Report to the Chairman, Subcommittee 

on Human Resources, Committee on 

Ways and Means, House of 

Representatives 

United States Government Accountability Office

GAO

September 2004 TANF AND SSI 

Opportunities Exist to 

Help People with 

Impairments Become 

More Self-Sufficient 

GAO-04-878 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

www.gao.gov/cgi-bin/getrpt?GAO-04-878.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Cindy M. 

Fagnoni (202) 512-7215 fagnonic@gao.gov.

Highlights of GAO-04-878, a report to the 

Chairman, Subcommittee on Human 

Resources, Committee on Ways and 

Means, House of Representatives 

September 2004

TANF AND SSI

Opportunities Exist to Help People with 

Impairments Become More Self-Sufficient 

In our nationwide survey of county TANF offices, we found that nearly all 

offices reported that they refer recipients with impairments to SSI, but the 

level of encouragement to apply for SSI varies. While almost all of the county 

TANF offices stated that they advise such recipients with impairments to 

apply for SSI, 74 percent also follow up to ensure the application process is 

complete, and 61 percent assist recipients in completing the application. 

Because TANF offices are referring individuals with impairments to SSI, 

these referrals will have some effect on the SSI caseload. However, due to 

data limitations, the magnitude of the effect these referrals have on SSI 

caseload growth is uncertain. While SSA can identify whether SSI recipients 

have income from other sources, it cannot easily determine whether this 

income comes from TANF or some other assistance based on need. In 

addition, past research has not found conclusive evidence regarding the 

impact that TANF referrals have on SSI caseload growth. 

Estimates from our survey found that although some TANF offices impose 

work requirements on individuals with impairments, about 86 percent of all 

offices reported that they either sometimes or always exempt adult TANF 

recipients awaiting SSI determinations from the work requirements. One key 

reason for not imposing work requirements on these recipients is the 

existence of state and county TANF policies and practices that allow such 

exemptions. Nevertheless, county TANF offices, for the most part, are 

willing to offer noncash services, such as transportation and job training, to 

adult recipients with impairments who have applied for SSI. However, many 

recipients do not use these services. This low utilization may be related to 

exempting individuals from the work requirement, but it may also be due to 

the recipients’ fear of jeopardizing their SSI applications. Another reason for 

the low utilization of services is that many services are not necessarily 

available; budgetary constraints have limited the services that some TANF 

offices are able to offer recipients with impairments. 

Many county TANF offices’ interactions with SSA include either having a 

contact at SSA to discuss cases or following up with SSA regarding 

applications for SSI. Interactions that help individuals with impairments 

increase their self-sufficiency are even more limited. In all the states we 

visited, we found that such interactions generally existed between TANF 

agencies and other agencies (such as the Departments of Labor or 

Education). In addition, 95 percent of county TANF offices reported that 

their interactions with SSA could be improved. State and county TANF 

officials feel they have to take the lead in developing and maintaining the 

interaction with SSA. One SSA headquarters official stated that SSA has no 

formal policy regarding outreach to TANF offices but would consider a 

partnership provided there is some benefit for SSA. Still, about 27 percent of 

county TANF offices reported that they were discouraged in their attempts 

to establish a relationship with SSA because staff at the local SSA field office 

told them that they did not have the time or the interest. 

The nation’s social welfare system 

has been transformed into a system 

emphasizing work and personal 

responsibility, primarily through 

the creation of the Temporary 

Assistance for Needy Families 

(TANF) block grant. The 

Supplemental Security Income 

(SSI) program has expanded 

policies to help recipients improve 

self-sufficiency. Given that SSA 

data indicate an overlap in the 

populations served by TANF and 

SSI, and the changes in both 

programs, this report examines (1) 

the extent that TANF recipients 

with impairments are encouraged 

to apply for SSI and what is known 

about how SSI caseload growth has 

been affected by such TANF cases, 

(2) the extent that work 

requirements are imposed on TANF 

recipients applying for SSI, and the 

range of services provided to such 

recipients, and (3) the extent that 

interactions exist between the SSI 

and TANF programs to assist 

individuals capable of working to 

obtain employment. 

What GAO Recommends

GAO recommends that SSA, in a 

new demonstration project, work 

with TANF officials to identify 

recipients with impairments 

capable of working and coordinate 

services to help them improve selfsufficiency. GAO also recommends 

that HHS use its Web site as a 

clearinghouse for information 

regarding opportunities for TANF 

agencies to work with SSA. Both 

SSA and HHS generally agreed with 

our recommendations. 
Page i GAO-04-878 TANF and SSI 

Letter 1

Results in Brief 3 

Background 5 

TANF Recipients with Impairments Are Encouraged to Apply to 

SSI; Impact on SSI Caseload Growth Is Inconclusive 10 

TANF Offices Differ in Their Exemptions from Work 

Requirements, but Utilization of Noncash Services Is Generally 

Low 13 

Some Interaction Between County TANF Offices and SSA Exists, 

but Opportunities Exist for Improvement 16 

Conclusions 19 

Recommendations 20 

Agency Comments and Our Response 21 

Appendix I Scope and Methods 23 

Appendix II Comments from the Department of Health and 

Human Services 25 

Appendix III Comments from the Social Security Administration 29 

Appendix IV GAO Contacts and Staff Acknowledgments 31 

GAO Contacts 31 

Staff Acknowledgments 31 

Tables 

Table 1: County TANF Office Policies for Referring Adult Cash 

Recipients to SSI 10 

Table 2: Information Used by County TANF Offices to Determine 

whether to Refer Adult Recipients to SSI 11 

Table 3: Agencies or Programs That Support TANF Offices by 

Providing Services to At Least Some Adult TANF Cash 

Recipients Awaiting SSI Eligibility Determinations 19 

Contents 
Page ii GAO-04-878 TANF and SSI 

Abbreviations 

AFDC Aid to Families with Dependent Children 

ALJ Administrative Law Judge 

DDS Disability Determination Service 

DI Disability Insurance 

HHS Department of Health and Human Services 

PRWORA Personal Responsibility and Work Opportunity 

 Reconciliation Act of 1996 

SSA Social Security Administration 

SSI Supplemental Security Income 

TANF Temporary Assistance for Needy Families 

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately. 
Page 1 GAO-04-878 TANF and SSI 

September 15, 2004 

The Honorable Wally Herger 

Chairman, Subcommittee on Human Resources 

Committee on Ways and Means 

House of Representatives 

Dear Mr. Chairman: 

Over the past several years, the nation’s social welfare system has been 

transformed from a system emphasizing income support to one 

emphasizing work and personal responsibility. Central to this 

transformation was the creation of the Temporary Assistance for Needy 

Families (TANF) block grant in 1996. Administered by the Department of 

Health and Human Services (HHS), TANF provides states with 

$16.5 billion each year. The Social Security Administration’s (SSA) 

disability programs, including the Supplemental Security Income (SSI) 

program, have also recently expanded policies and initiated demonstration 

projects aimed at helping recipients enter the workforce and achieve selfsufficiency. SSI, which serves adults with low income and assets, paid 

about $18.6 billion in benefits in 2002 to about 3.8 million working age 

(18-64) recipients with blindness or other disabilities.1

SSA’s disability determination process can be lengthy, extending over 

2 years when all administrative appeals are included. Concerns exist 

whether TANF recipients with impairments who are applying for SSI 

receive employment-related services while waiting for an eligibility 

determination. The disability management literature has emphasized that 

the longer an individual with an impairment remains out of the workforce 

the less likely the individual is to ever return to work. Providing such 

services in a timely manner also has implications for TANF recipients 

running up against the TANF program’s 5-year time limit because in 

2000, nearly 59 percent of all working age applicants for SSI were denied 

benefits.2

 1

SSI also provides income assistance to children with disabilities and the aged who have 

low income and assets. 

