SMA 05-4051 17120.0705.7765020301
A Case Manager’s Manual for Assisting Adults 

Who Are Homeless, with Social Security Disability 

and Supplemental Security Income Applications

Stepping Stones

to Recovery

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Rockville, MD

www.samhsa.gov

DHHS Pub. No. SMA 05-4051

i

ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS

Numerous people contributed to the development of this document (See Appendix E for 

a complete list of contributors.). The document was written by Jeremy Rosen and Yvonne 

Perret for Policy Research Associates under Contract 01M00896301D with the Center for 

Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration 

(SAMHSA), U.S. Department of Health and Human Services (DHHS). Fran Randolph provided 

direction and support for the development of the project. Dorrine Gross and Michael Hutner 

served as the Government Project Officers. 

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not 

necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, DHHS, or the Social 

Security Administration (SSA).

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or 

copied without permission from SAMHSA. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication may be accessed electronically through the following Internet World Wide Web 

connection: www.samhsa.gov. For additional free copies of this document please call SAMHSA’s 

National Mental Health Information Center at 1-800-789-2647 or 1-800-889-2647 (TTD). 
ii STEPPING STONES TO RECOVERY

Recommended Citation

Rosen, J. and Perret, Y., Stepping Stones to Recovery: A Case Manager’s Manual for Assisting 

Adults Who Are Homeless, with Social Security Disability and Supplemental Security Income 

Applications. DHHS Pub. No. SMA 05-4051. Rockville, MD: Center for Mental Health Services, 

Substance Abuse and Mental Health Services Administration, 2005.

Originating Office

Homeless Programs Branch, Center for Mental Health Services, Substance Abuse and Mental 

Health Services Administration, U.S. Department of Health and Human Services,

1 Choke Cherry Lane, Rockville, MD 20857

DHHS Publication No. SMA 05-4051 

Printed 2005
iii

TABLE OF CONTENTS

TABLE OF CONTENTS

Introduction vii

Chapter 1—An Overview of the Social Security Administration’s . . . . . . . . . . . . . . . . 1

 Disability Programs

What are SSDI and SSI? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

How does SSA define disability?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

What is the difference between SSI and SSDI? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Figure 1. Comparison between SSI and SSDI for Persons who are Disabled . . . . . . . . . . . . . . . .3

What about health insurance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

What are the SSI and SSDI application processes like?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

How are SSI and SSDI eligibility determined?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

How long does the disability determination process take? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

What happens after the determination is made? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Chapter 2—The Case Manager’s Role in Assisting Applicants . . . . . . . . . . . . . . . . . . . . 7

How can case managers help?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Case managers as contact persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Case managers as representatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Chapter 3—Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Where does a case manager start? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

How is a disability application filed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Pros and cons of filing approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

What information is needed to apply? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Figure 2. Advantages and Disadvantages of Filing Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
iv STEPPING STONES TO RECOVERY

Figure 3. SSI/SSDI Documentation Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

What is presumptive disability? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Chapter 4—Evaluating Income, Resources, and Citizenship for SSI . . . . . . . . . . . . . . 21

Why is financial eligibility determination necessary? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

What are the income guidelines for SSI? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

What is deeming? How does it affect income eligibility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

What are SSI resource guidelines? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Can excess resources be transferred? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

How does immigration status affect SSI eligibility?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Chapter 5—SSA’s Disability Determination Process . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

What are the standards for disability? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

How is disability evaluated? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

What is the sequential evaluation process? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Figure 4. Steps in the Determination Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

What happens when there are co-occurring mental and physical illnesses? . . . . . . . . . . . . . . . .36

What about alcohol or drug addiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

How should alcohol or drug use be handled?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

Chapter 6—Documenting Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

What is the purpose of documenting disability? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

How should information be reported to SSA? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

What information is required? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

What are the functional areas that DDS considers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

How is functioning documented? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

How can case managers help obtain medical evidence? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46

What are the barriers to obtaining medical records? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46

Why should case managers obtain records? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

Can case managers get copies of what DDS receives? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

When is a consultative exam needed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
TABLE OF CONTENTS v

What do case managers need to know about consultative exams? . . . . . . . . . . . . . . . . . . . . . . . .50

Pulling it all together: Writing a summary letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Chapter 7—The Appeals Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

What does SSA’s initial decision mean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

How is a Request for Reconsideration filed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

What can case managers do after the appeal is filed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

How is a request for an ALJ hearing filed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

How can a case manager prepare for a hearing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

What is the representative’s role at the hearing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61

When should the Appeals Council or Federal Court be used? . . . . . . . . . . . . . . . . . . . . . . . . . . .65

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Chapter 8—What To Do When Benefits Are Approved . . . . . . . . . . . . . . . . . . . . . . . . . 67

How will a case manager know a determination has been made? . . . . . . . . . . . . . . . . . . . . . . . .67

What happens after a favorable determination? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

How can case managers be sure that calculations are correct? . . . . . . . . . . . . . . . . . . . . . . . . . .69

How are retroactive benefits paid? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

How should retroactive benefits be spent?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Chapter 9—Representative Payees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

What is a representative payee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

When does SSA appoint a representative payee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

What are the responsibilities of representative payees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

What expenditures does SSA deem appropriate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

How does a payee account for benefit payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Who can be a representative payee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

What rights does a beneficiary have? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

What do case managers need to consider before becoming 

representative payees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
vi STEPPING STONES TO RECOVERY

Chapter 10—Maintaining Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

How do living arrangements affect ongoing eligibility? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

When are benefits suspended or terminated? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85

What should case managers know about overpayments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88

What are SSA’s work incentive programs?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90

What if income from work exceeds allowable limits? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93

Appendix A—Immigration Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Appendix B—SSI and State Medicaid Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Appendix C—Samples from the Field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Appendix D—Sample SSA Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Appendix E—Additional Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Abbreviations and Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

For More Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
INTRODUCTION vii

INTRODUCTION 

This manual was developed by the Substance 

Abuse and Mental Health Services 

Administration (SAMHSA) to help case 

managers and others assist adults who are 

homeless, especially adults who are homeless 

and have serious mental illnesses, apply 

for the Social Security Administration’s 

(SSA) disability programs.1 The Social 

Security Disability Insurance (SSDI) 

and Supplemental Security Income (SSI) 

programs are administered by SSA to provide 

income support to aged, blind, or disabled 

individuals. 

The decision by SAMHSA to develop this 

manual was influenced significantly by 

front–line staff who work with people who 

are homeless. People who are homeless 

confront unique barriers and have a 

particularly difficult time applying for 

disability programs. This manual identifies 

the challenges, explains why and how 

they occur, and offers suggestions to case 

managers and others about how to address 

them.

The receipt of disability benefits is crucial 

for people who are homeless. Often, these 

benefits provide the foundation from which 

individuals can take the first steps toward 

recovery and employability. A case manager’s 

role in the process of applying for these 

benefits often is critical to an applicant's 

success. 

Applicants and case managers who better 

understand SSA’s requirements and the need 

for appropriate documentation can facilitate 

the process, decreasing the time required to 

issue determinations and reducing the need 

for appeals.

To meet these objectives, the manual explains 

the various roles that case managers can 

play in assisting people who are applying for 

SSA disability programs. Particular attention 

is paid to the disability eligibility criteria 

and the disability documentation process so 

case managers can help applicants furnish 

the information that SSA needs to make 

a decision and determine proper benefit 

amounts. The manual also describes ways 

to ensure that people approved for disability 

benefits receive the correct amount. It 

explains how decisions can be appealed if an 

individual believes an application has been 

denied in error. 

1 This manual provides information relevant to SSA disability programs for adults. It does not address any program requirements or restrictions for children 

who may be eligible. SSA disability programs for children may have different definitions, procedures, and regulations.
viii STEPPING STONES TO RECOVERY

Perhaps the most important point of the 

manual is that case managers have a critical 

role to play in assisting people who are 

homeless with the application process for SSA 

disability programs. The services that case 

managers can provide to assist applicants 

with the development and documentation 

of their disability claim are vital to the 

application process (see Chapter 6). 

Another key point is the importance of 

establishing direct communication with 

the claims representative at the SSA field 

office and the disability examiner at the 

Disability Determination Services (DDS), 

the State agency under contract with SSA to 

perform disability evaluations. Establishing a 

communication link to the individuals who 

process the claim is key to learning about the 

need for additional details from the applicant. 

Taken together, improved documentation 

and increased communication can reduce the 

time required to make the determination and 

can result in more accurate determinations. 

More informed decisions may also reduce the 

need for appeals.

Case managers also should be aware that 

the SSA rules cited in this manual are subject 

to change due to revisions in the Federal law, 

court rulings, or SSA administrative policy 

updates. Before relying on any specific SSA 

rules cited in this manual, case managers 

should confirm that the information is 

current and applicable in their locality. 

Questions can be answered by consulting the 

SSA Web site at www.socialsecurity.gov.

This manual has been developed for people 

who are homeless. It has been reviewed and 

improved by feedback from experienced 

individuals, including case managers, 

consumers, public policy professionals, 

Federal staff, and others who specialize in 

the field. The manual is informative but not 

exhaustive. Readers are directed to review 

the table of contents and index if they are 

looking for answers to specific questions. 

Additional technical information is included 

in the appendices. Any detail can be checked 

by consultation with SSA.

The information contained in the manual 

covers the application and appeals processes 

for both SSI and SSDI. In many respects, 

these processes are similar. For example, the 

disability documentation and determination 

processes described in Chapters 5 and 6 are 

the same for both SSI and SSDI. Differences 

between SSI– and SSDI–related procedures 

are noted in the text.

While this manual has been prepared for 

case managers working with individuals 

who are homeless, the information may be 

useful for anyone assisting someone with the 

disability benefit application process, as well 

as for applicants themselves. It is likely to 

be helpful whether individuals are disabled 

by mental or physical illnesses, and whether 

they are homeless or housed.

The manual is divided into ten chapters—

each designed to answer key questions. 

Chapter 1 provides a broad overview of the 

SSI and SSDI programs as well as the Federal 

and State health insurance options aligned 

with each. 

Chapter 2 addresses the various roles that 

case managers can play to help individuals 

apply for disability benefits. 
INTRODUCTION ix

Chapter 3 discusses options for filing an 

application and provides an overview of 

the documentation needed to complete an 

application. 

Chapter 4 outlines SSA’s income and 

resource criteria for the SSI program. This 

chapter also includes a brief discussion of 

how immigration status may affect eligibility 

for benefits. 

Chapter 5 describes SSA’s process to 

determine whether individuals are disabled, 

with particular attention to disabilities 

associated with mental illnesses, co-occurring 

mental illness and substance use disorders, 

and co-occurring mental and physical 

disorders. 

Chapter 6 focuses on how case managers 

can participate in the process of assembling 

and/or obtaining information pertinent to 

a disability determination and provide such 

information to the relevant State’s Disability 

Determination Services (DDS). 

Chapter 7 provides an overview of the 

appeals process, including guidelines for case 

managers who may need to represent an 

applicant at a hearing. 

Chapter 8 looks at what needs to be done 

once a favorable decision is made on an SSI 

application. Payment and expenditure of 

retroactive benefits are discussed. 

Chapter 9 covers issues related to 

representative payees: when payees are 

needed; how they are selected; their 

responsibilities; and how, when appropriate, 

responsibility of receiving and managing 

benefits eventually can be transferred to the 

recipient. 

The last chapter, Chapter 10, provides 

tips on how to maintain benefits for 

applicants. Specific topics include how living 

arrangements affect benefit levels, issues 

related to suspensions and terminations, 

what to do about overpayments, and 

information about work incentives.
x STEPPING STONES TO RECOVERY
This chapter provides a broad overview of Supplemental Security Income (SSI) and Social 

Security Disability Insurance (SSDI), the two major Federal programs that provide cash benefits 

based on disability. It also briefly outlines the health insurance options aligned with each program. 

Many people who are homeless qualify for SSI; some may qualify for SSDI instead of, or in 

addition to, SSI. 

What are SSDI and SSI?

Social Security Disability Insurance (SSDI) 

and Supplemental Security Income (SSI) 

are the two Federal disability programs 

administered by the Social Security 

Administration (SSA). 

SSDI provides benefits to disabled or blind 

individuals who are “insured” based on 

contributions paid into the Social Security 

trust fund, as authorized by the Federal 

Insurance Contributions Act (FICA). To 

qualify for SSDI benefits, an individual 

must have worked long enough and recently 

enough under Social Security to receive 

benefits. A person also may qualify as an 

SSDI beneficiary through parents or a 

spouse. Disabled widows/widowers age 

50 or over may qualify for benefits on a 

spouse’s earnings. In addition, an adult 

found to have become disabled before age 

22 may qualify for benefits if his or her 

qualifying parent is deceased, disabled, or 

receiving SSA retirement benefits. An alien 

who obtained a Social Security number 

on or after January 1, 2004, must meet 

additional requirements to meet eligibility 

for SSDI. Since the SSDI benefit amount 

depends on the average earnings of the wage 

earner, the benefit amount will be different 

for each beneficiary. 

In contrast, SSI provides benefits to low 

income people who are disabled, blind, or 

elderly. To qualify for SSI, an applicant must 

meet strict income and resource guidelines 

to establish that he or she has low or no 

income and minimal resources, and criteria 

establishing that he or she is aged (age 65 

and older), blind, or disabled, as defined by 

SSA. People can be eligible for both SSI and 

SSDI if their SSDI benefit is lower than the 

full SSI Federal Benefit Rate (FBR). 

In some states the SSI benefit is 

supplemented by money from the state. 

1

An Overview of the Social Security 

Administration’s Disability Programs

CHAPTER 1

CHAPTER 1
These funds provide disabled individuals 

with more money to meet their shelter, 

food, and health care needs. The size of the 

supplement varies from state to state. 

Eligibility criteria for supplements differ by 

state.1

For both SSI and SSDI, 

the definition of disability 

is based on an inability 

to do significant work. 

How does SSA define disability?

For both SSI and SSDI, disability is based on 

an inability to work at the level of substantial 

gainful activity (SGA). SGA is work that 

involves significant mental and physical 

activity completed for pay or profit. An 

individual will be considered disabled by 

SSA only if he or she cannot do work that 

was done before and if SSA decides that 

the individual cannot adjust to other work 

due to his or her medical condition(s). An 

individual’s disability also must have lasted 

or be expected to last for at least a year or to 

result in death.

SSA has an extensive process for determining 

whether a person is disabled for the purpose 

of receiving disability benefits. This manual 

describes the process in detail. The goal of 

this manual is to provide information to case 

managers that will improve their ability to 

help people who are homeless and who have 

mental illnesses apply for SSI and/or SSDI.

What is the difference between 

SSI and SSDI?

Both SSDI and SSI use the same definition 

of disability. However, there are notable 

differences. The amount of the monthly SSDI 

benefit depends on earnings while employed 

or self-employed, and on work history, 

while SSI benefits are based on a recipient’s 

income or resources. Further, most people 

who are entitled to SSDI must first serve a 

five–month waiting period (starting with the 

date of onset of the disability) before they 

can receive benefits. However, this can be 

retroactive, and individuals may receive up 

to 12 months of benefits before the date of 

application. SSI payments cannot begin until 

the month following the date of application.

It is important to note that, before receiving 

any SSI payments, an individual must have 

applied for other benefits to which he or she 

might be entitled (i.e., SSDI, VA benefits, 

Workers’ Compensation, etc.). Case managers 

should ensure that such applications are 

completed so payments by SSA are made in a 

timely fashion if an individual is approved. 

SSA should review an individual’s eligibility 

for SSI and SSDI whenever a person applies 

for either.

1 A list of states that provide supplementary SSI payments can be viewed at www.socialsecurity.gov/notices/supplemental–security–income/text–benefits–

ussi.htm. These payments are administered by the state, by the Social Security Administration, or by both.

2 STEPPING STONES TO RECOVERY
Figure 1. Comparison between SSI and SSDI for Persons who are Disabled

SSI SSDI

Must meet the definition of “disabled or blind” Must meet the definition of “disabled or blind”

Not based on any requirement of insured status Based on insured status of individual or 

another qualified person

Income and resource limits No income or resource limits

Monthly benefit amount (Federal Benefit Rate 

(FBR) and State supplement, if any)

Benefit amount based on contributions 

during work history

No work history requirement Work history generally required

Living arrangements may affect eligibility 

and benefit amount

Living arrangements have no effect on 

eligibility or benefit amount

Automatic Medicaid eligibility in most states May be eligible for Medicaid

Not eligible for Medicare, unless also entitled to SSDI Eligible for Medicare 24 months after 

entitlement to SSDI benefits 2

Some of the differences between SSI and 

SSDI are summarized in Figure 1. 

What about health insurance?

Two publicly–funded health insurance 

programs exist for individuals who are 

disabled: Medicaid and Medicare. In most 

states, people eligible for SSI automatically are 

eligible for Medicaid, a Federal–State health 

insurance program with fairly comprehensive 

benefits, including prescription drug 

coverage. 3 While SSI and some SSDI 

beneficiaries are eligible for Medicaid, only 

those people receiving SSDI benefits are 

eligible for Medicare. Most SSDI beneficiaries 

qualify for Medicare 24 months after 

becoming eligible for benefits. A beneficiary 

receiving both SSI and SSDI may be covered 

by both Medicaid and Medicare.

Medicare routinely covers physician visits 

and hospital services, and it requires 

copayments, deductibles, and monthly 

premiums for outpatient services. Recent 

amendments to the Medicare statute 

have allowed recipients access to partial 

prescription drug coverage through a variety 

of third–party providers.

2 Since July 2001, people with Amyotrophic Lateral Sclerosis (ALS or Lou Gherig's disease) do not have to serve a 24–month waiting period. Also, 

beneficiaries who have end–stage renal disease and are undergoing a course of dialysis or who have had a kidney transplant may not have to wait 24 

months. However, there is still a five–month waiting period for SSDI eligibility.

3 Seven states and the Northern Mariana Islands use the same rules to determine Medicaid eligibility as SSA uses for SSI, but require individuals to file a 

separate application. Eleven additional states not only require a separate application, but also use their own rules to determine if an individual is eligible for 

Medicaid. For further information, see Appendix B of this manual and/or refer to the National Association of State Medicaid Directors Web site: 

www.nasmd.org.

CHAPTER 1 3
Medicaid benefits differ from state to state 

but are required by Federal statute to cover 

prescription drugs. It should be noted, 

though, that not all States’ rules allow 

coverage for all drugs that may be prescribed, 

and some states may require copayments. 

In many states, Medicaid also covers the 

cost of the monthly Medicare premium and 

copayments for outpatient services. Beyond 

this, all states have supplemental Medicaid 

programs: (1) the Qualified Medicare 

Beneficiary (QMB), (2) Specified Low–

Income Medicare Beneficiary (SLMB), and 

(3) Qualifying Individuals–1 (QI–1S) and 

Qualifying Individuals–2 (QI–2S) for eligible 

Medicare beneficiaries. These programs 

are available to those with limited income 

and resources who nonetheless are not SSI 

eligible. SLMB and QI–1S allow states to 

pay for the Part B Medicare premium; QMB 

covers deductibles, coinsurance, and the 

Part B premium. Case managers can find the 

income and resource eligibility requirements 

for each of these programs on the Medicare 

Web site: www.medicare.gov.

Unlike Medicare, no waiting period is 

required for Medicaid once the disability 

eligibility determination is completed. Some 

SSDI beneficiaries may qualify for Medicaid 

by spending a certain portion of their income 

on medical services or goods each month. 

This is referred to as a “spend down.” Paying 

off a significant medical bill, such as a bill for 

inpatient hospitalization, also may qualify as 

a spend down.

Sometimes, the savings realized due to 

SSI coverage of prescription drug costs 

and monthly premiums can mean that an 

individual might be financially better off 

under SSI than SSDI. Even if this is the case, 

an individual cannot choose to be on SSI. 

Applicants who qualify for SSDI must accept 

this benefit before receiving SSI.

What are the SSI and SSDI 

application processes like?

SSI and SSDI applications can be filed in 

person at a local Social Security field office, 

or by calling the SSA toll–free number (1-

800-772-1213; TTY 1-800-325-0778) to 

schedule an appointment. In addition, some 

SSDI application forms can be accessed and 

printed online at the SSA Web site: www.

socialsecurity.gov. If the applicant schedules 

an appointment using the toll–free number, 

he or she usually is given an appointment 

for a telephone interview. However, 

the applicant may request a personal 

appointment at a field office. 

Once an application is received and SSA 

determines the applicant satisfies income 

and resource (for SSI claims), insured 

status (for SSDI claims), and other general 

eligibility requirements, the application 

is reviewed by the State’s Disability 

Determination Services (DDS). This is a 

State agency with an agreement with SSA 

to make medical decisions on behalf of SSA 

about whether or not a person is disabled. 

As a State agency, the DDS in each state 

is located administratively within a larger 

State department or agency, such as the State 

Department of Labor or the Department 

of Social Services. This varies from state 

to state. To ensure that the eligibility 

determination process is completed in a 

timely manner, mail received from the State 

agency housing the disability service should 

be responded to with the same urgency as 

that received from SSA.

4 STEPPING STONES TO RECOVERY
How are SSI and SSDI eligibility 

determined?

As with many other public benefit programs, 

an applicant must meet income, resource, 

and U.S. residency criteria to qualify for and 

continue to receive SSI. In contrast, earnings 

history requirements must be met to qualify 

for SSDI. In both cases, the individual must 

document a disability that precludes the 

ability to work. While many people who are 

homeless are likely to meet these criteria, 

case managers who understand the rules can 

better help people document their compliance 

with them. The steps are as follows:

■ When someone applies for disability 

benefits with SSA, the claims 

representative will check the earnings 

history for potential eligibility for SSDI, 

and will assess the income and resource 

information for SSI. An individual must 

meet these criteria before his or her case 

will be evaluated for disability.

■ If a person meets the initial criteria, 

the SSA claims representative then 

routes the claim to the State Disability 

Determination Services (DDS) to 

determine if the disability standard is 

met. The disability decision will be based 

on medical records and other information 

submitted by the applicant. 

■ If an applicant is found to be disabled, 

and the claim took more than 120 days 

to process, the applicant’s income and 

resources will be examined again. The 

SSA representative will have to 

determine how much money the 

applicant is entitled to receive monthly 

and also will assess any retroactive 

payments. In most instances, retroactive 

payments will date to the initial date of 

eligibility. For SSI, this most often is the 

first month after the date of application. 

For SSDI, the date of eligibility most 

often is set after a five–month waiting 

period from the date of onset (the date 

that SSA determines a person's disability 

began) but may precede the date of 

application by up to a year.

How long does the disability 

determination process take?

The length of time that it takes to process 

a Social Security Disability claim varies 

depending upon:

■ The nature of the disability;

■ The speed with which medical evidence 

can be obtained for an individual 

applicant; and

■ Whether it is necessary to send the 

applicant for additional medical 

examinations.

In 2002, the average processing time for an 

initial SSI application was 104 days, or about 

three–and–a–half months. This is a national 

average. The actual time it takes to process an 

individual claim may vary. 

It is important for case managers to 

understand that if an application is 

denied, a request for reconsideration will 

add additional time; an appeal before an 

Administrative Law Judge (ALJ) will add 

even more time before a final decision is 

rendered. By understanding the disability 

determination process and assisting 

CHAPTER 1 5
applicants with filing complete applications, 

case managers may help clients avoid the 

need for appeals. This manual is designed 

to help case managers avoid unnecessary 

delays and to improve their ability to assist 

applicants with filing successful disability 

applications.

What happens after the 

determination is made?

After a determination is made, several 

outcomes are possible. Most often, the 

person either will be found to be disabled 

and begin to receive benefits, or he or she 

will be found not to be disabled. In some 

instances, a person might even receive 

a partially favorable allowance. After an 

applicant receives a favorable decision, SSA 

will determine if he or she continues to 

meet the requirements for eligibility and will 

calculate the correct benefit amount due. 

Further information on determinations is 

offered in Chapter 8. 

If DDS issues a denial, the applicant has 

60 days from the date of the denial notice 

to file an appeal, called a reconsideration.4

A DDS staff person, other than the one 

who made the initial decision, will make 

the reconsideration determination. If, after 

reconsideration, it is determined that an 

applicant is disabled, SSA will pay benefits. 

If the applicant again is found not to be 

disabled, he or she has another 60 days to 

file another appeal, in the form of a hearing 

before an ALJ. Case managers should help 

the applicant understand that the appeals 

process adds additional processing time. The 

appeals processes are covered in Chapter 7.

Summary

SSA has two income support programs to 

assist persons who are disabled and cannot 

work at the level of substantial gainful 

activity—the SSI and SSDI programs. While 

people who apply for disability assistance 

will be evaluated for their eligibility for 

both programs, generally people who are 

homeless are more likely to qualify for the 

SSI program. Although the cash payments 

for SSI typically are lower than for SSDI, in 

most states persons who qualify for SSI also 

will be enrolled in Medicaid. This can be a 

significant benefit, especially for persons 

with serious mental illnesses.

4 At the time of this printing, SSA is conducting a study in 10 states, known as Disability Prototype States, in which, rather than a reconsideration 

as the first step of appeal, the individual can go directly to a request for a hearing before an ALJ. In these states, there is a separate set of 

procedures that the DDS uses before recommending an unfavorable disability determination.

6 STEPPING STONES TO RECOVERY
7

The Case Manager’s Role

in Assisting Applicants

CHAPTER 2

CHAPTER 2

This manual has been written to provide guidance to case managers about how to help people 

who are disabled apply for and retain SSI and/or SSDI. While there are many specific tasks and 

responsibilities related to providing this assistance, there are generally three “roles” that a case 

manager can play: contact person, representative, and representative payee. This chapter explains 

the different roles associated with the application process and provides advice to case managers 

about the decision to take on one or more of these roles. 

How can case managers help?

Case managers play an important role in 

helping to secure SSI and/or SSDI for the 

people with whom they work. First and 

foremost, a case manager can encourage a 

potential applicant to apply for benefits. This 

is especially important for people who may 

presume they are not eligible because they 

do not have a single, defining disability, or 

for those who have current or past histories 

of substance abuse and may believe wrongly 

that these histories disqualify them from 

benefits.1 Offering accurate information and 

encouragement may be the first important 

function a case manager can fulfill. 

However, case managers also can play 

a critical role in the application process 

by facilitating accurate and timely case 

determinations. If case managers successfully 

work with their clients and with their 

contacts in the SSA and DDS agencies, 

they can have a beneficial impact on the 

disability determinations. Case managers can 

be helpful to applicants by serving in one or 

more of three specific roles:

■ Contact person. With the applicant’s 

consent, a case manager can be listed 

as a contact person on the Disability 

Report form (SSA–3368; see Appendix 

D for sample forms) under “third party 

contact person.” The form offers a space 

1 The test for determining eligibility is whether “drug addiction or alcoholism is a contributing factor material to the determination of disability” 

(20 C.F.R. 416.935(a)). This means if an applicant would still be disabled if he or she stopped using drugs or alcohol, then the applicant will be found disabled, 

providing that all other eligibility criteria are met. For more information on this issue, see Chapter 5.
8 STEPPING STONES TO RECOVERY

for an address and phone number. If 

a case manager is serving as a contact 

person, it is also a good idea to call the 

claims representative to whom the file 

is assigned and provide that person with 

an address and telephone number(s), in 

addition to those listed on the SSA–3368. 

■ Representative. As an authorized 

representative, a case manager can 

receive and file paperwork on the 

applicant’s behalf. It is important 

to distinguish between being a 

representative and being a representative 

payee, as they are distinctly different 

roles. A prospective authorized 

representative, with the applicant’s 

permission, must file an application 

with SSA, using Form SSA–1696, 

Appointment of Representative.

■ Representative payee. As a 

representative payee, the case manager 

becomes responsible for receiving 

and managing a recipient’s SSI/SSDI 

benefits. It is a separate responsibility 

and requires authorization forms 

different from those required of a 

representative. Being a representative 

payee can be time–consuming and 

challenging.

This chapter provides additional details 

about a case manager’s roles and functions 

as contact person and representative. The 

role of representative payee will be discussed 

in–depth in Chapter 9.

Case managers as contact persons

Generally speaking, a contact person is the 

“go to” person for a claim when a claims 

representative cannot reach an applicant. 

The contact person can receive messages 

and facilitate the exchange of information. 

However, the person has no legal role in the 

disability proceedings and no legal basis for 

receiving or imparting information on 

behalf of the applicant. That means, for 

example, that a contact person cannot file 

an appeal for an applicant if the person 

is found not to be disabled, even if the 

applicant, for any reason, cannot file 

the appeal him– or herself. 

Even if a case manager and an applicant 

decide together that the case manager will 

limit his or her role to that of a contact 

person, many functions still can be 

performed. Basically, responsibilities fall into 

two broad categories:

■ Helping the individual develop 

and submit complete and accurate 

information for his or her application; 

and

■ Helping representatives at SSA and DDS 

obtain the information they need to make 

an appropriate determination, whether 

through the applicant or other sources.
CHAPTER 2 9

Assisting the individual with the claim

Chapters 3 and 4 provide details about 

assisting individuals with the application 

process itself. Functions include:

■ Explaining the application process to 

the applicant to reduce anxiety;

■ Educating the applicant about the 

required documents to be filed;

■ Helping the applicant gather required 

documents and/or get copies of required 

documents; 

■ Assisting the applicant with processing 

his or her application; and

■ Accompanying the applicant to 

interviews with SSA.

By ensuring an applicant knows what to 

expect and has important documentation 

available at the time of filing, the case 

manager can facilitate the determination 

process. However, an applicant should not 

delay filing if the necessary documentation is 

not readily available.

Assisting SSA and DDS gather 

information for the claim 

A case manager can help SSA and DDS 

with documentation in two specific ways. 

The first is to serve as a liaison between 

the agencies and the applicant—taking 

calls when information is missing, working 

with the applicant to find records and 

documentation, keeping in contact with the 

claims representative and disability examiner 

to monitor the process, and ensuring that 

materials are sent to the SSA field office 

and DDS on a timely basis. This type of 

assistance is crucial to move the process 

forward and support accurate and timely 

determinations. 

Case managers also can help generate 

information for the SSA and DDS about 

the applicant’s disability and functioning. 

While medical records may do a good job 

of describing a medical condition and 

listing treatment, they sometimes do a poor 

job conveying the types of day–to–day 

limitations a person experiences due to his 

or her medical condition. Case managers 

have the ability to collect observations from 

individuals (such as previous employers) 

who can provide letters and other documents 

describing the applicant’s functioning 

on a day–to–day basis. In addition, the 

case manager can report his or her own 

observations of the applicant, describing 

aspects of the applicant’s functioning 

that indicate the applicant is incapable of 

working. This type of documentation can 

help the disability examiner get a clear 

picture of exactly how and to what extent the 

applicant is disabled.

Finally, the case manager can file a letter 

summarizing all of the evidence presented 

in the applicant’s case. This letter can direct 

the disability examiner’s attention to specific 

evidence that documents the applicant’s 

case. The case manager also can help tie 

those pieces of evidence together to present a 

picture of the applicant. A detailed portrayal 

of the applicant can serve as a careful 

statement about why and how the applicant 

is impaired. More information about these 

activities can be found in Chapters 5 and 6.
10 STEPPING STONES TO RECOVERY

Case managers as representatives

Many times, individuals with serious 

mental illnesses are so disabled, or find 

the application process so overwhelming, 

that they need additional help in applying 

for benefits. In addition, people who are 

homeless may not be able to respond easily 

to requests for information in a timely way. 

In these situations, it is extremely helpful for 

a case manager or other responsible person 

to become an individual’s representative. A 

representative is authorized by an applicant 

to deal directly with SSA on the applicant’s 

behalf. A representative can be helpful in the 

following ways:

■ SSA can release information about an 

applicant to a person who is authorized 

by the applicant to be his or her 

representative; 

■ A representative will receive copies of all 

notices and letters issued by SSA or the 

DDS to an applicant; and

■ A representative can file reports, 

applications, and appeals on an 

applicant’s behalf.

Release of information

At the most basic level, an applicant with 

mental health problems should have someone 

who can call a claims representative in the 

field office or a disability examiner in the 

DDS to discuss his or her case. Once a case 

manager is an authorized representative, he 

or she can call to ask if records have been 

received, what information is included in a 

record, and whether it meets the examiner’s 

needs. Representatives can question SSA 

and DDS employees about the meaning 

of particular notices or requests. In fact, 

representatives are authorized to discuss 

all aspects of the case and to act on the 

applicant’s behalf. Without an applicant’s 

authorization, a claims representative or 

disability examiner cannot discuss the 

specifics of a case with anyone else, including 

contact persons.

Receiving copies of notices and letters

Applicants who are homeless may not receive 

mail and, thus, may be especially difficult to 

reach. Individuals who are homeless and/or 

who have mental illnesses may lose claims 

and/or required documents and may fail to 

respond to notices. In these cases, applicants 

are likely to be unable to follow through with 

important requirements of the disability 

determination process. A case manager who 

receives copies of all documents, who is 

authorized to call the claims representative or 

disability examiner to get more information, 

and who can schedule and/or reschedule 

meetings is particularly helpful.

Taking action on an applicant’s behalf

Since representatives receive copies of all 

notices sent to applicants whose claims are 

pending, the representative can respond for 

the applicant. As a result, case managers 

can help clients avoid administrative denials 

based on what SSA calls their “failure to 

cooperate” or “whereabouts unknown.” 

Representatives also can appeal on behalf of 

applicants, helping to preserve the right to 

retroactive pay back as early as the month 

after the initial date of application.
CHAPTER 2 11

How to become a representative

To become a representative, a person 

must be authorized by the applicant using 

an Appointment of Representative form 

(SSA–1696). It is available at any SSA field 

office; it can be printed from the SSA Web 

site: www.socialsecurity.gov/online/ssa1696.pdf. Once this form is submitted, the

representative immediately will be able to 

assist the applicant. The approval process 

for a representative appointment generally 

is a formality unless SSA has experienced 

difficulty with the proposed appointee in 

the past. Applicants do not have to appoint 

a representative when they file their initial 

application. A representative can be named at 

any time during the process.

Summary

A case manager can assume one of three roles 

when assisting a person who is applying for 

SSA disability benefits. As a contact person, 

the case manager monitors a claim and 

serves as a liaison between SSA or DDS and 

the applicant. As a representative, the case 

manager agrees to a more formal liaison role 

and is authorized to receive information and 

take action on an applicant’s behalf. Finally, 

as a representative payee, the case manager 

agrees to accept and manage a recipient’s 

benefits over time. This is discussed in 

greater detail in Chapter 9. The roles of 

contact person and representative provide 

essential support to a person who is applying 

for disability benefits. A case manager 

should carefully consider the role that he or 

she will assume in his or her efforts to help 

potential applicants. To help people more 

effectively apply for disability benefits, case 

managers are encouraged to take an active 

role as a contact person or as a representative 

whenever possible and as desired by the 

applicant.
12 STEPPING STONES TO RECOVERY
13

Getting Started

CHAPTER 3

CHAPTER 3

The application process for SSI and/or SSDI requires a great deal of information and 

documentation. It takes time and can be overwhelming for any applicant. For an applicant who 

is homeless, the documentation requirements can be especially difficult. He or she may not have 

access to important paperwork that confirms his or her identity or medical history. This chapter 

provides an overview of how case managers can help individuals through the SSI and/or SSDI 

application processes. 

Where does a case manager start?

The initial step is preparing for the 

application interview. Case managers should 

meet with applicants in a familiar, low–stress 

environment to explain the process and the 

documentation that is needed. A checklist of 

the documentation that usually is needed is 

found in Figure 3. 

Case managers should work with the 

applicant to compile the required information 

before meeting with SSA. This can help 

reduce the likelihood that the applicant and 

case manager will need to submit additions 

and/or amendments to the initial application. 

Working with a supportive and informed 

case manager, an applicant is more likely to 

remember this important information. Even 

if all the information is not readily available, 

a case manager should encourage appropriate 

SSI/SSDI applications.

