How to Apply for SSI and Determining Your Eligibility
Do you have questions about how to Apply for SSI Disability benefits? We answer them in this second section of a two-part report on Supplement Security Income.
Ready to begin your application for benefits? Let’s get started! When you apply for SSI, you will need to provide proof that you are eligible, including the following:
• Your Social Security card or, at least, your Social Security number.
• Your birth certificate or other proof of age (e.g., driver’s license).
• Proof of U.S. citizenship or SSI-eligible non-citizen status.
• Information about your residence: address and phone number; mortgage document or rental lease with landlord’s contact information; proof of living arrangements with names, birth dates, and medical assistance or Social Security numbers for all household members; property tax bill; costs of utilities, food, etc. Information about your income: paycheck stubs, self-employment records, income tax return, bank statements, etc.
• Information about your resources: real estate, personal property, vehicles, insurance policies, cash, stocks, bonds, CDs, burial funds, money owed you, etc.
• Also, if disabled or blind: contact information for medical service providers.
If you don’t have all of these items, the SSA invites you to apply anyway. They may be able to help you obtain some of the information (e.g., copies of the tax forms you filed).
How to Apply for SSI in 3 Steps
Step 1: Fill out the SSI application, so the SSI can see if you meet the basic eligibility requirements and also evaluate any current work activities. Then your application is sent to the Disability Determination Services office in your state.
Step 2: DDS doctors and disability specialists ask your doctors for specific information about your disability. They will study the medical evidence from your doctors, hospitals, clinics and other facilities where you have been treated, to find out:
- What your medical condition is, exactly.
- When your medical condition began.
- How it limits your past, current and future activities.
- What your medical examinations and tests have shown.
- What treatment you have received, and its effectiveness.
They will also ask for information about your ability to do work-related activities, such as walking, sitting, lifting, carrying and remembering instructions. Your doctors will not be asked to decide if you are disabled; that’s the job of the DDS. If more information is needed, the DDS may ask you to visit your doctor or one of theirs for a special examination, at the SSA’s expense. After the investigation is completed, a disability determination is made by a two-person adjudicative team: a medical or psychological consultant and a disability examiner.
Step 3: When the DDS reaches a decision on your case, you will receive a letter from the SSA. If your application is approved, the letter will show the amount of your monthly benefit and when your payments will begin. If your application is not approved, the letter will explain why and tell you how to appeal the decision if you do not agree with it.
Keep in mind that you may become eligible for SSI even you are not blind or disabled, as long as you meet the other criteria: age 65 or older, have few financial resources, earn less than the limit, and need financial assistance. For more detailed information, go to https://www.ssa.gov/disabilityssi/ssi.html
However, if blindness or disability is a factor, then…
5 Steps For Determining Your Eligibility for Supplemental Security Income
Step 1: Are you working? If so, and your earnings average more than $733 a month (in 2016 or whatever the current limit is), the SSA will possibly not consider you to be disabled and eligible for SSI. They will include unearned income, such as Social Security benefits or food and shelter you get for free. But some income is “not countable” (excluded) when determining eligibility. The most common exclusions are income tax refunds, the value of Supplemental Nutrition Assistance Program, and the first $20 of most income received in a month. (If you are disabled, you may be eligible for SSDI if you have enough work credits, since current earnings are not a factor.) You can review the income that doesn’t count towards SSI eligibility here: https://www.ssa.gov/ssi/text-income-ussi.htm
Step 2: Is your physical or mental disability “severe”? If you are not working, or your monthly earnings average the current limit or less, the DDS then looks at your medical condition. For the DDS to decide that you are disabled (whether for SSI or SSDI), your medical condition must significantly limit your ability to perform basic work activities—walking, sitting, remembering instructions, etc.—for at least the next 12 months. If your medical condition is not that severe, you are not considered disabled. However, if it is that severe, the determination process continues.
Step 3: Is your medical condition on the SSA’s List of Impairments? It lists medical conditions that are considered so severe, that if you have one or more it may automatically mean you are disabled as defined by law. The conditions for adults are listed under these 14 categories: Musculoskeletal System • Special Senses and Speech • Respiratory System • Cardiovascular System • Digestive System • Genitourinary Impairments • Hematological Disorders • Skin Disorders • Endocrine System • Impairments that Affect Multiple Body Systems • Neurological • Mental Disorders • Malignant Neoplastic Diseases • Immune System Disorders. The children’s list is the same, plus: Growth Impairment.