2

This includes individuals who may have been denied benefits and abandoned their claims 

before exhausting all appeals. 

United States Government Accountability Office

Washington, DC 20548 
Page 2 GAO-04-878 TANF and SSI 

While TANF caseloads have decreased since the program’s inception, in 

1996, not all recipients leave TANF to go to work. Some recipients with 

impairments severe enough to qualify them for SSI leave TANF once they 

are determined eligible for SSI. SSA administrative data have shown an 

overlap in the populations served by TANF and SSI: Up to 25 percent of 

the SSI caseload age 18 to 64 received income assistance based on need 

(including TANF) prior to becoming eligible for SSI, and this figure has 

remained fairly stable over the past few years.3

Given the new environment in which both programs have placed increased 

emphasis on encouraging recipients to find employment, and the overlap 

in both populations, this report examines (1) the extent to which TANF 

recipients with impairments are encouraged to apply for SSI and what is 

known about how SSI caseload growth has been affected by such TANF 

cases; (2) the extent to which work requirements are imposed by TANF 

agencies on their recipients who are applying for SSI, and the range of 

services TANF agencies provide to such recipients with impairments; and 

(3) the extent to which interactions exist between the SSI and TANF 

programs to assist individuals capable of working obtain employment. 

To do this work, we conducted a mail survey of a stratified random sample 

of 600 county TANF offices,4

 representative of county TANF offices 

nationwide. The survey gathered data on the extent that TANF recipients 

with impairments are encouraged to apply for SSI, whether work 

requirements are imposed and the type of services provided during the 

period of SSI eligibility determination, and the extent that interactions 

exist between the SSI and TANF programs. Our survey achieved an 

88 percent response rate, and we weighted the results to generalize our 

findings to all county TANF offices nationwide.5

 To determine what is 

known about how SSI caseload growth has been affected by TANF 

referrals for SSI, we identified and reviewed reports studying this issue 

and assessed each study’s findings. We also visited five states (Arizona, 

 3

A field in SSA’s database does indicate whether an applicant receives assistance based on 

need, but this includes TANF as well as other forms of income assistance based on need. 

While this does not give an accurate estimate of the portion of SSI recipients who were 

TANF recipients, it does provide an upper bound. 

4

The surveys were mailed to either the director of the county TANF office or the regional 

director, depending on the structure of the TANF program in each state. The surveys were 

completed by the director or his/her designee. 

5

Sampling errors for estimates presented in this report did not exceed 5 percentage points. 

See appendix I for a more detailed discussion of sampling errors. 
Page 3 GAO-04-878 TANF and SSI 

Colorado, Iowa, Oregon, and Vermont) known for providing employmentrelated services to TANF recipients with impairments, to gain an 

understanding of the types of interactions that exist between the SSI and 

TANF programs and to assess whether there are opportunities for 

improving these agencies’ efforts at assisting their recipients with 

impairments into employment. In each of these states, we interviewed 

state and county TANF officials, and SSA field office staff, as well as SSA 

headquarters officials. We conducted our work between June 2003 and 

May 2004 in accordance with generally accepted government auditing 

standards. See appendix I for a more detailed discussion of our methods. 

Estimates from our nationwide survey of county TANF offices indicated 

that almost all offices reported that they encourage at least some TANF 

recipients with impairments to apply for SSI, but the effect these TANF 

referrals have had on SSI caseload growth is inconclusive. In order to 

better serve individuals with impairments, nearly all TANF offices rely on 

one or more methods to identify impairments. Although nearly all county 

TANF offices reported that they refer recipients with impairments to SSI, 

the level of encouragement that these individuals receive to apply for SSI 

appears to vary. While almost all county TANF offices stated that they 

advise such recipients with impairments to apply for SSI, about 74 percent 

also follow up to ensure the application process is complete, and about 

61 percent assist recipients in completing the application. Because TANF 

offices are referring individuals with impairments to SSI, these referrals 

will have some effect on the SSI caseload. However, due to data 

limitations, the magnitude of the effect these referrals have on SSI 

caseload growth is uncertain. While SSA can identify whether SSI 

applicants have income from other sources, it cannot easily determine 

whether this income comes from TANF or some other assistance based on 

need. Furthermore, SSA does not collect any data indicating whether an 

applicant is referred from another program. In addition, past research has 

not found conclusive evidence regarding the impact that TANF referrals 

have on SSI caseload growth. 

Although some TANF offices impose work requirements on individuals 

with impairments, about 86 percent of all offices reported that they either 

sometimes or always exempt adult TANF recipients with impairments 

awaiting SSI eligibility determinations from the work requirement. One 

key reason, cited by some county TANF officials we interviewed, for not 

imposing work requirements on adult TANF recipients with impairments 

awaiting SSI is the existence of state or county TANF policies and 

practices that exempt recipients from the work requirements. 

Results in Brief 
Page 4 GAO-04-878 TANF and SSI 

Nevertheless, county TANF offices, for the most part, are willing to offer 

noncash services, such as transportation and job training, to adult 

recipients with impairments who have applied for SSI. However, our 

survey and interviews with state and county TANF officials indicate that 

many recipients do not use these services. This low utilization may be 

related to exempting individuals from the work requirement, but there are 

other reasons. Some TANF officials we interviewed in the states we visited 

said that one of the reasons recipients with impairments do not use these 

services is because of the recipient’s fear of jeopardizing their SSI 

applications. Another reason for the low utilization of services is that 

many services are not necessarily available. Forty percent of county TANF 

offices noted that one of the reasons adult TANF recipients with 

impairments were not participating in work activities was an insufficient 

number of job training or related services. Some state and county TANF 

officials we interviewed indicated that budgetary constraints have also 

limited the services that they are able to offer recipients with impairments. 

Interactions between TANF offices and SSA are limited. Our survey 

showed that some TANF offices have stated an interest in developing a 

relationship with SSA. However, estimates from our survey showed that 

53 percent of counties reported that their interactions included having a 

contact with SSA, and 64 percent reported that their interactions included 

following up with SSA regarding a recipient’s application for SSI. 

According to our survey results and interviews with TANF officials in the 

states we visited, interactions that help individuals with impairments 

increase their self-sufficiency are limited. In the states we visited, we 

found that such interactions generally existed between TANF agencies and 

other agencies (such as the Department of Labor or Department of 

Education). Nevertheless, county TANF offices would like to improve 

their interactions with SSA, with 95 percent of county TANF offices 

reporting that their interactions could be improved. For example, about 

57 percent of counties reported that receipt of training on the SSI 

application process and eligibility requirements is a useful interaction. 