It is crucial for a case manager to accompany 

the applicant to his or her interview. During 

the interview, the case manager can:

■ Provide reassurance and intervene, as 

needed, in the event of behaviors that 

might interfere with the completion of 

the application;

■ Assist the applicant in answering 

questions, such as contact information 

for psychiatrists or other physicians who 

have provided treatment;

■ Provide information about the applicant, 

such as a detailed statement regarding 

the applicant's day–to–day functioning; 

and

■ Ensure submission of complete disability 

claims. 

Frequently, people with serious mental 

illnesses do not mention their mental 

illnesses on their applications. They instead 
14 STEPPING STONES TO RECOVERY

may limit their report to physical problems 

that, by themselves, may not meet disability 

eligibility criteria. Without additional 

information from the case manager, SSA 

may process the claim based on the limited 

information provided by the applicant. 

Consequently, the application of a person 

with a serious mental illness may be denied. 

Case managers can begin to document a 

mental illness by encouraging the applicant to 

talk about his or her disability in terms that 

he or she finds comfortable. This may include 

using language that the applicant finds more 

acceptable—such as “nervous condition” or 

“trouble concentrating,” or documenting that 

the applicant has been told by others that he 

or she has schizophrenia.

How is a disability application filed?

Once the case manager has discussed the 

application process with the individual and 

both come to agreement about representation, 

it is time to file an application. A person can 

apply for disability benefits in any one of 

four ways: 

■ Call the SSA toll–free number 

(1-800-772-1213) or use the TTY 

number (1-800-325-0778) to schedule 

an appointment at a nearby field office;

■ Call the SSA toll–free number or 

use the TTY number to schedule an 

appointment to file an application by 

telephone; 

■ Use the SSA Web site (www.

socialsecurity.gov) to start completing 

the application forms; or

■ Go to the nearest SSA field office to 

apply in person.

Schedule an appointment to apply

SSA encourages applicants to schedule an 

appointment to apply for disability benefits 

by calling the toll–free number above. 

The Teleservice Center representative can 

schedule an in–person interview at the field 

office most convenient for the applicant 

and his or her case manager. If the claim is 

Disclosing Mental Illness

Applicants who have serious mental illnesses frequently do not mention the illnesses. 

Since claims development is based largely on information provided, denials occur more 

often than they would if information were more complete from the start. 

■ Together, the stress of being homeless, the anxiety produced by the SSA interview 

situation, and the cognitive changes caused by mental illness can cause people to 

provide incomplete information unintentionally. 

■ People may deny the existence or extent of their mental illnesses because of the 

difficulties associated with facing the problem or the stigma associated with it. 

Denial can also be a symptom of their illness. 
CHAPTER 3 15

filed within 60 days for SSI (or 6 months for 

SSDI) after the date of this first call, then 

the date of the first call will be considered 

the official application date, rather than the 

date on which the application is filed. Called 

a protective filing date, this is the date from 

which eligibility for benefit payments is 

determined.

Apply by telephone

A telephone application can be scheduled 

by calling the same toll–free number (1-800-

772-1213; TTY 1-800-325-0778). The call 

can be used to set a date and time for SSA to 

call back and take the information required 

to file the claim. Again, the initial call date 

will be considered the protective filing date if 

the claim is filed within 60 days for SSI (or 6 

months for SSDI).

Start completing the application online

Access to the online application materials 

might be difficult for a person who is 

homeless. However, if a case manager would 

like to help an individual complete an 

application online, the forms can be found at 

www.socialsecurity.gov/applyforbenefits.

As of preparation of this manual, only the 

SSDI application may be started online. SSI 

application forms are not available online.

Apply at a field office without an 

appointment

In some cases, a case manager may want to 

take advantage of a “window of opportunity” 

and take an individual directly to a field 

office to apply for benefits. To find the 

nearest office, click on the “Find your nearest 

Social Security office” link on the SSA 

Web site (www.socialsecurity.gov), which 

has an interactive service that will provide 

information regarding the location, hours, 

and phone number.

Although individuals can go to the SSA 

office without an appointment, the waiting 

period to see an SSA representative can 

be significant. Also, many field office 

representatives specialize in a particular SSA 

program, handling only SSI claims or SSDI 

claims. This can result in longer waits than 

otherwise might be the case. 

Pros and cons of filing approaches

Each filing approach has both advantages and 

disadvantages. The chart on the following 

page outlines important considerations for 

each type of filing.

Many case managers prefer to call SSA 

to set up an in–person interview. The 

applicant then secures a protective filing 

date. In addition, the claims representative 

at SSA interviewing the applicant will make 

observations about the person’s responses, 

appearance, and behavior that could not 

be noted over the phone. Ultimately, this 

could benefit the applicant’s case. However, 

the decision regarding the best way to 

file an application should be based on the 

individual’s physical and mental status at the 

time of application.

What information is needed 

to apply?

Whichever filing method is used, SSA needs 

to see various documents—such as the 
16 STEPPING STONES TO RECOVERY

Figure 2. Advantages and Disadvantages of Filing Methods

Option Advantages Disadvantages

 Schedule an in-person 

interview

• Avoids a wait

• Establishes protective filing date 

• Gives case manager time to 

gather necessary information 

• SSA representative can see the 

applicant and share observations 

with the disability examiner

• Individual may not show up 

for appointment

 Walk-in without an 

appointment

• Allows case manager to take 

advantage of a “window of 

opportunity” with individuals who 

otherwise are reluctant to apply

• Individual may feel threatened by 

security measures or other features 

of the setting 

• Long wait

• Individual may become discouraged 

by long wait and leave

 Schedule a phone interview

• Avoids a wait

• Establishes protective filing date 

• Gives case manager time to 

gather necessary information

• Environment may be less 

threatening to the applicant

• Individual may not show up 

for appointment

• Mailed forms and documents 

may be lost

• Limits SSA observations

 Start completing the 

application online

• Avoids a wait

• Establishes protective filing for 

SSDI only if the person starting 

the online application is the 

claimant

• Gives case manager time to 

gather necessary information

• Environment may be less 

threatening

• Allows individual to start an 

application and come back to it 

later, which may be valuable to 

individuals who cannot tolerate a 

long interview

• Case manager may not have access 

to a computer or the Internet

• Individual may be threatened by 

the use of computer

• Mailed forms and documents 

may be lost
CHAPTER 3 17

Figure 3. SSI/SSDI Documentation Checklist

(Required documentation may vary depending on applicant’s situation)

SSI

(all applicants)

 Photo ID

 If own/rent, copy of rent/ 

 mortgage agreement

 If no rent, name, address, of 

 person(s) providing in-kind help

 List of dependents

 Ownership of vehicle(s)

 Copy of life insurance policy

 Most recent bank account 

 statement

 Copy of certificates of deposit

 Copy of stock/mutual funds 

 certificates

 Copy of bonds held in own

 name

 Copy of real estate owned

 Copy of burial contracts

 Copy of other household

 income: Pay stubs, other

 benefits, child support

 Aliens:

 Proof of sponsorship—original

 Proof of citizenship or alien

 status—original

 Birth certificate (may be 

 required)

Non-medical Information

Same for Both SSI and SSDI

Name, address, phone number

of health care provider for:

 Physical health care:

 Outpatient physical health

 Physical health specialist

 Physical therapy

 Occupational therapy

 Speech therapy

 Inpatient physical health

 Rehabilitation program

 Emergency room visits

 Mental health care:

 Outpatient therapist

 Outpatient psychiatrist

 Inpatient hospital

 Day or partial hospital

 Psychiatric rehab. program

 Psychological testing

 Neuropsychological testing

 Mobile treatment services

 Crisis services

 Emergency room visits

 Other:

 Third party contact person

 Other supportive letter/

 contacts:

 Family members

 Friends

 Housing provider

 Employer

Medical Information

SSDI

(all applicants)

 Birth certificate

 Copy of current pay stubs

 List of dependents

 Proof of Worker’s 

 Compensation or State 

 Disability Insurance Benefits 

 (benefits letter or check stubs)

 Aliens:

 Proof of sponsorship—original

 Proof of citizenship or 

 alien status—original

applicant’s identification and, often, a birth 

certificate—to process the non–medical 

portion of the application. In addition, 

medical information is needed to determine 

disability. A comprehensive list of needed 

documents can be found on the Office 

of Disability’s Web site located at www.

socialsecurity.gov/disability.html.

The table above provides a quick checklist 

of documentation that a case manager may 

need to obtain, depending on an applicant's 

situation.

Please note, especially, items under 

the medical column. While the DDS is 

responsible for gathering medical evidence, 
18 STEPPING STONES TO RECOVERY

any medical documentation, where relevant, 

can be useful to the disability determination. 

For documentation on treatment, the 

case manager should obtain the dates the 

applicant received treatment. 

Obtaining some of these documents may be 

difficult. The following offers some clues to 

handling some of the requirements.

Identity

A current valid photo identification (ID) 

should be sufficient to prove an applicant’s 

identity. However, many people who are 

homeless have no formal identification 

documents. Do not delay applying for 

benefits just because ID is not immediately 

available. If the person knows his or 

her Social Security number, that may be 

sufficient to file an application. If the 

applicant does not have or recall his or her 

Social Security number, the SSA may be able 

to find it on the computer system using the 

person’s name, date of birth, parents’ names, 

and other names used. 

Birth certificate

If an applicant is thought to be eligible for 

SSDI, he or she may be asked to present a 

birth certificate. If the applicant does not 

have a birth certificate at the time the initial 

application is taken, SSA will still accept the 

application. Case managers often need to help 

homeless individuals who do not have a birth 

certificate or other forms of ID by contacting 

the office of vital records in the state in 

which the applicant was born. Case managers 

should be aware that typically a $15–$20 

charge is assessed for this service. 

Immigration status

Under the law, some legal aliens are 

potentially eligible for SSI benefits, and case 

managers should assist these applicants. If 

the applicant is a non-citizen, verification 

of immigration is required. If the applicant 

has immigration documents that contain 

only some of the information necessary to 

determine eligibility, SSA must verify the 

additional information with the Office of 

U.S. Citizenship and Immigration Services 

(USCIS). It is also the case manager’s 

responsibility to help an alien applicant 

file an appeal of an SSI denial if the denial 

appears to be in error. Case managers should 

review the SSI denial notice to see if the 

benefits were denied based on the applicant's 

failure to meet the special requirements for 

alien eligibility.

Please note that status as a legal alien does 

not guarantee that the applicant will meet the 

special alien eligibility requirements under 

the law.

Also, be aware that illegal aliens are 

not eligible for SSI disability payments. 

Therefore, a case manager must ascertain an 

applicant's immigration status to determine 

the appropriate action. It may be necessary 

to help the applicant resolve his or her 

immigration status with USCIS. Immigration 

issues are covered in further detail in Chapter 

4 and in Appendix A. 

Income, resources, and living 

arrangements

At the application interview, SSA will 

require documentation of income, resources, 

and living arrangements. SSA will accept 

information provided by an applicant but also 
CHAPTER 3 19

may seek verifying documents. Depending on 

the source, income can be verified in different 

ways. Work income can be verified through 

pay stubs or a letter from an employer. 

Income provided from a friend or family 

member can be verified by signed letter from 

that person. If money provided from a friend 

or family member is a gift, a letter to that 

effect is acceptable. Chapter 4 provides more 

information about requirements regarding 

income and resources.

People living in a shelter, with someone 

else, or in some type of temporary housing, 

must provide a letter from the shelter or the 

person providing housing. The letter should 

explain the living arrangement and state how 

much—if anything—the applicant pays in 

rent. If individuals are homeless and living 

on the streets, they do not have to provide 

verification of living arrangements.

Medical information and work history

At the time of application, SSA will 

ask the applicant to list all of his or her 

medical problems, the dates on which those 

problems began, the names and addresses 

of all treatment providers since the onset 

of the medical problems, and work history 

spanning the last 15 years. SSA collects this 

information on two forms, the Disability 

Report for Adults (SSA–3368) and the Work 

History Report (SSA–3369). These forms 

are available at the SSA Web site, from 

which they can be printed and completed. 

Additionally, electronic versions of the forms, 

respectively referred to as the i3368 and the 

i3369, are available at www.socialsecurity.

gov/adultdisabilityreport. These electronic 

versions may be completed online, either in 

a single session or over a number of sessions, 

and may be linked to the application itself.

The most important role for a case manager 

is to do everything possible to help the DDS 

obtain medical evidence to document an 

applicant's medical condition and disability. 

Chapter 5 covers the disability determination 

process and the role of work history in 

greater detail.

Other information

At the end of the disability report, space 

is provided for additional comments. Case 

managers should use this section to provide 

detailed contact information and to list any 

other back–up contacts for the applicant 

(e.g., another case manager or a family 

member). 

What is presumptive disability?

Presumptive disability payments, authorized 

by Social Security statute, enable SSI 

applicants to receive SSI payments before a 

full medical evaluation is completed when 

there is a high probability that they will be 

found disabled. This allows SSI (but not 

SSDI) applicants to begin receiving benefits 

immediately—for up to six months—while 

a formal determination is pending. If the 

review finds the applicant disabled, he or she 

will continue to receive SSI payments. If the 

applicant is found not to be disabled, he or 

she can appeal and will not be required to 

repay any presumptive benefits paid. SSDI 

applicants are not eligible for presumptive 

disability benefits.

An applicant can be found determined 

disabled presumptively at either of two 

different points in the application process. 

Presumptive disability can be established 
20 STEPPING STONES TO RECOVERY

by the local office where an application is 

filed or at the State DDS agency where the 

application undergoes a medical review.

Local SSA office staff do not evaluate 

medical records. As a result, presumptive 

disability can be granted at the local 

office only in cases in which the disabling 

impairment is readily apparent. Examples of 

qualifying impairments include amputations 

and allegations of deafness or blindness. 

A complete list is available at policy.ssa.

gov/poms.nsf/lnx/0423535005. Field 

offices are authorized to make presumptive 

disability payments in HIV cases, if medical 

documentation clearly shows that an 

applicant meets HIV disability criteria.

As disability adjudicators, DDS staff 

have broader discretion to determine 

disability presumptively. DDS can award 

SSI presumptively in any case in which, 

after reviewing the available evidence, 

staff believes a high probability exists that 

the applicant will be found disabled after 

additional evidence is received. However, it 

should be noted, DDS is never required to 

award SSI presumptively.

Despite the broader review powers of 

DDS staff, many State DDS agencies do 

not determine disability presumptively 

as often as they could. Most frequently, 

this appears to be due to a concern among 

disability examiners that an applicant who 

is found disabled presumptively later will be 

determined not to be disabled, resulting in 

decision reversal. Multiple reversals can be 

detrimental for SSA, which cannot recover 

the payments; the DDS claims examiner; and 

potentially the SSI/SSDI recipient. 

Case managers can work closely with DDS 

staff to provide necessary documentation, 

including comprehensive medical 

evaluations, to enable DDS to make more 

efficient presumptive awards. In addition, 

case managers, who are familiar with 

documentation requirements and who have 

established communication with the DDS, 

can propose pilot programs to enhance use of 

SSI presumptive determinations of disability.

Summary

Case managers play a significant role in 

helping people who are homeless with 

applications for SSI and SSDI. Assistance 

can range from referring potentially eligible 

applicants to the appropriate offices to apply 

for assistance, to serving as liaison between 

the DDS and the applicant. The balance of 

this manual explores the ways in which case 

managers can assist both applicants and SSA 

in facilitating the application process.
21

Evaluating Income, Resources, and 

Citizenship for SSI

CHAPTER 4

CHAPTER 4

This chapter outlines SSA’s income and resource criteria and explains the SSA’s approach to 

evaluating financial eligibility for the SSI program. Financial eligibility is determined before disability 

determination. The balance of the chapter covers other details of eligibility, including how 

immigration status may affect eligibility for benefits. 

Why is financial eligibility 

determination necessary?

SSI was established as a benefit program for 

aged, blind, and disabled people determined 

to have low income and very limited resources. 

Financial eligibility criteria for the program 

has been set by statute. SSA has rules and 

policies for evaluating an applicant’s financial 

status to ensure that he or she meets the 

income and resource standards before 

determining whether the applicant meets 

disability standards. This chapter outlines the 

criteria established for determining income 

and resource eligibility.

What are the income guidelines 

for SSI?

To be income eligible for SSI, an individual’s 

monthly countable income must be lower 

than the Federal SSI benefit payment rate. 

Income is defined as cash and in–kind 

services available to an applicant that can 

help to obtain food or shelter. 

SSA requires that information on both 

earned and unearned income be provided 

when evaluating an applicant’s income 

eligibility. However, some income may be 

excluded during the determination process. 

Excluded income is mandated by law. Since 

exclusions reduce the individual’s income, 

they increase the chances of receiving 

benefits. Exclusions also may result in 

applicants receiving higher monthly 

payments. Different exclusions exist for 

earned and unearned income. To encourage 

work, SSA excludes more earned income 

than unearned income.

Among the types of excluded income at 

the time of this writing are: a $65 monthly 

earned income exclusion; earned income tax 

credit refunds; work expenses for people 

who are blind; and impairment–related work 
22 STEPPING STONES TO RECOVERY

expenses (IRWE), costs related to items and 

services medically necessary to work.

Unearned income is any income not 

earned through paid employment or 

self–employment. Examples may include:

■ Alimony;

■ Child support;

■ Dividends on savings or stocks;

■ Rental income;

■ VA benefits;

■ Pensions;

■ Workers’ Compensation;

■ Unemployment;

■ Retirement benefits;

■ Lottery winnings; and 

■ Insurance proceeds. 

Unearned income that may be excluded when 

determining SSI eligibility includes:

■ The first $20 of unearned income per 

month (if not already deducted in other 

earned or unearned income);

■ Federal housing assistance such as 

Section 8 or public housing;

■ State crime victims payments;

■ The value of domestic transportation 

tickets received as gifts and not 

converted to cash;

How SSA Determines Countable Income

Countable income (based on the number of paydays per month) is determined as follows: 

■ The first $65 of earned income is deducted (pre-tax gross wages or net 

self–employment income) as part of the earned income disregard. 

■ If there is unearned income, $20 can be deducted from the total amount of 

unearned income; if there is no unearned income, an additional $20 is deducted 

from earned income. 

■ Then, half of whatever earned income remains is not counted. 

So, a recipient receiving $579 per month in SSI payments who takes a job and earns 

$605 per month will have his payment calculated as follows: 

■ First, the earned and unearned disregards are applied. This totals $85. 

■ The $85 is subtracted from the $605 he earned, leaving $520. 

■ The remaining $520 is divided in half, leaving $260 of countable income. 

■ The countable income is subtracted from the maximum monthly SSI payment of 

$579, leaving $319. 

■ So, the recipient is eligible to continue receiving $319 in SSI, while receiving 

$605 in work income, for a total of $924.
CHAPTER 4 23

■ Disaster assistance;

■ Some foster care payments;

■ Tax refunds; and 

■ Grants or scholarships for educational 

expenses.

Once countable earned and unearned income 

is identified and documented, it is combined 

and compared to the monthly SSI payment 

amount. An individual is eligible for SSI if he 

or she has a countable income less than the 

Federal Benefit Rate (FBR), which normally 

increases annually due to a cost of living 

adjustment. In 2005, the maximum SSI FBR 

for a single individual is $579 per month.1 If 

both spouses meet the eligibility criteria, the 

maximum payment rate for a couple is $869. 

An individual or a couple with countable

monthly income above these amounts 

is ineligible for SSI; however, Medicaid 

eligibility sometimes continues under certain 

work–related incentive provisions. 

Many people receive food or shelter from 

friends or family members to make ends 

meet while going through the SSI application 

process. They intend to pay the borrowed 

funds back either when they are approved for 

SSI and receive a retroactive benefit check 

or, if they are able to work or are eligible 

for some other form of benefits, as soon as 

they can. When this situation exists, case 

managers should help applicants get a letter 

clearly stating that they have accepted a loan 

that will be repaid. Applicants also should 

write a brief letter to the lender stating 

that they agree to repay the loan. The letter 

should be signed, dated, and copied, with the 

original given to the lender. Since the loan 

is not counted as income when this occurs, 

an applicant approved for SSI who receives 

retroactive benefits will not have those 

benefits reduced. This is discussed further in 

Chapter 8. 

Having Countable Income and Receiving SSI 

If an individual’s countable monthly income (earned and unearned) is less than the 

monthly SSI Federal payment rate plus any applicable Optional State Supplement 

payment, he or she is income eligible for SSI. If the individual meets all other factors of 

eligibility, the payment is the difference between the countable monthly income and the 

monthly Federal benefit payment rate.

In 2005 the payment rate is $579. Thus, if a person’s countable income is $0, the SSI 

benefit will be $579; if countable income is $100, the SSI benefit will be $479.

If excess countable income is reported at the time of application, the application will 

be denied without a disability determination being made. This is because the applicant 

immediately is considered income ineligible.

1 The 2005 SSI amounts can be viewed on the SSA Web site at www.socialsecurity.gov/pressoffice/factsheets/colafacts2005.htm.
24 STEPPING STONES TO RECOVERY

Unstated income

Unstated income is income that, while not 

reported or otherwise known to SSA, is 

determined to exist because an applicant’s 

living expenses exceed income from known 

sources. Whenever information obtained 

from statements of the applicant or third 

parties creates questions as to how living 

expenses are being met, SSA will look for the 

presence of unstated income. If insufficient 

or conflicting evidence exists, the applicant 

will be questioned about possible unstated 

income. Ultimately, the amount of unstated 

income charged is the difference between 

stated (or known) monthly income and 

monthly living expenses.

While discrepancy between income and 

living expenses may indicate unstated 

income, valid explanations for discrepancies 

do exist. Careful interviewing can help 

a case manager ascertain if the person is 

receiving help from a local church, food bank, 

community service center, or other sources. 

If the case manager solicits such information, 

he or she should assist the applicant in 

obtaining a letter to that effect.

In–kind income

In–kind income is counted as income for SSI 

purposes if it provides food or shelter directly 

to the SSI recipient or pays a provider of food 

or shelter (e.g., payment to the recipient's 

An Example of Unstated Income

An applicant claims to receive $50 per week in unemployment, but he pays monthly rent 

of $450. He is unable to explain where he gets the money to make up the difference. The 

difference between the $200 he receives in pay (4 weeks per month multiplied by $50) 

and the $450 rent, or $250, will be counted as unstated income. This is the sum that will 

be used when determining his SSI payment amount. 

Common situations that may suggest the 

presence of unstated income include:

■ Stated income is insufficient to pay 

costs associated with resources owned 

(e.g., gas, maintenance, insurance and 

licensing of an automobile);

■ Stated income is insufficient to provide 

for known living expenses; or

■ The applicant claims no income and 

does not live in a setting, such as a public 

institution or the household of another, 

in which food and shelter are provided. 

landlord). However, as of March 9, 2005, 

clothing, generally, is no longer counted as 

income, in–kind support or maintenance. 

In–kind services that do not provide food or 

shelter are excluded from income (e.g., third–

party payment for a phone bill). 

For example, many people who otherwise 

might be living in shelters or on the street 

live instead with a friend or family member. 

Under those circumstances, friends or family 

often understate the amount of rent owed. 

However, discounting rent ultimately means 
CHAPTER 4 25

that the individual is paying less to live in the 

space than a stranger would. The value of 

this discount is considered in–kind income to 

the applicant and may result in the applicant 

having his or her retroactive SSI benefits 

reduced by up to one–third.

Suppose, however, that the person seeks a 

higher rent from the applicant—one more 

in keeping with the fair–market value of the 

property—but realizes that the applicant 

currently has no money to pay for it. The 

renter (e.g., friend, family, landlord) can 

consider such support a loan to be repaid 

when the applicant receives his or her 

SSI benefits. If the renter writes up an 

agreement, indicating the rent payment is a 

loan and it is the amount charged to any such 

tenant, the applicant may be eligible for the 

full SSI benefit. The applicant then repays 

these loans when his or her retroactive 

benefit check is received.

What is deeming? How does it 

affect eligibility?

Under certain circumstances, income and 

resources from another person are counted 

as available to an SSI applicant. This is 

called deeming. Income may be deemed 

from an SSI ineligible spouse, an ineligible 

parent of a minor child, or the sponsor of an 

alien.2 Deeming is required on the grounds 

that these persons have a legal obligation 

to contribute to the support of the person 

applying for SSI. 

What are SSI resource guidelines? 

In addition to income criteria, an applicant 

must meet SSA’s resource test. Resources 

are the goods an applicant owns that have 

monetary value. These include savings and 

possessions. Just as in the income section, 

certain types of resources are counted toward 

resource limits, and certain types of resources 

are excluded. The SSI resource limit is $2,000 

for an individual and $3,000 for a couple.

Countable resources include:

■ Bank accounts—individual or joint. If 

an applicant has funds in an individual 

bank account and can withdraw and use 

those funds at will, the account balance 

will count as a resource. If an applicant 

has a joint account with someone, SSA 

also will presume the applicant has 

access to all the funds in the account. 

If the applicant does not have access to 

the money, he or she needs to provide 

evidence documenting who owns the 

funds.

■ Stocks, bonds, investments, savings.

■ Real property (housing/land). The 

house in which one lives can be excluded 

(explained below).

■ Life insurance with a face value over 

$1,500. (Cash surrender value is the 

amount one could get for the policy if 

it were returned to the company, not 

the face value, which is the amount of 

insurance.)

■ Vehicles. One may be excluded 

(explained below).

2 SSA rules governing sponsor deeming are complicated and beyond the scope of this manual. If a case manager is in a situation where these rules may apply, 

he or she should contact a legal services or immigration attorney for advice.
26 STEPPING STONES TO RECOVERY

Many resources are excluded in part or 

entirely from the calculation of resources:

Burial plots/spaces

A burial space/plot for an applicant and his 

or her immediate family are excluded. This 

has no effect on the burial funds exclusion. 

Burial funds

Up to $1,500 of burial funds are excluded, 

unless the funds are set aside in an 

irrevocable burial fund. The difference of the 

excludable amount ($1,500) and the burial 

fund may count toward the resource limit 

of $2,000 for an individual and $3,000 for a 

couple.

Housing

If an applicant owns a home and makes that 

home his or her principal place of residence, 

the value of the home does not count as a 

resource. While this manual is intended 

to assist people who are homeless, this 

provision is worth noting in the event that an 

applicant is in danger of becoming homeless 

due to foreclosure, or is considered homeless 

because he or she lives in a place generally 

considered uninhabitable. Also, occasionally, 

applicants may inherit or otherwise acquire a 

home while being considered for, or already 

qualified for, SSI. In all of these cases, the 

value of the home is excluded as a resource 

as long as the home is or becomes the 

applicant’s principal place of residence.

The value of housing assistance (public 

housing, Section 8, etc.) also is excluded. 

Thus, helping an applicant who is homeless 

move into subsidized housing will not result 

in a reduction of benefits. Note that under 

HUD rules, a SSDI or SSI recipient receiving 

Federal housing assistance such as public 

housing or Section 8 will pay 30% of that 

income in rent.

Household goods and personal effects

As of March 9, 2005, the exclusion of 

household goods and personal effects from 

countable resources is no longer limited to 

a designated dollar amount (e.g., $2,000 

for individuals or $3,000 for couples). 

Instead, household goods are excluded from 

countable resources, if they are items of 

personal property, found in, or near a home, 

that are used on a regular basis, or items 

needed by the householder for maintenance, 

use and occupancy of the premises as a 

home. Personal effects are excluded from 

countable resources if they are items of 

personal property that ordinarily are worn or 

carried by the individual, or are articles that 

otherwise have an intimate relation to the 

individual. 

Automobiles

One automobile is fully excluded from 

resources if it is used for transportation of the 

individual or a member of the individual’s 

family. In a change of regulations, effective 

March 9, 2005, applicants no longer need 

to document that the vehicle will be used 

for certain specified purposes (e.g., medical 

treatment or essential daily activities). 

Further, any value of the vehicle in excess of 

$4,500 will no longer be counted against the 

resource limit.

Earned income tax credits

All earned income tax credits (EITC) 

payments are excluded until the end of the 
CHAPTER 4 27

month following the month of receipt. That 

means if an EITC payment were received in 

January, it would not be counted until the 

beginning of March. If a person received an 

EITC payment that put his or her countable 

resources over the limit, he or she would not 

be disqualified from applying for SSI until 

the end of the month following the month 

in which the EITC payment was received. 

However, the applicant would have until 

the beginning of the second month to spend 

enough of the money to get below the limit.

Other compensation

Additionally, resource exclusions may 

include: 

■ Crime victims’ compensation payments. 

Such payments are excluded from 

resource calculations for up to nine 

months after they are received.

■ Life insurance. If the total face value 

of all the claimant’s life insurance is 

below $1,500, the insurance is totally 

excluded. However, if the face value 

exceeds $1,500, the cash surrender value 

of the life insurance becomes a countable 

resource. Cash surrender value is the 

amount of money the claimant would 

receive if he or she cancelled the life 

insurance policy; it is not the amount of 

life insurance that the claimant has. The 

cash surrender value of a life insurance 

policy typically is much lower than the 

amount of insurance for which the policy 

is written. For example, a $100,000 

life insurance policy might have a cash 

surrender value of only $1,000.

■ Disaster assistance. In the event of 

a disaster for which compensation 

was received, a person will not lose 

SSI eligibility. This provision covers 

assistance provided by Federal, State, or 

local governments, as well as disaster 

assistance organizations.

Resources will be verified in different ways. 

Bank accounts can be verified with an 

up–to–date statement of the account balance. 

The value of a car that does not qualify 

as an excluded resource can be verified 

by providing the National Automobile 

Dealers Association (NADA) value. Along 

with the NADA value, an applicant can 

submit a statement from a mechanic that a 

particular car has problems that cause it to 

be worth less than the listed value. Valuation 

of other resources may require different 

documentation.

Can excess resources be 

transferred?

Case managers must be familiar with SSA 

rules regarding the transfer of resources. 

Applicants, or people who assist them, often 

assume that if they have too many resources 

to qualify for SSI, they can transfer the 

resources to someone else to become eligible. 

This is usually incorrect. Individuals who 

transfer non-excluded resources for less 

than fair market value, for the purpose of 

establishing SSI or Medicaid eligibility, will 

be penalized with a period of ineligibility 

for SSI, not to exceed 36 months.3 Several 

important points must be understood about 

this rule. 

3 Certain uncompensated transfers of resources may not result in a penalty, if the resources are transferred to a spouse or child.
28 STEPPING STONES TO RECOVERY

Evaluation of transfers of resources

For SSA, the question regarding transfer of 

resources is whether the transfer occurred 

specifically to obtain eligibility for SSI. A 

transfer penalty only applies to non-excluded 

resources. 

For example, consider an applicant who owns 

a car valued at $6,000. He or she transfers 

the $6,000 car when a family member offers 

one worth $10,000 that is in better condition. 

In this situation, the extra value does not 

count as a resource since owning one car 

used for transportation of the individual or a 

family member is not counted as a resource. 

However, suppose another applicant had 

two cars, one worth $10,000 and another 

one, worth $6,000. If he or she transferred 

the $6,000 car, SSA would investigate the 

time of transfer and make a determination 

whether it was for the purpose of obtaining 

SSI. In this second case, a transfer penalty 

might be applied.

Transfers for fair market value are allowed

Transfers are allowed if they are either 

to a spouse or for fair market value. This 

means that applicants legitimately can spend 

resources or transfer non-excluded resources 

in exchange for excluded resources as long as 

the resources are for him– or herself.

For example, if a single applicant received 

a cash award of $3,000, he or she would 

be over the resource limit. However, by 

pre-paying rent for an apartment or by 

purchasing a $3,000 car, the individual 

could spend funds to drop below the $2,000 

resource limit. The individual then would 

qualify for SSI. It is important for case 

managers and applicants to think through 

these situations. This allows people to make 

the most of the resources available to them, 

while remaining eligible for SSI.

If someone mistakenly made a resource 

transfer for less than fair market value, the 

situation can be remedied. If an improperly 

transferred resource is returned to the 

individual who transferred it, transfer 

penalties will be removed. Of course, the 

applicant then may exceed the resource limit. 

However, given resource exclusions and 

the ability to receive fair market value for 

resource transfers, the applicant will have the 

Establishing the Period of Ineligibility

Suppose an individual has a bank account containing $2,337 and lives in a state in 

which the monthly SSI supplement is $200. The individual gives the entire bank balance 

to another person and receives no compensation.

To determine how long this person will be ineligible, SSA divides the $2,337 by the total 

of the monthly Federal Benefit Rate ($579 in 2005) plus the State supplement ($200). 

Thus, $2,337 divided by $779 ($579+200) is 3. This means that, due to the resource 

transfer, the individual will be ineligible for three months of benefits.
CHAPTER 4 29

opportunity to make a legitimate transfer and 

preserve eligibility.

Transfers cannot be made for the 

purpose of establishing eligibility

Transferring resources does not always make 

an applicant ineligible for SSI. Transferring 

resources solely for the purpose of qualifying 

for SSI is what affects an applicant’s 

eligibility. If the resource transfer was made 

for another purpose, it does not necessarily 

affect eligibility. Case managers can help 

applicants by documenting when resource 

transfers were not made for the purpose of 

applying for SSI.

For example, suppose an employed person 

transfers $3,000 to help a friend. At the time 

of the transfer, the person lending the money 

has no idea that she might become disabled 

and consequently has no intent of applying 

for SSI. If, nine months later, the lender has 

an unexpected accident and becomes unable 

to continue working, the transfer of the 

$3,000 will not affect her SSI application.

Improperly transferred resources 

can result in ineligibility. 

Only transfers made within the past 36 

months are subject to review. If someone 

is found by SSA to have made an improper 

resource transfer, he or she will be ineligible 

for SSI for a period of up to 36 months.

To calculate the number of months the 

applicant will be ineligible, SSA adds the 

monthly Federal Benefit Rate and the amount 

of any State supplement, and then divides 

the sum by the uncompensated value of the 

transferred resource(s).4 The sum of the 

calculation is rounded to the nearest whole 

number. This is the number of months for 

which the applicant or recipient is ineligible. 

(See Establishing the Period of Ineligibility 

on the preceding page.)

How does immigration status 

affect SSI eligibility?

All United States citizens are eligible for 

SSI as long as they meet the income, age, 

and disability standards. Conversely, any 

alien not legally in the U.S. is not eligible to 

receive SSI. While all legal aliens used to be 

considered eligible for SSI, the rules changed 

on August 22, 1996; today, only some legal 

aliens are SSI eligible. 

Large numbers of aliens live in some states, 

such as New York, Florida, California, 

and Texas. More detailed immigration 

information can be found at the USCIS Web 

site at www.uscis.gov. 

SSA refers to non-citizen immigrants as 

“aliens.” A “qualified alien” is an alien whose 

immigration status makes him or her eligible 

for SSI under current rules. To receive SSI, 

a “qualified alien” (or a person in one of the 

miscellaneous categories of eligible aliens) 

must be elderly, blind, or disabled, and meet 

all other SSI eligibility requirements. An 

applicant also must satisfy two additional 

tests to be considered a qualified eligible 

alien. For additional information about 

qualifying criteria, see Appendix A.

4 Uncompensated value means the difference between the value of the resource and the amount for which it was transferred. This could be the full value of 

the resource, but it may also be only a portion of the value of the resource if the applicant received some payment, but less than fair market value.
30 STEPPING STONES TO RECOVERY

If a case manager is unsure 

of a person’s immigration 

status, but is sure that the 

individual is legally in the 

U.S., it is appropriate to 

send the individual to SSA 

to apply for SSI.

It is beyond the scope of this document to 

explain how to determine which of these 

categories, if any, a particular applicant fits 

into. This document does, however, provide 

general advice for case managers trying 

to determine the immigration status of an 

applicant. 

First, case managers should ask for copies 

of all immigration documents from the 

applicant. Such documents might include the 

I–94, a card that the USCIS gives to people 

when they arrive at a U.S. port of entry. Case 

managers also should request a copy of a 

valid passport or other valid U.S. immigration 

document, such as the temporary resident 

card or an employment authorization of alien 

resident card, received by aliens once lawfully 

admitted for permanent residence (LAPR). 

