What Is SSI?
SSI stands for Supplemental Security Income. The Social Security Administration (SSA) administers this program. SSA pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. Blind or disabled children may also get SSI.
How Is SSI Different From Social Security Benefits?
Many people who are eligible for SSI may also be entitled to receive Social Security disability insurance (SSDI) benefits. In fact, the application for SSI is also an application for Social Security benefits. However, SSI and Social Security are different in many ways.
- Unlike SSDI benefits, SSI benefits are not based on your prior work or a family member’s prior work. Social Security benefits may be paid to you and certain members of your family if you are “insured” meaning you worked long enough and paid Social Security taxes to earn enough work credits.
- SSI is financed by general funds of the U.S. Treasury – personal income taxes, corporate and other taxes. Social Security taxes collected under the Federal Insurance Contributions Act (FICA) or the Self Employment Contributions Act (SECA) do not fund the SSI program.
- In most States, SSI beneficiaries also can get medical health assistance (Medicaid) to pay for hospital stays, doctor bills, prescription drugs, and other health costs.
- Most States also provide a supplemental payment to certain SSI beneficiaries.
- SSI beneficiaries may also be eligible for food assistance in every State except California. In some States, an application for SSI also serves as an application for food assistance.
- SSI benefits are paid on the first of the month.
- To get SSI, you must be disabled, blind, or at least 65 years old and have “limited” income and resources.
- In addition, to get SSI, you must also:
- be a resident of the United States; and
- not be absent from the country for a full calendar month or more or for 30 consecutive days or more; and
- be either a U.S. citizen or national, or in one of certain categories of eligible non-citizens.
How Is SSI Like Social Security Disability Benefits?
- Both programs pay monthly benefits.
- The medical standards for disability are the same in both programs for individuals age 18 or older. [Note: There is a separate definition of disability under SSI for children from birth to age 18.]
- SSA administers both programs.
SSI APPLICATION PROCESS AND APPLICANTS’ RIGHTS
How To Apply For SSI
You can apply for SSI by:
- Calling Social Security at 1-800-772-1213 and making an appointment to apply for SSI. With an appointment, one of Social Security’s representatives will help you apply for benefits. You can have an appointment to apply for SSI on the telephone or in person at your local Social Security office.
- Having someone else call and make the appointment for you or assist you with your application for SSI. (See, How Someone Can Help You With Your SSI towards the bottom of this page), or
- Visiting your local Social Security District office to apply without making an appointment, but you may have to wait awhile or they will schedule you an appointment to come back on a later date to complete the application.
Once you file your application, you will have to provide information and work with Social Security to get documents concerning SSI eligibility.
Social Security dos not have SSI applications online. Most of the forms to apply for SSI are not designed for self-completion. A Social Security claims representative interviews you and uses a personal computer to complete the forms with information you give to them or someone else gives to them on your behalf.
When To Apply
Apply as soon as possible so that you do not lose benefits. Social Security cannot pay benefits for time periods earlier than your application effective date.
If you call Social Security to make an appointment to apply and you file an application within 60 days of the call, Social Security may use the date of your call as your application filing date.
If you do not keep this appointment and you do not contact SSA to reschedule the appointment, SSA will try to contact you. If SSA does not get in touch with you to reschedule the appointment, SSA will send you a letter. The letter will say that if you file an application within 60 days from the date of the letter, Social Security will use the date of your original contact with them as your SSI application date.
If you are in a public institution but you will be leaving within a few months, you may not be eligible for SSI until you leave. You may, however, be able to apply before you leave so that SSI benefits can begin quickly after you leave. Check with the institution and Social Security about filing an application under the “prerelease procedure.”
You Have The Right To Apply
- Anyone may apply for SSI.
- There is no charge to apply.
You Have The Right To Receive Help From Social Security
Social Security will complete the application forms for you based on information you give to them.
They will help you get documents you need to show that you meet the SSI eligibility requirements.
If you are applying because of disability or blindness and Social Security decides that the medical information needed to make a determination is not available from existing sources, SSA will pay for you to have a doctor’s exam or test and make the appointment for you. If you need a medical exam or test, you must go to the exam or test in order to receive SSI. SSA may also pay your travel costs to get to this exam or test.