However, only 6 percent of counties reported that they would like to 

improve interactions with SSA specifically related to providing SSA with 

information on employment-related services, such as vocational 

rehabilitation, that recipients received prior to applying for SSI. Some 

state and county TANF officials that we interviewed also said that they felt 

they had to take the lead in developing and maintaining interactions with 

SSA. One SSA headquarters official indicated that SSA has no formal 

policy regarding outreach to TANF offices but would consider such a 

partnership provided there is some benefit for SSA. The official also added 

that they will always respond to TANF training or information requests. 
Page 5 GAO-04-878 TANF and SSI 

However, about 27 percent of county TANF offices reported that they 

were discouraged in their attempts to establish a relationship with SSA 

because the local SSA field office told them that they did not have the time 

or the interest. 

In order to help individuals with impairments increase self-sufficiency and 

to address the gap in continuous work services between TANF and SSI, we 

are recommending that SSA, as part of a new demonstration project, work 

with TANF agencies to identify those low-income individuals with 

impairments who while potentially eligible for SSI may also have the 

capacity to work, and coordinate services to increase the likelihood that 

such individuals can obtain employment and become more self-sufficient. 

In order to facilitate and encourage a sharing of information among TANF 

offices to increase self-sufficiency of recipients with impairments, we are 

recommending that HHS provide space on its Web site to serve as a 

clearinghouse for information regarding best practices and opportunities 

for TANF agencies to interact with SSA. HHS should be able to minimize 

its work and expense by using its Web site to share this information. Both 

SSA and HHS generally agreed with our recommendations and indicated 

that they look forward to working together to help low-income individuals 

with impairments become more self-sufficient. 

The Personal Responsibility and Work Opportunity Reconciliation Act of 

1996 (PRWORA) replaced the individual entitlement to benefits under the 

61-year-old Aid to Families with Dependent Children (AFDC) program 

with TANF block grants to states and emphasized the transitional nature 

of assistance and the importance of reducing welfare dependence through 

employment. Administered by HHS, TANF provides states with 

$16.5 billion each year,6

 and in fiscal 2002, the total TANF caseload 

consisted of 5 million recipients. PRWORA provides states with the 

flexibility to set a wide range of TANF program rules, including the types 

of programs and services available and the eligibility criteria for them. 

States may choose to administer TANF directly, devolve responsibility to 

the county or local TANF offices, or contract with nonprofit or for-profit 

providers to administer TANF. Some states have also adopted “work first” 

programs, in which recipients typically are provided orientation and 

 6

In addition to federal funds, states must also provide funding for TANF. However, states 

are not required to spend all of their block grant in the year the money is received; instead 

they can accumulate unused funds to be used at a later time. Therefore, total TANF 

expenditures in 2002, including federal, state, and accumulated funds, totaled $28.4 billion. 

Background 
Page 6 GAO-04-878 TANF and SSI 

assistance in searching for a job; they may also receive some readiness 

training. Only those unable to find a job after several weeks of job search 

are then assessed for placement in other activities, such as remedial 

education or vocational training. 

While states have great flexibility to design programs that meet their own 

goals and needs, they must also meet several federal requirements 

designed to emphasize the importance of work and the temporary nature 

of TANF aid. For example, TANF established stronger work requirements 

for those receiving cash benefits than existed under AFDC. Furthermore, 

to avoid financial penalties, states must ensure that a steadily rising 

specified minimum percentage of adult recipients are participating in work 

or work-related activities each year. To count toward the state’s minimum 

participation rate, adult TANF recipients in families must participate in a 

minimum number of hours of work or a work-related activity a week, 

including subsidized or unsubsidized employment, work experience, 

community service, job search, providing child care for other TANF 

recipients, and (under certain circumstances) education and training. If 

recipients refuse to participate in work activities as required, states must 

impose a financial sanction on the family by reducing the benefits, or they 

may opt to terminate the benefits entirely. States must also enforce a 

60-month limit (or less at state option) on the length of time a family may 

receive federal TANF assistance,7

 although the law allows states to provide 

assistance beyond 60 months using state funds.8

The TANF caseload includes, as did AFDC, low-income individuals with 

physical or mental impairments considered severe enough to make them 

eligible for the federal SSI program. Administered by SSA, SSI is a meanstested income assistance program that provides essentially permanent 

cash benefits9

 for individuals with a medically determinable physical or 

mental impairment that has lasted or is expected to last at least 1 year or 

to result in death and prevents the individual from engaging in substantial 

 7

A state may exempt up to 20 percent of its average monthly caseload for hardship or 

having been subjected to domestic violence. 

8

Estimates from our survey show that only 2 percent of counties always, and 16 percent 

sometimes, move TANF recipients with impairments awaiting SSI determinations to state 

only funded cash assistance. 

9

While the SSI regulations do not guarantee permanent benefit status, only 0.4 percent of 

SSI disability recipients leave SSI because of work, and only 6.8 percent are no longer 

eligible because of medical improvement. Excess income or resources can also end a 

person’s SSI benefits. 
Page 7 GAO-04-878 TANF and SSI 

gainful activity. To qualify for SSI, an applicant’s impairment must be of 

such severity that the person is not only unable to do previous work but is 

also unable to do any other kind of substantial gainful work that exists in 

the national economy. Work is generally considered substantial and 

gainful if the individual’s earnings exceed a particular level established by 

statute and regulations.10 SSA also administers the Disability Insurance 

program (DI), which uses the same definition of disability, but is not 

means-tested and requires an individual to have a sufficient work history. 

For both DI and SSI, SSA uses the Disability Determination Service (DDS) 

offices to make the initial eligibility determinations.11 If the individual is 

not satisfied with this determination, he or she may request a 

reconsideration of the decision with the same DDS.12 Another DDS team 

will review the documentation in the case file, as well as any new 

evidence, and determine whether the individual meets SSA’s definition of 

disability. If the individual is not satisfied with the reconsideration, he or 

she may request a hearing before an Administrative Law Judge (ALJ). The 

ALJ conducts a new review and may hear testimony from the individual, 

medical experts, and vocational experts. If the individual is not satisfied 

with the ALJ decision, he or she may request a review by SSA’s Appeals 

Council, which is the final administrative appeal within SSA.13 Despite 

recent improvements to the process, going through the entire process, 

including all administrative appeals, can average over 2 years. 

In most states, SSI eligibility also entitles individuals to Medicaid benefits. 

TANF recipients may apply for Medicaid benefits and are likely to qualify, 

but receipt of TANF benefits does not automatically qualify a recipient for 

Medicaid. 

 10In 2004 the substantial and gainful activities level for nonblind individuals is $810 per 

month, and for blind individuals is $1,350 per month, of countable earnings. Both levels are 

indexed to the average wage index. 

11There are 54 primarily state-operated DDS offices; their staff consists generally of a 

variety of positions such as disability examiners, medical consultants, vocational 

specialists, and quality assurance personnel. 

12In September 2003, the Commissioner testified before the House Committee on Ways and 

Means, saying that she intended to revise the disability determination process. For 

example, she proposed eliminating the reconsideration and the Appeals Council stages of 

the current process. 

