decide whether you can get SSI, the staff at Social Security will ask you about: . Your income; . The things you own (resources); . Your living arrangements--where you live, with whom, who pays for things, etc.; and . Your citizenship or alien status. If you are age 65 or over, SSA will ask for proof of your age (unless you already get Social Security). If you are applying because you have a disability or are blind, SSA will also ask about your health problems, your treatment history, and how your health problems affect your daily activities. -23- DOCUMENTS YOU MAY NEED WHEN YOU APPLY ===================================== Social Security Card or Number Proof of Age Citizenship or Alien Status Record Proof of Income Proof of Resources Proof of Living Arrangements Medical Sources NOTE: You may not need all these documents. The Social Security employee will tell you what you need and will help you get it if you are having trouble. SOCIAL SECURITY CARD OR NUMBER ------------------------------ You will need to apply for a Social Security Number if you do not have one. PROOF OF AGE ------------ A public birth record recorded before age 5; or A religious birth record recorded before age 5; or Any other documents showing your age or date of birth. NOTE: If you already proved your age when you applied for Social Security benefits, you do not need to prove it again for SSI. CITIZENSHIP OR ALIEN STATUS RECORD ---------------------------------- If you are a citizen: . Birth certificate showing your place of birth; or . Religious record of birth or baptism showing your place of birth in the U.S.; or . Naturalization certificate; or . U.S. passport; or . Certificate of citizenship. If you are not a citizen: . Immigration form or certificate showing status (e.g., alien registration card). PROOF OF INCOME --------------- Earned Income -- payroll stubs, or if self-employed, a tax return. Unearned Income -- Any records you have (e.g., award letters, bank statements, court orders, receipts) showing how much you receive, how often, and the source of the payment. PROOF OF RESOURCES ------------------ Bank statement for all checking and savings accounts. Deed or Tax appraisal statement for all property you own besides the house you live in. Insurance policies. Either certificates of deposit, stocks, or bonds. PROOF OF LIVING ARRANGEMENTS ---------------------------- Deed or property tax bill. Lease or rent receipt. Medical assistance cards for all household members. Information about household costs, food, utilities, etc. MEDICAL SOURCES --------------- Medical reports, if you have them. Names, addresses, and telephone numbers of doctors and other providers of medical services, if you are applying as a blind or disabled person. OTHER SOURCES ------------- If you are applying as a disabled child, the names, addresses, and telephone numbers of people (teachers, caregivers) who can provide information about how your condition affects your day-to-day activities. NOTE: The above lists are not all inclusive and you may not need all of these proofs. Sometimes, one document can substitute for another. SSA will tell you what documents you need and what other documents are acceptable. THINGS TO REMEMBER ------------------ Do not wait to apply. The first date you contact SSA about applying for SSI is the earliest date from which benefits can be paid. If you do not have all of the things SSA needs, you can get them later, if necessary. Apply as early as possible so that you "protect" your filing date--the date from which benefits can begin. SSA needs to see the ORIGINAL documents. Photocopies are not acceptable. SSA will return the original documents to you. Try to keep a copy of things you send SSA. Keep track of the dates you send information to SSA, or talk to SSA, as well as the name of the SSA employee with whom you spoke. -25- IF YOU HAVE A DISABILITY OR ARE BLIND ===================================== WHAT INFORMATION DOES SSA ASK FOR ON THE DISABILITY FORMS? ---------------------------------------------------------- If you are applying for SSI because you have a disability or are blind, SSA will ask you: . What your disability is, how it affects your ability to work, how it affects your ability to function in your daily activities, and how long it has bothered you. . About the kind of medical treatments you have had or any medicines you take. . For names, addresses, and phone numbers of doctors and other providers of medical services; dates of treatment, and clinic or patient identification numbers. . For names and addresses of hospitals and dates of in-patient and out-patient treatment. . For names and addresses of persons who know how your condition affects your day-to-day functioning. . About schools you have attended. . Dates, places, and types of work you have done in the past 15 years. NOTE: SSA may ask you to fill out forms about your disability or blindness. If you need help, an SSA employee will help you. (If the forms are mailed to you, you can also ask someone you trust to help you.) WHO DECIDES IF YOU ARE DISABLED OR BLIND? ----------------------------------------- The Disability Determination Service (DDS) in your State makes the disability or blindness decision for SSA. NOTE: See page 10 for the definition of disability and blindness for adults over age 18 and children under age 18. Your local Social Security office decides whether you meet the other eligibility requirements concerning your income, resources, citizenship, etc. Your local Social Security office also decides if you are performing substantial gainful activity (SGA). (See Step 1 of the sections on the sequential evaluation process for adults on page 26 and for children on page 27.) HOW LONG DOES THE DECISION TAKE? -------------------------------- Usually about 3 to 4 months from the date of application. Sometimes SSA can make a "presumptive disability or blindness" decision which takes less time. NOTE: For more information on presumptive disability or blindness decisions, see the section on "Presumptive Disability or Blindness Payments" on page 40. HOW DOES THE DDS DECIDE IF YOU ARE DISABLED OR BLIND? ----------------------------------------------------- DDS workers ask your doctors and other people who have treated you for a medical history of your condition: what is wrong and when it began; how the condition limits your activities; what medical tests show; and what treatment they gave you. A trained DDS team, including a doctor and a DDS disability examiner, looks at the forms you filled out, your medical records, information about how you are functioning, and, if applicable, your work history, and then decides if you are disabled or blind for SSI purposes. If they cannot make a decision based on the information they have, the DDS will pay for you to have a special medical examination. It is important that you go to the special medical examination if one is scheduled. If you do not keep the appointment, your claim could be denied. NOTE: For more information on when SSA pays for you to attend a medical exam, see the SSI Spotlight on Payment for Travel to Medical Exams. In deciding if you are disabled, the DDS team uses a process called the sequential evaluation process. SEQUENTIAL EVALUATION PROCESS ----------------------------- If you appear to meet all the non-medical eligibility requirements (income, resources, residency, citizenship, etc.), a step-by-step process involving five questions is used to decide your disability case. These five steps are called the sequential evaluation process. The following sections describe how sequential evaluation is used for both adults and children. SEQUENTIAL EVALUATION FOR ADULTS AGE 18 OR OLDER ------------------------------------------------ STEP 1: ARE YOU WORKING? If you are working and performing substantial gainful activity, then you are not disabled, and the process ends here. This decision is made in the SSA office. SSA decides if work is "substantial" (significant) and "gainful" (for pay). A general rule is that substantial gainful activity is earnings over $500 per month. Earnings under $300 per month are not substantial gainful activity. If you are not working and performing substantial gainful activity, your case will be sent to the DDS for a decision. STEP 2: DO YOU HAVE A SEVERE IMPAIRMENT? If the DDS finds that you do not have a "severe" impairment, then you are found not disabled and the process ends here. A severe impairment is one which significantly limits your ability to do "basic work activities." Examples of basic work activities are: . Physical functions such as standing, walking, sitting, lifting . Seeing, hearing, speaking . Understanding and carrying out simple instructions . Use of judgment . Responding appropriately to supervision and co-workers . Dealing with changes STEP 3: DO YOU HAVE AN IMPAIRMENT WHICH MEETS OR EQUALS A SOCIAL SECURITY "LISTED IMPAIRMENT?" SSA's regulations list specific impairments under different body systems such as musculoskeletal, respiratory, cardiovascular, neurological, etc. If your impairment meets the requirements of a listed impairment, then you are found to be disabled and the process ends here. If your impairment is not listed, the DDS looks at whether the impairment is of a severity equal to a listed impairment. If your impairment equals the requirements of a listed impairment, then you are found to be disabled and the process ends here. If your disability does not