Since it may take months after approval for the first SSI payment to arrive, to speed initial payments to severely disabled persons the SSA recently expanded a list of 225 conditions that qualify for fast-track “Compassionate Allowances.” Among them are general or specific types of: Alzheimer’s disease, cancer, dementia, leukemia, muscular atrophy, muscular dystrophy, and various other diseases, tumors and syndromes affecting adults and/or children. For a current list, visit the SSA website at https://www.ssa.gov/compassionateallowances/conditions.htm
Step 4: Can you do the work you did before? If your disability does not prevent you from continuing to work at your occupation, the DDS will probably decide that you’re not eligible for SSI. However, if your disability prevents you from performing that kind of work, then the DDS goes on to the final step.
Step 5: Can you do any other type of work, even with your physical or mental disability? The DDS or SSA evaluates your medical condition, age, education, work experience, skills, personality, location, etc., to try and find some other substantial gainful activity you could engage in. If they can, your application for SSI will be denied. However, if they cannot, your application will be approved. Either way, the DDS will return your case file to the SSA field office in your area for appropriate action.
If you are officially determined to be disabled, the SSA will compute your benefit amount so you can start receiving monthly payments. If you are found to be not disabled according to their definition, your file will be retained in the field office in case you decide to contest the determination.
Expedited payments may be made if your financial need is dire.
The SSA can start payments more quickly than usual in four different types of situations:
1. Presumptive disability (PD) or presumptive blindness (PB) payment
If you applied for SSI because of an eligible disability or blindness, and are waiting for your state’s Disability Determination Services (DDS) to make a final decision, the SSA can, on request, start PD or PB payments faster than usual and continue making them for up to six months. The amounts paid would be based on your countable income.
You would need to have—or allege to have—one or more of the following medical conditions:
- Amputation of a leg at the hip • Total deafness • Total blindness • Bed confinement and immobility without a wheelchair, walker or crutches, due to a longstanding condition (not a recent accident or recent surgery) • Stroke (cerebral vascular accident) more than three months ago and with continued marked difficulty in walking or using a hand or arm • cerebral palsy, muscular dystrophy or muscular atrophy, with marked difficulty in walking (e.g., a need for braces), speaking, or coordination of the hands or arms • Down’s syndrome • Severe mental deficiency, if age 7 or older • Spinal cord injury producing an inability to ambulate without a walker or bilateral hand–held assistive devices for more than two weeks (with confirmation from an appropriate medical professional) • End stage renal disease (ESRD) requiring chronic dialysis • Amyotrophic lateral sclerosis (ALS—Lou Gehrig’s disease) • Terminal illness with a life expectancy of six months or less (requires confirmation that you are receiving hospice services) • HIV or AIDS.
- Or: You’re applying on behalf of a child under age 1 with medical evidence that shows a gestational age (GA) at birth with these corresponding birth-weights: • 37-40 weeks: less than 4 lbs., 6 oz. • 36 weeks: 4 lbs., 2 oz. or less • 35 weeks: 3 lbs., 12 oz. or less • 34 weeks: 3 lbs., 5 oz. or less • 33 weeks: at least 1200 grams (2 lbs., 10 oz.), but no more than 1325 grams (2 lbs., 15 oz.).
2. Emergency advance payment
On request, and only once, the SSA may make an emergency advance payment to you if you’re a new SSI applicant facing a financial emergency and you are due benefits that are delayed or not received. The maximum payment you may receive is the smaller of: 1) The SSI federal benefit (plus any federally administered state supplement); 2) The total amount of benefits due; or 3) The amount you requested for the financial emergency.
3. Immediate payment
On request, the SSA may send you an immediate payment—no higher than $999—if you’re a new SSI applicant, or you’re already receiving SSI but benefits are delayed or not received, and you’re facing a financial emergency. That is, you need money right away due to a threat to your health or safety; e.g., not enough money for food, clothing, shelter or medical care.
4. Expedited reinstatement cases
If your SSI benefits ended because you worked and had earnings that exceeded the limit, and now your earnings are below the limit, you can request to have benefits started again without having to complete a new application. You can also ask for reinstatement if you are unable to work or do substantial gainful activity because of an impairment that’s the same as, or related to, the impairment that allowed you to get benefits earlier. In this case, you must make your request within five years from the month your benefits ended, and you will need to provide updated medical information for the DDS to make their determination.
If approved, your provisional (temporary) benefits will begin the month after your request. And you may be eligible for Medicaid coverage. Provisional benefits are given for up to six months, while the DDS determines if you can again get benefits, including federal payments and Medicaid coverage. If not approved, the SSA may not ask you to repay the provisional benefits.