13If the individual is not satisfied with the Appeals Council action, the individual may appeal 

to a federal district court. The individual can continue legal appeals to the U.S. Circuit 

Court of Appeals and ultimately to the Supreme Court of the United States. 
Page 8 GAO-04-878 TANF and SSI 

While SSA has recently expanded policies and initiated demonstration 

projects aimed at helping DI and SSI beneficiaries enter or return to the 

workforce and achieve or at least increase self-sufficiency, its disability 

programs remain grounded in an approach that equates impairment with 

inability to work. This approach exists despite medical advances and 

economic and social changes that have redefined the relationship between 

impairment and the ability to work. The disconnect between SSA’s 

program design and the current state of science, medicine, technology, 

and labor market conditions, along with similar challenges in other 

programs, led GAO in 2003 to designate modernizing federal disability 

programs, including DI and SSI, as a high-risk area urgently needing 

attention and transformation.14

The Ticket to Work and Work Incentives Improvement Act of 1999 

amended the Social Security Act to create the Ticket to Work and SelfSufficiency Program (Ticket Program). This program provides most DI and 

SSI beneficiaries with a voucher, or “ticket,” which they can use to obtain 

vocational rehabilitation, employment, or other return-to-work services 

from an approved provider of their choice. The program, while voluntary, 

is only available to beneficiaries after the lengthy eligibility determination 

process. Once an individual receives the ticket, he or she is free to choose 

whether or not to use it, as well as when to use it. Generally, disability 

beneficiaries age 18 through 64 are eligible to receive tickets. The Ticket 

Program has been implemented in phases and is to be fully implemented 

in 2004. 

The Social Security Advisory Board15 (Advisory Board) has questioned 

whether Social Security’s definition of disability is appropriately aligned 

with national disability policy. The definition of disability requires that 

individuals with impairments be unable to work, but then once found 

eligible for benefits, individuals receive positive incentives to work.16 Yet 

 14GAO, High-Risk Series: An Update, GAO-03-119 (Washington, D.C.: Jan. 1, 2003). 

15The Social Security Advisory Board is an independent, bipartisan board created by the 

Congress and appointed by the President and the Congress to advise the President, the 

Congress, and the Commissioner of Social Security on programs and matters related to 

SSA. 

16In addition to the Ticket Program, SSA also offers other work incentives to disability 

beneficiaries aimed at encouraging work. For SSI recipients, these work incentives include 

such things as earned income exclusions (which are intended to make work more enticing 

since some earned income is excluded from countable income), a deduction for 

impairment-related work expenses, and continuation of SSI, which allows beneficiaries to 

work and continue receiving benefits until their countable income exceeds the SSI limit. 
Page 9 GAO-04-878 TANF and SSI 

the disability management literature has emphasized that the longer an 

individual with an impairment remains out of the workforce the more 

likely the individual is to develop a mindset of not being able to work and 

the less likely the individual is to ever return to work.17 Having to wait for 

return-to-work services until determined eligible for benefits may be 

inconsistent with the desire of some individuals with impairments who 

want to work but still need financial and medical assistance. The Advisory 

Board, in recognizing that these inconsistencies need to be addressed, has 

suggested some alternative approaches. One option they discussed in a 

recent report is to develop a temporary program, which would be available 

while individuals with impairments were waiting for eligibility 

determinations for the current program. This temporary program might 

have easier eligibility rules and different cash benefit levels but stronger 

and more individualized medical and other services needed to support a 

return to work.18

SSA has also realized that one approach may not work for all beneficiaries, 

and in recent years it has begun to develop different approaches for 

providing assistance to individuals with disabilities. One example of these 

efforts is the proposed Temporary Allowance Demonstration, which 

would provide immediate cash and medical benefits for a specified period 

to individuals who meet SSA’s definition of disability and who are highly 

likely to benefit from aggressive medical care. SSA is also in the process of 

developing the Early Intervention Demonstration. This demonstration 

project will test alternative ways to provide employment-related services 

to disability applicants. Although both of these demonstration projects 

only cover the DI program, SSA also has the authority to conduct other 

demonstration projects with SSI applicants and recipients. 

 17GAO, SSA Disability: Return-to-Work Strategies From Other Systems May Improve 

Federal Programs, GAO/HEHS-96-133 (Washington, D.C.: July 11, 1996). 

18Social Security Advisory Board, The Social Security Definition of Disability, 

(Washington, D.C.: Oct. 2003). 
Page 10 GAO-04-878 TANF and SSI 

Estimates from our nationwide survey of county TANF offices indicated 

that almost all offices reported that they refer at least some recipients with 

impairments to apply for SSI. But the level of encouragement these 

individuals receive from their local TANF office to apply for SSI varies, 

with many offices telling the individual to apply for SSI and some offices 

helping the recipient complete the application. Because TANF offices are 

referring individuals to SSI, these referrals will have some effect on the SSI 

caseload. However, findings regarding the impact that these SSI referrals 

from TANF have on SSI caseload growth are inconclusive, due to data 

limitations. 

Based on estimates from our survey, 97 percent of all counties refer at 

least some of their adult TANF recipients with impairments to SSA to 

apply for SSI. As table 1 shows, 33 percent of county TANF offices said 

that it is their policy to refer to SSI only those adults whose impairments 

are identified as limiting or preventing their ability to work. However, 

another 32 percent of county TANF offices said that it is their policy to 

refer all TANF recipients identified with impairments to SSI for eligibility 

determinations. 

Table 1: County TANF Office Policies for Referring Adult Cash Recipients to SSI 

Policy Percent

Refer all recipients with impairments 32

Refer based on criteria from SSI eligibility determination process 13

Refer only those who are work limited 33

No policy 20

Source: Percentages are estimated from GAO survey of county TANF offices. 

Note: Respondents were also given the option of indicating that their policy was something other than 

those listed above, and 2 percent of respondents indicated other. 

TANF offices reported that they rely on several methods to identify an 

individual’s impairment and assess whether the individual could work or 

should be referred to SSI. Estimates from our survey indicated that all 

county offices rely on the applicant to disclose his or her impairment. In 

addition, 96 percent of all counties rely on caseworker observation, about 

57 percent use a screening tool, and about 60 percent use an intensive 

assessment. 

Once recipients are identified as having impairments, TANF offices need 

to decide which individuals to refer to SSI. As table 2 shows, many 

TANF Recipients with 

Impairments Are 

Encouraged to Apply 

to SSI; Impact on SSI 

Caseload Growth Is 

Inconclusive 

Nearly All County TANF 

Offices Refer Recipients 

with Impairments to Apply 

for SSI, but the Level of 

Encouragement Varies 
Page 11 GAO-04-878 TANF and SSI 

counties rely on multiple forms of documentation or other information to 

make this decision, rather than referring all individuals with impairments. 

Specifically, 94 percent of all counties reported that they use 

documentation from a recipient’s physician, and 95 percent reported that 

they use self-reported information from the recipient. 

Table 2: Information Used by County TANF Offices to Determine Whether to Refer 

Adult Recipients to SSI 

Information Percent

Documentation from recipient’s physician 94

Documentation from medical professional other than a physician 80

Evaluation by an on-site or vendor medical professional 31

Evaluation of recipient’s ability to work by state vocational rehabilitation worker 70

Informal evaluation by caseworker or social worker 85

Documented evaluation by caseworker 49

Behavior observed by caseworker 82

Self-reported information from recipient 95

Source: Percentages are estimated from GAO survey of county TANF offices. 

