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7.4.3.1 SSI/SSDI
Application and Appeals
7.4.3.2 SSI/SSDI
Advocacy
7.4.3.3 Services
Provided by an SSI Advocate
7.4.3.3.1 Authorized
Representative
7.4.3.4 Communication
with SSA and DDB as an Advocate
7.4.3.5 SSI/SSDI
Eligibility and Receipt of Benefits
Through screening, formal assessment and consultation with other providers of disability-related services, the W-2 agency is responsible for identifying participants who have a reasonable chance of obtaining SSI/SSDI. When there is agreement between the participant and the agency that the participant is appropriate for SSI/SSDI advocacy, the agency is responsible for assisting with the SSI/SSDI application and appeals process to the extent needed by each participant. Participants who are determined to be appropriate for SSI/SSDI advocacy should be placed in W-2 T throughout the SSI/SSDI application process.
An SSI/SSDI application is submitted to the SSA. The SSA looks at the severity of an individual’s impairment(s), as well as current age, education and work history, to determine whether the individual is disabled according to Social Security regulations.
During the SSI/SSDI application process, the local SSA office is responsible for verifying non-medical eligibility requirements (financial and non-financial), which may include age, employment, marital status, or Social Security coverage information. The SSA office then sends the case to the Disability Determination Bureau (DDB) for evaluation of the disability.
The application process includes provisions for an applicant to appeal an SSI/SSDI eligibility decision. There are four levels to the application and appeal process:
1. Initial application;
2. Request for Reconsideration;
3. Request for Hearing with SSA office of Hearing and Appeals; and
4. Appeals Council Review.
A Disability Starter Kit is available on the SSA website to assist individuals with an online application or to prepare for a disability interview. Kits are available for adults and for children under age 18.
The starter kits provide information about the specific documents and the information that SSA will request. The kits also provide general information about the disability programs and the decision-making process.
SSI/SSDI advocacy must be provided either directly by the agency, through subcontract, or referral to an SSI/SSDI advocate. An SSI/SSDI advocate provides specific services to facilitate the approval of a W-2 participant’s application for SSI/SSDI or appeal of an SSA decision. The roles and responsibilities of the advocate are the same whether a W-2 agency provides for advocacy through its own in-house staff or through an outside resource. A W-2 participant may receive SSI/SSDI advocacy services at any point in the SSI application process (initial application, reconsideration, or appeal).
In general, a qualified SSI advocate must have the program background and knowledge necessary to successfully assist W-2 participants to navigate the SSI application process. In particular, an SSI advocate should have the following background and knowledge:
Experience working in an SSI/SSDI advocacy role;
General knowledge of W-2 policy and procedures;
Knowledge of the SSI/SSDI application processes; and
Legal or medical background or experience in the field of disabilities.
Services outlined below may be provided during all phases of the SSI process or may be provided at a specific phase of the process.
1. Review medical documentation;
2. Assist in supplying initial and subsequent documents including non-medical documentation;
3. Coordinate with the case manager or an appropriate service provider to schedule additional evaluations that may support the disability claim;
4. Communicate information to and facilitate contacts among involved parties;
5. Attend meetings, hearings, and appointments with the participant as needed or requested;
6. Present the facts in a participant’s case that favor a decision of disability;
7. Assure all pertinent documentation is available to the DDB;
8. Maintain regular contact throughout the process with SSA, DDB and the W-2 participant;
9. Assist the participant in complying with the SSI claim requirements;
10. Act as a liaison among SSA, DDB and medical professionals; and
11. Coordinate with the W-2 agency and the FEP to establish a referral process and an ongoing communication network, to include SSI related activities on the Employability Plan and to provide supportive services such as transportation and childcare for SSI related activities.
If a participant wants more involvement from the SSI/SSA advocate, s/he may appoint the advocate to be an authorized representative. The authorized representative may do all of the activities listed above, plus:
1. Review the applicant’s file at the local SSA office;
2. Get information from SSA about the claim, including notices and letters, just as the applicant does;
3. Represent the applicant at informal or formal hearings; and
4. Provide SSA with evidence for the applicant; and/or help with appeals process.
SSA has devoted a webpage, http://www.socialsecurity.gov/representation/, specifically designed to provide authorized representatives with information and forms needed to effectively assist individuals with their SSA application or appeal.
No W-2 agency, W-2 agency staff member, or W-2 agency subcontractor may charge the participant a fee for being the person’s authorized representative.
1. Authorization
to Send Information to SSA
To share necessary information with the
other providers working with the participant, including SSA and DDB, be
sure to have the participant sign the Authorization
for Disclosure of Confidential Information (DWSP-10779) form.
2. Authorization
to Receive Information from SSA
If you are not an authorized
representative, but want to receive information from SSA or DDB about
the participant during the application or appeals process, send a signed
SSA
Consent for Release of Information (SSA-3288) form to SSA or DDB.
In determining the monthly SSI/SSDI payment, SSA divides the amount of the W-2 benefit by the number of individuals in the W-2 group and uses the resulting dollar amount to determine the SSI applicant’s share of the W-2 benefit. The SSI applicant’s share of the W-2 benefits is then used in the budget to determine the SSI/SSDI payment. This calculation is used whether the SSI/SSDI applicant is the W-2 participant or another W-2 group member.
If the SSI/SSDI applicant is also the W-2 participant, SSA will use a portion of the W-2 benefits to determine the monthly SSI/SSDI benefit amount until the participant is no longer receiving W-2 benefits. Generally the SSI/SSDI applicant will be eligible for monthly SSI/SSDI benefits back to the month of application.
This page last updated in Release
# 12-03
Release Date: 04/04/12
Effective Date: 04/04/12