The alien card may contain important 

information about the person’s immigration 

status at the time he or she entered the U.S., 

along with the date LAPR status was granted. 

Case managers should review the documents 

closely with the applicant to best determine 

his or her immigration status. 

If a case manager is unsure of a person’s 

immigration status, but is sure that the 

individual is legally in the U.S., it is 

appropriate to send the individual to SSA 

to apply for SSI. If the application is later 

denied due to immigration status, case 

managers can consult with an expert in 

immigration law to determine if the status 

was evaluated accurately. 

Summary

The SSI program was created to provide 

financial support to low income elderly and 

disabled individuals. SSA has developed 

protocols to determine that individual 

applicants meet the criteria established by 

law. This chapter summarized the income 

and resource criteria with which case 

managers should be familiar, and some of the 

strategies that case managers can adopt to 

help the persons they are assisting organize 

their affairs and document their income and 

resources in a manner that is consistent with 

SSA requirements. Following these guidelines 

should ensure that applicants receive correct 

eligibility determinations in a timely manner. 
31

SSA’s Disability Determination Process

CHAPTER 5

CHAPTER 5

What are the standards for 

disability?

Under SSA rules, an adult is disabled if 

he or she is unable to do any “substantial 

gainful activity by reason of any medically 

determinable physical or mental impairment 

which can be expected to result in death or 

which has lasted or can be expected to last 

for a continuous period of not less than 12 

months.” 1 This definition includes several 

specific points: 

■ Substantial gainful activity (SGA) is 

defined by SSA as work that involves 

doing significant and productive physical 

or mental duties and is done for pay or 

profit, even if a profit is not realized. 

As of 2005, wages or work of $830 per 

month or more is considered SGA.

■ Any medically determinable physical 

or mental impairment means a 

physical or mental disorder resulting 

from anatomical, physiological, or 

psychological abnormalities, which 

can be confirmed by “medically 

acceptable” 2 clinical and laboratory 

diagnostic techniques. A combination of 

impairments also may be considered by 

SSA.

■ An impairment must be expected to result 

in death or to have lasted, or be expected 

to last, for a continuous period of not less 

than 12 months for a person to qualify 

for benefits.

While every person has the right to apply for 

SSA disability benefits, some applicants may 

not meet SSI/SSDI eligibility requirements. 

In these instances, case managers should 

Once SSA has determined that an applicant meets non-medical criteria, the application is 

sent to the State Disability Determination Services (DDS) for an evaluation of the applicant’s 

disability. This chapter explains the process that the DDS uses to make that determination 

and outlines some of the special factors that affect applicants with mental illnesses and 

substance use disorders. 

1 20 C.F.R. 404.1505(a) and 416.905(a).

2 Evidence to establish a “medically determinable impairment” must be provided by “acceptable medical sources.” Acceptable medical sources are licensed 

physicians, psychologists (including school psychologists), optometrists, podiatrists, and licensed or certified speech-language pathologists. See 20 C.F.R. 

404.1513 and 416.913.
32 STEPPING STONES TO RECOVERY

explain the requirements and assist the 

person in finding more appropriate and 

available sources of support.

SSA defines disability in ways different 

from other government programs such as 

Food Stamps or Temporary Assistance to 

Needy Families (TANF). Under both of 

those programs, a doctor’s letter stating 

that his or her patient is unable to work 

usually is sufficient to prove disability. SSA, 

by law, is not allowed to accept a doctor's 

letter as proof of disability. However, while 

SSA’s rules are stricter than those used in 

other programs, case managers should not 

discourage applicants from applying.

How is disability evaluated?

Once an SSA field office determines an 

applicant meets income and resource 

guidelines, the application is sent to the State 

Disability Determination Services (DDS) 

for processing. SSA has agreements with 

each state and the District of Columbia to 

undertake disability evaluations. Every state 

has its own DDS, which may be located 

in the State’s Department of Labor, Social 

Services, or another agency.

The process of determining whether an 

individual is disabled entails a five–step test, 

or sequential evaluation process. At each step, 

the DDS asks and answers a specific question 

regarding the applicant, ensuring that 

different aspects of disability are considered 

before an application is either approved or 

denied. 

What is the sequential evaluation 

process?

To determine whether an individual meets 

disability criteria, SSA and DDS staff use 

the sequential evaluation process to consider 

different kinds of information, ensuring that 

the person’s disability is completely reviewed. 

Since the steps are sequential, the process 

may stop at a step if specified criteria are met. 

The specific steps are shown in Figure 2 and 

described in further detail below.

Step 1. Substantial gainful activity

This step evaluates whether an applicant is 

engaging in substantial gainful activity or 

SGA. If an applicant is engaging in SGA, he 

or she is ineligible for either SSI or SSDI. The 

amount of gross earnings considered changes 

An Example of Probable Disability

A case manager assisted an applicant diagnosed with schizophrenia in August 2001. 

Medical notes indicated that his functioning was severely impaired—he was unable to 

interact with others and could not stay focused on task. He had not worked since the 

diagnosis due to his schizophrenia, and according to the medical notes, he was unlikely 

to work again in the foreseeable future. Such a person would appear to meet disability 

criteria and should be encouraged to apply for SSI.
CHAPTER 5 33

Is the individual engaging in Substantial Gainful Activity? Step

One

Step

Three

Step

Two

yes 

yes 

yes 

no 

no 

no 

Does the applicant have any severe impairment(s)?

Does the applicant have an impairment of severity that meets or equals 

the severity in the listings?

Figure 4. Steps in the Determination Process

DENY

DENY

ALLOW

Step

Four

yes 

DENY Does the applicant have sufficient residual functional capacity to perform 

past relevant work?

Step

Five

yes 

yes 

yes 

yes

no 

no 

Does the applicant have a 6th grade education or less, and at least a 35-

year work history of arduous unskilled physical labor which he or she 

cannot perform because of a severe impairment? 

 Does the applicant have severe impairment? Is he or she age 55 years 

or older? Does he or she have an 11th grade education or less and no 

relevant work experience?

Is the individual able to perform other work?

no 

 Is she or he age 60 or older? Does he or she have an 11th grade education 

or less? Does he or she have an unskilled work background or semiskilled or skilled with no transferable skills? Does he or she have a lifetime 

commitment to a field of work that can no longer be done because of a 

severe impairment?

DENY

ALLOW

ALLOW

ALLOW

no

ALLOW

no 
34 STEPPING STONES TO RECOVERY

annually. In 2004, the amount was $810 

per month; in 2005, the amount is $830 per 

month. Individuals who earn these sums 

but who have special conditions or expenses 

related to their disabling condition may not 

be considered to be earning SGA by SSA. If 

an applicant is not working at all, or he or 

she is not earning at the level of SGA, the 

case moves to the next step. 

Step 2. Documenting severe impairment

A severe impairment is defined as an 

impairment or combination of impairments 

that “significantly limit ... physical or 

mental ability to do basic work activities.” 3

Under Social Security regulations and 

guidelines, the threshold for this test is 

not particularly demanding. The critical 

issue for case managers is to ensure that 

information sent to the DDS demonstrates 

that a person’s functioning has been 

severely impaired. If the information shows 

the presence of a severe impairment, the 

process moves to the next step.

Step 3. The listings

Disability Evaluation under Social 

Security (also known as the Blue Book), a 

publication distributed by SSA, provides 

criteria under which SSA automatically 

will find an applicant disabled in the Adult 

and Childhood programs. These criteria 

take the form of a Listings of Impairments, 

commonly referred to as “the listings.” 4

Disability determinations at this step are 

made without regard to age, education, 

and work experience. 5 The nature of an 

individual’s physical or mental impairment 

is compared against the criteria that must 

be met or equaled for that impairment to be 

considered disabling. If medical evidence 

shows the applicant meets these criteria or 

has impairments equivalent in severity to 

them, the applicant will be found disabled—

as long as the criteria have been met, or are 

expected to be met, for at least 12 months, or 

if the impairment can be expected to result 

in death.

Case managers should 

note that even if a person 

doesn’t qualify under 

the listings for a single 

diagnosis, he or she may 

qualify as a result of 

multiple impairments.

Case managers should note that even if a 

person doesn’t qualify under the listing for 

a single diagnosis, he or she may qualify, 

at a later step of the sequential evaluation 

process, as a result of multiple impairments. 

For example, a person might have diagnoses 

of depression, diabetes, congestive heart 

failure, and hypertension. While any one 

of these chronic illnesses might not rise to 

3 20 C.F.R. 416.920(c).

4 The listings can be viewed at the Web site www.socialsecurity.gov/disability/professionals/bluebook/index.htm and at 20 C.F.R. 404, Supart P, Appendix 1. 

Also, see 20 C.F.R. 416.925–926.

5 20 C.F.R. 416.920(d).
CHAPTER 5 35

the level of a disability under SSA rules, the 

combination of these illnesses might do so. 6

Therefore, case managers are advised to refer 

all potential applicants to SSA for evaluation.

If an individual does not meet or equal the 

requirements of the listings, the sequential 

evaluation process continues.

Step 4. Past relevant work

In this step of the sequential evaluation, 

SSA determines whether the applicant has 

the ability to perform the same work he or 

she did in the past. If the answer is yes, the 

applicant will be found not to be disabled. If 

the answer is no, the analysis moves to Step 

5 of the sequential evaluation that examines 

whether the applicant can perform other 

work.

In determining whether an individual has the 

ability to perform past relevant work, SSA 

will review:

■ Medical records and input from the 

applicant's physician, psychologist, or 

speech and language pathologist and 

evaluate them to produce a Residual 

Functional Capacity (RFC) assessment 

report that is based on the applicant's 

current mental and physical abilities. 

■ Work history over the past 15 years. If 

there is no work history, the analysis 

automatically moves to Step 5. 

■ If a work history exists, the RFC of the 

applicant is compared to the functional 

requirements of each job performed 

over the past 15 years. Based on this 

comparison, if the RFC assessment 

determines the applicant is capable of 

performing any of his or her past jobs, 

the applicant will be found not disabled. 

■ If the applicant cannot perform past 

work, the analysis advances to Step 5.

Step 5. Other work

At Step 5 of the sequential evaluation, SSA 

determines if the applicant can do any other 

work that exists in significant numbers in the 

national economy. It does not matter whether 

a specific job is available where the applicant 

lives, whether a specific vacancy exists, or 

whether the applicant would be hired if he 

or she applied for the job. Thus, an applicant 

might be found capable of being a gardener 

even if no gardening positions are available 

in his or her area and even if the applicant 

wouldn’t be hired for such a job if one were 

available. In making this decision, SSA once 

again will use the applicant’s RFC but will 

now take into account the applicant’s age, 

education, and work experience. To help 

make this evaluation, SSA relies on Medical–

Vocational Guidelines, also known as “the 

grids.” 7

The grids are designed to make observations 

about a large number of people. For 

example, one of these observations is that 

a person under age 50 with a high school 

education can do many different jobs. Older, 

uneducated applicants are more likely to be 

found disabled than younger applicants, even 

when their disabilities are the same. 

6 This is a particularly important consideration for individuals with substance use disorders. More information about substance use appears later in 

this chapter.

7 The grids are available at www.socialsecurity.gov/OP_Home/cfr20/404/404-ap10.htm. Note that the grid rules were recently revised. See the final rules 

amended at www.socialsecurity.gov/regulations/articles/rin0960_af37f.htm.
36 STEPPING STONES TO RECOVERY

What happens when there are 

co-occurring mental and physical 

illnesses?

A significant proportion of individuals who 

are homeless have physical health problems 

as well as mental health problems. All of 

these difficulties need to be reported and 

documented to be considered during the 

sequential evaluation process. The presence 

of physical ailments in combination with 

mental disorders may lead to the stronger 

possibility of a finding of disability by the 

DDS. For example, a person who is homeless 

may have skin, feet, breathing, or infectious 

disease problems from living outdoors. Case 

managers should ensure that all physical and 

mental health problems are documented and 

reported. 

What about alcohol or drug 

addiction?

Alcohol or drug addiction alone does not 

constitute a disability for the purposes of 

SSI and SSDI. It is possible, however, for 

applicants using drugs and/or alcohol at 

the time of application to be found disabled 

and receive SSI. The test for determining 

eligibility is whether “drug addiction or 

alcoholism is a contributing factor material 

to the determination of disability.” 8 Thus, 

SSA determines whether an applicant would 

still be disabled if he or she were sober and 

abstinent from drugs or alcohol. If SSA's 

determination is positive, the applicant will 

be found disabled, providing that income and 

resource criteria are met.

Although SSA has considered drug and 

alcohol addiction materiality since the SSI 

program began in 1974, the definition of 

disability as it is affected by addictions 

has evolved. Before 1996, a person with a 

substance use disorder could obtain benefits 

if he or she could show the presence of a 

disabling condition, whether or not the 

condition was related to a substance use 

disorder. SSA required that he or she adhere 

to certain restrictions (e.g., a requirement 

to have a representative payee). Since 1996, 

however, if a person has a substance use 

disorder that is determined to be material 

to his or her disability, he or she will not 

receive SSI. 

Documenting All Disorders

A 45–year–old obese woman has a history of treatment for major depression. While 

her depression has improved, she continues to need treatment and cannot work. The 

depression, combined with her obesity, heart problems, and lung problems result in 

her inability to engage in SGA. The depression alone does not qualify her for disability 

benefits, but her overall health status can. 

8 20 C.F.R. 416.935(a).
CHAPTER 5 37

How should alcohol or drug use be 

handled?

When assisting individuals who are using 

drugs and/or alcohol, case managers should: 

■ Advise the person to apply. Some people 

wrongly believe that people who abuse 

substances cannot receive SSI, despite 

any other disabilities they may have. As 

a result, they erroneously discourage 

them from applying.

■ Make sure that the medical records 

submitted to SSA contain evidence of 

an existing medical diagnosis. Case 

managers should understand thoroughly 

the applicant’s functional impairment(s) 

and their origin(s). Since an applicant 

Substance Use and Disability Determination: An Illustrative Example

Jim Jones, a 45–year–old single, homeless man has a diagnosis of major depression 

with psychotic features and a history of cocaine abuse. In getting to know Mr. Jones, a 

case manager learned that Mr. Jones’s grandfather consistently physically abused him 

between the ages of 3 and 12 years. The case manager also learned that a neighbor, who 

befriended Mr. Jones in his early years, sexually abused him. He had kept this secret all 

his life. 

As a child, Mr. Jones was a poor learner. He had an undiagnosed learning disability, and 

he received no special education. His learning was also affected by his home situation. 

He became confused and significantly depressed.

At the age of 14, Mr. Jones began smoking marijuana. For years, he had felt ashamed and 

belittled; he believed that smoking marijuana might help him to feel better and fit in with 

other teenagers. 

His despair continued. Over time, he began using cocaine, which helped him to feel 

stronger, more competent, and energized. However, this feeling was short–lived and after 

the effects of cocaine diminished, he felt just as depressed. He had intermittent episodes 

of sobriety that lasted anywhere from six months to a year. During his sobriety, he felt 

despair and depression again, and he would then return to cocaine for relief. 

After numerous hospitalizations for depression and several relapses into substance use, 

Mr. Jones entered a recovery program. Treatment records and other documentation 

supported that he worked hard on his problems, but he continued to use cocaine, though 

not as intensely as in the past. Even in the midst of recovery, Mr. Jones evidenced 

significant functional problems. When sober, he found his depression affected his ability 

to take care of his personal hygiene, resulting in his not washing, sometimes for as long 

as a week. During these times, which were frequent, he also did not eat. His learning 

disability made it hard for him to read bus signs, making it (continued) 
38 STEPPING STONES TO RECOVERY

with no independent diagnosis will 

be denied benefits, applicants must 

emphasize independent diagnoses 

determined by a medical professional. 

■ Advise applicants to be candid about 

past or current drug/alcohol use. Many 

applicants fear their claim will be 

denied if they admit drug or alcohol 

use. However, since medical records 

usually refer to any history of alcohol 

or drug use, any inconsistency between 

oral accounts and medical records could 

undermine the applicant’s credibility. 

This can result in a finding of “not 

disabled.”

■ Consider the application in the context 

of a person’s substance use disorder. 

Case managers need to take thorough 

historical information. A comprehensive 

longitudinal history, including issues 

such as trauma, abuse, educational 

problems, employment history and 

problems, legal history, and physical 

health history, is vital to documenting 

disability. Case managers should work 

closely with experienced clinicians to 

assure that the applicant can manage 

any symptoms that could arise from 

providing such sensitive information.

Once a case manager has a better sense 

of a person’s life history, he or she should 

find out more about the individual’s level 

of functional impairments, if any, and the 

source of these impairment(s). Drugs may 

be used by a person with mental illness to 

address or to mask feelings and behaviors 

related to his or her mental health status. 

Therefore, the case manager should inquire 

whether reported problems occur when a 

person is sober or only when the person is 

using drugs or alcohol. 

difficult to use public transportation to go out. Despite his lack of mobility, the State 

public assistance benefit he received was spent quickly; he clearly needed assistance to 

manage his money. 

Socially, Mr. Jones isolated himself, and when depressed, he would not communicate 

with anyone. When angered, he was unable to express himself and would resort to 

drugs to manage his feelings. In addition, due to his depression, his anger became self–

destructive, including purposeful attempts to overdose. He had been hospitalized several 

times due to these behaviors. 

Mr. Jones’s depression also interfered with his concentration, attention, and memory. 

The depressive symptoms of hopelessness, lack of energy, sadness, and suicidal thoughts 

rendered him incapable of completing tasks, such as applying for food stamps. He was 

clearly functionally impaired from the effects of his depression. 

Upon applying for SSI, Mr. Jones was found eligible, despite his ongoing, intermittent 

drug use.
CHAPTER 5 39

For example, if a person stated that he or 

she takes substances to dull the fear and 

discomfort created by hallucinations, the 

case manager could conclude that the 

mental disorder is the problem and that the 

symptoms are likely to remain, even in the 

context of abstinence from drugs. Conversely, 

if an individual reported that he or she 

manages activities of daily living fairly well 

when sober, but avoids these tasks when 

using or withdrawing from substances, this 

person might be found not disabled.

Many applicants fear their 

claim will be denied if they 

admit drug or alcohol use.

The determination of disability is 

complicated when substance use is involved. 

At the same time, it is possible for the DDS 

to make a correct determination when given 

thorough, accurate, and complete medical 

and functional information. By gathering this 

information, a case manager can understand 

better what is affecting the person’s 

symptoms and functioning and can share the 

information with the DDS examiner.

The critical question regarding substance 

abuse is: “Would this person be disabled if in 

recovery?” Case managers must make sure 

that the DDS receives all medical information 

to help to answer this question to foster an 

accurate determination.

Summary

While the criteria for determining disability 

are stringent, the process ensures that a range 

of issues related to disability are considered 

before an application is approved or denied. 

This chapter detailed the steps in the 

disability determination process to give case 

managers familiarity with each stage of the 

process. 

Sometimes issues such as substance abuse 

can complicate a disability determination. 

While individuals who are disabled solely on 

the basis of their addictions are not eligible 

for SSI, persons whose addictions exist in 

combination with other illnesses may be 

eligible. It is important for case managers 

to encourage these individuals to apply. 

Case managers can play a critical role in 

developing and providing the documentation 

to promote appropriate disability 

determinations. Additional information 

about how to provide medical documentation 

to SSA is discussed in the next chapter.
40 STEPPING STONES TO RECOVERY
41

Documenting Disability

CHAPTER 6

CHAPTER 6

This chapter focuses on the critical contribution of case managers in documenting disabilities. 

Emphasis is placed on claims based on mental illness and mental illness in combination with other 

disorders. The case manager’s role is critical for the disability determination process to move 

forward accurately and in a timely fashion. 

What is the purpose of 

documenting disability?

Disability programs are designed for people 

who cannot work because of a physical and/

or mental disorder. Therefore, information 

submitted to SSA or to the DDS should 

substantiate a person’s health status, 

ability to function, and duration of their 

impairment. The applicant must demonstrate 

a “medically determinable physical or mental 

impairment” that renders him or her unable 

to do any “substantial gainful activity” and 

“which can be expected to result in death or 

which has lasted or can be expected to last 

for a continuous period of not less than 12 

months.” 1

SSA and DDS staff must determine whether 

an applicant’s impairment meets these 

criteria. Yet, the SSA claims representative 

often is not able to meet with the applicant 

frequently, and the DDS disability examiner 

never meets the applicant. Therefore, 

especially in the instances of people with 

mental disorders, a case manager can help 

to gather and provide complete, accurate 

information related to an applicant’s ability 

to do work. A collaborative relationship 

between a case manager, SSA, and the DDS 

throughout the determination process can 

create an easier, more expeditious process for 

everyone involved.

How should information be 

reported to SSA?

Descriptions of the medical information 

available, and the source(s) from which it can 

be obtained, are provided by the applicant 

on a Disability Report form (SSA–3368). 

As much of the supporting information as 

possible should be submitted at the time of 

initial application. If necessary, additional 

information can be added as it becomes 

available. 

1 20 C.F.R. 416.905(a).
42 STEPPING STONES TO RECOVERY

Case managers should help applicants 

ensure that information about all medical 

problems—mental as well as physical—is 

included with the application. To do so, case 

managers need to find out where treatment, 

including treatment in emergency rooms, 

was provided. In that way, the case manager 

will know where medical records for the 

applicant can be found. This is particularly 

true for treatment received in the preceding 

12 months.

What information is required?

Case managers need to assist in gathering 

records—including clinical and laboratory 

findings—that address the following areas.

Medically determinable impairment

For a person to be found eligible for disability 

benefits, he or she must have a “medically 

determinable impairment.” This impairment 

does not need to be a specific diagnosis but 

must be supported by objective clinical and 

laboratory findings. 

Case managers working in mental health 

are used to thinking of impairments in the 

context of the diagnoses in the Diagnostic 

and Statistical Manual of Mental Disorders 

IV—Text Revision (DSM–IV–TR) and/or 

the International Classification of Disease 

(ICD). These texts, however, are not 

what the DDS uses to make a disability 

determination. Rather, the DDS uses “the 

listings,” as described in Chapter 5, which 

contain descriptions of a number of physical 

and mental impairments considered to be 

disabling. A person’s impairment must 

meet criteria for a single listing—or a 

combination of listings—or be equivalent to 

it for the individual to be found disabled at 

Step 3 of the sequential evaluation. Proof of 

impairment is critical in the context of the 

disability determination process since the 

DDS requires a severe impairment resulting 

from a person’s health conditions.

Duration

In addition to presenting evidence of 

a medically determinable impairment, 

applicants must show that the impairment 

has lasted or is expected to last 12 months 

or more, or will result in death. Often, this 

requirement is difficult to meet. Sometimes, 

a person may have an impairment due to a 

very recent illness or injury, which has not 

yet lasted for 12 months. Determining that 

the impairment will last for 12 months may 

be difficult.

Functional information

Along with diagnostic and duration of 

impairment requirements, an applicant must 

show that his or her impairment prevents 

him or her from being able to work. When 

DDS considers functional impairment, 

the important question is what causes 

the problems in functioning? A clear link 

needs to be established between the stated 

impairment and the functional problems 

being experienced. For example, a person 

with major depression may have difficulty 

with simple tasks, such as getting up on time 

early in the morning, washing, and dressing, 

because the depression has a profound effect 

on energy and interest in doing these tasks. 

On the other hand, another person simply 

may not like to get up early in the morning, 

a dislike unrelated to any disability or 

impairment. While the first person may be 
CHAPTER 6 43

found functionally impaired per SSA criteria, 

the second person likely would not.

To delve into this area of functioning, a case 

manager needs to find out what a person’s 

typical day is like: What time does the 

individual get up; how does he or she spend 

time, etc?

When examining the functional areas 

described below, the standard against which 

an impairment is judged is whether the 

individual can function in a work setting on 

a sustained basis. However, case managers 

can describe behaviors not specifically related 

to working that could affect the ability 

to maintain employment. For example, if 

the person experiencing depression in the 

previous example is constantly tired and 

cannot get up on time, this could be a factor 

that affects work performance.

What are the functional areas 

that DDS considers?

Obtaining information on a typical day 

generally leads to a discussion regarding 

more specific functioning. At Step 3 of the 

sequential evaluation process, the DDS 

considers four functional areas when 

considering a mental impairment claim. For 

most mental disorders, a person must provide 

evidence of marked limitations in at least 

two of the four areas to meet or medically 

equal the requirements of a listing; however, 

some listings for mental retardation include 

different criteria.2 If an individual is found 

not to meet the listings requirements, DDS 

proceeds to Steps 4 and, if necessary, Step 5; 

at these steps, the individual’s impairment, in 

light of the four functional areas, also is kept 

in mind, although not addressed in the same 

manner as in Step 3.

The areas that SSA considers under the 

mental disorders listings are:

Activities of daily living

These include behaviors such as cooking, 

cleaning, using public transportation, 

budgeting, taking care of one’s hygiene, and 

maintaining a residence. A person must show 

that his or her impairment causes limitations 

or restrictions in this area that affect his or 

her ability to work. 

When obtaining information about a person’s 

impairment, case managers should gather 

specific information about functioning, 

including the last time activities have 

been performed, and how well they were 

completed. For instance, a person might 

report that he or she can cook, but in fact, 

may not have been functioning well enough 

to have prepared a meal in years. 

Any documented information about 

functioning should be provided to the DDS 

examiner. In describing such behavior, a case 

manager should connect it to the diagnosis. 

For example, a case manager might state: 

Mary has a severe psychotic disorder 

that continuously impairs her ability to 

2 While most often the requirement to be found disabled is evidence of marked impairment in two of the four areas of functioning, SSA can determine an 

individual has a disability based on an “extreme” limitation in only one area. See 20 C.F.R. 404.1520a(c) and 416.920a(c). Also, an individual who does not 

meet or medically equal the listings can still be found disabled based on his or her physical and/or mental RFC.
44 STEPPING STONES TO RECOVERY

complete her activities of daily living. 

For instance, she prefers to douse herself 

with lavender–scented toilet water, rather 

than to bathe. When asked about this, she 

stated, “The water is dirty, and full of 

foul odors that have been there since the 

Vietnam War.” She also stated that she 

did not believe in using tap water to wash 

dishes, since it left a horrible smell. 

Social functioning

This area is concerned with an individual’s 

ability to communicate clearly and to get 

along with other people. A case manager 

might glean information about this area by 

simply observing how an individual interacts 

with people in natural settings, such as soup 

kitchens and stores. If a person is extremely 

fearful and isolates him– or herself, success 

at work is unlikely. This also is true for an 

individual who is consistently aggressive 

or threatening. If a person has a psychotic 

illness, communication may be confusing and 

unclear. Again, the ability to engage in work 

would be difficult. 

A case manager can help disability 

examiners, who rarely meet an applicant, 

obtain a better understanding of an 

individual’s functioning by clearly 

outlining how he or she interacts with 

others. By ensuring that this information is 

comprehensive, detailed, and that it addresses 

many levels of functioning over a period of 

time, a case manager can help ensure more 

accurate determinations.

Concentration, persistence, or pace in 

task completion

This area is concerned with certain cognitive 

functions required for work to be done 

successfully. For a case manager to document 

this function for the disability examiner, 

he or she needs to elicit information about 

concentration, attention, distractibility, 

memory, and ability to follow directions. 

A case manager should ask about an 

individual’s ability to remember and keep 

appointments, and to complete necessary 

applications; and the case manager should 

observe whether a person can do these 

things consistently. Also, the case manager 

can note whether a person can stay on one 

topic in conversation. Finding out about the 

individual’s literacy level is important, as 

well. 

Repeated periods of illness, each of 

extended duration

The SSA regulations define this area of 

functioning as “exacerbations or temporary 

increases in symptoms or signs accompanied 

by a loss of adaptive functioning, as 

manifested by difficulties in performing 

activities of daily living, maintaining social 

relationships, or maintaining concentration, 

persistence, or pace.” While this definition 

of functioning is somewhat redundant, 

information related directly to this point 

can help to meet the duration requirement, 

since it factors in fluctuations of symptoms. 

For example, if a case manager can show 

that someone is having trouble maintaining 

functioning on an ongoing basis, the 

applicant would meet the criteria.

This area can be particularly helpful when 

documenting whether the individual can 

work on a sustained basis. For example, if an 

individual has tried to work three or more 

times in the past year and has experienced 

increased symptoms each time, this might 

be an area in which marked impairment is 
CHAPTER 6 45

shown. Increased symptoms and repeated 

periods of decompensation also could be 

implied if an applicant has lost a succession 

of jobs over a short period. 

Other approaches to documenting this 

area of functioning are found in the 

listings regulations, which are found in the 

introduction to the section containing adult 

mental listings.3 

How is functioning documented? 

Evidence can be either medical or 

non-medical in nature.

Medical evidence is used to indicate the 

existence of specific impairments and 

to demonstrate the severity of those 

impairments for the period during which an 

applicant says he or she is disabled. Medical 

evidence includes objective information, such 

as medical or laboratory test results, as well 

as other information from medical sources 

such as medical histories, medical opinions, 

and medical statements about treatment 

received.

However, medical records alone rarely 

provide the functional information needed. 

People who know the individual well must 

provide additional information that can 

be used to create a complete picture of the 

individual. This information is called nonmedical evidence. 

Non-medical evidence, sometimes called 

collateral or third–party information, 

includes all statements from an applicant, 

statements from other sources or service 

providers, and prior disability decisions 

from government or non-government 

agencies. Sources such as case managers, 

nurse practitioners, physician’s assistants, 

naturopaths, chiropractors, audiologists, 

therapists, family, or friends can provide 

evidence to document information regarding 

functioning.

To do so, case managers, family members, or 

friends provide information in writing to the 

DDS. The clearer these observations are, the 

better. Verbal reports also are documented, 

but case managers are strongly advised to 

provide written reports regarding functioning 

whenever possible. Case managers can best 

assist applicants by helping to assemble 

these observations from family, friends, 

and associates and by providing these 

observations, in the form of a written report, 

to the disability examiners. 

The information submitted should address 

directly the applicant’s ability to function 

when working or performing tasks required 

by work. For example, a case manager who 

sees an applicant every day might write, 

“During the four hours that John Smith has 

been at my program, he is unable to sit still 

for any significant period of time.” Or, a past 

employer might write, “John was fired for poor 

attendance and for getting into arguments 

when he was present.”

Formal employment records provide another 

type of non-medical evidence that can be 

helpful. A case manager should be aware 

that he or she will need to have a release 

form signed by the applicant specifically 

authorizing the release of any employment 

3 The listings regulations can be found at www.socialsecurity.gov/disability/professionals/bluebook/index.htm.
46 STEPPING STONES TO RECOVERY

records. To obtain these records, a case 

manager should contact the personnel 

department of the relevant employer.

Collateral reports should focus not only on 

what the applicant has done on a day–to–day 

basis, but also on the independence, quality, 

timeliness, and appropriateness of those 

activities. The reports also should provide 

details about changes in the applicant’s 

activities before and after the onset of his 

or her impairment(s). It is particularly 

important for a case manager to get 

information from people who have observed 

the applicant over time. SSA is looking for 

proof that the person has been, or is expected 

to be, disabled for 12 months. 

Collateral reports help the DDS examiner 

understand the applicant as a person. 

Medical records document impairments and 

the medical treatment that a patient has 

received, but they often do not document 

the effect of those impairments on an 

individual’s daily activities. By filling in this 

gap, collateral or third–party reports make 

applications more complete. Accordingly, 

case managers assisting applicants should 

consider obtaining at least one of these 

reports for each applicant that they help. In 

addition, if such reports are co-signed by a 

physician or psychologist who has met with 

the individual, they are viewed as medical 

evidence and can carry more weight than a 

standard third–party report. 

How can case managers help 

obtain medical evidence? 

Case managers can play a key role in 

obtaining and submitting medical records to 

the DDS examiner. This can be a difficult 

process, but if well organized, it is likely to go 

more smoothly. Medical evidence essentially 

comes in three forms: (1) treatment records 

from a hospital or a doctor’s office, (2) 

a formal report from a doctor, and (3) 

information from a consultative examination

(CE) scheduled by the DDS. CEs are 

discussed in detail later this chapter. 

Medical treatment records from hospitals and 

clinics, including discharge summaries, may 

be particularly helpful. First, they tend to be 

concise. They also usually contain valuable 

information regarding diagnosis, duration of 

service, and a good summary of the course 

of treatment. Progress or contact notes from 

outpatient providers also can be helpful, 

because these tend to track the course of 

illness more specifically over time.

What are the barriers to obtaining 

medical records? 

The biggest barrier to obtaining medical 

records is having the appropriate paperwork 

to retrieve it. A case manager needs a Release 

of Information form (SSA–827) signed by the 

applicant. Without a release form, records 

will not be released to either the DDS or the 

case manager.

Case managers must be aware of State laws 

governing the release of medical information. 

Depending on the state, release forms may or 

may not need to be originals. Using a release 

form that says “photocopies shall be as 

valid as the original” can avoid the need for 

applicants to sign multiple release forms.
CHAPTER 6 47

Some states do not allow one agency to 

obtain information from a health care 

provider and to forward it to another place, 

such as the DDS. Transfer of records may be 

complicated further by the implementation 

of the Health Insurance Portability and 

Accountability Act (HIPAA). Case managers 

should check guidelines in their states.

When a case manager learns of a medical 

record or treatment source, he or she should 

inform the DDS, even if the record is not one 

he or she can obtain readily.

To obtain a medical record, a case manager 

must send the release form to the relevant 

medical records office with a letter explaining 

the purpose of the request. The letter 

should state clearly the exact records being 

requested. Most hospitals and medical offices 

are extremely busy, and staff rarely have the 

time to track down correct information for 

incomplete requests.

Why should case managers 

obtain records?

Case managers, working with treating 

clinicians, can identify existing medical 

records and information, collect them, review 

them, and help obtain evaluations that may 

assist in development of the application. 

For several reasons, the process of collecting 

information has inherent flaws, especially 

for individuals who are homeless with 

intermittent treatment histories.

The cognitive impairments that homeless 

adults with serious mental illness may have, 

mean that they may not be able to specify 

necessary information, such as dates, types 

of treatment received, and locations of 

treatment. As a result, the DDS must send 

requests for medical information that are 

fairly general.

When a provider receives a request for 

information, it usually is processed by 

medical records staff. This staff often are 

unfamiliar with the needs of SSA and/or the 

DDS. In addition, with personnel shortages 

in many medical records departments, 

such staff is usually extremely busy. Staff 

may send only the last entry or some of the 

most recent discharge notes. In many cases, 

this information may be minimal and may 

not include some relevant reports. When 

the DDS receives the information, the 

claims examiner obviously can evaluate the 

applicant only on the partial information 

received from the provider. 

As the case manager spends more time with 

the applicant, he or she often learns about 

treatment history that the person initially did 

not recall. Such information may be critical 

to establish the durational requirement or 

may provide more clues about the extent of 

the impairment. Because the case manager 

is able to establish a relationship with the 

individual that the DDS claims examiner 

cannot, the case manager can serve as a 

critical focal point in the process. The case 

manager then can collect information him– 

or herself. If so, the case manager should, as 

a courtesy and to help expedite adjudication, 

also send these to the DDS. Alternatively, the 

case manager can inform the DDS examiner 

about new information for collection.

When a case manager does not collect 

the information directly and relies on the 

disability examiner to do so, he or she should 

provide DDS with specific information 
48 STEPPING STONES TO RECOVERY

about service providers, service dates, and 

treatment received, whenever possible. The 

case manager can address the problems in the 

routine process by:

■ Working with the applicant to identify 

the treatment provider(s) likely to have 

the best information;

■ Sending specific requests for 

information; 

■ Trying to ensure either that staff 

familiar with the record photocopy it, or 

that the case manager is permitted to do 

so; and

■ Reviewing information received 

immediately to ensure it addresses 

exactly what the DDS examiner needs to 

document the impairment, the duration 

of impairment, and the impact of the 

impairment on functioning. 