While nearly all county TANF offices reported that they refer at least some 

individuals with impairments to SSI, the level of encouragement such 

individuals receive from their local TANF office appears to vary. About 

98 percent of county TANF offices reported that they tell these recipients 

to call or go to SSA to apply for SSI. About 61 percent reported that they 

will also assist a recipient in completing the SSI application, and about 

74 percent reported that they follow up to ensure the application process 

is complete. Some of the variation in the level of encouragement may be 

explained by the fact that some states are work first states. Officials we 

interviewed in four states acknowledged that they try to get all TANF 

recipients to work, including recipients with impairments. Therefore, 

while they make referrals to SSI, officials in these work first states told us 

that they try to encourage work more than the SSI application process.19

However, officials in all five of the states we visited stated that if they feel 

an individual has a severe impairment, they would have the individual 

apply for SSI. 

 19The labor market may also be a contributing factor in deciding to refer an individual with 

an impairment to SSI. 
Page 12 GAO-04-878 TANF and SSI 

Since county TANF offices refer individuals with impairments to SSI, these 

referrals will have some effect on the SSI caseload. To determine the 

magnitude of the effect that these TANF referrals have had on SSI 

caseload growth, SSA would need to know who among their applicants are 

TANF recipients. However, SSA headquarters officials told us that the 

agency does not know who is referred or how people are referred because 

it does not collect those data. Although the SSI application specifically 

asks whether the applicant is receiving TANF, this information is 

combined with other income assistance based on need in SSA’s database.20

Therefore, while the working age (18-64) SSI caseload has increased 

33 percent over the last decade, SSA does not have an easy way to 

accurately determine the magnitude of the effect that the TANF referrals 

have had on the growth of the SSI rolls. 21

Also, in a study funded by SSA and conducted by The Lewin Group, 

researchers found little, if any, evidence that TANF had increased referrals 

to SSI. 22 Only one of the five states the researchers visited remarked of a 

perceptible increase in transitions to SSI. The authors noted that the likely 

reason for not finding a significant increase in referrals due to welfare 

reform is the fact that referrals to SSI had already been occurring under 

AFDC, and that the full impact of the welfare reform changes would not be 

known until the time limit for benefit receipt had elapsed.23 However, to 

date there have not been any studies that looked at this issue. 

In addition to SSA not knowing the magnitude of the effect that TANF 

referrals have had on SSI caseload growth, TANF officials we interviewed 

stated that they generally do not have historical data on SSI referrals, 

approvals, and denials. But officials in most states that we visited said they 

are in the process of improving their data collection in this respect, 

 20In order for SSA to obtain this information, special processing runs are required. Based 

upon recent work, SSA determined that 95 percent of the reported income based on need 

was from TANF. 

21Over the last few years, the percentage of the SSI caseload age 18 to 64 that received 

income assistance based on need prior to becoming eligible for SSI has remained fairly 

stable at 25 percent. While this does not give an accurate estimate of the portion of SSI 

recipients who were TANF recipients, it does provide an upper bound. 

22Cornell University and The Lewin Group, Policy Brief: Transitions from AFDC to SSI 

Prior to Welfare Reform, (Ithaca, NY: Feb. 1, 2000). 

23HHS pointed out that recipients in all states have reached the 5-year national time limit. 

However, all states are under the 20 percent limit on extensions, so there is no reason to 

expect a sharp increase in referrals to SSI. 

Findings About How SSI 

Caseload Growth Has 

Been Affected by Referred 

TANF Recipients with 

Impairments Are 

Inconclusive due to Data 

Limitations 
Page 13 GAO-04-878 TANF and SSI 

including tracking methods to determine the status of an SSI application, 

which should provide them with better data in the future. 

TANF offices vary in whether they make work requirements mandatory for 

their adult recipients with impairments awaiting SSI eligibility 

determinations. Even though estimates from our survey showed that 

83 percent of county TANF offices reported offering noncash services to 

TANF recipients with impairments who are awaiting SSI eligibility 

determinations, these services may not be available or are not fully 

utilized. Reasons for this low service utilization may include exemptions 

from the work requirements and an insufficient number of job training or 

related services. 

Estimates from our survey showed that about 86 percent of county TANF 

offices have policies that always or sometimes exempt from the work 

requirements adult TANF recipients with impairments who are referred to 

SSI for eligibility determinations. Also, about 31 percent of county TANF 

offices consider the number of times a recipient is denied and appeals an 

SSI decision as a factor when deciding to exempt recipients from the work 

requirements. 

Our survey further found that 82 percent of counties reported exempting 

recipients, in part, on the basis of the degree to which the impairment 

limits the recipient’s ability to work. In addition, about 69 percent of 

county TANF offices reported that the severity of the impairment was a 

major factor in their decisions to exempt people with impairments who 

are awaiting SSI determinations from work requirements. One TANF 

official we interviewed told us that the recipients’ impairments were too 

great to participate in work activities. 

However, some of the state and county TANF officials we interviewed 

explained that they have developed alternative practices to help recipients 

with impairments participate in work activities. TANF officials from two 

of the states we visited told us that they have developed a modified work 

requirement for adult TANF recipients with impairments.24 A TANF official 

 24A modified work policy, for example, allows TANF recipients with impairments to work 

fewer hours than the federal work requirement without being sanctioned. Modified work 

policies are defined by the state and are not federally approved. 

TANF Offices Differ in 

Their Exemptions 

from Work 

Requirements, but 

Utilization of Noncash 

Services Is Generally 

Low 

Work Requirements Are 

Not Always Mandatory for 

Those TANF Recipients 

with Impairments Awaiting 

SSI Eligibility 

Determinations 
Page 14 GAO-04-878 TANF and SSI 

from one of these states said that the modified work requirements 

encourage individuals with impairments to work, but they do not expect 

that these individuals will be able to work in a full-time capacity. One 

county TANF official we interviewed explained that the work 

requirements and services provided for their recipients with impairments 

are very individualized, based on recommendations of the doctors who 

meet with the recipients. However, in all of the states and counties we 

visited, TANF officials said that individualized services can be costly. One 

state official said that his state’s program does not have the funds to pay 

for the training needed by people with learning disabilities. The official 

added that when people with impairments need substantial help, there 

were limits as to what could be funded in a work first state. 

Even though about 51 percent of county TANF offices do not require adult 

TANF recipients awaiting SSI determinations to participate in any type of 

job services, education services, work experience programs, or other 

employment services, 83 percent of county TANF offices reported that 

they are still willing to provide work-related or support services to this 

population. One state official we interviewed reported that the services 

provided are the same for persons with or without impairments. Officials 

in this state explained that these services include transportation, child 

care, medical assistance, tuition assistance, vocational rehabilitation, and 

assistance with obtaining SSI benefits. 