meet or equal a listed impairment, you can still be found disabled later in the process. The DDS decides what you can do physically and mentally despite the limitations resulting from your impairments. This decision is called a "Residual Functional Capacity" or RFC assessment. STEP 4: ARE YOU ABLE TO DO YOUR PAST WORK? If, taking into account your RFC assessment, you are able to do work you did in the past (generally the last 15 years), you will be found to be not disabled and the process ends here. STEP 5: CAN YOU DO ANY OTHER KIND OF WORK? The DDS looks at your RFC assessment and takes into account your age, education, and work experience. If the DDS finds that you can do some other work, you will be found to be not disabled. If you can do no other work, you will be found disabled. SEQUENTIAL EVALUATION FOR CHILDREN UNDER AGE 18 ----------------------------------------------- STEP 1: ARE YOU WORKING? This step is exactly the same as Step 1 for adults. (See page 26.) STEP 2: DO YOU HAVE A SEVERE IMPAIRMENT? If the DDS finds that you do not have a "severe" impairment, then you are found not disabled and the process ends here. A severe impairment is one which causes more than a minimal limitation in your ability to perform age-appropriate activities of daily living. Age-appropriate activities can involve: . Recreation and play . School and academics . Self-care . Relating to peers and family members STEP 3: DO YOU HAVE AN IMPAIRMENT WHICH MEETS OR EQUALS A SOCIAL SECURITY "LISTED IMPAIRMENT?" If your impairment meets the requirements of a listed impairment, then you are found to be disabled and the process ends here. Likewise, if your impairment is not the same as a listed impairment but its severity equals the requirements of a listed impairment, then you are found to be disabled and the process ends here. If your disability does not meet or equal a listed impairment, you can still be found disabled later in the process. The DDS evaluates what you can do physically and mentally based on evidence in your file. This evaluation is called an "Individualized Functional Assessment" or IFA. STEP 4: DO YOU HAVE AN IMPAIRMENT WHICH IS OF COMPARABLE SEVERITY TO AN IMPAIRMENT WHICH WOULD DISABLE AN ADULT? The IFA is an evaluation of the impact of your impairment on your overall ability to function independently, appropriately, and effectively as other children your age would. Your ability to function is assessed in several areas including communication, motor skills, social skills, cognition, and task completion skills including concentration, persistence, and pace. If your impairment so limits your physical or mental ability to function in an age-appropriate manner that your limitations are comparable to those which would disable an adult, you will be found disabled. If the limitations are not comparable to those which would disable an adult, you will be found to be not disabled. ONCE YOU ARE ON SSI DISABILITY, DOES IT ALWAYS CONTINUE? -------------------------------------------------------- SSA and the DDS periodically reevaluate your disability or blindness to decide if you are still disabled or blind. If you are no longer disabled or blind, your benefits will stop. This reevaluation is called a Continuing Disability Review. The type of disability you have determines how often SSA reevaluates your disability. You can appeal if SSA proposes to stop your benefits. If SSA proposes stopping your disability benefits, you may continue to receive disability benefits if you appeal SSA's decision. SSA's notice proposing to stop your benefits will tell you how to appeal. -29- SSI WORK INCENTIVES =================== WHAT ARE WORK INCENTIVES? ------------------------- Work incentives are rules which are intended to help disabled or blind SSI recipients return to work by minimizing the risk of losing their SSI or Medicaid benefits. Some incentives allow SSA to not count some of your income or resources. Other incentives let you continue to receive Medicaid coverage even though you are not receiving an SSI check. EARNED INCOME EXCLUSION ----------------------- SSA does not count the first $65 of earned income plus one-half of the amount over $65. Therefore, your SSI check is reduced only $1 for every $2 you earn over $65 ($85 if you have no unearned income). This rule also applies to people age 65 or older. STUDENT EARNED INCOME EXCLUSION ------------------------------- If you are a student under age 22, SSA may exclude up to $400 of gross earnings in a month (but not more than $1,620 in a calendar year) in figuring your countable income. IMPAIRMENT-RELATED WORK EXPENSES -------------------------------- If you are a person with a disability, you may deduct the cost of certain items and services related to your disability which you need in order to work. For example, the costs of car modifications or attendant care may qualify. If you have impairment-related work expenses, the amount of countable earned income SSA uses to figure your SSI payment may be reduced. This means your SSI payments could go up. SSA may also consider these items when it figures your earnings in order to decide if you are doing substantial work. Other work expense deductions apply to blind individuals. WORK EXPENSES FOR BLIND PERSONS ------------------------------- If you are blind, SSA will deduct any part of your earned income that you spend to be able to work, such as for transportation, taxes, or special equipment. PLANS FOR ACHIEVING SELF-SUPPORT (PASS) --------------------------------------- If you are blind or have a disability, you may set up a fixed length plan to put aside income or resources to meet expenses for reaching an occupational goal. Unlike impairment-related work expenses, you may use a PASS to exclude unearned income and resources as well as earned income. SSA does not count income or resources set aside under a plan when figuring the SSI payment amount. You can use a PASS to establish, maintain, or increase SSI payments. NOTE: See SSI Spotlight on Plans for Achieving Self-Support. SECTION 1619(a) OF THE SOCIAL SECURITY ACT: BENEFIT CONTINUATION ----------------------------------------------------------------- FOR PEOPLE WHO WORK ------------------- Even if you are working at or above the SGA level, you can continue to receive cash and Medicaid benefits. Your payments are not stopped because you show that you can work. However, your disabling condition must continue to exist. SECTION 1619(b) OF THE SOCIAL SECURITY ACT: MEDICAID ELIGIBILITY ----------------------------------------------------------------- FOR PEOPLE WHO WORK ------------------- Section 1619(b) provides that, in most cases, even if your earned income (after the applicable exclusions) is too high to permit an SSI payment, you may still be eligible for Medicaid as long as you need Medicaid benefits in order to work. SPECIAL BENEFITS FOR INSTITUTIONALIZED "1619" BENEFICIARIES ----------------------------------------------------------- If you are eligible under section 1619 of the Social Security Act and you enter a medical institution, you are eligible for a full SSI payment for up to 2 months. REINSTATEMENT WITHOUT REAPPLYING -------------------------------- If you are eligible for Medicaid under section 1619(b), you may begin receiving payments again if your earnings drop. If you are not eligible for Medicaid under section 1619(b) because your earnings are too high, you again may become eligible for Medicaid or to receive cash payments if your earnings drop within 12 months. In each case, you do not need to file a new application. SECTION 301 OF THE SOCIAL SECURITY ACT: CONTINUATION OF BENEFITS ----------------------------------------------------------------- AFTER MEDICAL RECOVERY ---------------------- You can continue getting SSI payments even after you medically recover if you are participating in an approved vocational rehabilitation program. HOW TO FIND OUT MORE -------------------- Each Social Security office has a Work Incentive Liaison who works with outside organizations that serve disabled and blind people. An SSA claims representative at the local Social Security office can explain how work incentive provisions apply to your individual case. For more information on work incentives see the SSI Spotlight on: . Student Earned Income Exclusion . Continued Medicaid Eligibility for People Who Work (Section 1619(b)) . Special SSI Rule for Blind People Who Work . Impairment-Related Work Expenses . Plans for Achieving Self-Support The "Red Book on Work Incentives," which is also available on audio cassette, contains additional information on both SSI and Social Security disability work incentives. A copy of this booklet may be requested from Social Security. -32- REPORTING RESPONSIBILITIES OF SSI RECIPIENTS ============================================ WHAT YOU MUST REPORT TO SSA --------------------------- You must report the changes listed below to SSA. They may affect your eligibility for SSI and your payment amount: . Change of address; . Change in living arrangements; . Change in income; . Change in resources; . Death of spouse or anyone in your household; . Change in marital status; . Eligibility for other benefits; . Admission to or discharge from a hospital, nursing home, or other institution; . Change in school attendance; and . Leaving the U.S. WHAT HAPPENS IF YOU DO NOT REPORT CHANGES ----------------------------------------- You may be underpaid and not receive the additional