Part of the case manager’s work, then, 

involves educating staff in treating agencies 

and health care settings about the kinds of 

information needed to support a disability 

claim and collaborating with them to obtain 

the needed information. 

When case managers collect medical records 

information themselves, they should be 

aware that medical records departments 

frequently charge a fee for processing records 

requests. If a provider does charge, these 

costs can easily outpace a case manager’s 

budget. Sometimes, however, departments 

will consider records sent from one medical 

provider to another to be a professional 

courtesy and may not charge. A case manager 

should discuss the possibility of dismissing 

the fee with the directors of medical records 

departments, explaining the work he or she is 

doing assists people who are homeless.

Typically, when a provider responds to a 

request from a DDS examiner, a charge for 

providing records is involved. However, the 

DDS has a process to cover these charges.

Finally, case managers should be aware 

it frequently is necessary to follow up on 

records requests. Phone calls always should 

be made to medical records departments to 

confirm that a request was received and that 

it is being processed. A case manager should 

document when he or she called, to whom he 

or she spoke, and what was said.

Can case managers get copies 

of what DDS receives? 

In many cases, the DDS obtains records 

directly. If the case manager has been made 

representative for the applicant through the 

use of the Appointment of Representative 

form (SSA–1696), the exchange of 

information between the DDS and the 

case manager can flow more smoothly and 

completely. While the case manager may not 

see all the records that the DDS examiner 

receives, he or she can inquire about these 

records, what is missing, what additional 

information is needed, and can volunteer to 

help obtain such information. If requested, 

the DDS may make copies of the evidence 

received and provide it to a case manager.

When is a consultative exam 

needed?

Occasionally a case manager may believe an 

applicant’s case would be strengthened with 

the results of an additional new medical or 

psychological test. This often is true when 
CHAPTER 6 49

insufficient evidence exists for an applicant's 

case to be assessed. When a case manager 

has such concerns, he or she can discuss 

them with the disability examiner. In either 

situation, once the examiner is aware of the 

issue, he or she can schedule a consultative 

examination (CE). A CE is a medical test 

ordered and paid for by the DDS. 

Case managers should keep in mind that 

CEs can be simultaneously helpful and 

problematic. Potentially, the CE can provide 

medical evidence to substantiate a disability 

determination. However, problems can 

include:

■ The applicant’s treating physician or 

psychologist usually is the preferred 

source for a CE but may be unavailable 

or not qualified to provide the kind 

of evidence the DDS needs. When 

another doctor unfamiliar with the 

individual does the exam, he or she may 

not understand the full meaning of the 

applicant's responses. This can affect the 

interpretation of the information that 

the applicant provides.

■ CEs provide a “snapshot” of a person 

and his or her situation rather than 

a longitudinal clinical picture. This 

snapshot cannot provide the fuller 

representation of an individual's 

impairment over time that a treating 

physician or psychologist can provide.

■ Applicants who are homeless often miss 

CE appointments. If the applicant fails to 

appear initially and for any appointment 

that may be rescheduled, the application

can be denied.

■ Applicants with serious mental illnesses 

often deny these conditions, contributing 

again to an erroneous diagnosis.

■ Applicants often want to present their 

“best side” rather than the struggles 

and difficulties they experience. Thus, 

in the CE appointment, they talk about 

what they feel they can do rather than 

what they struggle with or experience 

symptomatically.

Even with these difficulties, CEs may be the 

only way to collect additional information 

needed for an applicant. Case managers 

should be aware that SSA will pay for a 

CE only if the DDS examiner requests it. 

The DDS process for initiating a CE or 

psychologist is:

■ A medical or psychological consultant at 

the DDS reviews the medical evidence.

■ He or she determines what, if any, 

additional information is needed.

■ The assigned claims examiner schedules 

a CE and contacts the applicant with 

appointment information. It is important 

for case managers to know that the 

applicant is notified of a CE by mail. 

If the case manager is the assigned 

representative for an applicant, he 

or she also will receive a copy of this 

appointment letter. In this way, the case 

manager knows when the appointment 

is and can accompany the applicant to 

the CE.

The importance of having the CE done 

by the individual’s treating physician or 

psychologist cannot be overemphasized. Most 
50 STEPPING STONES TO RECOVERY

often, these appointments are fairly brief. 

Therefore, it is easy to miss details that could 

be critical to the determination. When this 

exam is conducted by a physician who knows 

the person well, the result can be a wealth of 

information for the examiner that is likely to 

be critical to the eligibility decision.

What do case managers need to 

know about consultative exams?

The DDS must authorize the CE to be 

performed if the State is to pay the cost of 

the CE. This authorization results from a 

review of extant case information and a 

determination that additional information is 

needed to make a decision. 

CEs can be of greatest 

benefit to applicants if they 

are performed by a doctor 

who knows the applicant’s 

case history and who can 

devote the time to explore 

fully all aspects of the 

applicant’s disabilities.

CEs can be performed by an applicant’s 

own doctor or by a doctor chosen from a list 

maintained by DDS. A case manager should 

inform the DDS of any instance where a 

treating physician or psychologist is willing 

to do the CE. The applicant’s doctor is most 

familiar with the person and the applicant’s 

medical impairments. SSA regulations 

concur that an applicant’s treating physician 

or psychologist is the preferred source to 

perform a CE. So, if the treating physician 

or psychologist is qualified to perform the 

necessary test and is willing to do so for the 

fee that SSA will pay, then that physician or 

psychologist should be selected.

If a CE is scheduled with a DDS–selected 

doctor and an applicant has a treating 

physician or psychologist willing and 

qualified to perform the CE, a case manager 

should request, in writing, cancellation of the 

DDS appointment in favor of a CE performed 

by the treating physician or psychologist. 

If DDS agrees the treating physician or 

psychologist is qualified to perform the CE, 

this request should be granted.

In short, CEs can be of greatest benefit if 

they are performed by a doctor who knows 

the applicant’s case history and who can 

devote time to explore fully all aspects of the 

applicant’s disabilities.

The case manager should plan to accompany 

the applicant to a CE to ensure that he or 

she keeps the appointment. If the applicant 

cannot be found or won’t cooperate, the case 

manager should call the DDS and let the 

claims examiner know. DDS policy requires 

a rescheduling where the applicant may have 

a mental impairment, no representative, 

and can provide what may be considered a 

good reason for missing the appointment. In 

practice, DDS offices and claims examiners 

may reschedule appointments even if some of 

these criteria are not met. However, it is not 

a good idea for a case manager to rely on any 

such use of discretion because the DDS office 

may proceed to adjucate the case without 

having a CE.
CHAPTER 6 51

Pulling it all together: 

Writing a summary letter

Case managers can help make an applicant’s 

health status, diagnosis, and functioning 

clear to the DDS examiner by writing a 

summary report. As stated previously, 

two main complications exist for a DDS 

examiner attempting to make a disability 

determination: he or she most often never 

meets the applicant; and the medical 

evidence, from which the determination is 

based, seldom addresses the full impact of the 

impairment on day–to–day functioning. In 

this report, co-signed by a treating physician 

or psychologist, a case manager can compile 

collateral information provided by family, 

former employers, or other providers, and 

can illustrate clearly the impact of a person’s 

impairment on his or her functioning. 

Excerpts from medical records can be 

included to illustrate symptoms, diagnosis, 

and duration. A written, co-signed report 

ensures the whole story is told and is 

considered medical evidence. 

Such a report can be written simply as 

a letter. If the case manager has medical 

records to submit along with the letter, that 

is fine. By writing narratives, as opposed to 

filing out forms or checklists, case managers 

can describe a person completely and with 

clarity. In this letter, the case manager 

should:

■ Address the letter to the DDS examiner. 

The applicant’s name and Social 

Security number should be referenced. It 

is helpful to include the applicant’s date 

of birth.

■ State that the purpose of the letter is 

to provide information relevant to the 

applicant’s disability claim. The letter 

should be on agency letterhead and 

should include, at the end, the phone 

number for the case manager and that of 

the co-signing physician or psychologist.

■ When there is a mental disorder, 

describe the applicant and how he or she 

interacts with others in conversation. 

This begins to give the examiner a “feel” 

for the applicant.

■ Provide additional personal history 

not contained in the records, including 

history of physical and/or sexual abuse, 

educational history (e.g., grade level 

achieved, special education, repeat of 

grades, literacy). Employment history 

can be provided along with reasons for 

leaving past work (e.g., fired, laid off, 

problems with co-workers, resignation, 

walked off the job). Additional medical 

problems (and sources of information 

from which they are derived) can be 

included. Head injury history, accidents, 

surgeries, and other details also should 

Sample Opening for a Summary Letter

I am writing to ask that you find Mr. Smith disabled, beginning on January 1, 2000. 

Since this date, Mr. Smith has been unable to work due to the following medical 

problems: hypertension, bipolar disorder, and depression.
52 STEPPING STONES TO RECOVERY

be provided, if not already in submitted 

records. 

■ Include critical excerpts from submitted 

medical records.

■ Describe functional deficits and link 

these clearly to the person's impairment.

■ Write a summary section that ties 

the information together and clearly 

articulates the severity of impairment, 

duration, and functional difficulties.

For samples of each section of the summary 

letter, see Appendix C.

Once the report is complete, the case manager 

should send it to DDS and confirm that it has 

been received by calling or emailing the DDS 

examiner. After the submission of the report, 

the case manager can maintain regular 

contact with the DDS examiner to determine 

if additional information is needed. The next 

chapter addresses what to do once a decision 

on eligibility is made. 

Summary

Often, SSA and DDS are unable to obtain 

additional information and to maintain 

contact with applicants who are homeless. 

They usually are pleased to learn of 

community agencies whose staff are assisting 

applicants and willing to become their 

representatives. 

Case managers have two important ways to 

help adults who are homeless and who have 

mental illnesses apply for disability programs. 

The first is to help gather information to 

document an impairment and certify that it 

has lasted, or will last, for a year. The second 

is to provide information from the case 

manager’s own observations of the applicant, 

particularly how the person’s impairments 

affect the ability to work. The most critical 

need is for comprehensive, accurate, and 

timely information. Providing this assistance 

is one of the most important functions that a 

case manager can fulfill. 
53

The Appeals Process

CHAPTER 7

CHAPTER 7

This chapter provides an overview of the full appeals process for an SSI or SSDI application, from 

the Request for Reconsideration through an appeal in Federal court. It outlines the range of 

considerations an applicant should review before obtaining an attorney, and it provides guidelines 

for case managers who represent claimants at appeal hearings before SSA Administrative Law 

Judges (ALJs). Emphasis is on the outcome of the initial application; SSA reviews and appeals that 

occur once an individual receives benefits are not covered. 

What does SSA’s initial 

decision mean?

After SSA makes an initial determination, 

a letter—called a notice—is sent to both the 

applicant and the applicant’s representative, 

if there is one. The letter indicates whether 

the applicant has been found to be disabled. 

If the applicant is found disabled, he or 

she usually will be considered disabled as 

of the first full month after the date of SSI 

application, or for SSDI, as of the date on 

which the person said the disability began. 1

If the applicant is found not to be disabled, 

the determination will apply to the entire 

period of time covered by the application.

In some cases, an applicant may be found 

disabled as of a date following the date of 

SSI or SSDI application. This generally 

occurs when SSA is unable to find an earlier 

date of disability based on the medical 

evidence in the applicant’s file. Under these 

circumstances, the SSA notice will state that 

the date of onset (the date that a person’s 

disability began) is later than the date on 

which the person applied for benefits.

While this manual does not discuss these 

“partially favorable” determinations in great 

detail, case managers should be aware that 

they may occur.

In all cases, the initial determination letter 

will include information that explains how 

applicants can appeal the determination. 

Obviously, there are few reasons one 

would appeal a determination that finds an 

1 As will be discussed at length later in the manual, a person who is found disabled may have payment begin effective earlier or later than the date

 of application.
54 STEPPING STONES TO RECOVERY

applicant disabled. 2 On the other hand, an 

applicant almost always will want to appeal 

a determination that finds the applicant not 

disabled.

When an applicant is found disabled with 

a later date of onset, applicants will need to 

decide whether or not to appeal. Filing such 

an appeal usually is in the applicant’s best 

interest, since he or she will receive benefits 

during the appeal period. If the appeal is 

successful, additional retroactive benefits will 

be paid.

However, risk is involved. At any level 

of appeal, SSA can reverse its previous 

determination. In the case of a partially 

favorable determination, SSA could find, on 

appeal, that the applicant is not disabled at 

all. To avoid this risk, some people choose 

not to file an appeal, and they accept the 

partially favorable determination. Case 

managers should present applicants with all 

of their options, so the applicants can make 

fully informed decisions on whether or not to 

file appeals.

The remainder of this chapter explains what 

a case manager should do if the applicant is 

found not disabled. Next steps to assist an 

applicant who is found disabled are explained 

in the next chapter. 

What can a case manager do when an 

applicant is found not disabled? 

If an applicant receives an unfavorable 

determination, or chooses to appeal 

a partially favorable determination, a 

representative or case manager can assist 

with filing an appeal. This initial appeal 

is called a Request for Reconsideration. 3

The Request for Reconsideration form 

(SSA–561) is available from the local Social 

Security office or on the SSA Web site at 

www.socialsecurity.gov/online/forms.

html. 4 It can be found under the section of 

the page called “other forms.” An appeal 

also can be filed by sending a letter to SSA. 

The letter must have the applicant’s name 

and Social Security number on it. It does 

not have to be detailed; it needs only to 

state that the applicant wishes to appeal the 

determination.

The letter or Request for Reconsideration 

form must be supported by a 

Reconsideration Disability Report. This 

should be submitted with release forms 

for any additional medical sources. These 

forms also are available at the SSA Web site: 

www.socialsecurity.gov. These forms must 

accompany the Request for Reconsideration 

for a reconsideration of medical eligibility to 

be accepted and processed.

2 Applicants do, however, have the right to appeal a completely favorable decision. While this occurs rarely, when it does, the applicant is often appealing 

because of a mental impairment that prevents him or her from understanding the importance of receiving a stable monthly income, along with health 

insurance. In such a situation, a case manager should work with the applicant to explain how these benefits can be used to assist in recovery. This will 

usually prevent applicants from seeking to file an appeal.

3 At the time of this writing, SSA is conducting a study in 10 states, known as Disability Prototype States, in which, rather than a reconsideration as the first 

step of appeal, the individual can go directly to a request for a hearing before an ALJ. In these states, there is a separate set of procedures that the DDS 

uses before recommending an unfavorable disability determination.

4 At the time of this writing, the Request for Reconsideration form (SSA–561) is under review by the SSA. Be aware that differences may exist between the 

information contained in this manual and the current SSA rules for the reconsideration process.
CHAPTER 7 55

How is a Request for 

Reconsideration filed?

A case manager should follow a number 

of steps in filing an appeal. These are 

listed below.

Copy the applicant’s SSA case file

When a claim is denied, the case file is 

returned to the SSA office where the claim 

was made. The file stays there for at least 

65 days, until SSA knows whether the 

determination will be appealed. While at 

the office, the file is available for copying by 

representatives. If a case manager has filed 

to be a representative, he or she should call 

the local SSA office and arrange to copy the 

file. The location and phone number of the 

appropriate SSA office, generally the one 

where the claim was filed, are listed on the 

denial letter. 

The file should contain internal DDS 

documents that can give representatives an 

idea of the decision–making process for the 

applicant’s claim. Case managers should look 

for specific documentation, including:

■ A log of what the analyst and medical 

consultant did, including medical 

records requested and received, third 

parties spoken to, and so forth; 

■ Psychiatric Review Technique Form 

(PRTF) for applicants who allege a 

mental illness; and

■ For applicants whose denial occurred 

at Step 4 or Step 5, the mental and/or 

physical Residual Functional Capacity 

(RFC) assessment forms, which 

are completed by the medical and 

psychological consultants. These forms 

contain a series of check boxes, showing 

medical and psychological symptoms 

and conditions that were documented, 

as well as the degree of functional 

impairment that was supported by the 

records. These forms also may have 

comments by the reviewer that provide 

a summary of the findings and the 

reasoning behind such findings.

Copying the content of the file can give the 

case manager an important road map to 

follow when trying to document disability on 

appeal. Once the appeal is filed, however, the 

case file leaves the SSA office and is returned 

to DDS. Be sure to copy the file before filing 

the appeal.

File a Request for Reconsideration 

The Request for Reconsideration form is one 

page long. It asks the applicant’s name, SSI 

claim number (this is usually the applicant’s 

Social Security number), the type of claim 

being appealed, and briefly, the relevant 

reasons for filing an appeal. The form also 

asks for the addresses of the applicant and his 

or her representative. 5

Either the applicant or a representative 

(who has submitted an Appointment of 

Representative form signed by the applicant) 

should sign the Request for Reconsideration 

form. Both can sign, but it is not necessary. 

If an applicant’s whereabouts are not 

5 The filing period is considered to be 60 days from the date of the receipt of the letter, which SSA assumes to be five days after the letter is dated.
56 STEPPING STONES TO RECOVERY

known at the time the form must be filed, 

the representative should file the Request 

for Reconsideration while he or she tries to 

contact the applicant. 

Organize the appeal 

For a reconsideration based on medical 

eligibility to be accepted and processed at 

the SSA office and forwarded to the DDS, 

additional forms must be filed. A supporting 

form, the Reconsideration Disability Report 

(SSA–3441) is required, as are several other 

release forms for additional medical sources 

listed on the Reconsideration Disability 

Report. 

The Reconsideration Disability Report 

seeks updated information, in the following 

sections:

Section 1 asks for name and contact 

information.

Section 2 includes questions about 

changes in the severity of the applicant’s 

illness or injury since filing the original 

claim.

Section 3 includes questions regarding 

new doctors, new hospitalizations, and 

new agencies accessed by the applicant.

Section 4 includes questions about any 

medications the applicant is taking.

Section 5 asks about any new medical 

tests.

Section 6 asks if the applicant has worked 

since the last disability report. If so, SSA 

will ask the applicant to provide the details 

on a separate form.

Section 7 asks for a description of how the 

applicant’s impairments affect his or her 

ability to care for him- or herself, and any 

changes in daily activities.

Section 8 asks if the applicant has 

completed any job training or vocational 

school since the last disability report.

Section 9 includes information on 

participation in the Ticket program, 

vocational rehabilitation, and other 

support services.

Submit the paperwork

When a case manager or applicant files 

the Request for Reconsideration, he or she 

should receive a date–stamped copy from 

the SSA field office. This helps the applicant 

retain proof of the date on which an appeal 

was filed, in case questions arise during the 

process. Appeal forms also can be mailed 

to the SSA office, certified return receipt 

requested; the date–stamped copy will be sent 

to the applicant or representative by mail. 

The Request for Reconsideration must be 

filed at an SSA office within 60 days of the 

date on which the applicant receives notice 

of the initial determination. SSA assumes, 

unless an applicant can provide evidence 

to the contrary, that the determination is 

received five days after the date printed on it.

The question of timeliness is an important 

one. If an appeal is not accepted because it is 

filed too late, the applicant may have to file 

a new SSI application and begin the process 

all over again. Therefore, when filing for 

reconsideration, case managers should help 

applicants submit the forms as quickly as 

possible. 

Submitting a late Request for 

Reconsideration

People who are homeless may not see a case 

manager right after receiving a determination 

notice, may lose their notices entirely, or may 
CHAPTER 7 57

not understand their right to appeal. In such 

situations, a case manager should work with 

the applicant to submit a written statement 

of good cause for missing the 60–day deadline. 

If SSA finds that good cause exists for failure 

to file a timely Request for Reconsideration, 

the reconsideration will be processed as if the 

request were filed in a timely manner.

The Request for 

Reconsideration must be 

filed within 60 days 

of the date on which the 

applicant receives notice 

of the initial decision.

A statement of good cause must contain 

one or more reasons why the applicant did 

not request reconsideration within 60 days. 

Federal regulations require SSA to consider: 

(1) all the circumstances that prevented 

an applicant from making the request on 

time; and (2) whether an applicant had any 

physical, mental, educational, or linguistic 

limitations that prevented him or her 

from filing within 60 days, or knowing or 

understanding that the request needed to be 

filed within that time period.

Frequently, people who are homeless 

experience problems for which they can 

claim good cause under both of these 

categories. The most common is non-receipt 

of a determination due to homelessness. 

If an applicant was unaware that a 

determination had been made in his or her 

case, then a solid argument can be made 

that he or she was unaware of the need to 

file an appeal. Other examples of difficult 

circumstances include a severe illness that 

prevented contact with SSA; a mental illness 

that prevented a complete understanding of 

the notices; or the loss of important records 

due to fire, theft, or some other accident. 

What can case managers do 

after the appeal is filed?

When a Request for Reconsideration is 

received by the DDS, the applicant’s case 

file is given to a new disability examiner 

and medical or psychological consultant 

team that is responsible for making the 

reconsideration determination. The new 

team will have played no role in making the 

initial determination.

A case manager should communicate with 

the new team in the same way he or she 

did with the examiner who made the initial 

determination. To find out who composes 

the new team, a case manager should call the 

DDS.

When undertaking an appeal, it is important 

to know that the application can be expanded 

to include new diagnoses or impairments 

that have been identified since the original 

application was filed. Therefore, case 

managers should focus on providing not only 

updated information about impairments 

already disclosed in the initial application, 

but also new information about impairments 

that may have arisen since the initial 

application was filed.
58 STEPPING STONES TO RECOVERY

For example, an individual may have filed 

for SSI based on depression and been 

denied. Since that time the applicant may 

have discovered that she also has diabetes. 

While it is important to provide the DDS 

with additional medical records about the 

individual’s depression, it is equally critical 

to provide records relating to the newly 

developed medical condition.

How should case managers follow up 

on reconsideration decisions?

The reconsideration determination will look 

similar to the initial determination. It will 

state whether or not the applicant is disabled 

and will briefly list the evidence considered 

in making the determination. If the applicant 

is found not disabled, and the case manager 

and/or applicant continue to believe that 

this finding has been made in error, the case 

manager should work with the applicant to 

file a second appeal. This appeal is called a 

Request for Hearing by Administrative Law 

Judge (ALJ).

How is a request for an 

ALJ hearing filed?

The Request for Hearing by ALJ form 

(HA–501) also must be filed at any SSA 

office within 60 days of the date on which 

the applicant receives the reconsideration 

determination.6 Once again, a representative 

can sign and file the form on behalf of an 

applicant. And, good cause can be found 

for failure to file within the filing period, as 

described in the previous section regarding 

the Request for Reconsideration. The 

Request for Hearing by ALJ form can be 

found at www.socialsecurity.gov/online/

forms.html.

What happens after an ALJ hearing 

is requested? 

Once a hearing is requested, no further 

contact is needed with the State DDS agency. 

The case file is sent to a local Social Security 

Office of Hearings and Appeals (OHA) 

immediately after a hearing is requested. 

However, the applicant and representative 

may not hear from OHA for two months 

or more. During this time, there is no 

opportunity for any substantive interaction 

with SSA. The best way to keep track of 

the case is to call the OHA. As soon as the 

case arrives there it will be logged into the 

computer system. You can get the phone 

number for your local OHA by calling SSA’s 

toll free number: 1-800-772-1213.

What can be done to facilitate a 

favorable decision? 

Once the case file reaches OHA, case 

managers should discuss the possibility of 

hiring or obtaining an attorney with the 

applicant. While a representative need not 

be an attorney, the hearing before the ALJ 

is much more of a legal proceeding than the 

earlier parts of the application and appeals 

process. 

In many places around the country, attorneys 

from Federally funded legal services or local 

legal aid programs will represent individuals 

at ALJ hearings. If such a program is 

6 In certain types of cases, such as when an appeal is based on non-disability issues like income, the appeals process allows applicants to choose whether 

their appeal will be handled through a “case review,” an “informal conference,” or a “formal conference.” These choices are not available in cases where 

the issue is based on findings related to a person’s disability status. 
CHAPTER 7 59

available, the applicant can be represented at 

no charge. The attorneys and paralegals in 

these offices typically are skilled in preparing 

for and attending disability hearings. A list 

of Federally funded legal services programs 

is available at www.lsc.gov. In addition, 

most local SSA offices have a list of legal 

aid services available to the beneficiaries. 

A claims representative can provide a copy 

of the list. If a legal services or legal aid 

attorney cannot be found to handle the claim, 

the applicant may consider hiring a private 

attorney. 

What are the pros and cons of hiring 

a private attorney? 

Private attorneys typically represent people 

on a contingency basis. This means the 

attorney will get paid only if the claim is 

successful. If the claim is unsuccessful, the 

applicant will not owe the attorney anything. 

For this reason, private attorneys often will 

not take a case unless it is a strong one. 

Therefore, consulting a private attorney can 

provide good information about whether the 

applicant has a strong case or not.

If a claim is successful, under SSA rules, a 

representative may ask SSA for approval 

of a fee not to exceed 25 percent of past 

due benefits or $5300, whichever is less. 

Thus, if an applicant is eligible to receive 

back benefits of $10,000, the attorney can 

charge up to $2,500. While this reduces the 

amount of funds available for an individual, 

it is sometimes worth the price since it can 

improve the likelihood that an applicant will 

be found eligible for benefits (and obtain any 

health insurance benefits to which he or she 

may be entitled). 

If an attorney takes the case, what 

should the case manager’s role be? 

If the applicant obtains an attorney, the 

attorney should become the applicant’s 

representative, taking over this role from the 

case manager. This can be done by having 

the attorney complete and submit a new 

Appointment of Representative form. The 

case manager should take the steps needed 

to allow the attorney to take the lead in 

handling the case. However, as someone with 

detailed knowledge of the applicant and the 

case, the case manager should provide the 

attorney with all the necessary information 

to proceed and should consider serving as a 

witness at the hearing. 

Making the Case for an Attorney

Case managers should devote the time and effort necessary to have a hearing handled by 

an attorney, as a hearing is a legal proceeding. A legal services attorney will not charge a 

fee. Other attorneys who also have expertise in social security law will charge a fee if the 

case is selected. Their expertise also ensures full representation and should be seriously 

considered if representation by a legal services attorney is not available.
60 STEPPING STONES TO RECOVERY

What if the applicant decides against 

having an attorney? 

If the applicant decides against having an 

attorney or is unable to find one to take the 

case, it is important to understand that a 

case manager is still permitted to represent 

the applicant under SSA rules. One positive 

aspect of not retaining a lawyer is not having 

to pay a fee. On the other hand, a case 

manager should be aware that representatives 

cannot serve as witnesses at the hearing. 

Since the case manager may have the best 

understanding of the case, this might present 

a problem.

The balance of this chapter explains the 

remainder of the SSA appeals process, 

discussing the ALJ hearing level in some 

detail for case managers who represent 

applicants at this level. Less detail will be 

provided about the Appeals Council and 

the U.S. Federal courts, the two appeal 

levels following an ALJ hearing. Since 

representation by an attorney typically 

is recommended at ALJ hearings, it is 

also important for such representation to 

continue at the Appeals Council. Further, if 

the case goes to Federal court, a claimant is 

required to have attorney representation.

How can a case manager prepare 

for a hearing? 

Representing a client in a legal proceeding is 

probably beyond the scope of responsibilities 

for most case managers. Therefore, it is 

important that the case manager know what 

to expect should he or she choose to take on 

that role.

What should a case manager do 

before the hearing? 

Once a representative knows that a particular 

claim is at the OHA, he or she should find 

out the name of the judge who will be 

handling the case, as well as the name of 

the judge’s hearing assistant. That may not 

happen immediately: Sometimes cases are not 

assigned for several months after they arrive 

at an OHA. Once the case has been assigned, 

the representative should contact the judge’s 

hearing assistant to let that person know that 

he or she will be representing the applicant, 

usually referred to as the claimant, once a 

claim is filed.

After a claim file arrives at OHA, it is 

reorganized into a hearing file. Each piece 

of medical or other evidence in the hearing 

file is labeled as a separate exhibit so it can 

be referred to at the hearing. The ALJ will 

consider only documents associated with the 

hearing file. 

As soon as possible, a case manager should 

go to OHA and arrange to copy the file. This 

will ensure that the case manager knows 

exactly what is included in the record, and 

can make sure that any known evidence 

that is not in the file is submitted in a timely 

fashion.

If new medical records or other evidence 

need to be submitted, the representative 

should do so in a way that provides 

verification that the materials were received. 

The representative also should submit a letter 

outlining the medical and legal reasons why 

the claimant should be found disabled. All 

evidence should be addressed to the judge, 

although once it gets to the hearing office, it 

will be given to the hearing assistant to place 

in the case file. 
CHAPTER 7 61

Case managers should submit any new 

medical records prior to a hearing. Records 

can also be submitted at the time of the 

hearing and these must be accepted, even 

though some judges may express initial 

reluctance to do so. If the records are recent, 

most judges will not object. 

Immediately prior to a hearing, the 

representative should review the file again 

to determine what is in it. Items may be 

missing, in which case the representative 

will need to resubmit them. Also, the OHA 

may have records or information in the file of 

which the representative may not be aware. It 

is very important that a representative review 

this information so he or she is not surprised 

by anything at the hearing.

The amount of time it takes to schedule a 

hearing varies by OHA. The OHA is required 

to provide 20 days notice before a hearing 

is scheduled. Occasionally, a decision can 

be made without a hearing, based on the 

medical evidence in the file and the strength 

of the evidence.

Preparing claimants for hearings

Many claimants have had prior negative 

interactions with judges that concluded 

with their incarceration or involuntary 

commitment to a psychiatric hospital. 

Therefore, representatives should explain 

to applicants what to expect. Most hearings 

are held in small conference rooms or 

courtrooms; the judge sits on a bench above 

where the claimant sits. Remind the client 

that ALJs do not have the authority, at the 

hearing, to incarcerate or order medical 

treatment. It is important that clients 

understand this before their hearings, so that 

they feel free to speak candidly about all of 

their mental and physical impairments.

What is the representative’s role 

at the hearing? 

At a hearing, the representative may have 

several responsibilities. A representative 

should be prepared to take any of the 

following actions:

■ Make an opening statement, citing the 

specific reasons why the claimant is 

disabled. The statement should include 

references to the medical and other 

evidence that has been submitted. 

■ Stay quiet while the judge elicits 

information through direct questioning 

of the claimant.

■ Make a closing statement, intended to 

persuade the ALJ with the same type 

of summary given during an opening 

statement. 

■ Question the claimant, and any other 

witnesses, to present the facts that 

should be highlighted. 

What should a representative know 

about testimony? 

In preparing for a hearing, it is important 

to remember that testimony is intended to 

expand on the information in the medical 

records and other evidence. This makes it an 

invaluable part of any case. When preparing 

a claimant or another witness to testify, 

the most important thing is to ensure the 

claimant’s medical limitations are explained 

as well as possible, without exaggerating. If a 

claimant exaggerates, the ALJ may find that 

the testimony is not credible. In such a case, 

the claim may be denied, even if the medical 

records and other evidence arguably could 

support a finding of disability.
62 STEPPING STONES TO RECOVERY

The first witness usually will be the claimant. 

If the claimant is a child, the ALJ may or 

may not ask him or her to testify, depending 

on age and ability to provide relevant 

information. When a child claimant does not 

testify, a parent typically testifies instead.

When questioning the claimant, or any other 

witness, hearing rules are not as strict as 

courtroom rules. However, representatives 

should be careful not to use leading 

questions. For example, a proper question is 

“You have been diagnosed with depression. On 

a day when you are feeling depressed, can you 

describe for me all of the daily activities that 

you perform?” It would be improper to ask, 

“Isn’t it right that on most days, you are stuck 

at home not doing anything because you are 

depressed?” Representatives also should avoid 

questions that result only in “yes” or “no” 

answers.

In most cases, other witnesses will include 

people who know the claimant and see 

the claimant frequently, people who can 

testify about his or her daily activities and 

apparent limitations. However, on rare 

occasions, a representative may want the 

claimant’s doctor or psychiatrist to testify 

at the hearing. Typically, a doctor will write 

a letter; however, if a case is extremely 

complicated, and the doctor is available, it 

may be useful to have him or her testify.

Witnesses are especially useful to corroborate 

key points of the claimant’s testimony. 

However, they must be asked only about 

matters within their knowledge. For example, 

it is improper to ask about how much the 

claimant’s back hurts, since the witness 

cannot have personal knowledge of someone 

else’s back pain and its severity. It would 

be equally improper to ask a doctor to 

corroborate a claimant’s testimony that he or 

she takes two–hour naps each day, since the 

doctor does not see the claimant every day 

and could not specifically corroborate that 

the claimant, in fact, takes naps. However, 

the doctor could testify to whether someone 

with the claimant’s condition might need or 

want to take two–hour naps.

Medical expert testimony

If the judge deems it necessary, a medical 

and/or vocational expert will be present at 

the hearing. The hearing notice will indicate 

whether the judge is asking experts to be at 

the hearing. After the claimant and witnesses 

have testified, the experts will testify. 

The job of the medical expert (ME) is 

to assess all the medical evidence in the 

case file, as well as the testimony of the 

claimant and other witnesses. Based on that 

information, the ME first gives an opinion 

about whether or not the claimant has a 

condition that meets or equals any of the SSA 

listings. If the ME states the claimant meets 

or equals a listing, the ALJ almost always 

will stop the hearing and allow the claim. 

However, because the ALJ is the ultimate 

decision–maker, he or she is not required to 

do so. 

If the ALJ does not accept the opinion of 

the ME that the claimant meets or equal 

a listing, or if the ME’s opinion is that the 

claimant does not meet or equal a listing, the 

ALJ will ask the ME for an opinion about 

the claimant’s residual functional capacity 

(RFC). As discussed in Chapter 5, RFC is the 

claimant’s ability to work in relation to his or 

her previous capacity—for example, it covers 
CHAPTER 7 63

how many hours per work day a claimant 

could sit, stand, or walk. If the ME's opinion 

is that a claimant's RFC is so restrictive that 

he or she is clearly unable to work, the ALJ 

may stop the hearing and make a finding that 

the claimant is disabled. 

However, if the testimony provided does not 

result in an ALJ finding that the claimant 

is disabled, the representative should cross–

examine the ME. In the questioning, the 

representative should review the evidence 

that suggests the claimant is disabled and 

make the ME acknowledge it and explain 

why he or she is not crediting it. It is 

important to refer to both medical records 

and medical opinion letters in the case file. 

It also is critical to ask the ME why he or 

she has determined that the claimant does 

not meet a listing or that the claimant has a 

particular RFC, despite the evidence to the 

contrary. 

Vocational expert testimony 

A vocational expert (VE) provides the 

ALJ with an opinion about whether a 

hypothetical claimant is able to work based 

on his or her knowledge about the effect of 

various vocational factors and functional 

limitations on the ability to perform work. 

The VE bases his or her opinion on the 

RFC provided by the ALJ; the Dictionary of 

Occupational Titles (a Department of Labor 

publication that describes how occupations 

are performed in the national economy); 

other reliable sources of vocational 

information; professional expertise; and 

a variety of non-medical factors such as 

age, education, work history, ability to 

communicate in English, and transferable job 

skills. VEs are necessary particularly when 

a claimant has non-exertional impairments, 

which can make use of the grids more 

subjective.

A VE is questioned in a very specific manner. 

First, the judge will present the VE with one 

or more hypotheticals, based on the age, work 

history, and the documented medical and/or 

vocational impairments of the claimant. For 

example, a judge will ask:

Are there any jobs available in the national 

economy for a 47–year–old male, with an 

RFC of less than a full range of sedentary 

work because he cannot sit for more than 

30 minutes without severe pain, cannot 

stand up for more than 10 minutes without 

having to sit down, cannot walk for more 

than one block before needing to sit down 

and rest, and cannot concentrate for 

more than an hour at a time because of 

depression?” 

If the VE says that a person with those 

limitations cannot perform any jobs, there 

is no need for further questioning, because 

he or she has provided a favorable response 

likely to result in a finding of disability.