Even though county TANF offices may be willing to offer noncash services 

to their recipients, among those counties that could provide us with 

information on service utilization, utilization of these services tended to be 

low. While the low utilization of services may be due to exemptions from 

the work requirements, service availability may also be an issue. Estimates 

from our survey showed that 40 percent of county TANF offices reported 

one of the reasons adult TANF recipients with impairments, who are 

awaiting SSI eligibility determinations, are not participating in work 

activities is that there are an insufficient number of job training or related 

services available for them to use. In addition, some TANF officials that 

we interviewed cited not only limited funding, but also their offices’ own 

TANF policies as factors that might explain why services may not be 

available to recipients with impairments. For example, a state TANF 

official we interviewed said that state budget cuts have resulted in 

trimming of support services made available to recipients. Another state 

official explained that adult recipients with impairments who are placed in 

an exempted status are allowed access to medical services but not workrelated support services, such as transportation, clothing, or vehicle 

A Broad Range of Services 

Are Offered to Recipients 

Awaiting SSI 

Determinations, but 

Utilization Is Low 
Page 15 GAO-04-878 TANF and SSI 

repairs. The official further explained that those services are limited to 

those individuals who are in work activities. 

In addition, estimates from our survey showed that 50 percent of county 

TANF offices reported recipients’ motivation to apply for SSI was one of 

the conditions that might challenge or hinder their offices in providing 

employment services. Some state and county TANF officials we 

interviewed also believe that one of the main reasons why there is low 

utilization of services is recipients’ fear of jeopardizing their SSI 

applications. While participation in a work activity does not necessarily 

preclude an individual from obtaining disability benefits from SSA, 

estimates from our survey showed that 41 percent of county TANF offices 

reported that their recipients with impairments, awaiting SSI eligibility 

determinations, are unsure whether or not the demonstration of any work 

ability would hinder or disqualify their chances for SSI eligibility. State and 

county TANF officials we interviewed explained that recipients applying 

for SSI or awaiting an SSI decision fear participating in work activities. 

Some of the county TANF officials we interviewed explained that this 

population does not want to participate in work-related services for fear of 

jeopardizing their applications. These officials noted that compounding 

recipients’ fears are attorneys who may be attempting to protect their 

clients’ interests by sending TANF offices notices saying that any work 

activity could jeopardize their clients’ SSI applications. These fears have 

led to TANF workers having some difficulty in getting their recipients with 

impairments to explore work options during the time they are applying for 

SSI. One state TANF official we interviewed pointed out that 

conversations with their recipients about work activities have generally 

occurred because the recipients want to volunteer for such activities. A 

county TANF official explained that there is a challenge in providing work 

services to this population, as the recipients are so focused on getting on 

SSI that it is difficult to get them to focus on anything else. 

Yet another reason for the low use of noncash service is that some of the 

county TANF officials we interviewed expressed some uncertainty as to 

how to best serve their adult TANF recipients with impairments, 

explaining that they are sending mixed signals when it comes to 

encouraging work. One county TANF official we interviewed said that on 

one hand, recipients are being told about using TANF services to obtain 

employment, and then, on the other hand, recipients are being told to 

apply for SSI benefits, which require an applicant to focus on his or her 

inability to work. Some TANF offices also allow TANF recipients with 

impairments to count applying for SSI as a work activity. Estimates from 

our survey showed that about 30 percent of county TANF offices reported 
Page 16 GAO-04-878 TANF and SSI 

that they consider the SSI application process an activity that satisfies the 

work requirement. Also, another county official we interviewed stated that 

if a client goes into an exempted status, the client must participate in at 

least one activity a week, but not necessarily a work activity. It can be any 

service the TANF office has to offer, including physical therapy or 

assistance in completing the SSI application. 

Some county TANF offices have developed interactions with SSA offices, 

but such interactions have been of a limited nature and have focused on 

the SSI application process. Estimates from our survey indicated that 

some TANF offices have some form of interaction with SSA. Estimates 

from our survey also showed that two frequently reported forms of 

interaction between county TANF offices and SSA include having a 

contact at SSA with whom to discuss cases and following up with SSA 

regarding applications for SSI. 

In describing his office’s interactions with SSA, one state TANF official we 

interviewed said that his office, SSA, and DDS have a good working 

relationship, which includes cross training between the agencies and 

discussions concerning the SSI application process. However, estimates 

from our survey showed about 95 percent of county TANF offices reported 

that they would like to develop a relationship, or improve their 

relationship, with their local SSA field office with regard to adult TANF 

recipients applying for SSI. One state TANF official that we interviewed 

said that his office does not have much of a relationship with SSA. He 

noted that he had no contacts within SSA but would like to develop a 

formal relationship with DDS so that they could make faster 

determinations for the deferred TANF caseload. A county TANF official 

we interviewed said that her office’s communication with SSA is largely 

one-sided. This TANF official explained that even though her office sends 

documentation that supports a recipient’s SSI application, SSA does not 

inform them of any eligibility decisions it makes with TANF applicants. As 

a result, TANF staff must rely on their recipients telling them about 

decisions or on a computer system that indicates if an individual is 

receiving benefits. Finally, in all of the states we visited, TANF officials 

told us that they interact with SSA to assist their TANF recipients with 

impairments get onto SSI. Estimates from our survey also showed that 

64 percent of counties reported that their interactions were TANF officials 

following up with SSA regarding a recipient’s SSI application, and 

53 percent reported having a contact at SSA to discuss cases. 

Some Interaction 

Between County 

TANF Offices and SSA 

Exists, but 

Opportunities Exist 

for Improvement 
Page 17 GAO-04-878 TANF and SSI 

TANF offices identified a number of ways they would like to improve 

interactions with SSA, but most of these focused on making the SSI 

application process more efficient and not on working together to assist 

TANF recipients with impairments toward employment and selfsufficiency. Estimates from our survey showed about 57 percent of the 

county TANF offices said that they would like to receive training from SSA 

regarding the SSI application process and eligibility requirements, 

50 percent said they would like to have a contact at SSA with whom to 

discuss cases, and 41 percent said they would like to have regular 

meetings or working groups with SSA regarding interactions and other 

issues related to serving low-income individuals with impairments. In 

addition, one TANF official we interviewed would like interactions with 

SSA to be improved and thinks they could be if he knew what DDS was 

looking for in the application process, such as what it requires for 

evidence. In contrast, only 6 percent of county TANF offices reported that 

they would like to improve interactions with SSA specifically related to 

providing SSA with information on employment-related services received 

while on TANF. 

Although TANF offices reported an interest in developing a close working 

relationship with SSA, based on their interactions with SSA, some state 

and county TANF officials believed that they had to take the lead in 

developing these relationships. For example, one TANF official we 

interviewed explained that he had attempted to make contact with SSA to 

discuss a potential partnership and address some of the county’s issues 

with the SSI application process but received no response. The county 

official then wrote a letter to a top SSA regional official asking about 

partnering opportunities. In response, the regional official instructed the 

SSA area director, along with the local SSA and state DDS office, to meet 

with county officials. 

One SSA headquarters official we interviewed told us there is no SSA 

policy that directs or encourages their field offices to interact with TANF 

offices. The official also told us that SSA would consider such a 

partnership with TANF offices but would want assurances of what the 

benefits would be for SSA. In addition, the official said that the agency 

does not want to start up a partnership that would overly tax its already 

high workloads. The official further said that if it were to develop a 

relationship with TANF offices, SSA would then have to develop a training 

program and then administer it to all operations personnel. The official 

noted that developing and administering such a training program would 

not be a small task. SSA officials did state that if a TANF office makes a 

request for training sessions, SSA would be willing to provide training on 
Page 18 GAO-04-878 TANF and SSI 

the application process. However, about 27 percent of county TANF 

offices reported that they were discouraged in their attempts to establish a 

relationship with SSA because the local SSA field office told the TANF 

office that SSA did not have the time or the interest. 