payments due you as early as you could if you report. You may be overpaid and may have to pay SSA back. A penalty may be charged for failing to report within the time limit. IF YOU ARE DISABLED YOU MUST ALSO REPORT: ----------------------------------------- . Medical improvement; . Refusal to accept vocational rehabilitation services if referred; . Refusal or stopping of treatment for substance abuse; and . Return to work. WHEN TO REPORT -------------- Within 10 days after the end of the month in which the event occurs. -33- NOTICES AND LETTERS FROM SSA ============================ WHAT DOES A NOTICE LOOK LIKE? ----------------------------- It will say "Notice of . . ." at the top of the page. WHEN DOES SSA SEND YOU A NOTICE? -------------------------------- Whenever there is any decision about your eligibility or change in your payment amount. WHY DOES SSA SEND YOU A NOTICE? ------------------------------- To tell you something about your SSI benefits. To give you the chance to appeal the decision if you do not agree with it. WHAT DOES A NOTICE TELL YOU? ---------------------------- All SSI notices state their purpose; e.g., notice of planned action, notice of decision, notice of change, etc. If SSA plans any change in the check amount, the notice will state the starting date of the proposed change. This will usually be about 30 days from the date of the notice. Notices give the reason for the planned action or decision. Most notices explain what you need to do if you disagree with what the notice says. WHEN DOES SSA SEND A LETTER? ---------------------------- The letter may ask you to call, come into the office, or to send some information or proofs. SSA sends you a letter when they need more information about your claim. WHAT SHOULD YOU DO IF YOU RECEIVE A LETTER FROM SSA AND YOU ----------------------------------------------------------- CANNOT DO WHAT SSA ASKS IN TIME? -------------------------------- Call SSA right away to tell them. They will help you do what you need to do. Do not ignore the letter. If you do, SSA may stop or reduce your benefits. Your Medicaid may also stop. If you are applying for benefits, SSA may deny your claim. RESPONDING TO A NOTICE OR LETTER -------------------------------- If you do not understand a notice or letter you receive, you should contact SSA, and they will explain it to you. Have the notice or letter with you for this contact. SSA has a special process for delivering notices and letters to people who are blind. Call SSA for more information. -34- SSI REDETERMINATION =================== WHAT IS A REDETERMINATION? -------------------------- SSA reviews your income, resources, and living arrangements to be sure you are still eligible for SSI and are getting the right amount of SSI payments. If you are married to someone not on SSI or you are a disabled child under age 18 living with your parents, SSA also reviews the income, resources, and living arrangements of your spouse or parents. WHEN IS A REDETERMINATION CONDUCTED? ------------------------------------ Generally, once within 6 months after benefits are awarded, then every 1 to 3 years. Sometimes when you report a change that affects eligibility or payment (e.g., marriage). HOW DOES SSA DO A REDETERMINATION? ---------------------------------- There are three ways that SSA does a redetermination: . By telephone interview; . In person; or . By mail. For telephone and in-person interviews, SSA sends a letter asking you to telephone or come into the Social Security office for a redetermination. The letter tells you what time to call or come to the office. SSA staff will fill out the forms during the interview based on information you give. If you are not able to make the scheduled appointment, call Social Security; they will make a new appointment that is more convenient. For redeterminations conducted by mail, SSA sends you a short redetermination form for you to complete and return to Social Security. If you have a representative payee, he or she can complete the form for you. If you need help completing a redetermination form you receive in the mail, call or visit Social Security. SSA staff will help you fill it out. RESPONDING TO THE APPOINTMENT LETTER OR THE REQUEST TO COMPLETE --------------------------------------------------------------- FORMS ----- You have 30 days to: . Respond to the appointment letter; . Complete and return the form; or . Tell SSA that you cannot keep the appointment or are having trouble filling out the form. WHAT HAPPENS IF YOU DO NOT RESPOND TO THE APPOINTMENT LETTER OR --------------------------------------------------------------- COMPLETE AND RETURN THE FORM? ----------------------------- If you do not respond you may: . Have your checks stopped; . Get overpaid; . Be underpaid; or . Lose your Medicaid eligibility. DOCUMENTS THAT YOU MAY NEED FOR A REDETERMINATION ------------------------------------------------- Savings account, checking account, or other bank statements Pay stubs or income tax returns Proof of other income you receive (e.g., pensions, annuities, unemployment compensation, worker's compensation, etc.) Life insurance policies Burial contracts NOTE: All these may not be needed. SSA will tell you what you need and help you get it. -36- SSI OVERPAYMENTS ================ WHAT IS AN OVERPAYMENT? ----------------------- When you have been paid more than the amount due for any month. WHAT CAN CAUSE AN OVERPAYMENT? ------------------------------ Your income is more than you estimated. Your living situation changes. You have more resources than the allowable limit. You are no longer disabled and continue to receive benefits. You do not report a change to SSA (on time or at all) as required. SSA incorrectly figures your benefits. WHAT WILL SSA DO IF THERE IS AN OVERPAYMENT? -------------------------------------------- SSA will send you a notice explaining the overpayment and asking for a full refund within 30 days. If you are currently getting checks and do not make a full refund, the notice will propose to withhold the overpayment at the rate of 10 percent of your total income. The notice will also fully explain your appeal rights. If you do not understand why you were overpaid, ask an SSA representative to explain. WHAT CAN YOU DO IF YOU GET AN OVERPAYMENT NOTICE? ------------------------------------------------- If you believe you were not overpaid, you may request a reconsideration. NOTE: For information on requesting a reconsideration, see the SSI Appeals Process, page 38. If you ask for an appeal within 10 days of the date on the notice, SSA will not reduce your check until they make a decision. *** IF YOU AGREE THAT YOU ARE OVERPAID, BUT FEEL THAT IT WAS NOT YOUR FAULT, ASK FOR A WAIVER. ASK FOR AND COMPLETE FORM SSA-632 (REQUEST FOR WAIVER). SSA WILL HELP YOU IF NECESSARY. You can ask for a waiver at any time. If SSA grants a waiver you will not have to repay the overpayment. Generally for SSA to grant a waiver, you must show that: . It was not your fault that you were overpaid; and . You cannot pay back the overpayment because you need the money to meet your ordinary living expenses. You may have to submit bills to show that your monthly expenses use up all of your income and that it would be a hardship for you to repay. *** IF YOU ARE NOT SURE WHAT CAUSED THE OVERPAYMENT, YOU MAY ASK FOR A RECONSIDERATION, OR A WAIVER, OR BOTH. You may ask to see your file to see the information SSA used in figuring the overpayment. Have SSA explain the reason for the overpayment while you are examining your file. WHAT IF THERE WAS AN OVERPAYMENT AND SSA DOES NOT GRANT YOUR ------------------------------------------------------------ REQUEST FOR A WAIVER? --------------------- You will have to pay back the overpayment or have it withheld from your monthly checks. You can ask that less than the proposed amount be withheld from your checks each month, or you can arrange to make monthly payments if you no longer get SSI. -38- SSI APPEALS PROCESS =================== YOU MAY APPEAL MOST DECISIONS THE SOCIAL SECURITY ADMINISTRATION ---------------------------------------------------------------- MAKES. ------ SSA has established procedures for individuals who disagree with a decision they make. These are: . Reconsideration; . Administrative Law Judge Hearing; and . Appeals Council Review. You may challenge any decision which is considered an "initial determination" by filing a written appeal. Most decisions SSA makes are considered to be an "initial determination" such as: . Whether or not you are eligible; . How much the SSI benefit amount should be; or . Whether you must repay an overpayment. Contact your local Social Security office to file an appeal. NOTE: You may have your representative act for you in the SSA appeals process. For information on how to appoint a representative, see How Someone Can Help You With Your SSI on page 9. INITIAL DETERMINATION --------------------- After you have filed an application for SSI benefits, SSA will mail you a written decision. This is the "initial determination." STEPS IN THE APPEALS PROCESS ---------------------------- 1. RECONSIDERATION If you disagree with the initial determination, you may request reconsideration by writing to SSA or by completing a Form SSA-561 (Request for Reconsideration). . You or your representative must ask in writing for reconsideration WITHIN 60 DAYS of when you receive the initial determination. If you ask for reconsideration WITHIN 10 DAYS, any payments SSA is currently making will continue until SSA makes a decision. . SSA will send you a notice of the reconsideration decision. 