1. Supplemental Security Income (SSI) for Adults with Disabilities
John S. Whitelaw, Supervising Attorney, Community Legal Services
Rebecca Vallas, Staff Attorney, Community Legal Services
SSI Applications Project
Pepper Hamilton, LLP
January 2013

2. Purpose of this Project
Elimination of General Assistance (GA)
Getting SSI applications approved quickly is even more critical
Unassisted applicants are much less likely to be approved at initial level
Overall approval rate: about 1/3

3. What is SSI? Signed into law in 1972 by President Nixon
Provides minimum income to elderly/ disabled low-income Americans
Must meet financial eligibility criteria and medical disability standard
Provides monthly benefit ($710 max for 2013) plus Medicaid (75% FPL)

4. Who gets SSI? 1.2 million aged 6.7 million disabled & blind
~7.9 million total
Compare: 34.6 million retired workers getting Social Security

5. Eligibility criteria Medical eligibility Nonmedical eligibility
Financial -- income & resources
Citizenship
Not discussed in this presentation

6. Definition of disability
Unable to engage in substantial gainful activity (SGA) because of a medically determinable impairment(s) which is (are) expected to last 12 months or result in death.
PHYSICAL
MENTAL
COMBINATION
Same for SSI and SSDI

7. SSI vs. SSDI
SSDI (aka Social Security Disability Insurance (“Title II”)
Insurance program for workers who have paid enough in FICA taxes to be covered
Not a needs-based program
SSI (“Title XVI”)
Provides a minimum income to people who have not worked enough to be covered
Or who are covered but receive less than $730 in SSDI (“concurrent beneficiaries”)
Means tested

8. Sources of Law Statute Regulations
Title II of the Social Security Act (42 USC § 401 et seq)
Title XVI of the Social Security Act (42 USC § 1381 et seq)
Regulations
20 CFR § 401 et seq
20 CFR § 416 et seq
Program Operations Manual System (POMS)

9. Application Process Individual submits application for benefits
Local SSA office processes application, sends to state agency that makes decision
Bureau of Disability Determination (BDD) (DOL)
BDD requests medical evidence from providers
BDD sends forms to providers to complete
BDD makes initial decision about whether individual is disabled
Average time: 3-5 months for initial decision

10. Application Process, cont’d
If denied, individual has right to appeal
60-day* deadline, from date of notice
Next step is hearing before SSA Administrative Law Judge
Year or longer delay before getting a hearing
Representatives often involved at this stage
ALJ makes decision on disability
Additional levels of appeal
* 60 day deadline plus five days for mailing

11. BDD processes claim & makes disability determination
April 17
Individual files application
SSA determines non-medical eligibility
SSA sends medical information and releases to BDD, disability examiner is assigned
BDD processes claim & makes
disability determination
Applicant’s electronic record is returned to initiating SSA office
SSA notifies applicant of decision by letter
Non-medical information is evaluated first
If the person does not qualify at this step, the application goes no further
Be sure to address all non-medical criteria thoroughly and accurately
Once accomplished, move on to the medical information – Module IV
SSA Disability Report
SSA-3369 Work History Report
(Required, can be completed on-line)
(optional, can be included in Medical Summary Report)
SSA-827 Authorization to Disclose Information to SSA
(one for each provider with medical information; use in conjunction with agency release form)
IV - 2 11 11

12. “Sequential Evaluation”
Five Steps
Is applicant working at SGA level?
Does the applicant have a medically determinable impairment or combination of impairments that is/are severe?
Do(es) the applicant’s impairment(s):
a. meet a listing; or
b. medically equal a listing?
Can the applicant return to “past relevant work”?
Is there other work that exists in significant numbers in the national economy that the applicant can perform despite his/her impairments?

13. Step One: SGA? $1,040 per month for 2013
If applicant is working and earning this much or more per month claim is denied at step one without further review.

14. Step Two: Severe Impairment
De minimis test
Not an issue in most cases
Typically comes into play with “older” adults 55+

15. Step Three: Listings Musculoskeletal Hematological Skin Digestive
Respiratory
Oncology
Mental
Immune

16. Step Four: Past Relevant Work (PRW)
What qualifies as PRW?
Work performed in the last 15 years
Determine applicant’s current “residual functional capacity” (RFC) – what he can do physically and mentally on a sustained basis
Can applicant do PRW with his/her current RFC?

17. Step Five: Other Work
Taking into account the applicant’s age, education, and PRW, is there work that exists in significant numbers in the national economy that the applicant can perform on a sustained basis?

18. SSI Application Project: What You Will Be Doing
“Clinic in a box”
Limited representation for duration of application assistance
Single meeting with each applicant
No ongoing relationship, follow-up, obligations

19. SSI Application Project: What You Will Be Doing (Cont’d)
Completion of online “disability report”
Completion of supplemental forms
Work History report
Activities of Daily Living report
SSA’s medical release forms
Benefits
Front-loads the application to increase chance of quick approval
Ensures greater completeness and accuracy

20. https://secure.ssa.gov/apps6z/radr/radr-fe

21. Part I: Online Disability Report
Basic info, medical history, work & education, functional information
Note special education
Don’t stress over specific details of treatment
What’s important: provider name & contact info
Think creatively about where applicant may have received treatment (eg: prison, hospital, therapy from LICSW)
Print re-entry number (early on) and summary sheet (at end)

22. Part II: Supplemental Forms
Activities of Daily Living report
Handouts
SSA’s medical release forms (827)
Handout
Get these signed and witnessed

23. Skills Development Interviewing skills Client contact
Dealing with challenging clients
Issue spotting and synthesizing facts into helpful evidence in support of approval

24. Interviewing Challenging Clients
Homeless
Mental illness
Unreliable historians
Difficulty abstracting

25. Questions?
We will be at clinic sessions to help!

26. Contact us John S. Whitelaw, Esq. Rebecca D. Vallas, Esq.
(215) ,
Rebecca D. Vallas, Esq.
(215) ,