However, if the VE says there are jobs 

that the hypothetical individual can do, 

the representative cross–examines the VE. 

This should focus on two things. First, the 

representative needs to ensure that the 

judge’s initial hypothetical included all of the 

claimant’s impairment–related limitations 

and restrictions. If not, the representative 

should ask: “Of the five jobs just mentioned, 

could the claimant still do them if she had

the following additional limitations and 

restrictions?” Then, the representative should 
64 STEPPING STONES TO RECOVERY

list the additional limitations and restrictions 

that were not included in the judge’s original 

instruction. If the VE says that there are 

no jobs that the claimant can do with the 

additional limitations, cross–examination 

should be ended. 

If the representative has added all of the 

claimant’s limitations, and the VE still 

identifies jobs available, the representative 

must try to prove that the claimant cannot 

do the specific jobs listed by the VE. To do 

so, the representative should ask the VE 

to describe the jobs and the skills involved 

with those jobs. The representative should 

question the VE about how someone with 

the claimant’s particular limitations could 

perform the tasks associated with that job. 

In this type of questioning, one important 

factor to consider is the number of 

consecutive hours the claimant is capable of 

sitting, standing, and walking. If a claimant 

cannot perform a job full–time, he or she is 

not able to perform that job. Ultimately, if 

the VE concludes the claimant cannot do any 

jobs, the examination has been a success. 

However, even if the VE does not concede 

this point, the ALJ sometimes will rule for 

the claimant. Since the ALJ has decision–

making authority, a favorable decision can be 

issued, even after a VE states that there are 

jobs that the claimant can do.

Closing the hearing 

At the close of the hearing, the ALJ should 

provide the representative with a brief 

opportunity to make a closing statement. The 

closing statement is a very short summary 

of why the representative believes that the 

claimant is disabled. The representative 

should take advantage of it. 

The only other thing that might occur at the 

close of the hearing is a request for additional 

information or medical tests. This may arise 

because the representative has persuaded the 

judge to hold the record open for a limited 

period while the representative tries to obtain 

an additional specified piece of evidence, or 

because the judge has determined additional 

evidence is necessary. After these requests 

are honored, the hearing will be closed.

How to read and understand the 

ALJ’s decision

Unlike the decisions at the initial and 

reconsideration stages, the ALJ’s decision 

will be lengthy. The decision typically comes 

with a cover page. The top of that cover 

page will read “Fully Favorable,” “Partially 

Favorable,” or “Unfavorable.” An unfavorable 

decision means it has been determined the 

claimant is not disabled.

If the decision for SSI eligibility is fully 

favorable, the claimant’s file will be 

forwarded to the local SSA office; the 

claimant will be asked to come in for a 

new financial eligibility determination. 

The financial eligibility determination is 

important, since it sets the amount of both 

retroactive and ongoing SSI benefits the 

claimant will receive. This will be discussed 

in more detail later.

If the decision is partially favorable or 

unfavorable, it can be appealed to the Appeals 

Council (AC) by filing a Request for Review 

of Hearing Decision/Order (HA–520) or by 

writing a letter to SSA. As with other SSA 

forms, the Request for Review is available 

at www.socialsecurity.gov, and it must be 

filed within 60 days of the date printed 
CHAPTER 7 65

on the OHA hearing decision (the 60 day 

filing period plus the five–day period SSA 

assumes for delivery of the decision). Either 

the Request for Review form or a letter must 

be submitted within the same time frame. 

Whichever method is chosen, it needs to 

state the claimant disagrees with the decision 

and wishes to appeal based on relevant 

information. The form or the letter can be 

filed at the local SSA office, the Appeals 

Council, or the OHA. However, it often is 

most efficient to file it at the local SSA office 

where an applicant has a known contact.

Deciding whether to appeal a partially 

favorable decision

As previously mentioned, partially favorable 

decisions are less common than full approvals 

or denials, but they may occur for a variety 

of reasons. Generally, they involve a finding 

that the applicant’s disability began later 

than the date stated in the application or that 

the applicant’s disability stopped a certain 

period of time after the date of application. 

The question of whether to appeal a partially 

favorable decision depends on how the 

decision is written and the applicant’s 

priorities.

One important consideration when 

considering appeal is that, while rare, a 

partially favorable SSI decision that is 

appealed could become an unfavorable 

decision on appeal. The risk, although 

not high, is real and considerable. Some 

applicants may feel that it is worth accepting 

a partially favorable decision, which 

provides SSI benefits and Medicaid, rather 

than risking a reversal at the time of appeal 

To help evaluate the risk, claimants may 

consider consulting an attorney before 

deciding whether to appeal a partially 

favorable decision. 

When should the Appeals Council 

or Federal Court be used?

The right to file an appeal to the Appeals 

Council (AC) is absolute. The AC looks at 

every request for a review, but grants review 

only where: (1) there appears to be an abuse 

of discretion by the ALJ; (2) there is an 

error of law; or (3) the action, findings, or 

conclusions of the ALJ are not supported 

by substantial evidence. If a claim does not 

meet one of these criteria, the AC will not 

review it.

Because this is a complicated standard, 

case managers should not continue as 

representatives once a claim gets to the 

AC. If a case manager believes that an ALJ 

decision was wrongfully made, he or she 

should help the client file an appeal, and 

then work to find an attorney, or a more 

experienced non–attorney representative, to 

review the claim and determine if there are 

grounds for pursuing the appeal.

When a case reaches the AC, SSA rules 

allow the claimant to file a new application 

for benefits, while still pursuing the appeal. 

This is beneficial for many claimants 

whose conditions may have worsened 

since filing the original application. Filing a 

new application sometimes may result in a 

favorable decision that provides the claimant 

with ongoing benefits, while still permitting 

an appeal in the hope of obtaining 

retroactive benefits.
66 STEPPING STONES TO RECOVERY

If a claim is denied at the AC, an appeal can 

be filed in Federal court. Any Federal court 

appeal must be handled by an attorney. 

Further discussion of Federal court appeals is 

beyond the scope of this manual.

Summary

SSA offers applicants a number of 

opportunities to appeal unfavorable and 

partially favorable decisions. Once an appeal 

is pursued beyond reconsideration, the first 

decision an applicant must make is whether 

to retain an attorney. If an applicant decides 

to hire an attorney, case managers can still 

serve an important role. As the person most 

knowledgeable about the claim (other than 

the applicant), a case manager can help an 

attorney organize a case. He or she can also 

serve as a witness. Additionally, the case 

manager provides ongoing contact with the 

applicant throughout the appeals process.

If an applicant decides not to hire an 

attorney, the case manager can continue 

to serve as the applicant’s representative. 

In this role, the case manager can help 

with everything from filing the request for 

reconsideration to cross–examining witnesses 

during the hearing.

In the event that the applicant still has an 

unfavorable determination after the first 

appeal, he or she can file another appeal with 

the Appeals Council. Again, a case manager 

can be helpful by assisting with filing the 

appeal. However, at this point the case 

manager should strongly recommend to the 

applicant that he or she engage an attorney.
67

What To Do When Benefits 

Are Approved

CHAPTER 8

CHAPTER 8

How will a case manager know a 

determination has been made?

Generally an applicant and his or her 

representative will receive a notice reporting 

a determination decision. Even if a case 

manager calls an SSA representative and 

hears that a claim has been approved, it is 

important to wait for official written approval 

from SSA before telling an applicant. Though 

records available to SSA field office might 

show the application was approved, the 

determination may be pending review by 

SSA quality review staff. If this is the case, 

quality review staff may review the medical 

decision and determine that the decision 

should be changed. Therefore, receipt of an 

official written notice of approval from SSA 

is necessary before informing applicants that 

they will be receiving SSI.

This chapter and the two chapters that follow look at how to assist an applicant to obtain 

benefits promptly once he or she is found disabled. In particular, this chapter covers the posteligibility interview and the payment of retroactive benefits. Since SSDI beneficiaries do not have 

to provide evidence of their income and resources, most of the material in this chapter applies 

only to individuals who receive at least one dollar of SSI. 

What happens after a favorable 

determination? 

After a fully favorable decision has been 

made, the case manager should assist the 

applicant with the steps necessary for him or 

her to begin receiving benefits.

Verifying the onset date of a fully 

favorable decision 

When reviewing a fully favorable decision, 

the first thing case managers should do 

is verify the onset date: the day SSA 

determined the applicant became disabled. 

In a fully favorable SSI decision, this date 

should correspond to the date on which the 

applicant filed his or her claim (the protective 

filing date or date of application). Generally, 

this is a formality. However, in the rare 

case in which the dates do not match, case 

managers need to determine the cause of 

the discrepancy.
68 STEPPING STONES TO RECOVERY

If the onset date is earlier than the date of 

application, the claim could actually be a 

combined SSDI and SSI claim. Alternatively, 

the applicant could have made a prior 

application of which the representative was 

unaware, that was re-opened by the judge 

and took precedence over the more recent 

application. Both of those scenarios are 

good for the applicant, as they may result in 

receiving additional retroactive benefits. 

However, if the onset date listed in a fully 

favorable decision is later than the date of 

application for SSI, then a mistake probably 

has been made somewhere within the ALJ’s 

office. In this situation, the first step is to 

contact the ALJ’s office and to speak with 

the judge’s assistant. The assistant can check 

the judge’s notes to determine what the judge 

intended when making the decision.

If the assistant concludes the judge made a 

clerical error, SSA regulations allow the judge 

to correct the error and issue a new decision. 

The case manager should send a letter for the 

case file requesting that the clerical error be 

corrected. This ensures that the agreement to 

correct the error is documented in writing in 

case there is a future dispute. If the corrected 

decision is not forthcoming, a printed record 

exists of the agreement to issue it.

Determining the date on which the 

applicant is first eligible to receive benefits.

 Under SSI, benefits are payable starting with 

the first day of the month following the onset 

date. So if the SSI onset date is July 2, 2002, 

benefits are payable as of August 1, 2002. 

When the beneficiary will be receiving SSDI, 

however, benefits are payable beginning five 

months later. Thus, with a July 2, 2002, 

onset date, benefits will be paid starting 

January 1, 2003.

Attending an SSA office interview 

Once an applicant has received a favorable 

decision and begins receiving benefits, 

he or she is referred to as the recipient 

instead of the applicant. Before benefits 

can be issued, however, the recipient must 

have an interview at the local SSA office 

to determine how much in retroactive and 

ongoing benefits he or she is eligible to 

receive. This determination is based on the 

person’s income and resources from the date 

of application for SSI through the date of the 

interview, or the date on which all required 

non-medical documents were obtained. The 

interview is used to obtain information from 

the recipient that will enable SSA to make 

the correct calculation.

Preparing for the office interview 

Soon after the applicant receives a fully 

favorable decision, the SSA office sends a 

letter setting up the interview. It is sometimes 

possible to accelerate this process. When a 

recipient receives a fully favorable decision, 

he or she can take the decision to the local 

SSA office. The local office either can 

interview the person right away or set up a 

future appointment.

To prepare for the interview, the recipient 

should get copies of any financial 

information relevant to his or her income 

and resources, dating back to the time when 

the application was filed. For example, he 

or she will need documentation of any 

earned or unearned income, as well as other 

financial records, such as bank statements. 

The recipient also will need to document 

any money that was received. The best 

form of documentation is written records or 

statements from employers or banks. Original 

documents must be brought in. The claims 
CHAPTER 8 69

representative will photocopy them and 

certify the copies with an SSA date stamp 

and signature. If original documents are not 

available, however, a case manager should 

not hesitate to bring copies and explain the 

situation.

This information sometimes is difficult 

for people who are homeless to obtain. It 

is critical for case managers to work with 

recipients who are homeless to get all the 

information that can be collected before 

the interview, to ensure that the recipient 

receives the benefits to which he or she is 

entitled (see Chapter 4 for more details about 

how to document financial eligibility for SSI).

At the interview, the recipient will be asked 

to present the financial information. Case 

managers should attend this interview 

to help recipients with the presentation. 

Ideally, after the recipient provides financial 

documents, the claims representative will 

tell the recipient how much money he or she 

can expect to receive in retroactive benefits, 

if applicable, and in ongoing monthly benefit 

checks. If additional information is needed, 

the claims representative should provide 

the applicant with a written list of all 

information that must be collected.

How can case managers be sure 

that calculations are correct? 

To determine if SSA is awarding the 

correct amount of retroactive and ongoing 

benefits, case managers should gain a 

general idea of the monthly SSI amount by 

using the SSI income/resource and living 

arrangements guidelines provided in the 

SSA handbook. However, these amounts 

are subject to change due to annual cost 

of living increase adjustments, as well as 

to the living arrangements, resources, and 

monthly income (earned and unearned) of 

the applicant. 

Calculating the correct amount of 

retroactive benefits

The calculation of retroactive benefits can be 

performed with the following information: 

■ Onset date (or protective filing date);

■ Type of living arrangement;

■ Type of income and resources; 

■ Maximum monthly SSI benefit for each 

year since the onset date; and

■ Amount of any deductions from the 

maximum benefit, for any month since 

the onset date.

A Model Letter to an ALJ’s Assistant

Thank you for discussing the case of Mr. Smith with me yesterday. As we determined 

during that conversation, the onset date listed in Mr. Smith’s fully favorable decision is 

incorrect. You informed me that this problem was due to a clerical error in your office. 

To resolve this matter, you agreed to issue a new decision, containing the correct onset 

date (provide date). I look forward to receiving this new decision shortly. 
70 STEPPING STONES TO RECOVERY

For example, if a recipient, living alone, 

applied for SSI in January 2002 and received 

a fully favorable decision at the appeal level 

in March 2003, the recipient would be 

eligible for benefits beginning in February 

2002. SSI benefits are payable beginning the 

first day of the month following the month 

of application, if all other non-medical 

requirements are met. Retroactive benefits 

would change if, from the date of application, 

the recipient had a friend give her $100 every 

month to assist with the rental expense, and 

that friend was only going to give her $50 

per month after she began receiving her 

SSI checks. Retroactive benefits would be 

calculated as follows: 

■ For 2002, the maximum monthly SSI 

benefit was $545. For each month 

in 2002 during which the recipient 

received $100 in cash from a third party, 

this cash would be deducted from the 

maximum monthly benefit, minus the 

monthly unearned income disregard of 

$20. Therefore, a total of $80 per month 

would be deducted from the maximum 

monthly benefit. This amount would be 

multiplied by 11, the number of months 

in 2002 during which the recipient was 

eligible for SSI. Doing this calculation 

provides the amount of retroactive 

benefits due to the recipient for all of 

2002. Here is the math:

 • Monthly SSI benefit in 2002 = $545 

 • Deduct $100 monthly unearned 

income from friend = $445

 • Add $20 income disregard = $465 

benefits due per month

 • Multiply by number of months 

benefits due= $465 × 11 = $5,115

 • Total retroactive benefits due for 

2002= $5,115

■ For 2003, the maximum monthly benefit 

was $552; the number of eligible months 

would be five, if the recipient is to be 

paid through the end of May. 1 So, the 

math would be as follows:

 • Monthly SSI benefit in 2003 = $552 

 • Deduct $100 monthly unearned 

income from friend = $452

 • Add $20 income disregard = $472 

benefits due per month

 • Multiply by number of months 

benefits due = $472 × 5 = $2,360

 • Total retroactive benefits due for 

2003= $2,360

■ The total amount of retroactive benefits 

due would be $5,115 + 2,360 = $7,475.

Calculating the correct amount 

of ongoing benefits

Ongoing benefits are calculated in much 

the same way. Under the above example, 

the maximum monthly SSI benefit for 2003 

was $552. The recipient is getting $50 in 

cash per month from a friend. There is a $20 

1 While the example states that a favorable decision was received in March 2003, it is assumed that SSA will take several months to process the retroactive 

payment. Therefore, the months of April and May are included in the retroactive payment calculation.
CHAPTER 8 71

unearned income disregard. Therefore, 

the recipient’s monthly benefit would be 

($552 – ($50-$20)) = $552 – $30 = $522. 2

How are retroactive benefits paid?

Retroactive payments are made through 

lump–sum checks. Payment is made in 

one, two, or three installments, depending 

on the amount due. The rule of thumb 

is that benefits less than 12 times the 

Federal Benefit Rate (FBR) plus any State 

supplement are paid in a single installment, 

as soon as an applicant is found disabled 

and determined to be financially eligible 

for SSI. Benefits between 12 and 24 times 

this amount are paid in two installments, 

with the first installment being 12 times the 

FBR plus State supplement, and the second 

installment for the balance. That check is 

issued six months after the first one. Benefits 

over 24 times this amount are paid in three 

installments. The first two installments are 

each in the amount of 12 times the FBR plus 

supplement; the third installment covers the 

balance. A third installment, if necessary, 

would be made six months after the second 

payment. All remaining benefits are paid in 

the third installment.

Several exceptions are made to the rule on 

installment payments. First, installment 

payments do not apply if a recipient has 

a medical impairment expected to result 

in death within twelve months or if the 

recipient is ineligible for SSI benefits and 

is expected to remain ineligible for the next 

twelve months. Under such circumstances, 

recipients receive all benefits in a single 

lump–sum check. Second, the amount of any 

installment payment can be increased by the 

amount of an applicant’s total “outstanding 

debt for food, clothing, shelter, or medically 

necessary services, supplies or equipment, 

or medicine.” Third, the amount of an 

installment payment can be increased by 

“current or anticipated expenses in the near 

future for medically necessary services, 

supplies or equipment, or medicine, or for the 

purchase of a home.” 3

Many people who are homeless have debts 

for food, clothing, shelter, medical care, 

and/or medicine. When meeting with 

applicants who have been found disabled, 

case managers should get information about 

any of these kinds of debts. If the applicant 

is to receive retroactive benefits in more than 

one installment, the case manager can have 

the initial installment raised by the amount 

of the debts by presenting this information 

to SSA. This could eliminate the need for a 

second installment.

When a claimant is entitled to both SSDI and 

SSI benefits, SSA utilizes a windfall offset 

provision to ensure that the claimant receives 

the correct amount of retroactive benefits. 

For example, if a claimant is entitled to $220 

per month in SSDI, $200 would be counted 

and that claimant would be entitled to only 

$352 per month in SSI (for calendar year 

2003). This would bring the claimant up to 

the Federal Benefit Rate for 2003 of $552. 

2 This example would not apply in all situations involving unearned income. In the example above, if the friend paid the $50 directly to the landlord, or if 

“deemers” were involved (see Chapter 4), the calculation would be different.

3 20 C.F.R. 416.545.
72 STEPPING STONES TO RECOVERY

The claimant would not be allowed to collect 

a “windfall” by receiving a full monthly SSI 

payment of $552 plus the $220 in SSDI, for a 

total of $772.

If the payment appears to be too low 

Before SSA sends out a retroactive benefits 

check or begins to make ongoing monthly 

payments, a notice is mailed to the recipient 

and to that person’s representative, 

explaining how retroactive and ongoing 

benefits totals were calculated. Sometimes, 

the case manager’s calculation of the 

retroactive and/or ongoing benefits due is 

higher than the amount that SSA asserts 

is due. In such a situation, case managers 

should understand that this SSA notice can 

be appealed within 60 days of receipt by the 

recipient or his or her representative.

The best way to handle such a situation is to 

schedule another interview appointment for 

the recipient at the local SSA office. The case 

manager should attend that appointment, 

at which he or she should request an 

explanation of retroactive or ongoing benefits 

calculations. If the case manager can show 

SSA staff that an error was made, the benefit 

will be recalculated to determine if more 

money is due the applicant. 

The representative should be aware that 

asking for a recalculation could result in a 

decrease in monthly SSI benefits. SSA has a 

right to correct the error even though it may 

adversely affect the recipient. However, the 

recipient has the right to request an appeal 

and/or file a waiver on the overpayment. 

If SSA does not believe an error was 

made, but the recipient and case manager 

continue to believe otherwise, the Request 

for Reconsideration form, as discussed 

in Chapter 7, should be completed and 

submitted to the local SSA office within 

60 days of the decision. When filing for 

reconsideration over a financial issue, 

the recipient is entitled to ask for a 

formal meeting at the local SSA office. 

Requesting this type of meeting is strongly 

recommended. At the meeting, the recipient 

should be prepared to bring any papers or 

other evidence showing that he or she may 

be entitled to additional benefits. If the 

reconsideration decision is not favorable, the 

An Example of a Retroactive Benefit Payment

Suppose that the Federal Benefit Rate for all retroactive months is $552, and the 

State supplement is $48, for a total of $600. A check for up to $7200 (i.e., $600 × 

12) would be paid immediately in one installment. A check for an amount between 

$7,200 and $14,400 would be paid in two installments—one for $7,200, and another 

six months later, for the balance. A check for more than $14,400 would be paid in 

three installments—two installments of $7,200 (separated by six months) and a final 

installment six months after the second, which would contain the balance due.
CHAPTER 8 73

recipient can appeal to an ALJ, then to the 

SSA Appeals Council and, finally to Federal 

court, just as in a case where the issue is 

proving disability.

If the payment appears to be too high 

At times, a case manager’s calculation of 

the retroactive benefits due may be lower 

than the amount that SSA states is owed to 

the recipient. If the case manager believes 

SSA has overstated the payment due the 

recipient, the case manager should discuss 

the situation immediately with the recipient. 

An overpayment is not a windfall that can 

be kept by the recipient without penalty. The 

case manager should advise the recipient 

to make arrangements to rectify the award. 

These funds frequently are reclaimed by SSA, 

and the recipient will need to be prepared to 

return the funds. More information about 

overpayment is discussed in Chapter 10.

How should retroactive benefits 

be spent?

The SSI resource limit is $2,000 for an 

individual and $3,000 for a couple. Once 

retroactive benefit checks are received from 

SSA, the cash received is not counted as 

a resource for the first nine months. To 

qualify for this exception, however, the 

funds must be kept separate from other 

money. Practically, this means that spending 

money from a retroactive SSI check should 

be tracked separately from other funds. The 

recipient should keep a complete, detailed 

record of when, where, and on what the 

money was spent.

Having unspent retroactive benefits after 

nine months should not be a problem for 

a person who is homeless, since he or she 

is likely to need items like food, clothing, 

and shelter—all of which can be expensive. 

Additionally, these funds can be spent 

on household goods and other personal 

items. Under SSA regulations, household 

goods worth up to $2,000 are excluded 

as resources, and in practice, SSA rarely 

verifies the worth of household goods. 

Also, retroactive benefits can be used to 

purchase an excluded resource, such as a car. 

Retroactive benefits can be spent on all of 

these things, and on many other things, in 

order to bring a bank account balance below 

the SSI resource limit.

Case managers should be aware that when 

funds are used to rent an apartment, they 

also can be used to prepay rent for months 

in advance. While most landlords require 

only a month’s rent plus a security deposit, 

typically landlords are more than happy to 

accept prepaid rent for additional months. 

Prepaying rent can reduce the amount of 

assets a person has to put him or her under 

the resource limits. 

Whenever retroactive benefits are 

deposited, transferred, or spent, receipts 

should be kept to show SSA how funds 

were moved or disposed, if ever required. 

Case managers should work with recipients 

to make sure they can account for the use 

of retroactive payments to ensure that 

monthly benefit payments are not cut 

off due to excess resources. For more 

information about income and resource 

rules, including transfers and exclusions, 

refer back to Chapter 4.
74 STEPPING STONES TO RECOVERY

Summary

Even after applicants are informed that 

their disability claims are approved, case 

managers still play a major role. The 

interview subsequent to the approval notice 

will determine how much money recipients 

are paid in retroactive and ongoing benefits. 

It is a crucial process during which case 

managers can be of assistance to recipients. 

Case managers can help obtain and organize 

financial documents, as well as work with 

the recipient and the claims representative to 

ensure all calculations are done correctly. 
75

Representative Payees

CHAPTER 9

CHAPTER 9

What is a representative payee?

A representative payee is an individual, 

agency, organization, or institution that SSA 

selects to receive and manage benefits on 

behalf of an incapable or legally incompetent 

beneficiary. When evidence suggests a 

beneficiary is unable to manage or direct 

management of benefit payments in his 

or her own best interests, representative 

payment may be made. SSA assumes that all 

adult beneficiaries have the right to manage 

their own benefit payments. However, if 

it is determined that a person is in need 

of a representative payee, the person or 

organization best suited to serve as the payee 

is selected.

When does SSA appoint a 

representative payee? 

SSA appoints a representative payee when 

the Agency determines that a beneficiary 

is unable to manage or direct someone else 

in the management of his or her benefit 

payments. SSA regulations state that a 

representative payee is required when a 

beneficiary is: (1) a minor child under 

age 15; (2) a legally incompetent adult; 

or (3) mentally or physically incapable of 

managing benefit payments or directing the 

management of his or her benefits.

Legal incompetence

Legal incompetence can be determined 

only by a court after a judicial proceeding; 

it cannot be determined by SSA. The 

This chapter explores several important provisions regarding representative payees, including 

when a representative payee is needed, how a payee is selected, the responsibilities of a payee, 

and how payees can be changed. It also provides information about when and how a person 

can begin to receive his or her own benefits. Much of this chapter was abstracted from the

 SSA Handbook, which provides guidance about these and many other issues related to 

representative payees. 1 

1 The Handbook can be found at: www.socialsecurity.gov/OP_Home/handbook/handbook.16/handbook-toc16.html. 
76 STEPPING STONES TO RECOVERY

determination that a person is legally 

incompetent results in the court’s 

appointment of a guardian. SSA relies on 

the decision of the court and appoints a 

representative payee for any beneficiary who 

has been declared legally incompetent—

even if the beneficiary was managing his 

or her benefits successfully. Of course, 

circumstances may change and the court 

subsequently may re-assess competence and 

find the beneficiary competent. In that case, 

as explained later in this chapter, SSA may 

resume direct payment.

Mental and physical incapability

Unless a court has determined a recipient 

is incompetent to manage SSI payments, 

mental and physical incapability is 

determined by SSA based on medical 

evidence, SSA’s own observations of the 

beneficiary's behavior, and statements 

from relatives, friends, and others who 

have known and observed the beneficiary. 

If a case manager believes that a client 

is mentally or physically not capable of 

managing or directing the management of 

his or her own benefit, he or she should 

notify SSA, so that SSA can determine 

incapability and consider appointing a 

representative payee. 

Not every applicant who is found disabled 

due to a mental impairment requires a 

representative payee. A payee is necessary 

only if a beneficiary is found unable to 

use money in his or her own best interest. 

Typically, this is limited to people unable to 

manage or direct someone else to manage 

their money due to delusions, impulse 

control problems, or recent histories of drug 

or alcohol abuse. However, if the beneficiary 

continually has been managing benefits 

successfully, SSA has the option to allow the 

beneficiary to continue to receive the benefit 

check directly.

What are the responsibilities of 

representative payees? 

The responsibilities of a representative 

payee are to: 

■ Determine the beneficiary’s current 

financial needs and save the remainder 

for the beneficiary's future use; 

■ Apply the benefit payments only for the 

beneficiary’s use and welfare; 

■ Maintain a continuing awareness of the 

beneficiary’s needs and condition; 

■ Notify SSA of any change in the 

payee’s circumstances that would 

affect performance of the payee 

responsibilities; 

■ Report any event that would affect 

the amount of benefits the beneficiary 

receives or the right of the beneficiary to 

receive benefits from SSA; and 

■ Report on the use of the benefits, 

when requested to do so, and make all 

supporting records available for review, 

if requested by SSA. 

Funds received on behalf of the beneficiary 

should be maintained separately from all 

other funds in the possession of the payee, 

including his or her own money. Any 

money deposited in a bank should be kept 

in a separate account and titled to show the 

beneficiary’s ownership of the account.

Responsibilities of representative payees 

are limited to managing the Social Security 

benefits received by the beneficiary. 
CHAPTER 9 77

Designation as a representative payee 

does not confer any other legal rights or 

responsibilities.

If a payee fails to carry out his or her duties, 

or if there is an abuse of the authority vested 

in him or her, SSA may reach a decision that 

the payee no longer is entitled to serve in that 

role.

What expenditures does SSA 

deem appropriate?

A representative payee must apply the 

payments for the use and benefit of the 

entitled individual. Social Security and/or 

SSI benefits are properly disbursed if they 

are: 

■ Spent for the beneficiary’s current and 

reasonably foreseeable needs; or 

■ Saved or invested for the beneficiary, 

after current needs have been met.

Current needs are defined as shelter, food, 

clothing, utilities, medical care and insurance, 

dental care, personal hygiene, education, 

and the rehabilitation expenses of disabled 

beneficiaries. Representative payees also may 

use funds to pay the beneficiary’s pre-existing 

debts, but only after all current needs have 

been met. Any additional funds should be 

invested or saved. Preferred investments are 

U.S. Savings bonds, or interest bearing bank 

accounts. Investments such as stocks and 

other types of bonds are discouraged. 

All invested funds must be monitored to 

ensure that the beneficiary’s income or assets 

do not exceed the SSI income or resource 

guidelines. If it becomes necessary to take 

action to reduce the assets of an SSI recipient, 

case managers should refer to Chapter 4 for 

guidelines regarding asset expenditure.

How does a payee account for 

benefit payments? 

SSA sends a Representative Payee Report 

form to each payee once a year asking:

■ The amount of benefit payments on 

hand at the beginning of the accounting 

period plus that received during the 

period;

■ How the benefit payments were used;

■ How much of the benefit payments 

were saved and how the savings were 

invested;

■ Where the beneficiary lived during the 

accounting period; and

■ The amount of the beneficiary’s 

income from other sources during the 

accounting period.2

A payee must submit this information in a 

timely manner or provide a good reason for 

not doing so.

If a case manager believes a representative 

payee is not acting in the best interests of 

a beneficiary, he or she should report it to 

SSA. This information can provide the basis 

for SSA to ask for such an accounting or to 

decide whether to change payees.

2 20 C.F.R. 416.665.
78 STEPPING STONES TO RECOVERY

Who can be a representative payee? 

In selecting a representative payee, SSA looks 

for the “person, agency, organization, or 

institution that will best serve the interest 

of the beneficiary.” When choosing a payee, 

SSA considers the:

■ Prospective payee’s relationship with the 

beneficiary; 

■ Amount of interest the payee has shown 

in the beneficiary; 

■ Any legal authority that the payee may 

have over the beneficiary; 

■ Whether the payee has custody of the 

beneficiary; and 

■ Whether the payee is in a position 

to understand and look after the 

beneficiary’s needs.

In most cases, the order of preference in 

selecting a payee for a beneficiary, age 18 or 

over, is— 

■ A spouse, parent, other relative, or 

legal guardian who has custody of the 

beneficiary, or who shows a strong 

concern for the personal welfare of the 

beneficiary; 

■ A friend who has custody of the 

beneficiary; 

■ A public or nonprofit agency or 

institution, Federal institution, or 

a statutory guardian or voluntary 

conservator that has custody; 

■ A private institution operated for profit 

and licensed under State law that has 

custody of the beneficiary; 

■ People other than the above who can 

carry out the responsibilities of a payee 

and who are able and willing to serve as 

a payee for a beneficiary (e.g., members 

of community groups or organizations 

who volunteer to serve as a payee for a 

beneficiary); 

■ A friend without custody, but who 

demonstrates a strong concern for the 

personal welfare of the beneficiary; or

■ An organization that charges a fee for its 

service.

SSA uses the preference list as a guide 

and is not required to follow this order of 

preference, if doing so would not serve the 

beneficiary's best interest.

In some cases, a beneficiary may ask that 

SSA appoint as representative payee, a 

friend, family member, or guardian who 

is not necessarily the best choice. A case 

manager is in a unique position to identify 

this potential misstep since he or she often 

knows the client best. The case manager 

should suggest to both the applicant and SSA 

alternative people or agencies to serve as the 

representative payee. If the case manager 

has completed a SSA–1696 Appointment of 

Representative form, this recommendation 

can be made to SSA (if absolutely necessary) 

without the client’s permission. This 

should occur only in situations when the 

case manager feels the client’s funds will be 

misused by the representative he or she has 

named.

In light of SSA’s stated preferences, case 

managers and the organizations they 

represent effectively are the payees of last 

resort. If a beneficiary does not have a family 

member or friend to serve as a payee, and 

the beneficiary is not in the custody of an 

institution that can be his or her payee, then 

a case manager or other homeless program 

staff person may apply to serve in that role. 
CHAPTER 9 79

What rights does a beneficiary 

have?

Beneficiaries have formal appeal rights in 

a number of areas related to representative 

payees, including the right to appeal the 

decision to appoint a payee; the right to 

appeal the payee selection; and the right to 

appeal with respect to a misuse of benefits 

determination.

Challenging the decision to require 

a representative payee 

It is not unusual for a beneficiary determined 

to be in need of a representative payee 

to object to that requirement. Several 

approaches can be taken to challenge a 

decision:

■ Challenges at the time the decision 

is made. When SSA determines a 

representative payee is necessary, they 

are required to notify the beneficiary 

before effectuating the decision. In the 

notice, SSA will state the intention to 

appoint a representative payee. 

A beneficiary may object to this proposed 

decision by contacting SSA. SSA must 

provide access to the evidence used to 

determine that a payee is necessary. SSA 

must allow the beneficiary to submit 

additional evidence to refute the evidence 

and/or affect the decision. 

■ Challenges after the decision is made. A 

beneficiary receiving benefits through a 

representative payee may challenge that 

decision at any time by submitting to 

SSA information that shows he or she is 

able to manage benefits alone. The most 

useful evidence is a treating physician’s 

statement or completion of the SSA–787 

form by the treating physician. SSA 

considers the medical evidence and 

makes a decision based on that evidence, 

along with any evidence it develops from 

non-medical services.

If a person previously has been judged 

legally incompetent by the court, he or 

she must submit a certified copy of the 

court order restoring his or her rights. 

Once that documentation is received, 

SSA may resume direct payment to the 

beneficiary, unless evidence suggests 

that the beneficiary remains mentally 

or physically incapable of managing his 

or her own benefits. If SSA denies the 

beneficiary’s request to resume direct 

payments, the beneficiary may file a 

Request for Reconsideration and proceed 

through the SSA appeals process.

Changing representative payees 

If a beneficiary believes a payee is not 

complying with legal obligations, SSA 

should be notified and will investigate the 

allegations. If necessary, SSA will process a 

payee application from another person, as 

long as the new applicant being suggested is 

suitable to serve as payee. In addition, the 

beneficiary, or a case manager working with 

a beneficiary, should provide SSA with any 

evidence they have uncovered that the payee 

has not complied with the rules. If SSA finds 

the evidence credible, in addition to selecting 

a new payee, SSA will note the information 

on the original payee’s record so he or she 

cannot become a representative for other 

beneficiaries.
80 STEPPING STONES TO RECOVERY

Misuse of benefits 

SSA is required to reissue benefits to 

beneficiaries whose funds have been misused 

by organizational representative payees 

or by an individual serving 15 or more 

beneficiaries. SSA then seeks to recover the 

misused funds from the payee. Reissued 

benefits are excluded from SSI resource 

determinations. This is effective for misuse 

determinations made by SSA on or after 

January 1, 1995. 

Requests for Reconsideration 

If SSA assigns a representative payee or 

does not agree to change a representative 

payee, the beneficiary may file a Request for 

Reconsideration. If the beneficiary continues 

to be dissatisfied, he or she may follow 

the regular SSA appeals process described 

in Chapter 7. Case managers can assist 

beneficiaries by serving as a representative 

and helping to appeal a decision.

While a representative payee is in charge of 

managing a beneficiary’s funds, he or she has 

no jurisdiction over when or if a beneficiary 

can file an appeal unless the individual is 

also a court–appointed legal guardian. This 

ensures that representative payees cannot 

prevent beneficiaries from enforcing their 

rights under SSA regulations.

What do case managers need 

to consider before becoming 

representative payees?