2. HEARING If you disagree with the reconsideration decision, you or your representative may request a hearing before an administrative law judge by writing to SSA or by completing a Form SSA-501 (Request for Hearing). SSA will help you complete this form. You or your representative must request a hearing WITHIN 60 DAYS after you get the notice of reconsideration. You or your representative may review your file before the hearing and may add new evidence to the file at this time. If you do not want a hearing before the judge, you or your representative may ask the judge to make a decision based on the evidence in your file. If you do want to have a hearing before a judge, it is very important that you or your representative appear in person at the scheduled hearing. If for any reason you cannot make it, contact the judge as soon as possible before the hearing and explain why. If you do not attend the scheduled hearing, you may lose your appeal rights and benefits. SSA may pay you for travel costs if travel to the hearing from your home is more than 75 miles one way. If you need money for travel costs, tell the judge as soon as possible before the hearing. In a disability case, the judge may also want you to have more medical exams or tests. You may request further medical exams or tests if you think you need more medical information. The judge decides whether to grant your request. The judge may ask other witnesses, such as doctors, to come to the hearing. You may ask the judge to order certain witnesses to attend the hearing. During the hearing, the judge will explain your case and may ask you and any witnesses questions. You may also ask any witnesses questions and present new evidence. The hearing is informal but is recorded. You may ask for a copy of the tape. The judge will send both you and your representative a copy of the hearing decision. 3. APPEALS COUNCIL If you disagree with the judge's decision, you or your representative may request an appeal by writing SSA and requesting an Appeals Council review or by completing a Form SSA-520 (Request for Review of Hearing Decision/Order.) SSA will help you complete this form. You or your representative must ask for an Appeals Council review WITHIN 60 DAYS after you get the hearing decision. You or your representative may enter any new evidence into your file. The Appeals Council carefully examines your case and will grant, deny, or dismiss your request for review. If the Appeals Council grants your request for review, it will either decide your case or return it to the judge for further actions, which could include another hearing and a new decision. The Appeals Council will send you and your representative a copy of its decision, which will explain the action taken on your request. 4. FEDERAL COURT If you disagree with the final decision of the Appeals Council, you may appeal the decision. You can do this by filing a civil action with the U. S. District Court in your area. SSA cannot help you file a court action. You may want to contact a lawyer or a legal aid group to help you. You must file an action in Federal court WITHIN 60 DAYS after you receive the Appeals Council decision. The Federal Court will review the evidence and the earlier decisions, but will not conduct another hearing. -40- EXPEDITED PAYMENTS ================== There are three different situations in which you may be able to receive payments more quickly than usual: . Presumptive Disability or Blindness Payment; . Emergency Advance Payment; and . Immediate Payment. PRESUMPTIVE DISABILITY OR BLINDNESS PAYMENTS -------------------------------------------- These benefit payments are available for up to 6 months if you applied for SSI because of a disability or blindness and are waiting for the Disability Determination Service (DDS) to make a final decision. NOTE: The amount of each benefit payment will be based on your countable income. See page 14 for an explanation of countable income. The SSA office can make a presumptive disability or blindness decision if you have one or more of the following medical conditions: . Amputation of two limbs . Amputation of a leg at the hip . Allegation of total deafness . Allegation of total blindness . Allegation of bed confinement or immobility without a wheelchair, walker, or crutches, allegedly due to a longstanding condition -- excluding recent accident and recent surgery . Allegation of cerebral palsy, muscular dystrophy, or muscular atrophy and marked difficulty in walking (e.g., use of braces), speaking or coordination of the hands or arms . Allegation of diabetes with amputation of a foot . Allegation of Down's Syndrome . An applicant filing on behalf of another individual alleges severe mental deficiency for claimant who is at least 7 years of age. The applicant alleges that the individual attends (or attended) a special school, or special classes in school, because of this mental deficiency, or is unable to attend any type of school (or if beyond school age was unable to attend), and requires care and supervision of routine daily activities. . Allegation of human immunodeficiency virus (HIV) infection . Allegation of a stroke (cerebral vascular accident) more than 3 months in the past with continued, marked difficulty in using arms or legs. If the SSA office is not able to make a presumptive disability decision, sometimes the DDS can make one for other severe medical conditions, if it has medical proof that would most likely make its final decision an approval. WHAT HAPPENS TO PRESUMPTIVE DISABILITY PAYMENTS IF SSI BENEFITS --------------------------------------------------------------- ARE LATER DENIED? ----------------- You are not asked to repay, even if you are later found not to be disabled or blind. EMERGENCY ADVANCE PAYMENT ------------------------- The SSA office can make an emergency advance check payment to new applicants, who face a financial emergency, before any regular payment is authorized. Only one such advance payment can be made. The emergency advance cannot be higher than the SSI benefit rate (plus any federally administered State supplement). See the "Understanding SSI Update" for the Federal benefit rate. NOTE: If your State supplements the Federal payment, see page 5 for more information. WHO CAN RECEIVE AN EMERGENCY ADVANCE PAYMENT? . People who are to receive presumptive disability or blindness payments; or . Other people who are likely to meet all SSI eligibility requirements; and . People facing a "financial emergency." They need money right away due to a threat to health or safety, such as not enough money for food, clothing, shelter, or medical care. WHAT HAPPENS TO EMERGENCY ADVANCE PAYMENT AFTER THE FORMAL SSI -------------------------------------------------------------- DECISION IS MADE? ----------------- If your benefits are approved: . SSA will subtract the emergency advance payment from the payments due you for the past months and pay you the difference. If your benefits are denied: . And the emergency advance payment was for presumptive disability or blindness, you will NOT be asked to repay; . In all other cases, you WILL be asked to repay. IMMEDIATE PAYMENT ----------------- Payment is made in special cases where SSA establishes eligibility but regular payment has been delayed. If you have a special situation, check with your local Social Security office. WHO CAN RECEIVE? ---------------- . Applicants AND those already receiving SSI who are fully eligible, and . Who face a financial emergency and have no other option. WHAT IF SSA DOES NOT GRANT EXPEDITED PAYMENTS? ---------------------------------------------- The decision to grant these expedited payments is up to SSA. You do not have formal appeal rights if SSA decides you are not eligible for these. -42- REPRESENTATIVE PAYEE ==================== WHAT IS A REPRESENTATIVE PAYEE? ------------------------------- A representative payee is a person, agency, organization or institution SSA selects to manage your benefits when you are physically or mentally unable to do so yourself. Before appointing a representative payee, SSA must get and evaluate medical or other types of evidence about your capability to manage your SSI checks. WHO MUST HAVE A PAYEE? ---------------------- . Children under age 18; . Legally incompetent adults; . Recipients SSA determines to be incapable of managing benefits; and . People receiving SSI because drug addiction or alcoholism is a cause of their disability. Approximately 25 percent of SSI recipients have representative payees. WHO CAN SERVE AS A REPRESENTATIVE PAYEE? ---------------------------------------- Someone (other than a convicted felon) who is concerned with your welfare, usually a spouse, close relative, guardian, or friend. The director of an institution such as a nursing home can also be a representative payee. Providers at homeless shelters. SSA uses a list of qualifications to evaluate prospective representative payees. SSA needs volunteers who can serve as representative payees. If you or anyone you know is interested in doing so, call your local Social Security office. WHAT ARE THE DUTIES OF A REPRESENTATIVE PAYEE? ---------------------------------------------- Representative payees must use SSI payments for your current basic needs--for food, clothing, and shelter. The