You Have The Right To A Representative
You may appoint someone such as a Board Certified Social Security Disability Attorney to help you with your SSI claim and go with you to your appointment(s) with SSA.
You Have The Right To A Notice
Social Security will notify you in writing of any determination about your eligibility or any change in your benefit amount. SSA will also send copies of all notices to your attorney if you have one. Each notice affecting your eligibility or change in SSI benefit amount will explain your appeal rights.
You Have The Right To Examine Your File
You or your attorney may examine and get a copy of the information in your case file, upon request. You or your attorney also may review and copy the laws, regulations and policy statements used in deciding your case at: http://www.socialsecurity.gov/ssi/law-regs-finder.htm
You Have The Right To Appeal
You may appeal most determinations SSA make about your eligibility for SSI or changes it makes in your benefit amount.
NOTE: See Appeals Process, below, for further information.
SSI ELIGIBILITY REQUIREMENTS
Who Is Eligible for SSI?
Anyone who is:
- aged (age 65 or older);
- blind; or
- has limited income; and
- has limited resources; and
- is a U.S. citizen or national, or a certain category of alien [Note: In general, an alien who is subject to an active warrant for deportation/removal does not meet the citizenship/alien requirement]; and
- is a resident of one of the 50 States, the District of Columbia, or the Northern Mariana Islands; and
- is not absent from the country for a full calendar month or for 30 consecutive days or more; and
- applies for any other cash benefits or payments for which he or she may be eligible, (for example, pensions, Social Security benefits); and
- gives SSA permission to contact any financial institution and request any financial records about you; and
- files an application; and
- meets certain other requirements.
What Does “Limited Income” Include?
- money you earn from work;
- money you receive from other sources, such as Social Security benefits, workers compensation, unemployment benefits, Department of Veterans Affairs, friends or relatives; and
- free food or shelter.
NOTE: Social Security does not count all kinds of income for SSI, but income that Social Security does count reduces your SSI benefit amount.
What Are “Limited Resources”?
Resources are things you own such as:
- bank accounts, stocks, U.S. savings bonds;
- personal property;
- life insurance; and
- anything else you own that could be converted to cash and used for food or shelter.
NOTE: Social Security do not count the value of all of your resources for SSI.
The SSI limits for resources that Social Security does count are:
IF YOU ARE DISABLED OR BLIND
What Does “Disabled” Mean For An Adult?
If you are age 18 and older Social Security may consider you “disabled” if you have a medically determinable physical or mental impairment which:
- results in the inability to do any substantial gainful activity (see definition of substantial gainful activity below); and
- can be expected to result in death; or
- has lasted or can be expected to last for a continuous period of not less than 12 months.
What Happens When You Apply For SSI?
When you file an application for SSI benefits based on disability or blindness, Social Security will first decide whether you meet the income and resource criteria and other eligibility requirements. If you do, Social Security will ask you for the:
- dates, places, and types of work you have done in the 15 years before you became unable to work because of your illnesses, injuries, or conditions, including your daily duties for the type of work you did and why your employment ended;
- information about your physical or mental impairment(s);
- names, addresses, and telephone numbers of doctors, hospitals and any other medical sources you have seen;
- dates of treatment and the kinds of treatment you have received from your doctors, hospitals and other medical sources;
- names of each prescription and non-prescription medicine that you take and the doctor who prescribed it;
- the kinds of medical tests you have had, when and where they were done, and who sent you for them; and
- for a disabled child, the name, address and telephone number of the child’s school and teacher and a third party to assist with the claim.
It is very important that you give Social Security complete information.
As part of the disability or blindness determination, Social Security also looks at any work you are doing. Generally, if you are working and earning more than $1,010 per month (effective January 2012) Social Security will not find you disabled because you are engaged in Substantial Gainful Activity (see below). [Note: This does not apply if you are blind.]
The local Social Security office personnel do not make the disability determination. The local Social Security office sends your claim to a State agency called Disability Determination Services (DDS). The DDS decides whether or not you are disabled according to the SSA definition of disability.
NOTE: Social Security or the DDS may ask you to fill out forms about your disability or blindness. If you need help, a Social Security or DDS employee will help you. If SSA mails the forms to you, you can also ask someone to help you.