A case manager can take a number of 

different roles with respect to representative 

payees. The most obvious is to be the 

representative payee. It is important to note 

that it is not the individual case manager, 

but the case manager’s organization, that 

becomes the representative payee. Besides 

taking on this role, case managers also can 

be active in educating family members 

or friends who are representative payees, 

monitoring payees to ensure that they are 

acting on the beneficiaries’ best interest, and 

helping beneficiaries meet the requirements 

necessary to regain responsibility for 

managing their own benefits.

Becoming a representative payee

While a case manager may not be SSA’s 

first choice for a representative payee, case 

managers are often asked by SSA, by the 

recipient, or by friends or family to take on 

this role. No matter how the issue comes up, 

case managers should be aware of what may 

be involved. 

■ Being a representative payee can 

be challenging. It usually is time–

consuming, and it can be difficult to 

assist a beneficiary when he or she does 

not believe that the funds are being used 

according to his or her preferences.

■ Being a representative payee changes the 

relationship with a client. Being in a 

position of managing someone’s money 

requires skill, sensitivity, respect, 

and empathy. It also infuses the case 

manager/client relationship with a 

level of power and control beyond what 

commonly may exist. Case managers 

must be respectful of that change, and 

clients must be very trusting to initiate it 

without resentment.

■ Case managers can provide critical 

assistance. Case managers willing to 

serve as a representative payee can 

ensure that their clients receive the 
CHAPTER 9 81

proper benefit amount, and that those 

benefits are managed appropriately. 

■ Nonprofit representative payees can 

be compensated. If an organization 

is community–based, a tax exempt 

501(c)(3) agency, bonded and licensed 

in the State, and regularly provides 

representative payee services to at least 

five beneficiaries, SSA may authorize 

to charge a monthly fee of up to $32 

($61 for a beneficiary with a substance 

use disorder), or up to 10 percent of the 

beneficiary’s benefits, whichever is less.3

However, the organization must not be a 

creditor of the beneficiary. Procedurally, 

organizations seeking to collect fees for 

serving as a representative payee must 

provide SSA with a written request. 

Along with the request, the organization 

must provide evidence to show that it 

meets the above criteria. Fees cannot be 

collected until SSA approves the request 

in writing. 

In light of the pros and cons presented by 

the situation, case managers must make 

informed decisions every time the possibility 

of becoming a representative payee arises.

Educating others to be 

representative payees 

Frequently, case managers work with family 

members and friends of the people they are 

helping. When someone else is serving as 

a representative payee, the case manager 

should help ensure that the person is aware 

of how to act effectively as a payee. In 

particular, the person should know the duties 

of a payee. Case managers always can direct 

others to the SSA Web site or can give them 

sections of this manual.

Monitoring payees 

Occasionally, case managers may suspect an 

existing payee is not acting in a beneficiary’s 

best interest. If this situation arises, case 

managers should contact SSA and explain 

their concerns. To the extent possible, if 

there is evidence of mismanagement, the case 

manager should forward that evidence to SSA.

Educating beneficiaries 

Case managers can help clients by teaching 

them money management skills. In this way, 

clients who previously have been poor money 

managers ultimately may be able to receive 

their benefit directly. Periodically, case 

managers may assess a beneficiary’s money 

management skills and provide evidence to 

SSA of the beneficiary’s capacity to receive 

and manage checks when, and if, those skills 

are mastered.

Summary

Sometimes beneficiaries are unable to 

manage the funds that are received from 

Social Security because of mental or 

physical limitations. When that situation 

occurs, SSA appoints a representative 

payee. Case managers can be helpful in 

many ways, including providing evidence 

to SSA that either confirms or refutes the 

need for a representative payee, serving as a 

representative payee when no other person 

or organization is available, monitoring or 

assisting representative payees to ensure 

that they meet the rules and requirements of 

the position, and helping beneficiaries learn 

the money management skills necessary to 

eliminate the need for a representative payee.

3 The fees are re-determined each December based on the annual Cost of Living Adjustment.
82 STEPPING STONES TO RECOVERY
83

Maintaining Eligibility

CHAPTER 10

CHAPTER 10

How do living arrangements 

affect ongoing eligibility?

Several common living arrangements can 

result in a reduction or loss of SSI benefits. 

Case managers should be aware of them 

and should advise beneficiaries about those 

issues.

Homeless shelters

Residents of emergency public homeless 

shelters are eligible for SSI, but only for six 

out of every nine months during which they 

reside in the shelter. Residents of homeless 

shelters may be affected by this rule, but it 

is very specific and may not apply, in most 

cases, for two reasons.

For a month to be counted against this limit 

the recipient must live in the shelter for the 

entire month. If a recipient does not live 

in the shelter for even one day, the month 

This chapter provides tips on how to maintain benefits for applicants who are found to be 

disabled. Specific topics include how living arrangements affect SSI benefit levels, issues related to 

suspensions and terminations, what to do about overpayments, and information about SSI and 

SSDI work incentives. 

does not “count against” the six–month time 

limit. Many people who are homeless are 

frequently in and out of public emergency 

shelters. Very few stay in a shelter for six full 

months. 

The definition of a public emergency 

shelter is very specific. It only covers 

shelters operated by Federal, State, or local 

governments that are intended to provide 

temporary places for people who are 

homeless to stay. Shelters sponsored by nonprofit organizations, even ones that receive 

government funds, are excluded from the 

definition and not subject to the cap. 

While few people are affected by this 

requirement, case managers should be aware 

that certain long–term emergency shelter 

residents could have their SSI eligibility 

suspended due to this rule.
84 STEPPING STONES TO RECOVERY

Receiving assistance from friends 

or family members 

Beneficiaries living “doubled up” in a friend's 

or family member’s home or receiving 

in–kind assistance from friends, family, or 

social service agencies must comply with 

SSA’s rules regarding living arrangements. 

SSI recipients need to be aware that certain 

types of living arrangements may result in a 

reduction in benefit amounts. Case managers 

can assist recipients in an inquiry regarding 

living arrangements and benefits. For a more 

in–depth discussion of this, see Chapter 4. 

SSA rules state that a recipient who lives 

in the house of another person for a full 

calendar month and receives both food and 

shelter from that person will have his or 

her benefits reduced by exactly one–third of 

the full Federal Benefit Rate, regardless of 

the amount of food and shelter assistance 

received. This is done under the value of 

one–third reduction rule (VTR). For example, 

a recipient who lives with his or her parents 

and does not pay for rent or food is subject to 

this rule. Under the rule, instead of receiving 

the 2005 Federal Benefit Rate of $579, the 

monthly check would be reduced by $579 / 3, 

or $193—making the total payment $386.

Recipients who live by themselves and 

receive in–kind assistance from third parties, 

or who live in the house of another person 

and receive either food or shelter (but not 

both) from that person, are subject to a 

reduction in benefits under the presumed 

maximum value rule (PMV). The rule creates 

a presumption that the assistance provided is 

at least equal to the total of one–third of the 

Federal Benefit Rate plus $20. 

Recipients cannot circumvent the PMV by 

renting a property from a friend or relative 

for less than fair market value. For example, 

a person may rent a one bedroom apartment 

for $200 from his or her parent when 

similar apartments rent for $500. Under this 

scenario, the $300 difference between the 

$200 actual rent and $500 fair market rent 

will result in a reduction in benefits under 

the PMV.

The PMV is rebuttable. For example, if an 

SSI recipient can submit documentation that 

shelter assistance actually is only worth $75, 

then his or her monthly SSI payment will 

only be reduced by that amount. 

Avoiding benefit reductions

To avoid the one–third reduction rule, the 

beneficiary should pay a pro-rata share of 

household expenses. A pro-rata share is 

calculated by dividing the average monthly 

household expenses (food, rent, mortgage, 

gas, property taxes, and other utilities) by 

the number of people in the household—

including children. If the SSI recipient 

is paying a pro-rata share of household 

expenses, his or her benefits will not be 

reduced. 

As long as the recipient is paying a prorata share of household expenses, a third 

party can provide assistance to the recipient 

without jeopardizing his or her benefit. The 

only stipulation is that the assistance cannot 

be used for food or shelter. If the recipient’s 

friend pays an outstanding debt or purchases 

an item on the beneficiary’s behalf, it will 
CHAPTER 10 85

not be subject to the PMV or the VTR. 

Medical bills are an excellent example of an 

in–kind payment that can be made without 

penalty on behalf of a recipient.

Other rules about in–kind support and 

maintenance (ISM) involve the person to 

whom payments are made. For example, if 

someone pays rent for a recipient directly 

to a landlord, it counts as in–kind support 

and can result in a benefit reduction no 

greater than one–third of the FBR (less than 

$200). However, if that same person gave the 

recipient the rent money each month, and let 

the recipient pay it directly to the landlord, it 

would count as unearned income. Unearned 

income results in a dollar–for–dollar 

reduction in the SSI grant, after the $20 

monthly earned income disregard. Therefore 

$400 for a rent payment, if given to the 

beneficiary to transfer, results in a $380 

benefit reduction.

Because living arrangements can affect a 

recipient’s monthly SSI benefit significantly, 

any changes should be reported to 

SSA immediately. When changes are 

reported, they should be accompanied by 

documentation. For example, if a recipient 

moves to a new apartment with a different 

rent expense, he or she should provide SSA 

with a copy of the new lease, which shows 

the new rent expense. If a recipient moves in 

with a friend or family member and agrees to 

pay rent, the recipient should have a written 

agreement signed by both the recipient and 

the person receiving the money. A copy of 

the signed agreement should be submitted 

to SSA.

When are benefits suspended 

or terminated?

SSI benefits can be suspended or terminated 

for a variety of reasons. This section 

discusses the scenarios that can lead to 

suspensions or terminations and suggest 

ways to avoid or fix them.

As a general rule, SSI benefits are suspended 

when a recipient no longer meets eligibility 

requirements (other than the requirement 

that a recipient be aged, blind, or disabled). 

To have a suspension lifted, a recipient does 

not have to file a new application. Rather, the 

individual is required to submit evidence that 

he or she once again meets the non-medical 

eligibility requirements. 

When a suspension is lifted, benefits are 

resumed effective the first day the eligibility 

rules are met. This date could be earlier than 

the date on which evidence is submitted. 

For example, suppose a recipient had excess 

resources in the month of March and her 

benefits were suspended. As soon as the 

recipient became aware of the problem, 

her case manager helped to manage the 

resources so she was back under the resource 

limit by April 1. She immediately requested 

reinstatement as of April 1. However, she 

had to wait until mid-May to get her bank 

statement, so she could not file evidence of 

meeting requirements until June 1. In this 

situation, the recipient would be eligible to 

receive retroactive benefits for the months of 

April and May.
86 STEPPING STONES TO RECOVERY

After twelve consecutive months of 

suspension, benefits are terminated. Benefit 

termination becomes effective on the first 

day of the thirteenth month. Once benefits 

are terminated, a new application must be 

filed to receive SSI again, necessitating a 

new disability determination. This makes 

it important for case managers to work 

closely with SSI recipients who report benefit 

suspensions to ensure that the suspension is 

resolved, if resolution is appropriate, before it 

becomes a termination.

Suspension for failure to provide 

necessary information 

When a recipient fails to provide requested 

information, benefits may be suspended. 

This type of suspension can be resolved by 

providing SSA the information requested. 

Once this is done, benefits can be restored 

immediately. Retroactive benefits, if 

applicable, can be paid for any portion of the 

suspension period where the recipient can 

document that he or she was eligible.

Suspension due to excess income 

or resources 

Benefits will be suspended beginning the 

first day of the month in which countable 

income is greater than or equal to the amount 

to be paid in benefits, or the month in which 

resources exceed the resource limit. For a 

suspension due to excess income, benefits 

are resumed the first month countable 

income is less than the benefit amount. 

For a suspension due to excess resources, 

benefits will be restarted on the first day of 

the month following the month in which the 

recipient’s resources are under the limit. So, 

if a recipient reduces his or her resources in 

March, he or she can begin to receive benefits 

again in April.

Suspension due to residence in 

a public institution

Benefits are suspended on the first full 

calendar month in which a recipient is 

residing in a public institution (e.g., jail, 

public residential treatment program). If 

the recipient is not in the public institution 

for even one day of the month, benefits 

are not suspended for that month. Benefits 

are resumed effective in the month that 

a recipient no longer lives in the public 

institution.

Suspension due to hospitalization 

While residents of public institutions 

generally are not eligible for benefits, 

an exception is made for those who are 

hospitalized. If a recipient is in a medical 

treatment facility for a full calendar month, 

benefits are reduced to $30. However, in 

1987, the Social Security Act was amended 

to provide recipients who are temporarily 

hospitalized (and who otherwise would have 

received a reduced benefit or none at all) to 

receive uninterrupted benefits during the 

first three full months of hospitalization. 

This is to enable the beneficiary to pay some 

or all of the expenses necessary to maintain 

his or her living arrangement. In this way, 

the beneficiary does not lose housing because 

of a need for medical care. Benefits paid 

under this section of law are referred to as 

temporary institutionalization (TI) benefits.
CHAPTER 10 87

Suspension due to loss of status 

as an eligible alien

If a recipient loses eligible alien status, 

benefits are suspended effective on the first 

day of the month after the recipient last has 

an eligible immigration status. Benefits can 

be resumed as of the specific date when a 

recipient regains an eligible immigration 

status. The first month’s benefits can be 

prorated.

Suspension due to absence 

from the United States 

If a recipient is out of the U.S. for more 

than 30 consecutive days, SSI benefits are 

suspended until the recipient returns to 

the country. For benefits to be reinstated, 

the beneficiary needs to remain in the U.S. 

for 30 consecutive days. If benefits are not 

reinstated on the first of the month, benefits 

will be prorated for that month.

Suspension due to criminal justice 

involvement

A recipient will not be eligible for SSI during 

any month in which he or she: 

■ Is fleeing to avoid prosecution for a 

felony crime or for an attempt to commit 

a felony crime; 

■ Is fleeing to avoid custody or 

confinement imposed after conviction 

for a felony crime; or 

■ Is violating any condition of a State or 

Federal probation or parole. 

Suspension will occur, effective the month 

in which an arrest warrant or an order to 

appear in court is issued, or in the month in 

which the individual flees, whichever comes 

earlier. Benefits can be resumed on the first 

month during which a recipient is found to 

no longer be fleeing or violating a condition 

of probation or parole.

This fairly recent provision of law 

increasingly is being applied to recipients. 

It can be particularly problematic for 

people who are homeless, since they move 

frequently and may be unaware that such 

warrants exist. Generally, outstanding 

warrants for people who are homeless are 

failure to appear warrants stemming from 

old arrests. These warrants are felonies, 

even though the crime that precipitated the 

warrant may have been a misdemeanor. 

For example, a person may have been 

charged initially with disorderly conduct, a 

misdemeanor. However, by missing a court 

hearing, a warrant for the individual is issued 

due to his or her failure to appear. Although 

the initial charge was a misdemeanor, 

the warrant is based on the felony of not 

appearing in court. 

Failure to appear warrants issued by cities 

in which a person who is homeless has lived 

previously can be hard to resolve. Typically, 

the city issuing the warrant is disinclined to 

seek extradition of the recipient from another 

jurisdiction since the warrant is for a minor 

offense. However, the court often is just as 

disinclined to drop the charges. As a result, 

the felony warrant remains and benefits are 

suspended.

Often, a recipient has no knowledge of the 

warrant and left the city where the warrant 

was issued for a reason other than fleeing 

justice. This is one approach a case manager 
88 STEPPING STONES TO RECOVERY

can use to help an individual charged with 

failure to appear. For example, the beneficiary 

may be able to document that he or she left 

town to find a place to live. As long as the 

recipient is not fleeing from justice, his or her 

benefits should not be jeopardized.

Responding to a notice of suspension 

Prior to suspending a recipient’s benefits, 

SSA must send a letter describing the 

proposed action. The recipient may choose 

to appeal the suspension. If so, he or she 

should file a request for reconsideration 

within 60 days of receiving the notice. If the 

recipient appeals within 10 days, benefits 

are continued at the pre-suspension level 

until the appeal is resolved. If payment is 

continued and the appeal is not resolved 

in favor of the recipient, any extra benefits 

received are considered an overpayment and 

subject to payback.

What should case managers know 

about overpayments? 

An overpayment is any payment made by 

SSA to an SSDI or SSI recipient in excess 

of the amount due to that recipient. When 

SSA determines an overpayment has been 

made, the recipient is sent a notice. The 

notice indicates the amount of the alleged 

overpayment and the reason the overpayment 

was made. The notice gives the recipient 

three options: (1) appeal the overpayment, 

(2) request a waiver of the overpayment, or 

(3) repay the overpayment.

Appeal of overpayments 

If a recipient believes that he or she is 

being charged for an overpayment based 

on incorrect information or an incorrect 

interpretation of SSA rules, he or she should 

file a request for reconsideration. This must 

be done within 60 days of receiving the 

notice. The recipient should provide SSA 

with information about why the payment 

was correct. For example, a recipient could 

be paid for a month, and later have SSA 

determine that he was over the resource 

limit. If the recipient is able to show that 

there was an error on his bank statement and 

that he was not over the resource limit for 

the month in question, the overpayment will 

be removed from his record.

Filing a request for reconsideration does not 

preclude filing a request for a waiver or vice 

versa. In many cases, it is best to file for both 

simultaneously.

Waiver of overpayments 

If an overpayment appears to be correct, 

a recipient can still apply to have the 

overpayment waived. A waiver means 

that SSA makes an official decision that a 

beneficiary does not have to repay all or 

part of an overpayment. There are several 

situations under which a waiver may be 

approved. 

SSA may grant a waiver when a recipient 

was not at fault for having caused 

the overpayment, and recovery of the 

overpayment would (1) defeat the purpose 

of the SSI program; (2) be against equity 

and good conscience; (3) prevent efficient 

administration of the SSI program due 
CHAPTER 10 89

to the small amount involved; or (4) lead 

to resources being less than $50 over the 

resource limit. Each of these situations is 

described below.

A waiver because recovery would defeat the 

purpose of the SSI program. This type of 

waiver can be granted if the individual’s 

income and resources are required for 

ordinary and necessary living expenses (food, 

clothing, shelter, and medical expenses—

including expenses for dependents). Most 

people who are homeless are likely to meet 

these criteria and, consequently, are likely to 

have an overpayment waived, as long as they 

can demonstrate they were not at fault for 

the overpayment.

Waiver because recovery is against equity 

and good conscience. This type of waiver is 

granted when an individual not at fault for 

an overpayment changed a position to his 

or her detriment or gave up a valuable right 

because he or she expected a payment or had 

a notice indicating a payment would be made. 

For example, suppose a person is told that 

she is eligible for SSI and received two 

months worth of SSI payments. In reliance 

on that eligibility, she signs a new lease for 

an apartment. After the two months, SSA 

determines that the payments were incorrect, 

and they send her a notice of overpayment 

stating their intention to recoup the money. 

In this situation, the beneficiary should file a 

waiver of the overpayment because she took 

action based on information she received 

from SSA and she cannot get the money 

back. Suppose the same person turned down 

$250 from a charity believing that she was 

entitled to SSI. If SSI was terminated after 

two months and it was determined that the 

benefits were incorrectly awarded, she would 

likely receive a waiver of the overpayment.

Waiver because recovery would impede 

administration of the SSI program. This type 

of waiver is narrowly limited to situations in 

which the overpayment to be recovered is so 

small that the cost of recovery would equal or 

exceed the administrative cost of collecting 

the overpayment. In such a situation, SSA 

will not seek to recover the overpayment. 

If the overpayment is under $500 and the 

recipient did not cause the overpayment, it 

can be waived.

Waiver due to recipient’s resources being 

less than $50 over the resource limit. An 

overpayment due to a recipient’s countable 

resources exceeding the resource limit by less 

than $50 will be waived, unless SSA finds 

that a recipient willfully and knowingly 

concealed the existence of the overpayment.

In many cases, the point that prevents a 

waiver from being granted is the recipient’s 

inability to demonstrate that he or she was 

not at fault for causing the overpayment. An 

erroneous SSA payment does not absolve a 

recipient from responsibility. For example, 

a recipient who receives money in excess of 

the entitlement and immediately spends the 

funds, could be considered at fault for the 

resulting overpayment. The recipient should 

have realized that she was spending funds to 

which she was not entitled, or because she 

may have failed to submit information that 

she knew or should have known she was 

supposed to submit.
90 STEPPING STONES TO RECOVERY

Reduction in benefits to repay an 

overpayment 

If SSA alleges a recipient has been overpaid 

and the overpayment is not challenged 

or waived, SSA will adjust the recipient’s 

monthly benefits to repay the overpayment. 

The maximum amount that can be recovered 

each month is limited. SSA either can 

take the recipient’s entire monthly Federal 

benefit payment or can take ten percent of 

the recipient’s total income for the month, 

whichever is less. 1 For example, if SSA were 

to take ten percent of the recipient’s total 

income, for a recipient whose sole income 

is the maximum FBR of $579 (in 2005), 

the repayment would be $57.90 per month. 

In another example, for someone whose 

countable income was such that their benefit 

payment was $45 per month, SSA could take 

100 percent of the benefit ($45 per month) 

which is less than ten percent of the FBR 

($57.90).

SSA does not always have to take the 

maximum repayment amount. A lower 

rate can be requested, in order not to 

deprive the recipient of income that is 

required for ordinary and necessary living 

expenses. Conversely, SSA may take 

more than the maximum reduction, if the 

overpayment occurred because of fraud, 

willful misrepresentation, or concealment of 

material information by the recipient or his 

or her spouse.

What are SSA’s work incentive 

programs?

The SSI program includes several important 

work incentive programs that encourage 

people receiving disability benefits to return 

to part-time or full-time employment. 

An overview of these incentives follows. 

Recipients should consult with a SSA 

representative prior to attending work, 

so that their individual situations can be 

determined.

Working and remaining eligible for SSI

Financial eligibility for SSI always can be 

maintained as long as countable income 

does not exceed the Federal payment 

standard ($579 in 2005). In states that offer 

a supplement above $579, countable income 

must not exceed the total of $579 plus the 

State supplement. 

If a person begins to work while receiving 

SSI, employment income exclusions come 

into play. For those whose only income is 

SSI, there is an $85 exclusion to earnings. 

Those with other income in addition to SSI 

have a $65 exclusion. A formula then is 

applied that considers Impairment–related 

Work Expenses (IRWEs) and reduces the 

SSI check, in general, by half the countable 

earnings from work. As these calculations 

are made, a case manager can soon see 

that, to have the entire SSI check stopped, 

earnings must be significant—approximately 

twice the FBR. 

1 Countable non-SSI income plus any SSI and State supplement.
CHAPTER 10 91

During the time a recipient has any SSI 

benefit—even as low as $1—he or she 

remains eligible for Medicaid. Clearly, trying 

to work improves a recipient’s financial 

status. 

Working and remaining eligible for SSDI

Work incentives under SSDI are quite 

different from those for SSI. Under SSDI, a 

beneficiary has a Trial Work Period of nine 

months during which he or she receives the 

full SSDI benefit. For a month to be counted 

as a trial work month, a person has to have 

gross earnings (in 2005) of $590 within the 

month. Gross earnings under this amount 

do not count in this calculation. After nine 

months of work at this earning level, SSA 

reviews the person’s situation, undertakes 

an additional review and calculation, 

and makes a determination whether the 

individual is eligible for ongoing SSDI. 

This determination can be complicated; 

recipients are urged to consult with a SSA 

representative when they begin to work 

to be well informed about the potential 

impact of employment on SSDI benefits. As 

is true with SSI, however, SSDI recipients 

are financially more sound obtaining 

employment.

As with any change in a beneficiary’s life 

(e.g., change of address, name), changes 

in work status need to be reported to SSA 

immediately and updated information 

should be provided as these occur. SSA 

conducts data matching with the IRS and 

other Federal and State agencies. This means 

that work income that is not reported by a 

recipient will likely be discovered by SSA 

anyway. If this occurs, the recipient may 

incur an overpayment and jeopardize his 

or her eligibility.

Impairment–related work expenses 

As mentioned in Chapter 4, impairment–

related work expenses (IRWEs) also can be 

deducted from work income. IRWEs are a 

person's out–of–pocket expenditures that 

are related to his or her disability and that 

enable the individual to work. For example, 

for people with physical disabilities, an 

IRWE might include special equipment or 

modifications to existing equipment for 

which the person must pay. For people with 

psychiatric disabilities, an IRWE likely would 

include medication copayments or medical 

bills that are not covered but that are related 

to one’s disability and help the person with 

work. IRWEs do not include such work–

related costs as routine bus transportation, 

meals, uniforms that everyone has to wear, 

or other expenses that people without 

disabilities also have. IRWEs are considered 

in the SSI calculation before the SSI income 

is reduced. For SSDI, IRWEs are taken into 

account when the person completes the trial 

work period.

Plans for Achieving Self–Support

For people receiving SSI, a Plan for Achieving 

Self–Support (PASS) is also available. This 

plan enables SSI recipients who work to set 

aside a portion of monthly income and/or 

assets to achieve a work goal. For example, 

a person might want to develop a PASS to 

go to college or another training program to 

learn a new skill. A PASS also could be used 

to purchase equipment to set up a business. 

To develop a PASS, a recipient must work 

with a SSA representative and have the plan 

approved by SSA. If a plan is approved, funds 
92 STEPPING STONES TO RECOVERY

saved are deducted from the earned income 

before the countable income is calculated. 

All PASS funds must be used for the agreed 

upon vocational goal. This use should be 

documented with receipts and any other 

paperwork, since SSA reviews PASS plans 

regularly, usually on at least an annual basis.

What if income from work 

exceeds allowable limits?

If countable work income exceeds the 

SSI Federal Benefit Rate (plus the State 

supplement, if available), SSI benefits will be 

suspended. If these benefits are suspended 12 

months, SSI is terminated. 

Expedited reinstatement provision

Under the expedited reinstatement provision,

an SSI recipient has up to 60 months to 

request reinstatement of benefits after 

income from work makes him or her 

ineligible. The individual gets up to six 

months of provisional benefits—just like in 

presumptive disability determination cases—

while medical eligibility is re-determined.

Continuation of SSI benefits: §1619(a)

Public Law 99–643 established two 

provisions helpful to SSI recipients. The 

first, Section 1619(a), enables individuals to 

receive SSI payments even though earnings 

exceed the SGA level. 2 To be eligible for 

§1619(a) benefits, individuals must continue 

to have the original disabling impairment 

and must currently meet all other eligibility 

rules, including the income and resource test. 

If all eligibility requirements continue to be 

met when earnings increase to greater than 

the SGA level but remain lower than the 

benefit rate plus supplements, recipients will 

automatically move into §1619(a) status.

There are not observable differences 

between regular SSI payments and §1619(a) 

payments. Eligibility for §1619(a) cash 

payments will continue until earnings fall 

below SGA, at which point individuals will 

automatically move back into regular status 

or when countable earnings exceed the 

payment rate, at which time cash payments 

will cease due to financial ineligibility. 

Maintaining SSI eligibility also would 

maintain Medicaid for most recipients.

Continuation of Medicaid 

eligibility: §1619(b)

The other provision under Public Law 

99–643 is Section 1619(b) that allows for 

Medicaid continuation despite work income. 

If a person’s SSI benefits are suspended solely 

because of increased earnings income, under 

§1619(b), the individual may keep Medicaid. 

This is possible as long as the recipient meets 

all SSI non-medical disability requirements 

except for earnings and needs Medicaid to 

continue to work.

2 Remember that to prove medical eligibility for SSI, one has to show that he or she is not engaged in Substantial Gainful Activity. SSA assigns a dollar figure 

to SGA—$810 in 2004. Anyone earning over SGA during their application process is presumed able to work and thus ineligible. As an incentive to working 

while on SSI, PL 99–643 was passed, allowing SSI to continue for disabled SSI recipients who earn over SGA.
CHAPTER 10 93

Individuals are eligible for §1619(b) status 

as long as their gross earnings fall between 

certain limits, which are called the threshold 

amounts. The thresholds are standards used 

to determine if earnings are sufficient to 

offset the loss of Medicaid. The law does 

not mention thresholds—they are designed 

to make administration of the program 

easier, much like the presumption that $830 

(2005) is equivalent to the ability to engage 

in Substantial Gainful Activity. Threshold 

amounts vary from state to state as a result 

of variations in the cost of medical services. 

Like SGA, threshold amounts are rebuttable 

presumptions. Individualized thresholds 

can be computed if individuals have medical 

costs higher than those represented by their 

state threshold.

Ticket to Work Program 

The Ticket to Work program was enacted 

by Congress in 1999 and is the newest SSA 

work incentive program. Implementation 

of this program is done by each state. In 

general, the statute has two significant 

parts that are helpful to SSA disability 

benefits recipients: (1) the ticket program 

provides a voucher system so that 

individuals can obtain vocational services 

from any willing provider who participates 

in the program, and (2) Medicaid buy–in 

allows SSDI recipients who work to 

“buy into” the Medicaid program. Again, 

particulars of each of these is different for 

each state. Detailed information on this 

program can be found on the SSA Web 

site: www.socialsecurity.gov/work/Ticket/

ticket_info.html. Local SSA offices also 

should have information on implementation 

in the state in which they exist.

Summary

The receipt of SSI and/or SSDI can provide 

for homeless individuals the ability to 

stabilize their lives and to begin to reach their 

goals. One of these goals is often beginning 

or returning to work. As with all aspects 

of the SSA program, case managers need to 

be informed about requirements for those 

approved for benefits and should assist 

individuals in meeting these. Understanding 

the work incentives under each of these 

programs can also enable case managers 

to be of greater assistance in the lives of 

individuals whom they serve. Helping a 

person maintain his or her disability benefits 

and, whenever possible, work toward greater 

self–sufficiency can provide the basis for a 

relationship that is rewarding, goal–oriented, 

and focused on recovery.
94 STEPPING STONES TO RECOVERY
95

Immigration Status

APPENDIX A

APPENDIX A

Figure 5. Aliens Eligible for SSI

Alien Category* Circumstances Under Which Alien Is Eligible for SSI

Qualified Alien

 (See following Figure 6 for 

explanation of qualified)

Eligible if:

• Was receiving SSI on 8/22/96; OR

• Was lawfully residing in the country on 8/22/96 and is currently blind or 

disabled; OR

• Meets veteran exemption; OR

• Meets Native American exception.

Legal Permanent Residents Eligible if:

• Entered the country on or before 8/22/96 and meets the 40-quarters 

exemption; OR

• Entered the country after 8/22/96, has been in the country at least 5 years, and 

meets the 40-quarters exemption. (Note: No one could qualify under these 

criteria prior to 8/23/01.) 

(See also “Qualified Alien” eligibility categories, above.)

- Entered the country as a 

refugee (or was granted 

refugee status)

-Granted asylum Status

- Granted Cancellation of 

Removal

-Cuban/Haitian Entrant

Eligible if:

• Entered the country or granted status in the last 7 years.

(The 7-year “clock” begins to run at the time the alien was granted one of these statuses.

 For example, asylees are eligible for SSI for the first 7 years after they were granted 

 asylum status, not seven years after they first entered the U.S. Similarly, those granted 

 cancellation of removal are eligible for SSI for the first 7 years after they were granted 

 cancellation of removal.) 

(See also “Qualified Alien” eligibility categories and, if applicable, the “Legal Permanent 

 Resident” eligibility categories, above.)

The following tables provide information about immigration statuses considered “qualified 

status” for SSI eligibility. For further information, consult the SSA Web site: www.ssa.gov/

notices/supplemental-security-income/spotlights/spot-non-citizens.htm. A case manager should 

consult an immigration expert or legal counsel for complex immigration issues.
96 STEPPING STONES TO RECOVERY 

Figure 6. Groups of Aliens Defined as Qualified

Alien Category Description

Legal Permanent Resident (LPR) Person granted lawful permanent residence status (green card holders)

Refugee Person admitted as a refugee

Asylee Person granted asylum

Granted Cancellation of Removal

 (formerly called—Withholding of 

Deportation)

Person granted cancellation of removal

Parolee for a year or more Person who has been paroled into the U.S. for at least one year

Cuban and Haitian Entrant Person paroled into the U.S. as a Cuban or Haitian Entrant who is the 

subject of exclusion or removal proceedings or who has an application 

for asylum pending

 Domestic Violence Victims and 

their parents or children

 Regardless of the individual’s immigration status, a victim of domestic 

violence or his/her parent or child is “qualified” if:

 • Alien has been battered or subjected to extreme cruelty, 

or alien’s child or parent has been battered, by a spouse, 

parent, or member of the household;

 • Alien has a pending or approved spousal petition or a petition 

pending for relief under the Violence Against Women Act; and

 • Alien’s need for assistance has a substantial connection 

to the battery or cruelty

Figure 5. Aliens Eligible for SSI (cont’d)

Amerasian Alien Eligible if:

• Entered the country or granted status in the last seven years.

(See also “Qualified Alien” and “Legal Permanent Resident” eligibility categories above.)

Non-Qualified Alien Eligible if meets Native American exception.

* Some aliens will fall into more than one alien category. In such cases, the alien is eligible for SSI if he or she falls into 

at least one eligible category.
97

SSI and State Medicaid Programs 1

APPENDIX B

APPENDIX B

Figure 7. 1634 States

In 1634 states, SSA makes Medicaid eligibility determinations and—essentially—authorizes Medicaid when a person is 

approved for SSI.

Alabama Kentucky New Jersey Tennessee

Arizona Louisiana New Mexico Texas

Arkansas Maine New York Vermont

California Maryland North Carolina Washington

Colorado Massachusetts Pennsylvania Washington DC

Delaware Michigan Rhode Island West Virginia

Florida Mississippi South Carolina Wisconsin

Georgia Montana South Dakota Wyoming

Iowa

Figure 8. SSI Criteria States

 SSI criteria states use SSI eligibility criteria for Medicaid but, beyond those criteria, may make their own Medicaid 

determinations or ask SSA to determine eligibility.

Alaska Kansas Nevada Oregon

Idaho Nebraska Northern Mariana Islands Utah

Figure 9. 209(b) States

209(b) states use at least one criterion that is more restrictive than the SSI program’s criteria for determining eligibility.

Connecticut* Indiana New Hampshire* Oklahoma

Hawaii Minnesota North Dakota Virginia

Illinois Missouri* Ohio

* Indicated states do not include individuals who are not blind and who are under the age of 18 in their definition of 

disability.

1 Information current as of July 2003.
98 STEPPING STONES TO RECOVERY
99

Samples from the Field

APPENDIX C

APPENDIX C

The following samples provide examples of documentation a case manager might find helpful 

when attempting to create a profile of an individual's disability:

■ Sample Summary Report Letter

■ Sample Employer Letter

■ Sample Letter from a Collateral Source
100 STEPPING STONES TO RECOVERY 
APPENDIX C 101

Sample Summary Report Letter

Please note that the following samples from a summary report letter are excerpts. They are 

provided here as an example of each section, not as a rendering of a complete letter.

Introduction

Ms. Amelia Smith is a 35–year–old woman who has a lengthy history of bipolar disorder, 

hypertension, diabetes, and homelessness. Ms. Smith is 5'5" and weighs 195 pounds. Her 

hair is matted and often dirty. She has had little dental care and is missing several teeth in 

the front of her mouth. She dresses in several layers of clothes despite the weather and has a 

strong body odor most of the time. In conversation, Ms. Smith either speaks very rapidly and 

is difficult to re-direct or she sits in long periods of silence. In either state, she seems to have 

difficulty following questions and responding to them appropriately. When depressed, she moves 

extremely slowly and appears very sad. When speaking rapidly, she becomes easily irritated if 

interrupted and then refuses to continue with the conversation. 

Personal history

Most of Ms. Smith’s history is contained in submitted medical records. However, her history of 

sexual abuse is not mentioned as she has not discussed this in treatment in the past. Ms. Smith 

reports that, from ages 8–13, her maternal uncle, who lived with the family, would come in her 

room at night and touch her “in private places” and make her “touch him.” She was afraid to 

tell her mother as she “felt that she would blame me, not him.” This has weighed on her and has 

contributed to her past use of alcohol as she felt, when she drank, that “the problems were no 

longer there.” 