representative payee must provide a simple accounting (usually on an annual basis) to Social Security of how the money was spent. The representative payee should respond on your behalf to any SSA requests for action or information. Common requests are the SSI redetermination of eligibility or request for a continuing disability review. The representative payee's authority is limited to matters between you and Social Security. The representative payee is responsible for reporting any changes in your circumstances (e.g., income, living arrangements, return to work, etc.) to Social Security. You may, at any time, request that SSA change or terminate the payee arrangement. Following such a request, SSA will investigate the situation and make a determination. The representative payee may also terminate the arrangement. -43- SSI AND ELIGIBILITY FOR OTHER GOVERNMENT PROGRAMS ================================================= Many people who are potentially eligible do not know how receiving SSI affects receipt of benefits from other government programs. MEDICAID -------- In some States, if you are an SSI recipient you may be AUTOMATICALLY eligible for Medicaid benefits. In other States, you must apply for and establish your eligibility for Medicaid. In these States, SSA will direct you to the office where you can file for Medicaid. In many States, an SSI application is also an application for Medicaid; you do not have to file a separate application. FOOD STAMPS ----------- The Food Stamp Program provides monthly benefits that help low-income households to buy the food needed for good health. If you receive SSI, you may be eligible to receive food stamps. If you are applying for or receive SSI, you can get food stamp information and an application form at your local Social Security office. If all members of your household have applied for and receive SSI, and you apply for SSI, SSA will help you complete a food stamp application. If you already receive SSI AND food stamps, you can complete the food stamp forms for a recertification at your local Social Security office. SSI payments count in computing food stamp benefits. AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDC) ---------------------------------------------- You cannot receive both SSI and AFDC. SSA pays SSI benefits only to the blind or disabled adult or child, or age 65 or older member(s) of a household. Other members of your household can continue to get AFDC payments even if you get SSI. A parent can continue to get AFDC even when his or her child gets SSI. SSI often pays higher benefits than AFDC. If you get AFDC when your SSI checks begin, SSA counts the AFDC as income. However, once you are taken off the AFDC grant, your SSI check should go up. If it does not, contact your local Social Security office. STATE OR LOCAL ASSISTANCE BASED ON NEED --------------------------------------- Some States offer State or local assistance based on need to aged, blind, and disabled people through the State welfare department. The State may require you to apply for SSI if you receive State or local assistance based on need. If you are approved for SSI, your State or local public assistance payments will usually stop. Your State may be entitled to collect part of your retroactive SSI check as repayment for the money they paid you while your SSI claim was being processed. SOCIAL SECURITY --------------- Many people receive both SSI and Social Security. Medicaid is linked to SSI in most States. Medicare is linked to Social Security. It is possible to get both Medicare and Medicaid. States pay the Medicare premiums for people who receive SSI if they are also eligible for Medicaid. QUALIFIED MEDICARE BENEFICIARY PROGRAM (QMB) -------------------------------------------- The QMB program helps low-income Medicare beneficiaries by paying Medicare premiums, deductibles, and coinsurance. The Health Care Financing Administration runs the QMB program. The rules for QMB vary from State to State. Usually you may qualify for QMB if: . You receive Medicare; . Your income is limited; and . Your resources are not more than $4,000 for one person or $6,000 for a couple. Only your State can decide if you qualify for help under the QMB program. If you think you may qualify, contact your State or local medical assistance (Medicaid) agency, social service office, or welfare office. If you apply for Social Security or SSI, your Social Security office can help you with QMB questions. -45- SOCIAL SECURITY ENTITLEMENT REQUIREMENTS ======================================== Many people who are eligible for SSI may also be entitled to receive Social Security benefits. The following sections provide information on who may be entitled to Social Security checks and how to apply. TO BE ELIGIBLE FOR SOCIAL SECURITY BENEFITS AS A WORKER YOU MUST: ----------------------------------------------------------------- . Be age 62 or older, or disabled; and . Be "insured" by having enough work credits. HOW MUCH WORK DO YOU NEED TO BE "INSURED?" ------------------------------------------ Work is measured in "Social Security credits." You can earn up to four credits per year based on your annual earnings. Contact your local Social Security office about your Social Security entitlement. For Social Security disability benefits, you need 5 years work (equal to 20 credits) in the 10 years prior to the onset of your disability. Those disabled before age 31 need less work to qualify. WHO CAN RECEIVE BENEFITS ON THE WORKER'S RECORD? ------------------------------------------------ Retired or disabled workers. Spouses who are: . Age 62 and over; or . Divorced age 62 and over and married to the worker at least 10 years; or . Under age 62 and caring for a disabled or blind child under age 16. The child must be receiving benefits on the worker's record. Widows or widowers who are: . Age 60 or older; or . Age 50 or older and disabled; or . Divorced and age 60 or older (age 50 if disabled), and married to the worker for at least 10 years Mothers and fathers who are: . Under age 60 caring for a child under 16 (or disabled) who is receiving benefits on the worker's record. Unmarried children (including step children, adopted children and, in some cases, grandchildren and illegitimate children) who are: . Under age 18 (or between ages 18 and 19 if a full time high school student) . Over age 18 and who became disabled before age 22; or Dependent parent(s), age 62 or older, of deceased workers. HOW TO APPLY FOR SOCIAL SECURITY BENEFITS ----------------------------------------- Call Social Security to arrange for an appointment to apply. You can apply over the telephone or in person at the Social Security office. An SSA representative will help you fill out any forms that you need based on information you give. SSA will tell you what you need to bring. SSA can help you obtain any evidence you need if you cannot get it yourself. Often you can start getting checks in only a few weeks. WHAT EVIDENCE WILL YOU NEED? ---------------------------- . Proof of your age: . A public birth record recorded before age 5; . A religious birth record recorded before age 5; or . Any other documents made early in your life showing your age or date of birth. . W-2 forms for last year. . Proof of marriage if applying for spouse's/widow(er)'s benefits. . Birth certificates and Social Security Numbers for eligible children. . Checkbook or savings passbook if you want to arrange for direct deposit. . Remember that you must bring or send original documents, not photocopies. SSA will return the original documents to you. NOTE: Do not delay applying if you do not have all the evidence you need. Social Security will tell you what you need and help you get it, if you need help. -47- SSI SPOTLIGHTS ============== The SSI Spotlights are an in-depth look at some of the program rules referred to earlier. They are designed as handouts to help applicants through the process of applying for and receiving SSI checks. The SSI Spotlights are intended for use by the general public. We encourage advocates to distribute them to their clients, and to any other individuals or groups who can use them. They provide more details than our general information pamphlets. The information in the SSI Spotlights is general and not to be applied to specific case situations. You must contact Social Security for specific case information. -48- SSI SPOTLIGHT ON TRUSTS ======================= What is a trust? ---------------- A trust is a legal arrangement regulated by State law in which one party holds property for the benefit of another. A trust can be set up for an SSI beneficiary. A trust can contain: . Cash or other liquid assets; and . Real or personal property that could be turned into cash. Can a trust be set up to give an SSI beneficiary--adult or child- ----------------------------------------------------------------- more financial independence? ----------------------------- Yes. The type of trust we are discussing here--often referred to as a discretionary trust--is one where: . The SSI beneficiary does not have the legal authority to control how the money is spent; and . A trustee manages the trust and decides how to spend the money to meet the person's needs. How do resources in this type of trust count in the SSI program? ---------------------------------------------------------------- Money or property in this type of trust for an SSI beneficiary (or person whose resources are deemed