The SSA may, or may not, agree to any of the above types of payment. If they do agree, later on, if you are required to repay any of the money, it will be deducted from your next payment (if any) or you will be sent a bill. To learn more about expedited payments, go to https://www.ssa.gov/ssi/text-expedite-ussi.htm
Most states supplement SSI payments.
In addition to payments from the federal government, most SSI recipients also receive monthly payments from the state they live in, unless they live in Arkansas, Kansas, Mississippi, Tennessee or West Virginia. Some states pay these supplements separately, but your SSA payments include them if you live in California, Delaware, District of Columbia, Hawaii, Iowa, Massachusetts, Michigan, Montana, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Utah or Vermont.
You may be eligible for other benefits.
Whether or not you are eligible for SSI, you may be able to get other types of financial assistance, via:
- The Supplemental Nutrition Assistance Program (SNAP), formerly and commonly known as food stamps. (These days, debit cards often replace food stamps.)
- Medicaid, to help pay doctor and hospital bills.
- Medicare premiums, paid by your state (perhaps).
- Medicare Rx program premiums, co-pays and annual deductibles.
- Social Security retirement benefits, if you are 62 or older and have enough work credits (i.e., you’ve paid into the system long enough); your family members may also qualify.
- Social Security disability benefits, if you qualify for SSDI
For full details on any of the above, please visit the SSA website: https://www.ssa.gov/ssi/text-other-ussi.htm
4 Levels of Appeal When Denied SSI Benefits
How to contest a denial of SSI benefits, whether or not disability is a factor
Generally, there are four levels of appeal:
- Reconsideration (if still available in your state) is a complete review of your claim by someone other than the person(s) who took part in the initial decision. You need not be present. Your original application, the evidence presented with it, and any new evidence are all reviewed, to determine if a denial was the correct decision. If not, it’s reversed and your claim is approved. Or…
- If your denial is upheld after reconsideration, you can request a hearing. The hearing is conducted by an administrative law judge (ALJ) who did not take part in either the original decision or the reconsideration. To help prove your case, you may be asked to provide, in advance of the hearing, more evidence and/or clarification of specific information you provided. If possible, the hearing will take place within 75 miles of your home, or it may be a video conference. Either way, you can choose whether or not to attend, and you can invite witnesses (e.g., medical or vocational experts) and/or an attorney with SSI experience to appear with you or on your behalf. After the ALJ makes a decision, you will receive a letter from the SSA with full details.
- If the ALJ upholds the denial of SSI benefits, you may request a review by the SSA’s Appeals Council. After reviewing details presented at your hearing, the Council may deny your request for review if it believes the hearing decision is correct. Or, if it decides to review your case, it will either decide your case itself or return it to a different ALJ for further review. Either way, the services of an attorney with SSI and courtroom experience is highly recommended. Then the SSA will send you a letter stating the Council’s decision and the reasons for it.
- If the Appeals Council decides not to review your case, or if the Council or an ALJ review it but your claim for SSI benefits is still denied, you have one more opportunity to contest the denial. You can file a lawsuit against the SSA in a federal district court. It makes sense to be represented by an attorney with SSI experience and who is also qualified to represent clients in federal court.
Visit the SSA’s Understanding the Appeals Process: https://www.ssa.gov/ssi/text-appeals-ussi.htm
SSI “work incentives” and How They Affect Your Benefits
If you receive Supplemental Security Income benefits because you have a disability, you may be interested in the programs offered by the SSA to disabled persons who would like to become financially independent…and still receive some or all of their disability benefits. These programs include the following…
Ticket to Work program
This allows you to get the services and support you may need to go back to work and earn more money, so you can become financially independent and not have to rely primarily or entirely on government assistance. When you use your Ticket (it’s a voucher) to get help finding a job or obtaining vocational rehabilitation or other assistance, you’ll be asked about your education, training, work history, disability, etc. The services are provided, at no cost to recipients, by employment networks—private organizations or government agencies working with the SSA to support those with disabilities. A network may be a single organization that provides all of the services you need, or it can be a group of providers. You’re free to talk with as many networks as you want without having to give any of them your Ticket.
Ordinarily, from time to time, the SSA reviews your medical condition to see if you are still disabled. If they find that you no longer are, they may stop your benefits. However, if you are participating in the Ticket program and making timely progress toward your return-to-work goal, the SSA will not review your medical condition. The program is voluntary. If you decide not to use your Ticket or are not able to find suitable work with adequate pay, you do not have to take part in the program and your decision will have no effect on your disability benefits. But keep the Ticket in case you change your mind and later decide to participate.