Obtaining Evidence About Your Impairments and Functioning
The DDS contacts doctors, hospitals, schools, teachers, therapists, relatives or others who can provide useful information about your impairment(s) and functioning.
The DDS does not examine you and they usually do not meet with you. They may contact you for additional information. While they will not base their decision solely on your statements about yourself, (for example, the fact that you are enrolled in special education classes), that kind of information is very important and useful.
If the DDS cannot get enough information from your doctors and other people to decide if you are disabled, they will arrange and pay for an examination or testing by a qualified medical professional (who may be your own physician, psychologist, optometrist, or speech-language pathologist or other health care provider).
What is Substantial Gainful Activity (SGA)?
Social Security uses the term substantial gainful activity (SGA) to describe a level of work activity and earnings that is both substantial and gainful. SGA involves performance of significant physical or mental activities, or a combination of both. For your work activity to be substantial you do not need to work full time. Work activity performed on a part-time basis may also be SGA. If your impairment is anything other than blindness, earnings averaging over $1,010 a month (for the year 2012) generally demonstrate SGA.
Gainful work activity is:
- work performed for pay or profit, or
- work of a nature generally performed for pay or profit; or
- work intended for profit, whether or not a profit is realized.
For SSI purposes, the SGA provision in initial eligibility cases does not apply to blind individuals.
How Long Does the Decision Take?
The decision usually takes about 3 to 4 months from the date of application.
If you have a compassionate allowance condition, your case may be fast-tracked and decided sooner. The compassionate allowance initiative is for applicants whose medical conditions are so severe that their conditions obviously meet Social Security’s disability standards. You must submit medical information that confirms your diagnosis. For more information about compassionate allowances, visit Social Security’s website at: www.socialsecurity.gov/compassionateallowances.
Sometimes Social Security can make a “presumptive” disability or blindness determination and start paying you while the DDS makes its decision.
Who Decides If You Are Disabled Or Blind?
After helping you complete your application, the Social Security office will review it to make sure that you meet the basic non-medical requirements for disability or blindness benefits. Then the Social Security office will send your application to the DDS office in your State. The DDS will decide whether you are disabled or blind under the Social Security laws and regulations.
The DDS will consider all the facts in your case. They will consider what your doctors or other sources have said about your impairment(s), when it began, how it limits your activities, what the medical tests have shown, and what treatment you have received. They will use medical evidence from your doctors and from hospitals, clinics, or institutions where you have been treated, and any other information they have about your condition.
The DDS will consider any information you have submitted to Social Security. They will review your medical records, information about how you are functioning, and if applicable, your work history, and then decide if you are disabled or blind for SSI purposes.
If they cannot make a determination based on the information they have, the DDS will schedule a special medical examination or test for you and will pay for this examination or test. They may pay for your travel expenses to this examination or test. It is important that you go to the special medical examination or test if one is scheduled. If you do not keep the appointment, the DDS could deny your claim.
In deciding if you are disabled, the DDS team uses a process called the sequential evaluation process.
What is the Sequential Evaluation Process?
If you appear to meet all the non-medical eligibility requirements (income, resources, residency, citizenship, etc.), Social Security uses a step-by-step process to determine if you are disabled. These steps are called the sequential evaluation process. The following sections describe how Social Security use the sequential evaluation for adults.
SEQUENTIAL EVALUATION FOR INDIVIDUALS AGE 18 OR OLDER
STEP 1: ARE YOU WORKING?
If you are performing SGA, Social Security cannot consider you disabled, and the sequential evaluation process ends here at Step 1. Social Security makes this decision in your local Social Security office.
Social Security generally considers earnings over $1,040 per month (effective January 2013) to be SGA.
If you are not performing SGA, Social Security will send your case to the DDS for a determination concerning your impairment(s). Social Security uses the DDS to decide whether you are disabled according to Social Security’s definition of disability.
STEP 2: DO YOU HAVE A SEVERE IMPAIRMENT?
If you are not performing SGA, Social Security then decides if your medically determinable physical or mental impairment or combination of impairments is “severe.” An impairment is considered severe if it significantly limits your physical or mental ability to do basic work activities. If your impairment(s) is not severe, Social Security will find that you are not disabled. If your impairment(s) is severe, they will go to the next step.
