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Wisconsin Department of Children and Families Wisconsin Works (W-2) Manual |
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
The W-2 agency is responsible for identifying participants who may be eligible, or who express an interest in applying for SSI/SSDI. through screening, formal assessment, and consultation with other providers of disability-related services. When the participant and the agency agree that the participant’s situation 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 receiving SSI/SSDI advocacy should be placed in the appropriate placement using the same criteria used to determine placements for other participants. (see 7.1)
A Disability Starter Kit is available on the SSA website and provides additional information and documents 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 W-2 Agency must maintain staff with a working knowledge of Social Security Administration (SSA) guidelines used to determine SSI/SSDI eligibility including, but not limited to, the forms needed to apply, and the methods used by the SSA when determining eligibility.
An SSI/SSDI application is submitted to the SSA. To determine whether an individual is disabled according to Social Security regulations, the SSA looks at:
The severity of an individual’s impairment(s);
Current age;
Education; and
Work history.
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. Once verified, the SSA office sends the case to the Disability Determination Bureau (DDB) for evaluation of the disability.
It may take several months for the Social Security Administration (SSA) to process a submitted application. During this time, the W-2 agency should maintain contact with the SSA to ensure they have all the necessary information, the application is being processed correctly, and any issues are being resolved in a timely manner.
In some cases, an SSI application may be denied. If this happens, it is essential to support the participant through the appeals process.
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:
Initial application;
Request for Reconsideration;
Request for Hearing with SSA office of Hearing and Appeals; and
Appeals Council Review.
The W-2 Agency must review, monitor, and document the progress of the SSI/SSDI application and the progress with the assigned activities in CARES and WWP. The FEP should review existing case comments and activity progress every 60 days.
SSI/SSDI advocacy must be provided directly by the W-2 agency, through subcontract, or through a 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 should receive SSI/SSDI advocacy services throughout the SSI application process including the initial application, reconsideration, or appeal.
In general, a qualified SSI/SSDI advocate must have the program background and knowledge necessary to successfully assist W-2 participants with the SSI/SSDI application process. In particular, an 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 and appeal processes; and
Legal or medical background, or experience in the field of disabilities.
The SSI/SSDI advocate plays a vital role in a participant’s application process. An SSI/SSDI advocate shall gather the necessary information to build a strong medical narrative to accompany the participant’s SSI/SSDI application. Advocates must also gather information about the participant’s ability and capacity to work.
Ways in which this information can be collected are:
Formal and informal assessments;
Case management relationship; and
Through the participant’s experience participating (or failing to participate) in assigned activities and/or work experience.
The services outlined below may be provided at any point during all phases of the SSI/SSDI application or appeal process.
Review medical documentation and build a medical narrative.
Assist in supplying initial and subsequent documents, including non-medical documentation.
Coordinate with the case manager or an appropriate service provider to schedule additional evaluations that may build the medical narrative and support the disability claim.
Communicate information to and facilitate contacts among involved parties.
Attend phone calls, meetings, hearings, and appointments with the participant as needed or requested.
Present the facts in a participant’s case that favor a decision of disability.
Ensure all relevant documentation is available to the DDB.
Assist the participant in complying with the SSI/SSDI claim requirements.
Act as a liaison among SSA, DDB, and medical professionals.
Coordinate with the W-2 agency and the FEP to establish a referral process and an ongoing communication network, to include SSI/SSDI related activities on the Employability Plan and to provide supportive services such as transportation and childcare for SSI/SSDI related activities.
The SSI/SSDI advocate should maintain regular contact with the SSA, DDB, and W-2 participant throughout the application and appeal process.
If a participant wants more involvement from the SSI/SSDI advocate, he or she may appoint the advocate to be an authorized representative. The authorized representative may do all of the activities listed in 7.4.3.3, and:
Review the applicant’s file at the local SSA office.
Get information from SSA about the claim, including notices and letters, just as the applicant does.
Represent the applicant at informal or formal hearings.
Provide SSA with evidence for the applicant, and/or help with the appeals process.
The SSA webpage, http://www.socialsecurity.gov/representation/, provides authorized representatives with information and the necessary 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 providing authorized representative services.
1. Authorization to Send Information to SSA
To share necessary information with the other providers working with the participant, including SSA and DDB, an advocate must have a participant signed Authorization for Disclosure of Confidential Information (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 participant signed SSA Consent for Release of Information (SSA-3288) form to SSA or DDB.
To determine the monthly SSI/SSDI payment, SSA divides the amount of the W-2 payment 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 payment. The SSI applicant’s share of the W-2 payments 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 payments to determine the monthly SSI/SSDI benefit amount until the participant is no longer receiving W-2 payments. Generally the SSI/SSDI applicant will be eligible for monthly SSI/SSDI benefits back to the month of application.
History: Release 23-05;.Release 20-01.