Plan to Achieve Self–Support (PASS)
Like the Ticket program, a PASS can help you get a job while receiving SSI payments. Or, instead of a job, a PASS can help you start your own small business. If you’re disabled, that may be even better, since you can start a home-based business that requires no commuting, walking, communicating or other activity that may be difficult for you.
A PASS is a written plan of action—a simple business plan—for getting a particular kind of job or starting a particular kind of business. In it you identify:
- The kind of job or business you’d like to have: your work goal.
- The steps you will take and the things you will need in order to achieve this work goal; e.g., special education or training; equipment; supplies; workplace; child care.
- The money you will use to pay for these things: e.g., income or assets, such as Social Security benefits, wages from a current job, self-employment income; or savings.
- A timetable for achieving your goal.
A PASS may help you achieve your goal. If the SSA approves your plan, they will not count the money you spend on it (within limits) when determining your eligibility for SSI. If you are already eligible for SSI, this will increase your SSI benefit, which will replace the money you spend on your PASS.
You may have a PASS if: 1) You would be eligible for SSI based on disability if not for your above-the-limit income and/or assets; or 2) You are already eligible for SSI and have income that reduces the amount of SSI you receive. Using PASS to reach your work goal will, in time, help you reduce or eliminate benefits you receive from SSI, Social Security or both as you become self-supporting. A vocational counselor may be available to help you write a PASS.
For more details on work incentives, see https://www.ssa.gov/ssi/text-work-ussi.htm
Some Frequently Asked Questions About Supplemental Security Income
Question: Can we get SSI if we have financial resources in excess of $2,000 for an individual or $3,000 for a couple?
Answer: Yes, if you agree to sell some of your countable assets, such as: land, a house you don’t live in, a second car, personal property, stocks, bonds, etc. You could receive conditional SSI benefits after you sign an “Agreement to Sell Your Property,” the SSA accepts it, and you demonstrate that you are diligently trying to sell those items. After they’re sold, you would need to pay back some or all of the SSI benefits you received during that time. However, as noted earlier, if the SSA discovers that you gave away a resource or sold it for less than it is worth, you may become ineligible for SSI for up to 36 months.
Question: If I withdraw money from my bank account and loan it to somebody, thereby reducing my financial resources enough to qualify for SSI, is this OK?
Answer: Probably not. If you’re reasonably certain you’ll be repaid, it would still be a countable resource. However, any interest you receive on the loan would not be counted.
Question: We have put aside money in a separate fund for our burial expenses. Does it count as a resource for SSI?
Answer: That depends on its dollar amount. You and your spouse can set aside up to $1,500 each to pay for your burial expenses and it won’t count as a resource. However, if you also own life insurance policies or have made additional arrangements to pay for burial expenses, some of those funds may count toward the resource limit of $2,000 per individual or $3,000 for a couple. [Keep in mind, though, that the average funeral in the United States costs $6,500.]
Question: What is a so-called “work incentive” for those receiving SSI?
Answer: Special rules make it possible for people with disabilities to work and still receive monthly SSI payments and Medicare or Medicaid benefits. They include: Blind Work Expenses • Earned Income Exclusion • Student Earned Income Exclusion • Plan to Achieving Self-Support • Property Essential to Self Support • Special SSI Payments for People Who Work • Continued Medicaid Eligibility • Special Benefits for People Eligible Under Section 1619 or Who Enter a Medical Treatment Facility. [Some brief definitions are in this report. Or visit the SSA site: https://www.ssa.gov/ssi/text-work-ussi.htm]
Question: Once I start receiving SSI payments, does the amount remain the same?
Answer: It’s subject to change, if you do. Via the mail, phone or personal interviews, the SSA will periodically reevaluate your eligibility for SSI to ensure that it continues and that payments are in the proper amount. They may ask you to provide up-to-date evidence regarding your age, disability, income, resources, residence or other relevant criteria. There may also be occasional Cost of Living (COLA) increases. The COLA is 0.3% for 2017.
Question: What are the potential penalties for SSI fraud?
Answer: Fines and/or imprisonment and, of course, a stop to SSI payments.
Question: What’s considered fraudulent?
Answer: Acts conducted with intent to defraud, such as: To willfully and knowingly deceive, mislead, or threaten any claimant, prospective claimant, or beneficiary regarding benefits; to make false statements or misrepresentations in applying for benefits; to make false statements or misrepresentations of material facts at any time if for use in determining benefit rights; to conceal, or fail to reveal, information about events affecting the initial or continued right to benefits or the amount of payment; or to convert payments received on behalf of another to a use other than for the use and benefit of the eligible person.
Want to know if you’re likely to be approved for SSI benefits? Read our first article Do I Qualify For SSI?