Examples of basic work activities are:
- physical functions such as standing, walking, sitting, lifting, pushing, pulling, reaching, carrying, or handling;
- seeing, hearing, speaking;
- understanding, remembering and carrying out simple instructions;
- use of judgment;
- responding appropriately to supervision, co‑workers and usual work situations; and
- dealing with changes.
If your impairment(s) is not severe, Social Security will find that you are not disabled. If your impairment(s) is severe, SSA will go to the next step.
STEP 3: DO YOU HAVE AN IMPAIRMENT THAT MEETS OR MEDICALLY EQUALS A SOCIAL SECURITY “LISTING”?
If your impairment(s) is severe, then Social Security decides if it meets or medically equals a listed impairment(s) in its Listings of Impairments (the Listings). Social Security decides if your impairment(s) “meets” one of the Listings by comparing it to the specific requirements in the Listings.
It is not enough just to have a diagnosis named in the Listings. Your condition must satisfy all of the requirements to “meet” a Listing. If your impairment(s) meets or medically equals the requirements of a listing and meets the duration requirement, Social Security will find you disabled and the process ends here.
If your impairment(s) is severe, but does not meet or medically equal a listing, Social Security can still find you disabled at a later step in the process. Social Security decides what you are physically and mentally able to do, despite the limitations resulting from your impairments. They call this decision a “Residual Functional Capacity” (RFC) assessment.
Note: the listings are published on the internet at: http://www.ssa.gov/disability/professionals/bluebook.
STEP 4: ARE YOU ABLE TO DO YOUR PAST WORK?
Social Security next considers whether, given your RFC, you are physically and mentally able to do any job that you did in the recent past (generally the last 15 years). At step four, Social Security does not consider whether you can get a particular job. If you are able to do work you did in the past, you are not disabled. If you cannot do your past work, Social Security considers the fifth step of sequential evaluation.
STEP 5: CAN YOU DO ANY OTHER KIND OF WORK?
At step five, Social Security considers your RFC limitations, your vocational factors such as age, education and experience, and work existing in the national economy. Generally, your ability to adjust to doing other work is better if you are younger, have more education, or have learned transferrable skills in previous work. Social Security looks at the limitations described in your RFC assessment, your age, education, and past work experience to decide if you could adjust to other work. If you can adjust to other work, you will be found not disabled. If you cannot adjust to other work, the SSA will find you disabled.
You can appeal most determinations and decisions Social Security makes about whether you can get SSI or if the SSA makes changes to your benefit amount. That means you can ask Social Security to look at your case again.
When you ask for an appeal, Social Security will look at the entire determination or decision, even those parts that were in your favor.
How To Appeal Social Security Determinations And Decisions
Social Security has established appeals procedures for individuals who disagree with the determination(s) or decision(s) it makes. The levels of appeal are:
- Reconsideration (available in most States like Florida);
- Administrative Law Judge Hearing;
- Appeals Council Review;
- Federal Court.
Social Security calls the determinations it makes that you can appeal “initial determinations.” These determinations include but are not limited to:
- whether or not you are eligible; and
- the amount of your SSI payment.
You must request an appeal in writing within 60 days of the date you receive your notice. The notice will tell you how to appeal. If you file an appeal within 10 days, your SSI benefits may continue at the same amount until Social Security makes a determination on your appeal.
The notice will tell you if you are entitled to continued benefits.
NOTE: You may appoint an attorney to act for you in the Social Security appeals process. For a free case evaluation by a Board Certified Social Security Disability Attorney, call (850) 898-9904, or fill out the contact form on this page.
After you file an application for SSI, Social Security will mail you a written determination. This is your first “initial determination.” Each time SSA makes a decision about your eligibility or payment amount after that is also an initial determination.
Steps In The Appeals Process
If you disagree with the initial determination, you may request reconsideration by writing to Social Security or by completing a Form SSA‑561 (Request for Reconsideration) or a Form SSA-789 (Request for Reconsideration – Disability Cessation).
You or your attorney must ask in writing for reconsideration within 60 days of the date you receive the written notice of the initial determination. Social Security considers that you receive a notice 5 days after they mail it. If you ask for reconsideration in writing within 10 days, any payment they are currently making will continue until they make their determination on the appeal, if you continue to meet all other SSI eligibility requirements.