While officials at SSA headquarters stated that they are largely unaware of 

any partnerships or interactions between TANF offices and local SSA field 

offices, some local SSA officials have found such relationships beneficial. 

In particular, one SSA official has found his office’s relationship with the 

local TANF office to be a form of outreach for SSA by helping his office 

identify people who would qualify for SSI. He explained that his local SSA 

office does not always have the time or staff to conduct outreach. He 

further explained that TANF case managers can explain the benefits and 

provide assistance to the TANF recipient applying for SSI. Thus, when a 

letter comes from the DDS that initially denies the claim, the individual is 

less likely to throw it away, as he or she is more aware of the process. This 

could save SSA time and money as the applicant knows that he or she 

must appeal within a certain amount of time, thereby reducing the need to 

start over because of missed deadlines. 

While 34 percent of those county TANF offices that provide services to 

recipients awaiting SSI eligibility determinations reported interacting with 

SSA in some manner to serve adult TANF recipients with impairments, a 

much higher proportion reported receiving assistance from other agencies 

or programs. For example, as table 3 shows, 91 percent of county TANF 

offices reported that at least some of their recipients awaiting SSI 

determinations received assistance from the state vocational rehabilitation 

agencies, and 86 percent of all offices reported that at least some of their 

recipients received assistance from the state or local mental health 

agency. Further, in all of the states we visited, TANF offices reported 

working with other agencies, such as the Department of Education and the 

Department of Labor, to help TANF recipients with impairments find 

work. 
Page 19 GAO-04-878 TANF and SSI 

Table 3: Agencies or Programs That Support TANF Offices by Providing Services to 

At Least Some Adult TANF Cash Recipients Awaiting SSI Eligibility Determinations 

Agencies Percent

State Vocational Rehabilitation 91

Other U.S. Department of Education Programs 67

Social Security Administration 34

U.S. Department of Labor 69

State or Local Mental Health Agency 86

Community Programs 67

Other 9

None 1

Source: Percentages are estimated from GAO survey of county TANF offices. 

With the new emphasis on work and self-sufficiency taken by TANF and 

SSI, and the overlap in the populations served by both programs, 

opportunities exist to improve the way these two programs interact in 

order to help individuals with impairments become more self-sufficient. 

While some interactions between TANF offices and SSA do exist, they are 

often limited to how best to assist a TANF recipient with impairments 

become eligible for essentially permanent cash benefits under SSI. 

Moreover, the practice by most TANF offices of exempting individuals 

from work requirements while awaiting SSI eligibility determination, as 

well as SSA’s policy of offering return-to-work services and incentives only 

after a lengthy eligibility process, undermines both programs’ stated goals 

of promoting self-sufficiency. In addition, this practice runs counter to the 

disability management literature that has emphasized that the longer an 

individual with an impairment remains out of the workforce the less likely 

the individual is to ever return to work. In recognition of this, SSA is 

planning demonstration projects that will test alternative ways to provide 

benefits and employment supports to DI applicants. However, TANF 

recipients with impairments, because of their low income and assets, are 

more likely to apply and qualify for SSI. Moreover, TANF recipients with 

impairments often receive assessments of their conditions and capacity to 

work while on TANF. Since SSA cannot easily identify who among its 

applicants are TANF recipients, SSA is also unable to systematically 

identify the types of services that the SSI applicant may have received 

through TANF or know whether the SSI applicant has been assessed as 

having the capacity to work or not. Being able to identify the receipt of 

TANF benefits, as well as the noncash services received through TANF, 

may help SSA accomplish its mission of promoting the employment of 

Conclusions 
Page 20 GAO-04-878 TANF and SSI 

beneficiaries with impairments. By sharing information and establishing 

better working relationships with TANF agencies, SSA could identify, 

among its applicants who are or were TANF recipients, those individuals 

capable of working and could then target them for employment-related 

services and help them achieve self-sufficiency or at least reduce their 

dependency on cash benefits. Although the disconnect in work 

requirements between TANF and SSA’s disability programs and the timing 

of when employment-related services are provided to SSI recipients could 

be barriers to establishing a continuity of services, the earlier provision of 

employment-related services, as part of a demonstration project, could 

mitigate these potential barriers. 

While some county TANF officials we interviewed have developed 

working relationships with their local SSA office, other counties have not 

or may be unaware of the possibilities for interactions with SSA and how 

to go about establishing these relationships. Sharing best practices about 

how TANF agencies can distinguish, among the recipients they have 

referred to SSI, those individuals without the capacity to work from those 

with the capacity to work and who could benefit from employment-related 

services could help ensure that those individuals with work capacity be 

given the assistance they need to help them obtain employment. Moreover, 

sharing best practices for establishing useful interactions with SSA could 

help ensure that employment-related services could continue after the 

person becomes eligible for SSI. 

To help individuals with impairments become more self-sufficient and to 

address the gap in continuous work services between the TANF and SSI 

programs, we are recommending that SSA, as part of a new demonstration 

project, work with TANF offices to develop screening tools, assessments, 

or other data that would identify those TANF recipients with impairments 

who while potentially eligible for SSI may also be capable of working. 

Once these recipients have been identified, the TANF offices and SSA 

could work together to coordinate aggressive medical care and 

employment-related services that would help the individual obtain 

employment and achieve or at least increase self-sufficiency. 

In order to facilitate and encourage a sharing of information among TANF 

offices regarding the development of interactions with SSA that might 

increase self-sufficiency of recipients with impairments, we are 

recommending that HHS provide space on its Web site to serve as a 

clearinghouse for information regarding best practices and opportunities 

for TANF agencies to interact with SSA. This would allow state and county 

Recommendations 
Page 21 GAO-04-878 TANF and SSI 

TANF officials to share information on what they are doing, what works, 

and how to go about establishing relationships with SSA. It would also 

provide states and counties with access to the research of federal 

agencies, state and county offices, and other researchers that they may 

need in order to develop a strong functional relationship with SSA and 

help TANF recipients with impairments move toward economic 

independence. HHS should be able to minimize its work and expense by 

using its Web site to share this information. 

We provided a draft of this report to HHS and SSA for comment. Both 

agencies generally agreed with our recommendations and indicated that 

they look forward to working together to help low-income individuals with 

impairments become more self-sufficient. Specifically, SSA stated that it 

would be pleased to work with HHS on the planning and design of a 

demonstration project. Likewise, HHS stated that it would be pleased to 

have its staff work with SSA to develop a process or criteria for identifying 

individuals who could benefit from employment services. 

In addition, in response to the findings of our report, SSA said it would 

take immediate measures to ensure that it responds to all requests from 

TANF offices for training on SSA’s programs. 