available to an SSI beneficiary) does not count toward the SSI resource limits of $2,000 for an individual (or $3,000 for a couple). NOTE: Some trusts which are not counted as resources for SSI purposes may affect Medicaid eligibility. In these cases, the State will determine Medicaid eligibility. How does money from the trust affect the individual's SSI --------------------------------------------------------- payments? --------- Money paid directly to the providers for items other than the person's food, clothing, and shelter does not reduce SSI payments. (Items that are not "food, clothing, or shelter" include medical care, telephone bills, education, and entertainment.) Money paid directly to the providers for food, clothing, or shelter does reduce the individual's SSI payments--but only up to a limit. Money paid directly to the individual from the trust reduces the SSI payment. How can you find out more about setting up a trust? --------------------------------------------------- Social Security cannot tell you how to set up a trust. Consult a lawyer or financial advisor to find out more about trusts. Your local Social Security office has a list of groups that can find you a lawyer or give you free legal services if you qualify. You may also contact the State or local bar association or the Legal Services Corporation for legal assistance if you qualify. THIS INFORMATION IS GENERAL; TO FIND OUT HOW IT APPLIES TO YOU OR FOR MORE INFORMATION, CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE. -49- SSI SPOTLIGHT ON BURIAL FUNDS ============================= What is a burial fund? ---------------------- A burial fund is money set aside to pay for burial expenses. Does a burial fund count as a resource for SSI? ----------------------------------------------- Generally, you and your spouse can set aside up to $1,500 each to pay for burial expenses. In most cases, this money will not count as a resource for SSI. But if you (and your spouse) own life insurance polices or have other burial arrangements in addition to your $1,500 burial funds, some of the money in the burial fund may count toward the resource limit of $2,000 for an individual or $3,000 for a couple. Interest earned on your burial fund that is left in the fund does not count as a resource for SSI. Does interest earned on your (and your spouse's) burial fund ------------------------------------------------------------ count as income for SSI? ------------------------ No. Interest earned on your (and your spouse's) burial fund that is left in the fund does not count as income for SSI and does not affect your SSI payment. How can you set up a burial fund? --------------------------------- Any account you set up must clearly show that the money is set aside to pay burial expenses. This can be done either by: . Titling the account as a burial fund; or . Signing a statement saying how much has been set aside for burial expenses, for whose burial the money is set aside, how the money has been set aside, and the date you first considered the money set aside for burial expenses. What happens when money is spent from a burial fund? ---------------------------------------------------- If you spend any money from a burial fund on items unrelated to burial expenses, there may be a penalty. THIS INFORMATION IS GENERAL; TO FIND OUT HOW IT APPLIES TO YOU OR FOR MORE INFORMATION, CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE. -50- SSI SPOTLIGHT ON RESOURCES ========================== What are resources? ------------------- Resources are things--like bank accounts, money, property, stocks, and bonds--that you own and can turn into cash. Why are resources important in the SSI Program? ----------------------------------------------- To get SSI, your countable resources must not be worth more than $2,000 for an individual, or $3,000 for a couple. This is called the resource limit. Countable resources are the things you own that count toward the resource limit. Many things you own do not count. What things do not count toward the resource limit? --------------------------------------------------- The following things generally do not count toward the resource limit--no matter how much they are worth: . The house you live in; . Your car, if it is equipped for use by a handicapped person, or if you need it for daily activities, or to go to work or get regular medical treatment. If a car cannot be excluded for any one of these reasons, then only the part of the current market value that is over $4,500 counts as a resource; . Life insurance policies you own with a face value of $1,500 or less per person; . Burial plots or spaces for you or your immediate family; . A burial fund of up to $1,500 each for you and your spouse's burial expenses; . Property you or your spouse use in a trade or business, or on your job if you work for someone else; . Money or property you own that is in a trust controlled by someone else; and . If you are disabled or blind--money or property you have set aside under a plan to become self-supporting. There are other things you own that may not count as resources for SSI. And sometimes you might be able to get monthly payments even if you own things that put you over the resource limit. THIS INFORMATION IS GENERAL; TO FIND OUT HOW IT APPLIES TO YOU OR FOR MORE INFORMATION, CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE. -51- SSI SPOTLIGHT ON DEEMING PARENTAL INCOME AND RESOURCES ====================================================== I have a disabled child under age 18 and I am working. Can my -------------------------------------------------------------- child qualify for SSI? ---------------------- Possibly. We consider some of your income and resources to be available to your child. They may affect whether your child can get SSI and how much. The process of determining how much of your income and resources will be used is called "deeming." When does deeming apply? ------------------------ When the parent(s) has income or resources OR BOTH; AND When a child: . Is under age 18; AND . Lives at home with his natural or adoptive parents; OR . Lives away at school, but comes home on some weekends or holidays and is subject to parental control. Does deeming count all income and resources? -------------------------------------------- No. Some types of income and resources are not deemed. Examples of income that are not deemed are: AFDC; VA pension; general assistance; foster care payments for an ineligible child; and income used to make court-ordered support payments. Examples of resources that are not deemed are: a home; up to $2,000 in household goods; and money in pension funds. And only a part of the types of income or resources we use are deemed. When does deeming not apply? ---------------------------- Deeming stops when a child turns age 18. So a child who could not receive SSI because of deeming may be able to get SSI when he turns age 18. Deeming does not apply in some other situations. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -52- SSI SPOTLIGHT ON SPECIAL SSI RULES FOR CHILDREN OF MILITARY =========================================================== PERSONNEL LIVING OVERSEAS ========================= What is SSI? ------------ SSI stands for Supplemental Security Income. It is a program run by Social Security. It pays monthly checks to people with limited income and resources who are age 65 or older, blind, or disabled. Blind or disabled children, as well as adults, can get SSI. Under SSI, a child is defined as being under age 18, or under age 22 and in school or other training to prepare for a job. Children of Military Personnel ------------------------------ Most people who get SSI and leave the United States (U.S.) for 30 days or more are no longer eligible for SSI. But there is a special rule for the children of military personnel. A child may continue to get benefits while overseas if the child: . Is a citizen of the U.S.; and . Is living with a parent who is a member of the U.S. armed forces assigned to permanent duty ashore anywhere outside the U.S.; and . Was eligible to receive SSI benefits in the month before the parent reported for duty overseas. How to Get More Information --------------------------- For more information, contact your local Social Security office or call 1-800-772-1213 before you leave the U.S. You must be able to tell Social Security: . When you expect to report to your duty station overseas. . When you expect your child to join you. . Your mailing address at your new duty station. . Any information you have about military allowances (e.g., housing allowances, rations allowances, etc.) at your new duty station. If you are already overseas and think your child may be eligible for continuation of benefits, contact the U.S. Embassy, the nearest U.S. Consular Office, or write to: Social Security Administration Winchester and Vocke Roads Cumberland, Maryland 21502 Attn: International Coordinator When you contact Social Security, be sure to give us your current address, telephone number, and your child's name and Social Security number. Special Reporting Instructions for Children Receiving SSI --------------------------------------------------------- Overseas -------- You should report any change in income, resources, or address for a parent or child in the household to Social Security within 10 days after the month it happens. Also, remember to report: . If your child who receives SSI moves. . If