Social Security will send you (and your attorney, if you have one) a notice of the reconsideration determination.
If you appeal a disability cessation and you want to keep receiving benefits until they make a determination, you must make a written request for benefit continuation within 10 days after the date you receive the written notice. You are entitled to a face-to-face hearing with a disability hearing officer.
If you disagree with the reconsideration determination, you or your attorney may request a hearing before an Administrative Law Judge by writing to Social Security or by completing a
Form HA-501 (Request for Hearing). Your attorney or Social Security itself will help you complete this form. A request for a hearing on a disability claim can also be completed online at: www.socialsecurity.gov.
You or your attorney must request a hearing within 60 days after you get the notice of reconsideration determination (or, in certain States like Alabama, the initial determination). You or your attorney may review your file before the hearing and may submit new evidence. You may continue to receive your SSI if you are appealing a determination that your disability has ended. You must ask in writing for your benefits to continue.
If you do not want to appear in person at a hearing before a judge, you or your attorney may ask the judge to make a decision based on the evidence in your file.
If you do want to have a hearing before a judge, it is very important that you or your attorney appear in person at the scheduled hearing. If for any reason you cannot make it, contact the judge as soon as possible before the hearing and explain why. If you do not attend the scheduled hearing, you may lose your appeal rights and benefits.
Social Security may pay you for travel costs if the distance to the hearing from your home is more than 75 miles one way. If you need money for travel costs, tell the judge as soon as possible before the hearing.
In a disability case, the judge may also want you to have more medical exams or tests.
The judge may ask other witnesses, such as medical experts to come to the hearing. You may ask the judge to order certain witnesses to attend the hearing.
During the hearing, the judge will explain your case and may ask you and any of your witnesses questions. You may also ask any witnesses questions and present new evidence.
The hearing is informal, but Social Security records it. You may ask for a copy of the hearing recording.
The judge will send you (and your attorney, if you have one) a copy of the hearing decision.
3. Appeals Council
If you disagree with the judge’s decision, you (or your attorney) may request an appeal by writing to Social Security and requesting an Appeals Council review, or by completing a form HA‑520 (Request for Review of Hearing Decision/Order). An attorney or Social Security itself can help you complete this form.
You (or your attorney) must ask for an Appeals Council review within 60 days after you get the hearing decision.
You or your attorney may submit new evidence. The Appeals Council will examine your case and will grant, deny, or dismiss your request for review. If the Appeals Council grants your request for review, it will either decide your case or return it to the judge for further action, which could include another hearing and a new decision.
The Appeals Council will send you (and your attorney) a copy of the action it takes on your request for review and explain the reasons for this action.
4. Federal Court
If the Appeals Council issues a decision or denies your request for review of an Administrative Law Judge’s decision and you disagree with the action of the Appeals Council, you may file a civil action with the U.S. District Court in your area. Social Security cannot help you file a court action as the lawsuit is suing the Social Security Administration. You can contact a lawyer to help you.
You must file an action in U.S. District Court within 60 days after you receive the notice of Appeals Council action.
The U.S. District Court will review the evidence and the final Agency decision, but will not conduct another hearing.
HOW SOMEONE CAN HELP YOU WITH YOUR SSI
You May Choose Somebody Who Can Help You With:
- Completing forms;
- Going with you to your local Social Security office;
- Interpreting for you;
- Gathering and giving information;
- Taking you to medical examinations, tests, or to the Social Security office; or
- Receiving mail for you at his or her address.
If You Want More Help, You May Appoint An Attorney To Help You:
- Do all of the above;
- Review your file at the Social Security office;
- Get information from Social Security about your claim, including notices and letters, just as you would;
- Represent you at informal or formal hearings;
- Give Social Security evidence for you; or
- Help you with appeals.
How Do You Appoint An Attorney?
- You must sign a statement naming your attorney as your representative. Social Security has an “Appointment of Representative” form that you can use. Your attorney should have these forms at his or her office.
- A representative’s duties are different from those of a representative payee.
What Social Security Will Ask You About
To decide whether you can get SSI, Social Security will ask you about:
- your income;
- the things you own (resources);
- your living arrangements(where you live, with whom, who pays for things); and
- your citizenship or alien status.