Also in its comments, SSA suggested that we include in our report the fact 

that states may exempt up to 20 percent of their caseload from the time 

limits and that many states waive work requirements for persons applying 

for SSI. In both the draft we sent to SSA and the final version, we included 

a footnote explaining the time limit exemptions, and in the body of the 

report we discussed the issue of work requirement exemptions for persons 

applying for SSI. 

HHS’ comments appear in appendix II and SSA’s comments appear in 

appendix III. In addition, both HHS and SSA provided technical comments, 

which we have incorporated as appropriate. 

As agreed with your office, unless you publicly announce its contents 

earlier, we plan no further distribution until 30 days after the date of this 

letter. At that time, we will send copies to the Secretary of HHS, the 

Commissioner of Social Security, appropriate congressional committees, 

and other interested parties. The report is also available at no charge on 

Agency Comments 

and Our Response 
Page 22 GAO-04-878 TANF and SSI 

GAO’s Web site at http://www.gao.gov. If you have any questions about 

this report, please contact me or Carol Dawn Petersen on (202) 512-7215. 

Other staff who made key contributions are listed in appendix IV. 

Cynthia M. Fagnoni 

Managing Director, Education, Workforce, 

 and Income Security Issues 
Appendix I: Scope and Methods 

Page 23 GAO-04-878 TANF and SSI 

To determine the extent that Temporary Assistance for Needy Families 

(TANF) recipients with impairments are encouraged to apply for 

Supplemental Security Income (SSI), whether work requirements are 

imposed, the range of services provided during the period of SSI eligibility 

determination, and the extent that interactions exist between the SSI and 

TANF programs, we conducted a nationally representative survey of 

600 county TANF administrators from October 14, 2003, through February 

20, 2004. 

For the most part, TANF services are provided at the county level, so we 

selected a random probability sample of counties for our survey. We 

derived a nationwide listing of counties from the U.S. Bureau of the 

Census’s county-level file with 2000 census data and yearly population 

estimates for 2001 and 2002. We selected a total sample of 600 counties out 

of 3,141 counties. To select this sample, we stratified the counties into two 

groups. The first group consisted of the 100 counties in the United States 

with the largest populations, using the 2002 estimates. The second group 

consisted of the remaining counties in the United States. We included all 

of the 100 counties with the largest populations in our sample to ensure 

that areas likely to have large concentrations of TANF recipients were 

represented. From the second group, consisting of all the remaining 

counties, we selected a random sample of 500 counties. 

After selecting the sample of counties, we used the American Public 

Human Services Association’s Public Human Services Directory 

(2002-2003) to determine the name and address of the TANF administrator 

for each county. In states with regional TANF programs, we asked the 

regional director to fill out a questionnaire for each county in the region. 

We obtained responses from 527 of 600 counties, for an overall response 

rate of about 88 percent.1

 The responses are weighted to generalize our 

findings to all county TANF offices nationwide. Sample weights reflect the 

sample procedure, as well as adjusting for nonresponse. 

Because we followed a probability procedure based on random selections, 

our sample is only one of a large number of samples that we might have 

drawn. Since each sample could have provided different estimates, we 

express our confidence in the precision of our particular sample’s results 

 1

The response rate for the stratum consisting of the 100 counties with the largest 

populations was 92 percent. The response rate for our sample of the remaining U.S. 

counties was 87 percent. 

Appendix I: Scope and Methods 
Appendix I: Scope and Methods 

Page 24 GAO-04-878 TANF and SSI 

at a 95 percent confidence level at an interval of plus or minus 

5 percentage points. This is the interval that would contain the actual 

population value for 95 percent of the samples we could have drawn. In 

other words, we are 95 percent confident the confidence interval will 

include the true value of the study population. 

In addition to the reported sampling errors, the practical difficulties of 

conducting any survey may introduce other types of errors, commonly 

referred to as nonsampling errors. For example, differences in how a 

particular question is interpreted, the sources of information available to 

respondents, or the types of people who do not respond can introduce 

unwanted variability into the survey results. We included steps in both the 

data collection and data analysis stages for the purpose of mitigating such 

nonsampling errors. 
Appendix II: Comments from the Department 

of Health and Human Services 

Page 25 GAO-04-878 TANF and SSI 

Appendix II: Comments from the Department 

of Health and Human Services 
Appendix II: Comments from the Department 

of Health and Human Services 

Page 26 GAO-04-878 TANF and SSI 
Appendix II: Comments from the Department 

of Health and Human Services 

Page 27 GAO-04-878 TANF and SSI 
Appendix II: Comments from the Department 

of Health and Human Services 

Page 28 GAO-04-878 TANF and SSI 
Appendix III: Comments from the Social 

Security Administration 

Page 29 GAO-04-878 TANF and SSI 

Appendix III: Comments from the Social 

Security Administration 
Appendix III: Comments from the Social 

Security Administration 

Page 30 GAO-04-878 TANF and SSI 
Appendix IV: GAO Contacts and Staff 

Acknowledgments 

Page 31 GAO-04-878 TANF and SSI 

Carol Dawn Petersen, (202) 512-7215 

Michael J. Collins, (202) 512-7215 

In addition to those named above, David J. Forgosh, Cady Summers, 

Megan Matselboba, Christopher Moriarity, and Luann Moy made key 

contributions to this report. 

Appendix IV: GAO Contacts and Staff 

Acknowledgments 

GAO Contacts 

Staff 

Acknowledgments 

(130263) 
The Government Accountability Office, the audit, evaluation and 

investigative arm of Congress, exists to support Congress in meeting its 

constitutional responsibilities and to help improve the performance and 

accountability of the federal government for the American people. GAO 

examines the use of public funds; evaluates federal programs and policies; 

and provides analyses, recommendations, and other assistance to help 

Congress make informed oversight, policy, and funding decisions. GAO’s 

commitment to good government is reflected in its core values of 

accountability, integrity, and reliability. 

The fastest and easiest way to obtain copies of GAO documents at no cost 

is through GAO’s Web site (www.gao.gov). Each weekday, GAO posts 

newly released reports, testimony, and correspondence on its Web site. To 

have GAO e-mail you a list of newly posted products every afternoon, go 

to www.gao.gov and select “Subscribe to Updates.” 

The first copy of each printed report is free. Additional copies are $2 each. 

A check or money order should be made out to the Superintendent of 

Documents. GAO also accepts VISA and Mastercard. Orders for 100 or 

more copies mailed to a single address are discounted 25 percent. Orders 

should be sent to: 

U.S. Government Accountability Office 

441 G Street NW, Room LM 

Washington, D.C. 20548 

To order by Phone: Voice: (202) 512-6000 

TDD: (202) 512-2537 

Fax: (202) 512-6061 

Contact: 

Web site: www.gao.gov/fraudnet/fraudnet.htm 

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470 

Gloria Jarmon, Managing Director, JarmonG@gao.gov(202) 512-4400 

U.S. Government Accountability Office, 441 G Street NW, Room 7125 

Washington, D.C. 20548 

Jeff Nelligan, Managing Director, NelliganJ@gao.gov (202) 512-4800 

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548 

GAO’s Mission 

Obtaining Copies of 

GAO Reports and 

Testimony 

Order by Mail or Phone 

To Report Fraud, 

Waste, and Abuse in 

Federal Programs 

Congressional 

Relations 

Public Affairs 

PRINTED ON RECYCLED PAPER