other people move into or out of your home. . If you leave the armed forces and remain overseas. CONTACT YOUR SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -53- SSI SPOTLIGHT ON STUDENT EARNED INCOME EXCLUSION ================================================ What is the student earned income exclusion? -------------------------------------------- This provision allows a person under age 22 and regularly attending school to exclude as income that counts against SSI up to $400 of earnings per month (up to a maximum of $1,620 per year). This exclusion is applied before any other exclusions. What does "regularly attending school" mean? -------------------------------------------- "Regularly attending school" means that the person takes one or more courses of study and attends classes: . In a college or university for at least 8 hours a week; or . In grades 7-12 for at least 12 hours a week; or . In a training course to prepare for employment for at least 12 hours a week (15 hours a week if the course involves shop practice); or . For less time than indicted above for reasons beyond the student's control, such as illness. A person who is homebound because of a disability may be "regularly attending school" by: . Taking a course or courses given by a school (grades 7-12), college, university, or government agency; and . Having a home visitor or tutor who directs the study. EXAMPLE: Jim is an 18-year-old SSI recipient who attends a vocational training course at a local high school for 12 hours a week. He will complete the training course in June. In January he began working 20 hours a week at $4.50 per hour. He is paid every Friday. His monthly earnings are as follows: January $360 February $360 March $450 April $360 May $360 June $450 Using the student earned income exclusion, Jim can exclude all of his wages in January and February, $400 in March, all of his wages in April, and $140 in May for a total of $1,620 for the year. His remaining wages for the year ($50 in March and any wages over the $1,620 limit) are still subject to the earned income exclusion of $65 per month plus one half of the remainder. Are there any other rules which may help? ----------------------------------------- Other SSI work incentives such as plans for achieving self-support, work expense exclusions, and continued Medicaid coverage may also help an SSI recipient while working. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -54- SSI SPOTLIGHT ON CONTINUED MEDICAID ELIGIBILITY FOR PEOPLE WHO ============================================================== WORK (SECTION 1619(b)) ====================== What will happen to my Medicaid if I go to work? ------------------------------------------------ In most cases, if you are blind or disabled and you have Medicaid before you go to work, your Medicaid will continue while you are working as long as your disabling condition still exists. If my SSI stops because of the amount of my earnings, can I still keep my Medicaid? In most cases, you can keep your Medicaid even if you earn too much to receive a monthly SSI payment as long as: . You are still blind or have a disability; and . You meet all the SSI eligibility requirements except for the amount of your earnings; and . You need Medicaid in order to work; and . Your earnings are not high enough to replace your SSI, your Medicaid coverage, and any publicly-funded attendant care which you receive. In some States you must also have Medicaid coverage in the month before you became eligible under section 1619(b). The amount you can earn and still receive Medicaid varies from State to State. Your local Social Security office can tell you what the amount is in your State. If your earnings are higher than this amount but you have special work expenses or medical expenses, you may still qualify for Medicaid. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -55- SSI SPOTLIGHT ON SPECIAL SSI RULE FOR BLIND PEOPLE WHO WORK =========================================================== What is the special rule? ------------------------- There is a special rule to help people who work and who are receiving SSI because of blindness. This rule lets a blind person exclude from income his or her earned income which is used to pay expenses which enable the person to work. What are some examples of expenses which can qualify under the -------------------------------------------------------------- rule? ----- Expenses which can qualify include: . Dog guides, including the cost of food and upkeep; . Transportation to and from work; . Licenses, fees, or taxes; . Attendant care services; . Meals eaten during work hours; . Medical equipment or supplies; and . Other work-related equipment or services. Example: Ray Barnett receives SSI because of blindness. He works and earns $800 per month. He has the following work expenses: . His employer withholds $250 per month for Federal and State income taxes and Social Security (FICA) taxes; and . He has to pay $100 per month for transportation to and from work. The $350 of Mr. Barnett's earnings, which he uses to pay these work expenses, are not counted in determining the amount of his SSI. Are there any other rules which may help? ----------------------------------------- A blind person may also use other SSI work rules such as plans for achieving self-support and continued Medicaid coverage while working. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -56- SSI SPOTLIGHT ON IMPAIRMENT-RELATED WORK EXPENSES ================================================= Because of my disability, I would have to pay for certain items --------------------------------------------------------------- so I could work. How would these expenses affect my SSI? --------------------------------------------------------- In most cases, SSA can deduct the costs of these items from the amount of earnings they use to figure your SSI payment. This means that your SSI payment will not be reduced as much because SSA will not count all of your earnings. What are some examples of expenses which can be deducted? --------------------------------------------------------- If you work, the cost of items such as pacemakers, braces and artificial limbs, and disposable items such as bandages, pads, and syringes could be deducted. SSA may also be able to deduct the cost of attendant care services in preparing for work, performed at work, or to get to and from work. Certain costs such as changes to your home or car or van, as well as costs of medicine and doctors visits, may also be deducted. What if I need the item or service both on and off the job? ----------------------------------------------------------- Generally, it does not matter if you also need the item or service for daily living. For example, the cost of a wheelchair usually can be deducted from the earnings we might count even though the wheelchair is used for daily living as well as when you work. Are there any other rules which may help? ----------------------------------------- A person who is disabled may also use other SSI work incentives such as plans for achieving self-support and continued Medicaid coverage while working. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -57- SSI SPOTLIGHT ON PLANS FOR ACHIEVING SELF-SUPPORT ================================================= What is a plan for achieving self-support? ------------------------------------------ This is a way in which a person with a disability or blindness uses or sets aside income or resources to reach a work goal. For example, a person could set aside money for an education or a training program or to start a business. Who may have a plan? -------------------- Any person who receives SSI because of a disability or blindness may have a plan. In addition, a person who does not receive SSI because his or her income or resources are too high, may use a plan to become eligible for SSI. How does a plan affect my SSI payment? -------------------------------------- Money that is saved under a plan will not count against your resource limit of $2,000 (or $3,000 for a couple). Income that is set aside under a plan is not counted when Social Security decides how much SSI a person receives. This means that a person who sets aside income under a plan will receive a higher SSI payment than if he or she did not have a plan. What are the requirements for a plan? ------------------------------------- A plan must: . Be in writing and be approved by the Social Security Administration; . Have a specific work goal which the person can probably reach; . Say how long it will take for the person to reach the goal (usually no longer than 36 months); . Say what income or resources will be set aside and how they will be used to reach the goal; and . Explain how you will keep the income or resources set aside separate from other money you have. How do I set up a plan? ----------------------- Anybody may help you write a plan including a counselor or a relative. Social Security can also help you write a plan. Are there any other rules which may help? ----------------------------------------- Other SSI work rules such as work expense exclusions, the student earned income exclusion, and continued Medicaid coverage may help an SSI recipient while working. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -58- SSI SPOTLIGHT ON PROPERTY YOU NEED FOR SELF-SUPPORT =================================================== Why are resources important for SSI? ------------------------------------ Resources are things that you own and can turn into cash. To get SSI, things you own that Social Security counts must be worth $2,000 or less for an individual, or $3,000 or less for a couple. But not all the things you own count as resources for SSI. A recent change in the law makes it possible for more people who have businesses to get SSI. Does property that you need for self-support count as a resource ---------------------------------------------------------------- for SSI? -------- Some property that you own and you use to support yourself never counts as a resource. For example: . Property that you own and use in a trade or business, such as a gas station, farm, or beauty parlor. . Personal property that you use for work, such as tools, uniforms, or safety equipment. . Government permits that allow you to do something to produce income, such as permits for commercial fishing or to grow tobacco. Some property may count but often does not. . Property you use to produce goods or services that you need in your daily life. Examples are land or equipment that you use to grow vegetables or raise livestock that you and your family eat. . Nonbusiness property that produces income. Examples are land or real estate or equipment you rent to someone. Other things that you own may not count for SSI either. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -59- SSI SPOTLIGHT ON CONTINUED PAYMENTS FOR PERSONS WHO ARE ======================================================= TEMPORARILY INSTITUTIONALIZED ============================= What happens to my SSI checks if I go into a nursing home or ------------------------------------------------------------ hospital? --------- Generally, if you enter a nursing home or hospital (or other facility) where Medicaid pays for more than half of the cost of your care, your SSI payment is limited to $30 a month. Some States supplement this $30 payment. The payment may be lowered by any income you may have. If you live in a public facility where Medicaid is not paying for more than half of the cost of your care, you may not be eligible for any SSI payment. What if I will be in the facility for a short time? --------------------------------------------------- A special rule applies if you will be in the facility for 90 days or less. If you give us certain information, you may continue to receive your regular SSI check. What information do I need? --------------------------- . A doctor must state in writing that you will be in the facility for 90 days or less. . We also need a statement from you or someone knowledgeable about your circumstances that you need your SSI checks to maintain your home or living arrangement while you are in the facility. These statements are needed as soon as possible after you enter the facility. They must be submitted before you leave or by the 90th day you are there. SSA often works with admissions offices so that the information SSA needs is available quickly. The admissions office can help you and your family contact SSA. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION AND FOR HELP IN OBTAINING THE STATEMENTS IF YOU NEED THEM. -60- SSI SPOTLIGHT ON LIVING ARRANGEMENTS ==================================== Does where I live affect how much SSI I get? -------------------------------------------- It can. If you live in your own place--regardless of whether you (or your spouse) own or rent--you may get up to the maximum SSI amount payable in your State. If you are a child living with your parent(s), who either own or rent, you may get up to the maximum amount. You also can get up to the maximum if you live in someone else's household as long as you pay your food and shelter costs. If you live in someone else's household and don't pay your food and shelter costs or pay only part of your food and shelter costs, your SSI benefit may be reduced by up to one-third. Do my living expenses affect my SSI payment? -------------------------------------------- Generally, they don't. Your SSI payment depends on your income-- not on your expenses. However, if someone else helps you pay your living expenses, see below. What if someone else helps pay my living expenses? -------------------------------------------------- Unless you are a child living in your parent's home, any food, clothing, or shelter you get from someone else and don't pay for may reduce your SSI payment. There is a limit on how much we may count. The limit is about one-third of the maximum Federal SSI amount payable for a month. Items you receive that cannot be used for food, clothing, or shelter are not considered income and, therefore, will not reduce your SSI payment. For example, if someone buys you a household or personal item, such as a small kitchen appliance or a piece of jewelry of modest value, it is not income and will not reduce your SSI payment. What about people in institutions? ---------------------------------- Generally, people who live in institutions such as hospitals, nursing homes or prisons, are not eligible for SSI or are only eligible for a maximum of $30 a month (some States supplement this $30 payment). But there are some exceptions. For more information about one of these exceptions, see the Spotlight on Continued Payments for Persons Who Are Temporarily Institutionalized. What about the homeless? ------------------------ Having a permanent residence is not a requirement for receiving SSI. If you are homeless you may receive up to the maximum SSI amount payable in your State. And receiving SSI may allow you to get permanent housing. If you live in a public shelter, you can receive SSI payments for up to 6 months out of any 9 months that you live there. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION. -61- SSI SPOTLIGHT ON GETTING SSI WHILE YOU TRY TO SELL EXCESS ========================================================= RESOURCES ========= Can I get SSI if I have excess resources? ----------------------------------------- To get SSI, your countable resources must not be worth more than $2,000 for an individual (or $3,000 for a couple). Can I get SSI if I have more than that? Yes, You may, but you must sell some of your countable resources. While you try to sell them, you may be able to get SSI. What kinds of things can I sell? -------------------------------- You can sell the following types of things: . Real property, such as land or a house that you don't live in; or . Personal property, such as jewelry or a stamp collection. How does this work? ------------------- . While you are trying to sell real property, you can receive SSI payments for up to 9 months. . While you are trying to sell personal property, you can receive SSI for up to 3 months. . And we may pay you even longer. What do I have to do? --------------------- . Your benefits can not begin until after you sign a "conditional benefits agreement" and submit it to your Social Security office. . The agreement form is available at your local Social Security office--ask for more details. What happens after I sell my real and/or personal property? ----------------------------------------------------------- . You may continue to get SSI payments. See your local Social Security office to find out if your SSI payments will continue after the sale. . You will also have to pay back any SSI payments up to the value of the excess resource which you received while trying to sell the property. THIS INFORMATION IS GENERAL; TO FIND OUT IF IT APPLIES TO YOU OR FOR MORE INFORMATION, CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE. -62- PAYMENT FOR TRAVEL TO MEDICAL EXAMS =================================== When you apply for disability and Social Security asks you to go ---------------------------------------------------------------- to a medical exam, can Social Security pay your travel costs? ------------------------------------------------------------- Social Security can pay your travel costs. SSA does this through your State Disability Determination Service (DDS). The State DDS makes the disability or blindness decision. What you need to do to get travel costs paid. --------------------------------------------- The DDS will tell you what you do after the exam so that your travel costs can be paid. What if you have a special problem or need some travel money ------------------------------------------------------------ before you go to the exam? -------------------------- Call or write the State DDS person who sent you the letter about the medical exam. Explain what your special problem is or why you need money before the exam. For example, if you do not have a car you may need to pay someone to drive you. How do I get the money? ----------------------- After the exam, you will need to fill out a form showing your travel costs. The State DDS will pay you the money based on the information on this form. If you were paid before the exam and the money did not cover your travel costs, your State DDS will pay you the rest of the money. If your were paid more money before the exam than you spent, you must repay the extra money. What to do if you need someone to help you to get to an exam. ------------------------------------------------------------- Call or write the State DDS person who sent you the letter about the exam. Explain why you need someone to help you. Your State DDS may be able to pay someone to go with you. CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE FOR MORE INFORMATION.