If you are applying because you have a disability or are blind, Social Security will complete a disability report. They will ask about your health problems, your treatment history, and how your health problems affect your daily activities.
Social Security will also ask for all of your medical records from medical sources and request authorization from you to obtain those records. You can also bring or mail copies of your medical records to the office prior to or at the time of application.
If you have access to the Internet, you can complete the disability report before you visit the Social Security office. Completing the report before you visit the office can help make your office visit shorter. You can complete the Adult Disability Report online at www.socialsecurity.gov/adultdisabilityreport.
NOTE: The disability report is not the application. You must still complete an application for SSI benefits.
DOCUMENTS YOU MAY NEED WHEN YOU APPLY FOR SSI
You may not need all of the following documents. Sometimes one document can substitute for another. The lists are not all-inclusive. Social Security will tell you what you need and what other documents are acceptable. SSA will help you get them if you are having trouble.
Social Security Card Or Number
You will need to apply for a Social Security number if you do not have one. If you need one, a number will be assigned at the time Social Security entitles you to SSI benefits.
Proof Of Age
- a public birth record recorded before age 5; or
- a religious birth record recorded before age 5; or
- other documents showing your age or date of birth.
NOTE: If you already proved your age when you applied for Social Security benefits, you do not need to prove it again for SSI.
Citizenship Or Alien Status Record
If you are a citizen, examples of documents you may need are:
- birth certificate showing you were born in the U.S.; or
- religious record of birth or baptism showing your place of birth in the U.S.; or
- naturalization certificate; or
- U.S. passport or passport card; or
- certificate of citizenship.
If you are an alien, examples of documents you may need are:
- a current immigration document; for example, an I-551 (Permanent Resident Card); or
- I‑94 (Arrival/Departure Record).
If you are an alien who has served in the U.S. Armed Forces, you may need your military discharge paper (form DD-214).
Proof Of Income
If you have income, you may need to provide the following:
- earned income ‑ payroll stubs, or if self-employed, a tax return for the last tax year;
- unearned income ‑ any records you have (for example, award letters, bank statements, court orders, receipts) showing how much you receive, how often, and the source of the payment; and
- work expenses.
Proof Of Resources
- bank statements for all checking and savings accounts;
- deed or tax appraisal statement for all property you own besides the house you live in;
- life or disability insurance policies;
- burial contracts, burial plots, etc.;
- certificates of deposit, stocks, or bonds;
- titles or registrations for vehicles like cars, trucks, motorcycles, boats, campers, etc.
Proof Of Living Arrangements
- lease or rent receipt;
- names, dates of births, medical assistance cards or social security numbers for all household members;
- deed or property tax bill;
- information about household costs, food, utilities, etc.
Medical Sources (If you are filing as blind or disabled)
- medical reports, if you have them;
- names, addresses, and telephone numbers of doctors, hospitals and other providers of medical services to you and the approximate dates you were treated;
- names of the prescription and non-prescription medications that you take.
- job titles;
- type of business;
- names of employers;
- dates worked;
- hours worked per day and hours worked per week;
- days worked per week, and rates of pay for work you did in the 15 years before you became unable to work because of your illnesses, injuries, or conditions;
- description of job duties for the type of work you performed.
THINGS TO REMEMBER
- Do not wait to apply. If you think you may be eligible for SSI, you should contact Social Security right away. The earliest SSA will pay SSI is the month after the filing date of your application, or the month after you first meet all the eligibility requirements, whichever is later. SSA may use the date you contact them as the filing date. If you do not have all of the things SSA needs, they will give you time to provide them.
- Social Security needs to see the original documents. If you do not have an original document, SSA can accept a certified copy from the office that issued the original document. SSA does not accept photocopies. They will return the document to you.
- Try to keep a copy of things you send SSA. Keep track of the dates you send information to SSA, or talk to SSA, as well as the name of the Social Security employee with whom you spoke.
HELP FROM A BOARD CERTIFIED SOCIAL SECURITY DISABILITY ATTORNEY
As stated above, you have the right to appoint an attorney to represent you in your SSI claim. Mr. Ortiz is a Board Certified Social Security Disability Attorney. Contact him at (850) 898-9904 for a free case evaluation.