In addition, Ms. Smith’s stepfather was often physically abusive to her when her mother was not 

at home. There were several instances when he pushed her against the wall very hard and she 

was knocked out briefly. She received no medical care for these injuries.

Finally, we have learned more details of Ms. Smith’s work history. Although she was able 

to work at the Hilton Hotel, in housekeeping, for two years, the work was intermittent, and 

she was frequently threatened with firing. She said, “My boss was against me. I had good 

ideas on how the work should be done. He wanted it his way. We frequently argued, and he 

would threaten me. Sometimes I was suspended for a week or two, and he would then let me 

back to work.” In most of her other work (the Hyatt, Marriott, and Motel 6), she had similar 

experiences. 
102 STEPPING STONES TO RECOVERY 

Medical/psychiatric history

In 1980, Ms. Smith was first diagnosed with a bipolar disorder when she was hospitalized 

at Mount Pleasant General Hospital’s psychiatry unit on an involuntary basis. The police 

picked her up in the street where she was yelling at people and was very agitated. Records 

there indicate that “she has had a two-year history of mood swings and inability to control her 

behavior. She has had several emergency room visits but refused voluntary admission and was 

deemed, at those times, as not meeting criteria for commitment. While on the unit, Ms. Smith 

remained manic for two weeks and only gradually responded to treatment. Discharge diagnosis 

was bipolar disorder, manic, with psychotic features. Medications were Zyprexa, 10 mg at 

bedtime, lithium, 400 mg t.i.d., and HCTZ for hypertension.”

Following this hospitalization, Ms. Smith apparently had no outpatient treatment. She remained 

homeless, and various emergency room records (1998–2002) indicate frequent visits there with 

manic/depressive symptoms and intermittent medication compliance. 

In July, 2003, Ms. Smith was hospitalized again, this time at Fort Covington Psychiatric Hospital 

in Brynburne, New Jersey. She was again admitted involuntarily through police intervention. 

Records note: “Ms. Smith was extremely dirty and agitated upon admission. She spent several 

days in the quiet room and gradually responded to treatment. She was abusive verbally to staff 

and inappropriate with other patients, being intrusive and sometimes aggressive with them. On 

two occasions, she was put in seclusion for these behaviors. After four weeks, Ms. Smith was 

discharged with a diagnosis of bipolar disorder, manic, with psychotic features. Medications 

were Zyprexa, 10 mg at bedtime, lithium, 500 mg t.i.d., and HCTZ for hypertension. She was 

referred to the ACT team for follow-up and to the Safe Haven for housing. 

Functional information

Ms. Smith shows significant functional impairment in her activities of daily living, social 

functioning, and ability to persist and pace in the completion of tasks.

Regarding her activities of daily living, this report noted above that Ms. Smith’s hygiene is quite 

poor. She estimates that she bathes approximately once every two weeks. She is either “too 

busy” to bathe or feels that her depression causes her to have little interest or energy for it. She 

walks everywhere she needs to go, and her feet are frequently sore and swollen from all the 

walking. She reports having no idea as to how to use the bus or subway. In addition, she is leery 

of these as there are “too many people” for her to handle in public transportation. Ms. Smith has 

had no place to live for five years. She intermittently goes to soup kitchens to eat but sometimes 

feels so agitated that she simply looks for leftovers in the dumpsters behind restaurants on Main 

Street. She talked at length about what good food one can find in the dumpsters. 
APPENDIX C 103

Socially, as was indicated in the employment history, Ms. Smith has a great deal of difficulty 

getting along with others. When she is manic, she becomes grandiose, irritable, and expects 

others, including employers, to do tasks “my way.” She does not understand why this causes 

her difficulty. On occasion, for example in the hospital, Ms. Smith becomes aggressive and 

suspicious of others. She has no sense of when she is being intrusive and, when manic, often 

acts inappropriately, e.g., singing standing in the middle of the street. When she is depressed, she 

isolates herself and wants no contact with anyone. When she feels this way, she sleeps on the 

street and eats little. She refuses even to go into the shelter at night as she “doesn’t care and has 

no energy.” 

Regarding her ability to complete tasks, Ms. Smith, when manic, is extremely distractible. It took 

the writers several sessions to obtain information from Ms. Smith as she was so distractible that 

she was unable to stay focused on an answer to questions. She missed appointments as she was 

“too busy” doing “things I cannot name.” She notes that she has to write down every detail of 

her life or she forgets them. “I used to have a crackerjack memory,” she said. 

Summary

Ms. Smith is a woman who has been homeless, psychotic, with a bipolar disorder and serious 

physical health problems for at least the past five years. She has had at least two known lengthy 

psychiatric hospitalizations. She has only recently begun taking medication and attending 

treatment as she is receiving the intensive services (treatment and case management) from the 

ACT team as well as support from the Safe Haven staff. Without these supports, Ms. Smith 

would likely decompensate once again and be on the street. We believe that Ms. Smith is 

disabled. Please contact us......if you have any questions.

 Sincerely,

 Jane Jones, Case manager

 Sandra Smith, M.D., Psychiatrist
104 STEPPING STONES TO RECOVERY 
APPENDIX C 105

Sample Employer Letter

Disability Determination Services

P.O. Box 99

Peoria, IL 61614

 Re: Jones, Jane

To Whom It May Concern:

Ms. Jane Jones was hired as an aide at our nursing home and worked here from 2000–

2003 in a full–time position. During the years that Ms. Jones was here, she had to take a 

significant amount of medical leave. However, because she was so well liked by the staff 

and patients here, we granted such leave. During the last year, she was unable to do her 

work without someone with her virtually at all times. She would often become confused 

and needed help completing her assigned duties on time. Initially, other staff was more 

than willing to pitch in with Ms. Jones as she was very sweet, pleasant, and appreciative. 

However, over time, this became an impossibility for us to keep doing this amount of 

support, and we had to let her go. We were sorry to have to do this.

If you have further questions, please call me at 640-782-9876.

 Sincerely,

 Clara Barton, RN

 Nursing Supervisor 
106 STEPPING STONES TO RECOVERY 
APPENDIX C 107

Sample Letter from a Collateral Source

Disability Determination Services

P.O. Box 55

Albany, NY 12210

 Re: Sam Ellis

To Whom It May Concern:

I am the mother of Sam Ellis, who is now 27 years old. For a very long time, Sam lived with 

me. Last year, I couldn’t keep him here any more because he was up a lot at night, talking 

loudly when he was up, and kept saying very strange things to me, like he didn’t think I was his 

mother. I had to ask him to leave because I work and I couldn’t keep working when I wasn’t 

getting sleep. I felt really bad about this and worry about him all the time, but I didn’t know 

what else to do.

As a youngster, Sam was a quiet, obedient boy. He didn’t give me any problems when he was 

little. In high school, he started staying more to himself and not doing so well at school. When 

we would talk about it, he didn’t seem to know why. He got quieter and quieter and didn’t seem 

to have any friends. But he was still nice at home, so I didn’t worry too much. And he wasn’t 

failing at school, so that was good.

Sam then barely finished high school. After that, he really didn’t do anything. He would stay 

in his room all day and read or just stare at stuff. He started not taking care of himself very well 

and wouldn’t wash without my asking him to. He couldn’t tell me why and, when I asked, he 

would get really angry with me, so I stopped asking. Since my husband passed away a few years 

ago, it was just Sam and me at home, so I tried not to push him too much.

For a little bit of time, Sam did a few odd jobs, but he couldn’t seem to be able to keep work. He 

would say that the people at work were out to get him or his bosses accused him of doing wrong 

things. At first I believed him but then I wondered if this could happen at so many different 

jobs. He gave up trying to get work and then just stayed in his room. Sometimes he would say 

that I was trying to feed him bad food and he would refuse to eat.
108 STEPPING STONES TO RECOVERY 

I didn’t know what to do. We’ve never had problems like this before and I didn’t realize 

that what Sam was doing were signs of a sickness. Finally, one day, he got so upset with 

me I was frightened and called the police. When they got here, he was angry with them 

and they took him to the hospital. He was there for a couple of weeks, and I was told he 

had schizophrenia. He came back home and was better for a while but then fell back to 

his old ways.

Right now, Sam doesn’t do anything. He’s stopped taking the medicine they gave him 

because he said he doesn’t like it. He sometimes goes to the clinic and meets with people 

there but not as often as he should. He also says that he doesn’t trust those people and 

they’re just going to try to put him away again. 

Since I had to ask him to leave, I don’t know what he does during the day. But, when he 

was here, he would just stay in his room, eat a little bit, and talk really loudly. When he 

comes here to see me now, he is dirty and smelly. I let him take a shower and try to wash 

the clothes he has with him if he will let me. He stops by about once or twice a week. 

He said that he sometimes goes in a shelter but doesn’t like the people there so he sleeps 

outside. He’s not eating much and looks real thin to me. I wish I could let him stay here 

but I just can’t. It breaks my heart to see my wonderful boy like this. 

I don’t think he talks with anyone and I know he doesn’t have any friends. He said 

people talk about him and point at him wherever he goes. He won’t take the bus because 

of the people and walks here, which makes him really tired. When he comes by, I try to 

get him to eat something. Sometimes he will, and sometimes he won’t. 

Sam has changed so much. He used to be so bright and clever. Now, he seems to get 

really confused when I ask him questions. He forgets to do things and can’t seem to tell 

me much about his life and what he does. He always seems to be distracted and thinking 

about something else even when I am talking to him, and he says he’s listening. I know 

that he hears voices and noises and that’s a big problem. I think these voices say very 

scary things to him. 

I hope that you can help my son. I try to give him some help, but my job doesn’t pay 

too much, so I can’t do a lot. If you know of some place he can get help, I’d sure 

appreciate it. Having some income would help him get a place, and that would help 

him a lot, too. Thank you for reading my letter. I hope this helps. You can call me 

at work 999-456-2345.

 Sincerely,

 Sara Ellis
109

Sample SSA Forms

APPENDIX D

APPENDIX D

Appendix D contains samples of SSA forms that were mentioned throughout the text of the 

manual as being necessary or helpful to the process of applying for disability benefits. The 

following forms are included in this appendix:

■ Form SSA–8000—SSI Application

■ Form SSA–3368—Disability Report for Adults

■ Form SSA–3369—Work History Report

■ Form SSA–1696—Appointment of Representative

■ Form SSA–561—Request for Reconsideration

■ Form SSA–827—Authorization to Disclose Information to SSA

■ Form SSA–787— Physician’s/Medical Officer’s Statement of Patient’s Capability 

to Manage Benefits

■ Form HA–501—Request for Hearing by Administrative Law Judge

■ Form HA–520—Request for Review of Decision/Order of ALJ
110 110 STEPPING STONES TO RECOVERY STEPPING STONES TO RECOVERY 
APPENDIX D 111

SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE
SAMPLE

DISABILITY REPORT - ADULT - Form SSA-3368-BK 

PLEASE READ ALL OF THIS INFORMATION BEFORE YOU BEGIN 

COMPLETING THIS FORM 

THIS IS NOT AN APPLICATION 

IF YOU NEED HELP 

If you need help with this form, do as much of it as you can, and your interviewer will help 

you finish it. However, if you have access to the Internet, you may access the Disability 

Report Form Guide at http://www.socialsecurity.gov/disability/3368/index.htm. 

HOW TO COMPLETE THIS FORM 

The information that you give us on this form will be used by the office that makes the 

disability decision on your disability claim. You can help them by completing as much of the 

form as you can. 

� Please fill out as much of this form as you can before your interview appointment. 

� Print or type. 

� DO NOT LEAVE ANSWERS BLANK. If you do not know the answers, or the answer is 

"none" or "does not apply," please write: "don't know," or "none," or "does not apply." 

� IN SECTION 4, PUT INFORMATION ON ONLY ONE DOCTOR/HOSPITAL/CLINIC 

IN EACH SPACE. 

� Each address should include a ZIP code. Each telephone number should include an area code. 

� DO NOT ASK A DOCTOR OR HOSPITAL TO COMPLETE THE FORM. However, 

you can get help from other people, like a friend or family member. 

� If your appointment is for an interview by telephone, have the form ready to discuss with us 

when we call you. 

� If your appointment is for an interview in our office, bring the completed form with you or 

mail it ahead of time, if you were told to do so. 

� When a question refers to "you," "your" or the "Disabled Person," it refers to the person who 

is applying for disability benefits. If you are filling out the form for someone else, please 

provide information about him or her. 

� Be sure to explain an answer if the question asks for an explanation, or if you want to give 

additional information. 

� If you need more space to answer any questions or want to tell us more about an answer, 

please use the "REMARKS" section on Pages 9 and 10, and show the number of the question 

being answered. 

ABOUT YOUR MEDICAL RECORDS 

If you have any medical records and copies of prescriptions at home for the person who is applying 

for disability benefits, send them to our office with your completed forms or bring them with you 

to your interview. Also, bring any prescription bottles with you. If you need the records back, 

tell us and we will photocopy them and return them to you. 

YOU DO NOT NEED TO ASK DOCTORS OR HOSPITALS FOR ANY MEDICAL 

RECORDS THAT YOU DO NOT ALREADY HAVE. With your permission, we will do that 

for you. The information we ask for on this form tells us to whom we should send a request for 

medical and other records. If you cannot remember the names and addresses of any of the doctors 

or hospitals, or the dates of treatment, perhaps you can get this information from the telephone 

book, or from medical bills, prescriptions and prescription bottles. 

Disability Report-Adult-Form SSA-3368-BK 
WHAT WE MEAN BY "DISABILITY"

"Disability" under Social Security is based on your inability to work. For purposes of this 

claim, we want you to understand that "disability" means that you are unable to work as defined 

by the Social Security Act. You will be considered disabled if you are unable to do any kind of 

work for which you are suited and if your disability is expected to last (or has lasted) for at least 

a year or to result in death. So when we ask, "when did you become unable to work," we are 

asking when you became disabled as defined by the Social Security Act. 

The Privacy And Paperwork Reduction Acts 

The Social Security Administration is authorized to collect the information on this form under 

sections 205(a), 223(d) and 1631(e)(1) of the Social Security Act. The information on this form 

is needed by Social Security to make a decision on the named claimant's claim. While giving us 

the information on this form is voluntary, failure to provide all or part of the requested 

information could prevent an accurate or timely decision on the named claimant's claim. 

Although the information you furnish is almost never used for any purpose other than making a 

determination about the claimant's disability, such information may be disclosed by the Social 

Security Administration as follows: (1) to enable a third party or agency to assist Social Security 

in establishing rights to Social Security benefits and/or coverage; (2) to comply with Federal 

Laws requiring the release of information from Social Security records (e.g., to the General 

Accounting Office and the Department of Veterans Affairs); and (3) to facilitate statistical 

research and such activities necessary to assure the integrity and improvement of the Social 

Security programs (e.g., to the Bureau of the Census and private concerns under contract to 

Social Security). 

We may also use the information you give us when we match records by computer. Matching 

programs compare our records with those of other Federal, State, or local government agencies. 

Many agencies may use matching programs to find or prove that a person qualifies for benefits 

paid by the Federal government. The law allows us to do this even if you do not agree to it. 

Explanations about these and other reasons why information you provide us may be used or 

given out are available in Social Security offices. If you want to learn more about this, contact 

any Social Security office. 

PAPERWORK REDUCTION ACT: This information collection meets the requirements of 44 

U.S.C. § 3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not 

need to answer these questions unless we display a valid Office of Management and Budget 

control number. We estimate that it will take about 60 minutes to read the instructions, gather 

the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO 

YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. 

Government agencies in your telephone directory or you may call Social Security at 

1-800-772-1213. You may send comments on our time estimate above to: SSA, 1338 Annex 

Building, Baltimore, MD 21235-0001. Send only comments relating to our time estimate to 

this address, not the completed form. 

PLEASE REMOVE THIS SHEET BEFORE RETURNING THE COMPLETED FORM.
Form Approved 

SOCIAL SECURITY ADMINISTRATION OMB No. 0960-0579 

For SSA Use Only 

Do not write in this box. 

DISABILITY REPORT Related SSN 

ADULT

Number Holder 

SECTION 1- INFORMATION ABOUT THE DISABLED PERSON 

A. NAME (First, Middle Initial, Last) B. SOCIAL SECURITY NUMBER 

C. DAYTIME TELEPHONE NUMBER (If you have no number where you can be reached, give us a 

 daytime number where we can leave a message for you.) 

Area Number Your Number Message Number None

Code

D. Give the name of a friend or relative that we can contact (other than your doctors) who

knows about your illnesses, injuries or conditions and can help you with your claim. 

NAME RELATIONSHIP

ADDRESS

(Number, Street, Apt. No.(If any), P.O. Box, or Rural Route) 

DAYTIME

City State ZIP PHONE Area Code Number

E. What is your F. What is your weight

 height without without shoes? 

shoes? feet inches pounds

G. Do you have a medical assistance card? (For Example, Medicaid YES NO

or Medi-Cal) If "YES," show the number here: 

H. Can you speak and understand English? YES NO If "NO," what is your preferred 

language?____________________________

NOTE: If you cannot speak and understand English, we will provide an interpreter, free of charge. 

If you cannot speak and understand English, is there someone we may contact who speaks and 

understands English and will give you messages? YES NO (If "YES," and that person is the same as in 

"D" above show "SAME" here. If not, complete the following information.) 

NAME __________________________________________________ RELATIONSHIP

ADDRESS

(Number, Street, Apt. No.(If any), P.O. Box, or Rural Route) 

DAYTIME

Disability Report-Adult-Form SSA-3368-BK 

City State ZIP PHONE Area Code Number

I. Can you read and YES NO J. Can you write more than YES NO

understand English? your name in English?

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 1 
SECTION 2

YOUR ILLNESSES, INJURIES OR CONDITIONS AND HOW THEY AFFECT YOU

A. What are the illnesses, injuries or conditions that limit your ability to work? 

B. How do your illnesses, injuries or conditions limit your ability to work? 

C. Do your illnesses, injuries or conditions cause you pain YES NO

or other symptoms?

D. When did your illnesses, injuries or 

conditions first bother you?

E. When did you become unable to work because

 of your illnesses, injuries or conditions? 

Month Day Year

Month Day Year

F. Have you ever worked? NO (If "NO," go 

to Section 4.) 

YES

G. Did you work at any time after the date your 

 illnesses, injuries or conditions first bothered you? YES NO

H. If "YES," did your illnesses, injuries or conditions cause you to: (check all that apply) 

work fewer hours? (Explain below)

change your job duties? (Explain below)

make any job-related changes such as your attendance, help needed, or employers?

(Explain below) 

I. Are you working now? YES NO

If "NO," when did you stop working? Month Day Year

J. Why did you stop working?

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 2 
SECTION 3 - INFORMATION ABOUT YOUR WORK 

A. List all the jobs that you had in the 15 years before you became unable to work because of your 

illnesses, injuries or conditions. 

JOB TITLE 

(Example, Cook) 

TYPE OF 

BUSINESS

(Example,

Restaurant)

DATES WORKED 

(month & year) 

HOURS

PER

DAY

DAYS

PER

WEEK

RATE OF PAY 

(Per hour, day, 

week,month or year) 

From To

$

$

$

$

$

$

$

B. Which job did you do the longest? 

C. Describe this job. What did you do all day? (If you need more space, write in the

"Remarks" section.) 

D. In this job, did you: 

Use machines, tools or equipment? 

Use technical knowledge or skills? 

Do any writing, complete reports, or perform duties like this? 

E. In this job, how many total hours each day did you: 

Walk? Stoop? (Bend down & forward at waist.) 

Stand? Kneel? (Bend legs to rest on knees.) 

Sit? Crouch? (Bend legs & back down & forward.) 

Climb? Crawl? (Move on hands & knees.) 

YES NO

YES NO

YES NO

Handle, grab or grasp big objects?

Reach?

Write, type or handle small objects?

F. Lifting and Carrying (Explain what you lifted, how far you carried it, and how often you did this.) 

G. Check heaviest weight lifted: 

Less than 10 lbs 10 lbs 20 lbs 50 lbs 100 lbs. or more Other 

H. Check weight frequently lifted: (By frequently, we mean from 1/3 to 2/3 of the workday.) 

Less than 10 lbs 10 lbs 25 lbs 50 lbs. or more Other 

I. Did you supervise other people in this job? YES (Complete items below.) NO (If NO, go to J.) 

How many people did you supervise? 

What part of your time was spent supervising people? 

Did you hire and fire employees? YES NO

J. Were you a lead worker? YES NO

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 3 
SECTION 4 - INFORMATION ABOUT YOUR MEDICAL RECORDS

A. Have you been seen by a doctor/hospital/clinic or anyone else for the illnesses, 

injuries or conditions that limit your ability to work? YES NO

B. Have you been seen by a doctor/hospital/clinic or anyone else for emotional or 

 mental problems that limit your ability to work? YES NO

If you answered "NO" to both of these questions, go to Section 5. 

C. List other names you have used on your medical records. 

Tell us who may have medical records or other 

information about your illnesses, injuries or conditions. 

D. List each DOCTOR/HMO/THERAPIST/OTHER. Include your next appointment. 

1. NAME DATES

STREET ADDRESS FIRST VISIT 

CITY STATE ZIP LAST SEEN 

PHONE PATIENT ID # (If known) NEXT APPOINTMENT

Area Code Phone Number 

REASONS FOR VISITS 

WHAT TREATMENT WAS RECEIVED? 

2. NAME DATES

STREET ADDRESS FIRST VISIT 

CITY STATE ZIP LAST SEEN 

PHONE PATIENT ID # (If known) NEXT APPOINTMENT

Area Code Phone Number 

REASONS FOR VISITS 

WHAT TREATMENT WAS RECEIVED? 

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 4 
SECTION 4 - INFORMATION ABOUT YOUR MEDICAL RECORDS

DOCTOR/HMO/THERAPIST/OTHER 

3. NAME DATES

STREET ADDRESS FIRST VISIT 

CITY STATE ZIP LAST SEEN 

PHONE PATIENT ID # (If known) NEXT APPOINTMENT

Area Code Phone Number 

REASONS FOR VISITS 

WHAT TREATMENT WAS RECEIVED? 

If you need more space, use Remarks, Section 9. 

E. List each HOSPITAL/CLINIC. Include your next appointment. 

1. HOSPITAL/CLINIC TYPE OF VISIT DATES

NAME DATE IN DATE OUT INPATIENT

STAYS

(Stayed at least 

overnight) STREET ADDRESS

DATE FIRST VISIT DATE LAST VISIT 

OUTPATIENT

VISITS CITY STATE ZIP (Sent home same 

day)

DATE OF VISITS

PHONE EMERGENCY

ROOM VISITS 

Area Code Phone Number 

Next appointment Your hospital/clinic number

Reasons for visits 

What treatment did you receive? 

What doctors do you see at this hospital/clinic on a regular basis? 

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 5 
SECTION 4-INFORMATION ABOUT YOUR MEDICAL RECORDS

HOSPITAL/CLINIC

2. HOSPITAL/CLINIC TYPE OF VISIT DATES

NAME DATE IN DATE OUT INPATIENT

STAYS

(Stayed at least 

overnight) STREET ADDRESS

DATE FIRST VISIT DATE LAST VISIT 

OUTPATIENT

VISITS CITY STATE ZIP (Sent home same 

day)

DATE OF VISITS

PHONE EMERGENCY

ROOM VISITS 

Area Code Phone Number 

Next appointment Your hospital/clinic number

Reasons for visits 

What treatment did you receive? 

What doctors do you see at this hospital/clinic on a regular basis? 

If you need more space, use Remarks, Section 9. 

F. Does anyone else have medical records or information about your illnesses, injuries or 

 conditions (Workers' Compensation, insurance companies, prisons, attorneys, 

welfare), or are you scheduled to see anyone else? 

YES (If "YES," complete information below.) NO

NAME DATES

STREET ADDRESS FIRST VISIT 

CITY STATE ZIP LAST SEEN 

PHONE NEXT APPOINTMENT 

Area Code Phone Number 

CLAIM NUMBER (If any) 

REASONS FOR VISITS 

If you need more space, use Remarks, Section 9. 

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 6 
SECTION 5 - MEDICATIONS 

Do you currently take any medications for your illnesses, injuries or conditions? YES

If "YES," please tell us the following: (Look at your medicine bottles, if necessary.) NO

IF PRESCRIBED, GIVE REASON FOR SIDE EFFECTS

NAME OF MEDICINE NAME OF DOCTOR MEDICINE YOU HAVE

If you need more space, use Remarks, Section 9. 

SECTION 6 - TESTS 

CARDIAC

CATHETERIZATION

part

MRI/CT SCAN Name of body 

part

BREATHING TEST 

HIV TEST 

EEG (BRAIN WAVE TEST) 

IQ TESTING 

VISION TEST 

TREADMILL (EXERCISE TEST) 

EKG (HEART TEST) 

Have you had, or will you have, any medical tests for illnesses, injuries or conditions? 

KIND OF TEST 

YES NO

WHEN DONE, OR 

WHEN WILL IT 

BE DONE? 

(Month, day, year) 

WHERE DONE? 

(Name of Facility) 

WHO SENT YOU FOR 

THIS TEST? 

SPEECH/LANGUAGE TEST 

HEARING TEST 

X-RAY--Name of body

BLOOD TEST (NOT HIV) 

BIOPSY--Name of body part 

If "YES," please tell us the following: (Give approximate dates, if necessary.) 

If you have had other tests, list them in Remarks, Section 9. 

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 7 
SECTION 7-EDUCATION/TRAINING INFORMATION 

A. Check the highest grade of school completed.

0 1 2 3 4 5 6 7 8 9 10 

Grade school: 

11 12 GED 1 2 

College:

3 4 or more 

Approximate date completed: 

NAME OF SCHOOL 

B. Did you attend special education classes? YES NO (If "NO," go to part C) 

ADDRESS

(Number, Street, Apt. No.(if any), P.O. Box or Rural Route) 

City State Zip

DATES ATTENDED TO

TYPE OF PROGRAM 

C. Have you completed any type of special job training, trade or vocational school? 

YES NO If "YES," what type?

Approximate date completed: 

SECTION 8 - VOCATIONAL REHABILITATION, EMPLOYMENT, 

or OTHER SUPPORT SERVICES INFORMATION 

Are you participating in the Ticket Program or another program of vocational rehabilitation 

services, employment services or other support services to help you go to work? 

YES (Complete the information below) NO

NAME OF ORGANIZATION 

NAME OF COUNSELOR 

ADDRESS

(Number, Street, Apt. No.(if any), P.O. Box or Rural Route) 

City State Zip

DAYTIME PHONE NUMBER 

Area Code Number

DATES SEEN TO

TYPE OF SERVICES OR 

TESTS PERFORMED (IQ, vision, physicals, hearing, workshops, etc.) 

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 8 
SECTION 9 - REMARKS

Use this section for any added information you did not show in earlier parts of the form. 

When you are done with this section (or if you don't have anything to add), be sure to 

go to the next page and complete the blocks there. 

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 9 
SECTION 9 - REMARKS

Name of person completing this form (Please Print) Date Form Completed (Month, day, year) 

Address (Number and street) e-mail address (optional)

City State Zip Code 

FORM SSA-3368-BK (2-2004) EF (2-2004) Use 6-2003 edition Until Supply Exhausted PAGE 10 
     

    

   

                  

                 



    

     

   

                   

                  

       

   

            

               

       

            

                

      

                

      

              

          

    

          

     

                

               

                  

                   

               

          
      

              

                

                 

                 

               

              

                 

               

              

              

               

            

                

              

                 

                   

                 



             

                   

               

                  

            

                

                 

              

               

 

     

  
 

     

 

     

  

             







     

       

                

         

   

                  

     

 













  

      







    








     



 

                

  

 

     



  

   

         

    

     

   

  

                 

          

                 

    

    

     

     

        

       

               

 

 

 

    

 

 

   



   

  























    

    








  



                

  

 

  



  

   

         

    

     

   

  



                 

          

                 

    

    

     

     

        

       

               





    

 

 

     

    

 

 

 

   



   

  



 

    






























                

  

 

     



  

   

         

    

     

   



                 

          

                 

    

    

     

     

        

       

               





    

 

 

 

     

    

 

 

 

  

   



   

  



    






























                 

                

  

 

     



  

   

         

    

     

   

  



                 

          

    

    

     

     

        

       

               





    

 

 

 

     

    

 

 

 

   



   

  



    






























                

  

 

     



  

   

         

    

     

   

  



                 

          

                 

    

    

     

     

        

       

               



    

 

 

 

     

    

 

 

 

   



   

  

 

    






























  



 

                

  

     

   

         

    

     

   

  



                 

          

                 

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       

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    

                        

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        

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 
Social Security Administration

 Please read the back of the last copy before you complete this form. 

Form Approved

OMB No. 0960-0527 

Name (Claimant) (Print or Type) Social Security Number 

Wage Earner (If Different) Social Security Number 

Part I APPOINTMENT OF REPRESENTATIVE 

I appoint this person, , (Name and Address) 

to act as my representative in connection with my claim(s) or asserted right(s) under: 

Title II Title XVI Title XVIII Title VIII 

(RSDI) (SSI) (Medicare Coverage) (SVB)

This person may, entirely in my place, make any request or give any notice; give or draw out evidence or 

information; get information; and receive any notice in connection with my pending claim(s) or asserted right(s). 

I appoint, or I now have, more than one representative. My main representative 

is . (Name of Principal Representative) 

Signature (Claimant) Address

Telephone Number (with Area Code) Fax Number (with Area Code) Date

Part II ACCEPTANCE OF APPOINTMENT 

I, , hereby accept the above appointment. I certify that I 

have not been suspended or prohibited from practice before the Social Security Administration; that I am not 

disqualified from representing the claimant as a current or former officer or employee of the United States; and that 

I will not charge or collect any fee for the representation, even if a third party will pay the fee, unless it has been 

approved in accordance with the laws and rules referred to on the reverse side of the representative's copy of this 

form. If I decide not to charge or collect a fee for the representation, I will notify the Social Security Administration. 

(Completion of Part III satisfies this requirement.) 

Check one: I am an attorney. I am a non-attorney who is eligible to receive direct fee payment. 

 I am not an attorney and I am ineligible to receive direct fee payment. 

I have been disbarred or suspended from a court or bar to which I was previously admitted to practice as an

attorney. YES NO

I have been disqualified from participating in or appearing before a Federal program or agency. YES NO

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying 

statements or forms, and it is true and correct to the best of my knowledge. 

Signature (Representative) Address

Telephone Number (with Area Code) Fax Number (with Area Code) Date

Part III (Optional) WAIVER OF FEE 

I waive my right to charge and collect a fee under sections 206 and 1631(d)(2) of the Social Security Act. I 

release my client (the claimant) from any obligations, contractual or otherwise, which may be owed to me for 

services I have provided in connection with my client's claim(s) or asserted right(s). 

Signature (Representative) Date

Part IV (Optional) WAIVER OF DIRECT PAYMENT 

by Attorney or Non-Attorney Eligible to Receive Direct Payment 

I waive only my right to direct payment of a fee from the withheld past-due retirement, survivors, disability 

insurance or supplemental security income benefits of my client (the claimant). I do not waive my right to request 

fee approval and to collect a fee directly from my client or a third party.

Signature (Attorney or Eligible Non-Attorney (for Direct Payment) Representative) Date

Form SSA-1696-U4 (1-2005) EF (1-2005) (See Important Information on Reverse) FILE COPY 

Destroy Prior Editions 
INFORMATION FOR CLAIMANTS 

What a Representative May Do What Your Representative(s) May Charge, 

continued

We will work directly with your appointed representative unless 

he or she asks us to work directly with you. Your representative 

may:

o get information from your claim(s) file; 

o give us evidence or information to support your claim; 

o come with you, or for you, to any interview, 

conference, or hearing you have with us; 

o request a reconsideration, hearing, or Appeals Council 

review; and 

o help you and your witnesses prepare for a hearing and 

question any witnesses. 

Also, your representative will receive a copy of the 

decision(s) we make on your claim(s). We will rely on your 

representative to tell you about the status of your claim(s), but you 

still may call or visit us for information. 

You and your representative(s) are responsible for giving Social 

Security accurate information. It is wrong to willingly furnish 

false information. Doing so may result in criminal prosecution. 

We usually continue to work with your representative until 

(1) you tell us that he or she no longer represents you; or 

(2) your representative tells us that he or she is withdrawing or 

indicates that his or her services have ended (for example, by 

filing a fee petition or not pursuing an appeal). We do not 

continue to work with someone who is suspended or disqualified 

from representing claimants. 

What Your Representative(s) May Charge 

Each representative you appoint can ask for a fee. To charge you 

a fee for services, your representative must get our approval. 

(Even when someone else will pay the fee for you, for example, 

an insurance company, your representative usually must get our 

approval.) One way is to file a fee petition. The other way is to 

file a fee agreement with us. In either case, your representative 

cannot charge you more than the fee amount we approve. If he or 

she does, promptly report this to your Social Security office. 

o Filing a Fee Petition 

Your representative may ask for approval of a fee by giving us a 

fee petition when his or her work on your claim(s) is complete. 

This written request describes in detail the amount of time he or 

she spent on each service provided you. The request also gives 

the amount of the fee the representative wants to charge for these 

services. Your representative must give you a copy of the fee 

petition and each attachment. If you disagree with the information 

shown in the fee petition, contact your Social Security office. 

Please do this within 20 days of receiving your copy of the 

petition.

We will review the petition and consider the reasonable value of 

the services provided. Then we will tell you in writing the 

amount of the fee we approve. 

o Filing A Fee Agreement 

If you and your representative have a written fee agreement, 

one of you must give it to us before we decide your claim(s). 

We usually will approve the agreement if you both signed it; 

the fee you agreed on is no more than 25 percent of past-due 

benefits, or $5,300 (or a higher amount we set and 

announced in the Federal Register), whichever is less; we 

approve your claim(s); and your claim results in past-due 

benefits. We will tell you in writing the amount of the fee 

your representative can charge based on the agreement.

If we do not approve the fee agreement, we will tell you and your 

representative in writing. Then your representative must file a fee petition 

to charge and collect a fee. 

After we tell you the amount of the fee your representative can charge, you 

or your representative can ask us to look at it again if either or both of you 

disagree with the amount. (If we approved a fee agreement, the person who 

decided your claim(s) also may ask us to lower the amount.) Someone who 

did not decide the amount of the fee the first time will review and finally 

decide the amount of the fee. 

How Much You Pay 

You never owe more than the fee we approve, except for: 

o any fee a Federal court allows for your representative's 

 services before it; and 

o out-of-pocket expenses your representative incurs or 

expects to incur, for example, the cost of getting your 

doctor's or hospital's records. Our approval is not 

needed for such expenses.

Your representative may accept money in advance as long as 

he or she holds it in a trust or escrow account. If an attorney 

or a non-attorney who is eligible to receive direct fee payment 

represents you, and if your retirement, survivors, disability 

insurance, and/or supplemental security income claim(s) 

results in past-due benefits, we usually withhold 25 percent of 

your past-due benefits to pay toward the fee for you. 

You must pay your representative directly: 

o the rest of the fee you owe 

- if the amount of the fee is more than any amount(s)

 your representative held for you in a trust or 

escrow account and we withheld and paid your 

 representative for you. 

o all of the fee you owe 

- if we did not withhold past-due benefits, for example, because 

 your representative waived direct payment, or you discharged the 

 representative, or the representative withdrew from representing 

 you before we issued a favorable decision; or if we withheld, but 

 later paid you the money because your representative did not either 

 ask for our approval until after 60 days of the date of your notice 

 of award or tell us on time that he or she planned to ask for a fee. 

Form SSA-1696-U4 (1-2005) EF (1-2005) 
Form Approved 

SOCIAL SECURITY ADMINISTRATION TOE 710 OMB No. 0960-0622

REQUEST FOR RECONSIDERATION (Do not write in this space) 

NAME OF CLAIMANT NAME OF WAGE EARNER OR SELF-EMPLOYED 

PERSON (If different from claimant.) 

SOCIAL SECURITY CLAIM NUMBER SUPPLEMENTAL SECURITY INCOME (SSI) OR SPECIAL 

VETERANS BENEFITS (SVB) CLAIM NUMBER 

SPOUSE'S NAME (Complete ONLY in SSI cases) SPOUSE'S SOCIAL SECURITY NUMBER 

(Complete ONLY in SSI cases)

CLAIM FOR (Specify type, e.g., retirement, disability, hospital insurance, SSI, SVB, etc.) 

I do not agree with the determination made on the above claim and request reconsideration. My reasons are: 

SUPPLEMENTAL SECURITY INCOME OR SPECIAL VETERANS BENEFITS RECONSIDERATION ONLY 

(See the three ways to appeal in the How To Appeal Your Supplemental Security Income (SSI) Or Special Veterans Benefit (SVB) Decision) instructions.)

 "I want to appeal your decision about my claim for Supplemental Security Income (SSI) or Special Veterans Benefits 

(SVB). I've read about the three ways to appeal. I've checked the box below." 

Case Review Informal Conference Formal Conference

EITHER THE CLAIMANT OR REPRESENTATIVE SHOULD SIGN - ENTER ADDRESSES FOR BOTH

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or 

forms, and it is true and correct to the best of my knowledge. 

CLAIMANT SIGNATURE SIGNATURE OR NAME OF CLAIMANT'S REPRESENTATIVE 

NON-ATTORNEY ATTORNEY

MAILING ADDRESS MAILING ADDRESS 

CITY STATE ZIP CODE CITY STATE ZIP CODE 

TELEPHONE NUMBER (Include area code) DATE TELEPHONE NUMBER (Include area code) DATE

TO BE COMPLETED BY SOCIAL SECURITY ADMINISTRATION

See list of initial determinations 

1. HAS INITIAL DETERMINATION

 BEEN MADE? YES NO 2. CLAIMANT INSISTS

 ON FILING YES NO

3. IS THIS REQUEST FILED TIMELY? YES NO

(If "NO", attach claimant's explanation for delay and attach only pertinent letter, material, or

 information in social security office.) 

SOCIAL SECURITY OFFICE RETIREMENT AND SURVIVORS RECONSIDERATIONS ONLY (CHECK ONE) REFER TO (GN 03102.125) 

ADDRESS

NO FURTHER DEVELOPMENT REQUIRED (GN 03102.300) 

REQUIRED DEVELOPMENT ATTACHED 

 REQUIRED DEVELOPMENT PENDING, WILL FORWARD OR ADVISE STATUS

 WITHIN 30 DAYS 

ODO, BALTIMORE 

DISABILITY DETERMINATION 

SERVICES (ROUTE WITH 

DISABILITY FOLDER) 

NOTE: Take or mail the signed original

ROUTING

INSTRUCTIONS

(CHECK ONE) 

OIO, BALTIMORE 

CENTRAL PROCESSING 

SITE (SVB) OEO, BALTIMORE 

DISTRICT OFFICE 

RECONSIDERATION

 to your local Social Security office, the Veterans Affairs Regional Office in Manila or any 

U.S. Foreign Service post and keep a copy for your records. 

PROGRAM SERVICE CENTER 

Form SSA-561-U2 (7-2003) EF (3-2005) Destroy Prior Editions Claimant
HOW TO APPEAL YOUR SUPPLEMENTAL SECURITY INCOME (SSI)

OR SPECIAL VETERANS BENEFIT (SVB) DECISION

There are three different ways to appeal. You can pick the appeal that fits your case. You can have a lawyer, 

friend, or someone else help you with your appeal. 

Here are the three ways to appeal: 

1. CASE REVIEW: 

You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the

person who decides your case. 

You can pick this kind of appeal in all cases.

2. INFORMAL CONFERENCE: 

You'll meet with the person who will decide your case. You can tell that person why you 

think you're right. You can give us more facts to help prove you're right. You can bring other people to 

help explain your case. 

You can pick this kind of appeal in all SSI cases except two. You can't have it if we turned down your SSI 

application for medical reasons or because you're not blind. Also you can't have it if we're giving you SSI 

but you disagree with the date we said you became blind or disabled. In SVB cases, you can pick this kind 

of appeal only if we're stopping or lowering your SVB payment. 

3. FORMAL CONFERENCE: 

This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. 

We can do this even if they don't want to help you. You can question these people at your meeting. 

You can pick this kind of appeal only if we're stopping or lowering your SSI or SVB payment. You can't 

get it in any other case. 

Now you know the three kinds of appeals. You can pick the one that fits your case. Then fill out the front of 

this form. We'll help you fill it out. 

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you the 

names of these groups. 

NOTE: DON'T FILL OUT THIS FORM IF WE SAID WE'LL STOP YOUR DISABILITY 

CHECK FOR MEDICAL REASONS OR BECAUSE YOU'RE NO LONGER BLIND. 

WE'LL GIVE YOU THE RIGHT FORM (SSA-789-U4) FOR YOUR APPEAL. 

The information on this form is authorized by regulation (20 CFR 404.907 - 404.921 and 416.1407 -

416.1421) and Public Law 106-169 (section 809(a)(1) of section 251(a)). While your response to these 

questions is voluntary, the Social Security Administration cannot reconsider the decision on this claim unless 

the information is furnished. 

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 

3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these 

questions unless we display a valid Office of Management and Budget control number. We estimate that it 

will take about 8 minutes to read the instructions, gather the facts, and answer the questions. SEND THE 

COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. To find the nearest office, 

call 1-800-772-1213. Send only comments on our time estimate above to: SSA, 1338 Annex Building, 

Baltimore, MD 21235-6401. 

Form SSA-561-U2 (7-2003) EF (3-2005) 

Destroy Prior Editions 
Social Security 

Online

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                    

               

                  

 

                  

                    

                     

                  

                

                      

      

                        

                        

                      

              

                    

               

                     



   

         

        

  

                   

                     

                     

                

                  

                 

          

                   

                     

               

                  

                 

                

                   

                  

                   

                     

            

                    

                     

                     

                     



                   

                     

            

                   

                    

                        

                   

   

                   

    

                  

             

                 

              

        
Disability Programs

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Form Approved 

SOCIAL SECURITY ADMINISTRATION TOE 250 OMB No.0960-0024

PHYSICIAN'S/MEDICAL OFFICER'S STATEMENT OF PATIENT'S CAPABILITY TO MANAGE BENEFITS

(

TELEPHONE NUMBER (Include Area Code) 

Privacy Act: This report is authorized by sections 205(a) and 205(j) of the Social Security

Act, as amended (42 U.S.C. 405(a) and 405(j). While you are not required to respond,

your cooperation will help us decide whether any Social Security benefits that may be due

should be paid directly to the patient or to someone else on the patient's behalf. Your

cooperation in completing and returning this statement will be appreciated. 

We may also use the information you give us when we match records by computer.

Matching programs compare our records with those of other Federal, State, or local 

government agencies. Many agencies may use matching programs to find or prove that a 

person qualifies for benefits paid by the Federal government. The law allows us to do this

even if you do not agree to it. Explanations about these and other reasons why

information you provide may be used or given out are available in Social Security Offices.

If you want to learn more about this, contact any Social Security Office. 

.

PATIENT'S NAME PATIENT'S ADDRESS (Number and Street, City, State, and ZIP 

Code)

In replying, use this address: 

SOCIAL SECURITY ADMINISTRATION 

DATE

SSA CONTACT 

NAME OF WAGE EARNER OR SELFEMPLOYED PERSON 

PATIENT'S DATE OF

BIRTH

IDENTIFYING INFORMATION (SSA Only)

If different from patient

PAPERWORK REDUCTION ACT:

This information collection meets the clearance requirements of 44 U.S.C. §3507, as

amended by Section 2 of the Paperwork Reduction Act of 1995. You are not required to answer these questions unless we display a valid Office of Management and Budget

control number. it will take you about 10 minutes to read the

instructions, gather the necessary facts, and answer the questions. 

/

PATIENT'S SOCIAL SECURITY NUMBER 

SOCIAL SECURITY NUMBER

/

)

We estimate that 

/

/

YOUR HELP IS NEEDED 

The patient shown above has filed for or is receiving Social Security or Supplemental Security

Income payments. We need you to complete the back of this form and return it to us in the 

enclosed envelope to help us decide if we should pay this person directly or if he or she needs a

representative payee to handle the funds. Please Note: This determination affects how benefits 

are paid and has no bearing on disability determinations. Thank you for your help. 

WHO IS A REPRESENTATIVE PAYEE

A representative payee is someone who manages the patient's money to make sure the patient's 

needs are met. The payee has a strong and continuing interest in the patient's well-being and is 

usually a family member or close friend. 

WHO NEEDS A REPRESENTATIVE PAYEE

Some individuals age 18 and older who have mental or physical impairments are not capable of

handling their funds or directing others how to handle them to meet their basic needs, so we

select a representative payee to receive their payments. Examples of impairments which may 

cause incapability are senility, severe brain damage or chronic schizophrenia. However, even 

though a person may need some assistance with such things as bill paying, etc., does not 

necessarily mean he/she cannot make decisions concerning basic needs and is incapable of 

managing his/her own money.

PLEASE COMPLETE THE INFORMATION ON THE REVERSE OF THIS FORM

Form SSA-787 (11-2002) EF (11-2002) Destroy Prior Editions
1. Date you last examined the patient .

2. Do you believe the patient is capable of managing or directing the management of benefits in his or her own best interest? 

By capable we mean that the patient: � Is able to understand and act on the ordinary affairs of life, such as providing for own adequate food, 

housing, clothing, etc., and � Is able, in spite of physical impairments, to manage funds or direct others how to manage them.

Yes No Unsure

If "Yes", please omit If "No", please provide a brief summary If "unsure",

question 3, but be sure to of the findings that led to this conclusion. please explain.

sign and date the form. Also, complete question 3.

3. Do you expect the patient to be able to manage funds in the future (for example, the patient is temporarily unconscious)?

Yes No 

If yes, please explain.

ADDRESS (Number and street, City, State, and ZIP Code) TELEPHONE NUMBER (Include Area Code)

NAME OF PHYSICIAN/MEDICAL OFFICER (Please print.) TITLE

( )

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge. I understand that anyone who knowingly gives a false or misleading statement about a material fact in this information, or causes someone else to do so, commits a crime and may be

sent to prison, or may face other penalties, or both. 

SIGNATURE OF PHYSICIAN/MEDICAL OFFICER DATE

Form SSA-787 (11-2002) EF (11-2002)
15. Check all claim types that apply:

CF requested

CF Attached:

Title II CF held in FO to establish CAPS ORBIT; or

TO BE COMPLETED BY SOCIAL SECURITY ADMINISTRATION-ACKNOWLEDGMENT OF REQUEST FOR HEARING

HO on 

Language (including sign language):

7. Check one of the blocks:

and I request that a decision be made

based on the evidence in my case.

(Complete Waiver Form HA-4608)

14. Check one:

12. Claimant is represented

5. I REQUEST A HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE. I disagree with the determination made on my claim because:

6. I have additional evidence to submit.

Name and address of source of additional evidence:

2. WAGE EARNER, IF DIFFERENT

16. HO COPY SENT TO:

1. CLAIMANT

13. Interpreter needed

 CF Attached:

11. Was the request for hearing received within 65 days of the reconsidered determination?

REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE

 3. SOC. SEC. CLAIM NUMBER

- -

 4. SPOUSE's CLAIM NUMBER

- -

SOCIAL SECURITY ADMINISTRATION

OFFICE OF HEARINGS AND APPEALS

Form Approved

OMB No. 0960-0269

If no is checked, attach claimant's explanation for delay; and attach copy of appointment notice, letter, or other pertinent material or information in the

Social Security office.

17. CF COPY SENT TO:

Form HA-501-U5 (5-2003) ef (05-2003)

Destroy Prior Editions

HO on 

(Copy of teletype or phone report attached)

Other Attached:

[You should complete No. 8 and your representative (if any) should complete No. 9. If you are represented and your representative is not available to

complete this form, you should also print his or her name, address, etc. in No. 9.]

You have a right to be represented at the hearing. If you are not represented but would like to be, your Social Security office will give you a list of legal

referral and service organizations. (If you are represented and have not done so previously, complete and submit form SSA-1696 (Appointment of

Representative).)

(Take or mail the signed original to your local Social Security office, the Veterans Affairs

Regional Office in Manila or any U.S. Foreign Service post and keep a copy for your records)

(Please submit it to the hearing office within 10 days. Your servicing Social Security Office will

provide the address. Attach an additional sheet if you need more space.)

(Title) (Address) (Servicing FO Code) (PC Code)

Title II Disablility-worker or child only

Title II Disability-Widow(er) only

SSI Aged/Title II

SSI Aged only

SSI Blind only

SSI Disability only

SSI Blind/Title II

HI Entitlement

Title VIII Only

SSI Disability/Title II

Yes No

Yes No

I wish to appear at a hearing.

I do not wish to appear at a hearing

Initial Entitlement Case

Disability Cessation Case

Other Postentitlement Case

Title II; Title XVI; Title VIII; or

Title II; Title XVI Title VIII

Title II; Title XVI

RSI only

See

Privacy Act Notice

List of legal referral and service organizations provided

Other - Specify:

Title VIII/Title XVI

Yes No

10. Request received for the Social Security Administration on by:

(Date) (Print Name)

ADDRESS

8. (CLAIMANT'S SIGNATURE) 9. (REPRESENTATIVE'S SIGNATURE/NAME)

CITY STATE ZIP CODE

-

CITY STATE ZIP CODE

-

 (DATE)

 TELEPHONE NUMBER 

( ) -

 (DATE)

 TELEPHONE NUMBER

( ) -

 FAX NUMBER

( ) -

 FAX NUMBER

( ) -

(ADDRESS) ATTORNEY; NON ATTORNEY;

YES NO

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is

true and correct to the best of my knowledge.

TAKE OR SEND ORIGINAL TO SSA AND RETAIN A COPY FOR YOUR RECORDS

An Administrative Law Judge of the Office of Hearings and Appeals will be appointed to conduct the hearing or other proceedings in your case. You will

receive notice of the time and place of a hearing at least 20 days before the date set for a hearing.

(RSI)

(DIWC)

(DIWW)

(SSIA)

(SSIB)

(SSID)

(SSAC)

(SSBC)

(SSDC)

(HIE)

(SVB)

(SVB/SSI)

 CLAIMANT
Form HA-501-U5 (5-2003) ef (05-2003)

PAPERWORK/PRIVACY ACT NOTICE

The Social Security Act (sections 205(a), 702, 1631(e)(1)(a) and (b), and 1869(b)

(1) and (c), and Public Law 106-169 (Section 809(a)(1) of Sections 251(a)) as

appropriate) authorizes the collection of information on this form. We need the

information to continue processing your claim. You do not have to give it, but if

you do not you may not receive benefits under the Social Security Act. We may

give out the information on this form without your written consent if we need to

get more information to decide if you are eligible for benefits or if a Federal law

requires us to do so. Specifically, we may provide information to another

Federal, State, or local government agency which is deciding your eligibility for

a government benefit or program; to the President or a Congressman inquiring on

your behalf; to an independent party who needs statistical information for a

research paper or audit report on a Social Security program; or to the Department

of Justice to represent the Federal Government in a court suit related to a

program administered by the Social Security Administration. We explain, in the

Federal Register, these and other reasons why we may use or give out

information about you. If you would like more information, get in touch with

any Social Security office, the Veterans Affairs Regional Office in Manila, or

any U.S. Foreign Service post.

We may also use the information you give us when we match records by

computer. Matching programs compare our records with those of other Federal,

State, or local government agencies. Many agencies may use matching programs

to find or prove that a person qualifies for benefits paid by the Federal

government. The law allows us to do this even if you do not agree to it.

Explanations about these and other reasons why information about you may be

used or given out are available in Social Security offices. If you want to learn

more about this, contact any Social Security office, the Veterans Affairs

Regional Office in Manila, or any U.S. Foreign Service post.

Paperwork Reduction Act Statement - This information collection meets the

requirements of 44 U.S.C. § 3507, as amended by Section 2 of the Paperwork

Reduction Act of 1995. You do not need to answer these questions unless we

display a valid Office of Management and Budget control number. We estimate

that it will take about 10 minutes to read the instructions, gather the facts, and

answer the questions. SEND THE COMPLETED FORM TO YOUR

LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S.

Government agencies in your telephone directory or you may call Social

Security at 1-800-772-1213. You may send comments on our time estimate

above to: SSA, 1338 Annex Building, Baltimore, MD 21235-0001. Send only

comments relating to our time estimate to this address, not the completed form.
Disability Programs

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Form Approved SOCIAL SECURITY ADMINISTRATION/OFFICE OF HEARINGS AND APPEALS OMB No. 0960-0277 

REQUEST FOR REVIEW OF HEARING DECISION/ORDER 

(Do not use this form for objecting to a recommended ALJ decision.) 

(Take or mail the signed original to your local Social Security office, the Veterans Affairs 

Regional Office in Manila or any U.S. Foreign Service post and keep a copy for your records) 

See Privacy Act Notice 

1. CLAIMANT 2. WAGE EARNER, IF DIFFERENT 

3. SOCIAL SECURITY CLAIM NUMBER

 - -

4. SPOUSE'S NAME AND SOCIAL SECURITY NUMBER 

(Complete ONLY in Supplemental Security Income Case) 

5. I request that the Appeals Council review the Administrative Law Judge's action on the above claim because: 

ADDITIONAL EVIDENCE 

If you have additional evidence submit it with this request for review. If you need additional time to submit evidence or legal argument, you must 

request an extension of time in writing now. If you request an extension of time, you should explain the reason(s) you are unable to submit the evidence 

or legal argument now. If you neither submit evidence or legal argument now nor within any extension of time the Appeals Council grants, the Appeals 

Council will take its action based on the evidence of record. 

IMPORTANT: Write your Social Security Claim Number on any letter or material you send us. 

SIGNATURE BLOCKS: You should complete No. 6 and your representative (if any) should complete No. 7. If you are represented and your 

representative is not available to complete this form, you should also print his or her name, address, etc. in No. 7. 

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or 

i

yp pply:

i

l

(2) i i l i l i i i l i

(

Retirement or survivors 

)

i

Initial Entitlement 

Yes No

(RSI)

(DIWE)

(DIWW)

(DIWC)

(SSIA)

(SSIB)

(SSID)

(HIA)

(HIB)

(SVB)

(SVB/SSI)

l by:

(Date) 

FAX NUMBER 

( ) - ( ) -

ADDRESS ADDRESS

( ) - ( ) -

A

THE SOCIAL SECURITY ADMINISTRATION STAFF WILL COMPLETE THIS PART 

9. Is the request for rev ew received within 65 days of the ALJ's Decision/Dismissal? 

12. Check all claim t es that a

APPEALS COUNCIL 

OFFICE OF HEARINGS AND APPEALS, SSA 

5107 Leesburg P ke 

FALLS CHURCH, VA 22041 - 3255 

11. Check one: 

10. If "No" checked: (1) attach claimant's exp anation for delay; and 

attach copy of appo ntment not ce, etter or other pert nent materia or nformat on n the Socia Security Off ce. 

(Title) Address) (Servicing FO Code) (PC Code) 

Disability-Worker 

Disability-Widow(er

Disability-Child 

SSI Aged 

SSI Blind 

SSI Disab lity 

Health Insurance-Part A 

Health Insurance-Part B 

Other - Specify: 

Title VIII Only 

Title VIII/Title XVI 

Termination or other 

forms, and it is true and correct to the best of my knowledge. 

8. Request received for the Socia Security Administration on 

(Print Name) 

(CITY, STATE, ZIP CODE)

 TELEPHONE NUMBER 

PRINT NAME PRINT NAME 

(CITY, STATE, ZIP CODE)

 TELEPHONE NUMBER FAX NUMBER 

6. CLAIMANT'S SIGNATURE DATE 7. REPRESENTATIVE'S SIGNATURE TTORNEY 

NON-ATTORNEY 

Form HA-520-U5 (5-2003) ef (10-2004) TAKE OR SEND ORIGINAL TO SSA AND RETAIN A COPY FOR YOUR RECORDS 

Destroy Prior Editions
PAPERWORK/PRIVACY ACT NOTICE

The Social Security Act (sections 205(a), 702, 1631(e)(1)(a) and (b), and 1869(b) 

(1) and (c), and Public Law 106-169 (Section 809(a)(1) of Sections 251(a)) as 

appropriate) authorizes the collection of information on this form. We need the 

information to continue processing your claim. You do not have to give it, but if 

you do not you may not receive benefits under the Social Security Act. We may 

give out the information on this form without your written consent if we need to 

get more information to decide if you are eligible for benefits or if a Federal law 

requires us to do so. Specifically, we may provide information to another 

Federal, State, or local government agency which is deciding your eligibility for a 

government benefit or program; to the President or a Congressman inquiring on 

your behalf; to an independent party who needs statistical information for a 

research paper or audit report on a Social Security program; or to the Department 

of Justice to represent the Federal Government in a court suit related to a program 

administered by the Social Security Administration. We explain, in the Federal 

Register, these and other reasons why we may use or give out information about 

you. If you would like more information, get in touch with any Social Security 

office, the Veterans Affairs Regional Office in Manila, or any U.S. Foreign 

Service post. 

We may also use the information you give us when we match records by 

computer. Matching programs compare our records with those of other Federal, 

State, or local government agencies. Many agencies may use matching programs 

to find or prove that a person qualifies for benefits paid by the Federal 

government. The law allows us to do this even if you do not agree to it. 

Explanations about these and other reasons why information about you may be 

used or given out are available in Social Security offices. If you want to learn 

more about this, contact any Social Security office, the Veterans Affairs Regional 

Office in Manila, or any U.S. Foreign Service post. 

Paperwork Reduction Act Statement - This information collection meets the 

requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork 

Reduction Act of 1995. You do not need to answer these questions unless we 

display a valid Office of Management and Budget control number. We estimate 

that it will take about 10 minutes to read the instructions, gather the facts, and 

answer the questions. SEND THE COMPLETED FORM TO YOUR LOCAL 

SOCIAL SECURITY OFFICE. The office is listed under U. S. Government 

agencies in your telephone directory or you may call Social Security at 

1-800-772-1213. You may send comments on our time estimate above to: SSA,

1338 Annex Building, Baltimore, MD 21235-6401. Send only comments

relating to our time estimate to this address, not the completed form. 

Form HA-520-U5 (5-2003) ef (10-2004) 
Social Security Forms

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111

Additional Contributors

APPENDIX E

APPENDIX E

In addition to those persons and agencies listed in the Acknowledgements, many people 

contributed to the production of this manual.

Editorial assistance and graphic design was provided by Kathleen Dalton, Deborah Dennis, Terri 

Hay, Aaron Seaman, and Janet Mattox at Policy Research Associates, Inc. in Delmar, New York. 

Westat, Rockville, MD, provided additional publication assistance.

Throughout the course of developing the manual, invaluable feedback and suggestions were 

received from the project’s Technical Work Group, including April Davis, Kristina Hoglund, 

Ken Kraybill, Ginny Lilly, Lonnie Mann, Peter McKee, Scott McNeilly, Andrew Posner, Connie 

Schlittler, Robert Smith, Debbie Webster, Dorothy Williford, and Linda Wren. Work Group 

members include consumers, case managers, case management supervisors, State PATH 

contacts, Health Care for the Homeless program staff, community mental health agency staff, 

and disability rights attorneys who help people who are homeless and who have serious mental 

illnesses to obtain disability benefits. Jean Hochron of the Health Resources and Services 

Administration provided invaluable suggestions.
112 DRAFT—APRIL 12, 2005 
113

ABBREVIATIONS AND ACRONYMS

ACRONYMS

AC— Appeals Council

ALJ— administrative law judge

CE— consultative examination

DDS— Disability Determination Services

DSM IV–TR— Diagnostic and Statistical 

Manual of Mental Disorders IV–Text 

Revisions

EITC— earned income tax credit

FBR— Federal Benefit Rate

FICA— Federal Insurance Contributions 

Act

The Grids— medical vocational guidelines

ICD— International Classification of 

Diseases

IRS— Internal Revenue Service

IRWE— impairment–related work expenses

ISM— In-kind Support and Maintenance

LAPR— lawfully–admitted permanent 

residence

ME— medical expert

OHA— Office of Hearings and Appeals

PASS— Plans for Achieving Self–Support

PATH— Projects for Assistance in 

Transition from Homelessness

PMV— presumed maximum value rule

RFC— residual functional capacity

SAMHSA— Substance Abuse and Mental 

Health Services Administration

SGA— substantial gainful activity

SSA— Social Security Administration

SSDI— Social Security Disability Insurance

SSI— Supplemental Security Income

TANF— Temporary Assistance to Needy 

Families
114 STEPPING STONES TO RECOVERY 

TI— temporary institutionalization benefits

TWP— trial work period

USCIS— U.S. Citizenship and Immigration 

Services

VA— Department of Veterans Affairs

VE— vocational expert

VTR— value of one–third reduction rule
115

GLOSSARY

GLOSSARY

1619(a) and (b)— Programs that allow SSI 

recipients to retain Medicaid eligibility even 

though earnings may exceed the SGA level.

Activities of daily living— Behaviors that 

a claimant engages in on a regular basis.

Administrative Law Judge (ALJ)— A 

judge responsible for holding hearings and 

making SSA appellate decisions, after a 

Request for Reconsideration has been denied.

Alien— A person who is not a citizen or 

national of the United States.

Appeals Council— The final level of appeal 

for a SSDI or SSI claim before filing in 

Federal court.

Consultative examination— A medical 

examination ordered by and paid for by the 

DDS that provides evidence regarding an 

applicant’s impairment.

Contact person— Person listed on a 

disability application who can provide 

information to SSA about an applicant’s 

functioning.

Countable income— The amount of 

monthly income that SSA attributes to an 

applicant for SSI benefits. Calculated by 

taking total net income and subtracting any 

income exclusions.

Deeming— When income from another 

person is applied to the income calculation 

for a SSI applicant or recipient.

Dictionary of Occupational Titles 

(DOT)— Department of Labor publication 

that describes how occupations are 

performed in the national economy. The 

DOT is used by SSA to help determine 

whether or not a SSDI or SSI applicant can 

perform their former work or any other type 

of work.

Disability Determination Services 

(DDS)— State agency under contract with 

SSA to determine medical eligibility for 

disability benefits.

Disabled— According to SSA, one is 

disabled if he or she cannot engage in any 

substantial gainful activity by reason of any 

medically determinable physical or mental 

impairment (or combination thereof) which 

can be expected to result in death or can be 

expected to last for a continuous period of 

not less that 12 months.

Diagnostic and Statistical Manual of 

Mental Disorders–IV–Text Revisions 

(DSM–IV–TR)— A manual that lists 

psychiatric and psychological conditions and 

their characteristics.

Earned income exclusion— Portion of the 

work income received by an applicant for 
116 STEPPING STONES TO RECOVERY 

disability benefits, that is not considered in 

determining “countable income.”

Expedited reinstatement— Process 

whereby a recipient of disability benefits 

who is terminated for earning too much 

income can quickly begin to receive benefits 

again if his or her income dips below SSA’s 

income limits. Expedited reinstatement 

must be requested within 60 months of the 

date that benefits are terminated for excess 

income.

Failure to cooperate— Term SSA uses 

when they ask an applicant to take an action 

and the applicant does not respond.

Federal Benefit Rate— Monthly maximum 

amount of SSI that the Federal government 

pays either an individual or a couple. Many 

states supplement this amount.

Fully favorable determination— SSA 

decision that is completely in favor of an 

applicant for, or recipient of, disability 

benefits.

Good cause— Valid reason for not 

complying with a SSA rule or regulation.

Grids— Medical–Vocational guidelines used 

by SSA at Step 5 of the sequential evaluation 

process to determine if a person can engage 

in SGA.

International Classification of Diseases 

(ICD)— A diagnostic manual.

Impairment–related work expenses—

Costs associated with helping a person with 

disabilities to work.

In–kind income— In–kind income is 

not cash, but is actually food or shelter, or 

something you can use to get one of these.

Legal incompetence— A decision issued 

by a court, after reviewing evidence, that a 

person is not able to make decisions on his or 

her own behalf.

Listings, the— Compilation of physical 

and mental impairments used by SSA to 

determine whether a SSDI or SSI applicant 

is disabled at Step 3 of the sequential 

evaluation process.

Medicaid— A Federal health insurance 

program for low-income and disabled people.

Medical evidence— In this context, 

evidence used to indicate the existence of 

specific impairments and to demonstrate 

the severity of those impairments. Medical 

evidence can include objective information 

such as medical or laboratory tests; 

treatment records from a hospital or doctor’s 

office; medical or psychiatric conclusions 

reached by a physician or psychologist; and 

medical histories.

Medicare— A Federal health insurance 

program for aged and disabled people.

Notice— Official communication from SSA.

Partially favorable determination—

When an applicant is determined disabled, 

but not for the entire time during which 

disability was alleged.

Period of ineligibility— A number of 

months during which a SSI recipient is not 

eligible to receive benefits.
GLOSSARY 117

Presumed value rule— A reduction in SSI 

benefits, of up to 1/3 + $20, that SSA makes 

when a person receives in kind assistance 

and the one third reduction rule does not 

apply.

Presumptive disability determination—

A procedure, authorized by Social Security 

rules, under which applicants for SSI who 

have a high probability of being found 

disabled once all evidence is received can 

receive up to six months of payments before 

a full medical evaluation is completed.

Protective filing date— The date SSA 

recognizes as the official date when an 

application was filed, even if the application 

was physically received on a later date.

Release of information— Legal document 

signed by an applicant allowing a health 

care or other service provider to release 

confidential treatment information to the 

DDS or to SSA.

Representative— Person who has been 

formally identified to SSA by an applicant 

as someone who can act on the applicant’s 

behalf.

Representative payee— Person who is 

responsible for receiving and managing a 

recipient’s SSI/SSDI benefit.

Request for Reconsideration (SSA–

561)— Form used to request an initial 

appeal in a SSDI or SSI case.

Retroactive benefit— Benefits paid from 

the date as of which a person is determined 

to be disabled through the date when the 

determination of disability is issued.

Sequential evaluation process— Five-step 

process SSA uses to determine if a person is 

disabled.

Transfer— When an applicant for or 

recipient of disability benefits gives cash or 

other resources to another person.

Trial work period— SSDI work incentive 

program that allows SSDI recipients to 

continue receiving benefits for a trial period 

once they are employed.

Unearned income— Any income that is 

not earned through paid employment (e.g., 

alimony, child support, retirement benefits)

Unfavorable determination— SSA 

decision that finds a person ineligible for 

disability or other benefits.

Unstated income— The difference between 

documented monthly living expenses and 

reported monthly income.

One–third reduction rule— A one–third 

reduction in SSI benefits that SSA makes 

when a person lives in the household of 

another person for a full month and receives 

both food and shelter from that person.

Waiver of overpayment— Formal 

agreement with SSA that a person who has 

been overpaid by SSA does not have to pay 

back some or all of the money.

Whereabouts unknown— Classification 

for cases that are closed by SSA when an 

applicant cannot be reached.
118 STEPPING STONES TO RECOVERY 
119

INDEX

INDEX

A, B, C

Administrative Law Judge 6, 62–68, 113

appeals process 6, 57–66, 68-70

application process 

 documentation necessary for 17–20

 See also documentation

 filing the application 14–16

consultative examination 48–50, 113

contact person 7–11, 17

D, E, F

decision See determination

deeming 25

determination

 favorable 6, 33, 58, 62, 63, 67–69, 116

 unfavorable 33, 66, 115

diagnosis 46 See also evidence

disability benefits

 benefits suspended, terminated 85–88

 overpayment 88–90

Disability Determination Service 4, 5, 6, 

8–11, 20, 36, 39, 42–43, 46–52, 

55–58, 113

documentation 9, 13, 19, 29, 42–48, 73, 84 

See also evidence

duration 44 See also evidence

earned income tax credits 26–27

failure to cooperate 10, 116 See also

whereabouts unknown

financial eligibility 21, 73 See also income; 

See also resources

functional information 43–46 See 

also evidence

G, H, I

health insurance 1, 3–4

immigration 18, 29-30

income 1–6, 17, 19, 23–25, 33–34, 71–72, 

77, 85, 90–93, 115

 earned income 22

 in-kind income 24–25

 unearned income 22

 unstated income 24

J, K, L

listings, the 34

M, N, O

Medicaid 3–4, 6, 116 See also health 

insurance

medical evidence 45–52

medical expert testimony 62–63

Medicare 3, 4, 116 See also health insurance

onset date 2
120 STEPPING STONES TO RECOVERY 

P, Q, R

presumptive disability determination 19–20

representative 8, 10–11, 48, 49, 52, 55, 56, 

60–65, 67–74, 117

representative payee 8, 75–81

Request for Reconsideration 54–58, 88, 117

resources 25–30

 countable resources 25–27

 excluded resources 28–29

retroactive benefits 69–74

S, T, U

sequential evaluation process 32–35

substance abuse 36–39

Substantial Gainful Activity 2, 6, 31, 32, 33, 

34, 92, 113

summary letter 51–52 See also evidence

Ticket to Work program 93 See also work 

incentive programs

V, W, X, Y, Z

vocational expert testimony 63–64

whereabouts unknown 115

work incentive programs 90–93
121

FOR MORE INFORMATION 

FOR MORE INFORMATION

IN PRINT

National Law Center on Homelessness and Poverty. (2002). Advocating on behalf of SSI 

claimants: A guide to rights and resources. Washington, DC: National Law Center on 

Homelessness and Poverty.

National Law Center on Homelessness and Poverty. (2002). Fact sheet: Supplemental security 

income. Washington, DC: National Law Center on Homelessness and Poverty.

Social Security Administration. (2003). Disability evaluation under social security. Baltimore, 

MD: Social Security Administration.

Social Security Administration. (2003). Red book on employment support: A summary guide 

to employment support available to people with disabilities under the SSDI and SSI programs. 

Baltimore, MD: Social Security Administration.

Social Security Administration. (2002). A desktop guide to SSI eligibility requirements. 

Baltimore, MD: Social Security Administration. 

Social Security Administration. (2002). Educational presentations for the social security 

disability programs. Baltimore, MD: Social Security Administration.

Social Security Administration. (2002). Social security administration homeless plan. 

Baltimore, MD: Social Security Administration.

Social Security Administration. (2002). Social security brochure series. Baltimore, MD: Social 

Security Administration. 

Social Security Administration. (2002). Social security: Understanding the benefits. Baltimore, 

MD: Social Security Administration. 

Social Security Administration. (2002). The ticket to work and work incentives advisory panel.

Baltimore, MD: Social Security Administration. 
122 STEPPING STONES TO RECOVERY

Social Security Administration. (2001). Social security: A guide for representative payees. 

Baltimore, MD: Social Security Administration. 

Social Security Administration. (1999). Social security: The appeals process. Baltimore, MD: 

Social Security Administration.

ONLINE

DisabilityInfo.gov: www.disabilityinfo.gov

GovBenefits.gov: www.govbenefits.gov

National Council on Disability: www.ncd.gov

National Law Center on Homelessness & Poverty: www.nlchp.org

Social Security Administration: www.socialsecurity.gov

Social Security Service to the Homeless: www.socialsecurity.gov/homelessness

Social Security Office Locator: s00dace.ssa.gov/pro/fol/fol-home.html

Social Security Regional Websites: www.socialsecurity.gov/regions/regional.html

BY PHONE

National Council on Disability: (202) 272–2004

National Law Center on Homelessness & Poverty: (202) 638–2535 

National Organization of Social Security Claimants’ Representatives: (800) 431–2804

Social Security Administration: (800) 772–1213

(see Office Locator & Regional Websites links, above, for listings of local phone numbers)
FOR MORE INFORMATION 123
124 STEPPING STONES TO RECOVERY
SMA 05-4051 17120.0705.7765020301