Benefit Development Resource Toolkit: Supplemental Security Income

Throughout the following section, links to various web pages are provided for reference. Please note that web page addresses change frequently and while the addresses provided were accurate as of the issuance of this Toolkit, if you are unable to access any of the web pages through the links, please refer to the main Social Security website at www.ssa.gov/ssi/ and navigate to the information you are seeking.

Supplemental Security Income (SSI) is a needs-based benefit program. The Social Security Administration (SSA) pays monthly SSI benefits to supplement the income of people with limited income and resources who are disabled, blind, or age 65 or older. Blind or disabled children, as well as adults, can get SSI benefits.

Note: Supplemental Security Income is separate and distinct from Social Security benefits (SSDI) which is discussed in the Social Security Benefits section.

This section explains what SSI is, who can get it, and how to apply for it. It provides basic information and is not intended to answer all questions. Detailed information about SSI Benefits is provided in the booklet, "Understanding Supplemental Security Income" at www.ssa.gov/ssi/ or through the information line: 1-800-772-1213.

When a voluntary agency or other representative develops SSI benefits for individuals, they must fully cooperate with the Social Security Administration and support individuals by helping to:

• Establish potential eligibility for SSI
• Assist in the completion of the SSI application
• Manage SSI benefits when appointed representative payee

Note:  A representative payee is a person or an organization. SSA appoints a payee to receive the Social Security or SSI benefits for anyone who can’t manage or direct the management of their benefits. A list of frequently asked questions about representative payees can be found at www.ssa.gov/payee/faqrep.htm. 
 

Since SSI is a needs-based program, financial eligibility for SSI depends on what an individual owns and how much income they have. If the individual is married and living with their spouse, SSA also looks at the income of the spouse and the things they own. If an individual is under age 18 and living with their parents, SSA may look at the income and resources of the parents. If the individual is a sponsored non-citizen, SSA may look at the income of the non-citizen’s sponsor and what they own.

To be eligible for SSI, an individual must meet the following criteria:

Must be one of:

• AGED: 65 or older

OR

• BLIND: 
  •  Adult or child with 20/200 vision or less in the better eye with best correction, or visual field of 20 degrees or less, even with corrective lens

OR 

• DISABLED: 
•  Adult:
  • Unable to work due to a physical or mental impairment that has lasted or is expected to last at least one year or to result in death
• Child:
  • Has a physical or mental condition(s) that is expected to last at least one year or to result in death
  • Under age 18 who has a physical or mental condition(s) that can be medically proven and which results in marked and severe functional limitations
  • Age 18-22 and meets the disability definition for adults

AND ALL the following:

• Limited income
• Limited resources ($2,000 for an individual, $3,000 for a couple)
• U.S. citizen or eligible qualified non-citizen
• Resident of the U.S., including the District of Columbia and the Northern Mariana Islands
• Agree to apply for other benefits
• Meet certain other requirements

Whether an individual can get SSI depends on their income.  If an applicant has income, they may need to document the following:

Earned Income - wages, earnings from self-employment, certain royalties/ honoraria and sheltered workshop payments

Unearned Income - Social Security benefits, pensions, Worker’s Compensation payments, Veterans’ benefits, Railroad Retirement benefits, unemployment benefits, interest income, dividends, and cash from friends and relatives

In-Kind Income - food or shelter the individual gets free or for less than its fair market value

SSA will disregard and not count some types of income, or a portion of the income, when deciding if an individual can get SSI.

Exclusions from Income

The following amounts are disregarded for the purposes of determining SSI eligibility:

• The first $20 of most income received in a month
• The first $65 of earnings and one half of earnings over $65 received in a month
• The value of SNAP (a/k/a Food Stamps) received
• Shelter the individual gets from private nonprofit organizations
• Most home energy assistance
• Some of the wages or scholarships a student receives
• Wages a disabled individual uses, subject to SSA approval, to pay for items or services the person needs in order to work.  For example, if the individual must

take a taxi to work instead of public transportation due to their medical condition, the wages they use to pay for the taxi do not count as income.

• Wages a blind individual uses, subject to SSA approval, to pay expenses that are related to working. For example, if a blind individual uses wages to pay for transportation to and from work, the transportation cost is not counted as income.
• Income tax refunds

A complete list of what SSA does not count toward income can be found within the “Understanding Supplemental Security Income SSI Home Page” at www.ssa.gov. For more information on the student earned income exclusion see https://www.ssa.gov/ssi/spotlights/spot-student-earned-income.htm.

SSI Treatment of Dividends and Interest

Dividends and interest are returns on capital investments such as stocks, bonds, or savings accounts. Dividends and interest may be countable income or excluded income for SSI purposes, depending on the resource itself and other circumstances. Further information is available at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0500830500.

Infrequent and Irregular Income

SSA also excludes, for SSI purposes, income that is received either infrequently or irregularly.

Infrequent income is income received no more than once in a calendar quarter from a single source and the individual did not receive that type of income in the month immediately preceding that month or in the month immediately subsequent to that month, regardless of whether or not these payments occur in different calendar quarters.

Irregular Income is income that the individual could not reasonably expect to receive. The SSI exclusion for infrequent or irregular income applies to earned and unearned

income and is limited to the first $30 per calendar quarter of earned income and the first

$60 per calendar quarter of unearned income.

Note: If an individual begins receiving a recurring payment (e.g., a social security check) in the third month of a quarter, the payment does not meet the definition of infrequent because it will be received in the following month, even though the following month is in another quarter. The same would be true if the recurring payment ended in the first month of a quarter but had been received in the prior month in another quarter.

Charts about the exclusions are available on the Social Security Program Operations Manual System at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0500810410.

Lump Sum, Windfall, and Retroactive Payments

Retroactive Supplemental Security Income and Social Security payments are exempt as a resource for nine months after the month of receipt. For other lump sums or windfalls, please contact your local Social Security Office.

The value of the applicant’s resources is one of the factors that determine whether they are eligible for SSI benefits.  See https://www.ssa.gov/ssi/text-resources-ussi.htm for a list of common resources. Resources are things an individual owns, such as:

• Cash
• Bank accounts, stocks, U.S. savings bonds
• Trusts
• Land
• Life insurance
• Individual’s property
• Vehicle(s)
• Anything else the individual owns that could be converted to cash and used for food or shelter
• Deemed resources (see SSI for Children for an explanation)

The Resource Limit

The limit for countable resources is $2,000 for an individual and $3,000 for a couple. If the individual owns property or another resource that they are trying to sell, the individual may be able to get SSI while trying to sell the resource. SSI does not consider everything an individual owns as a countable resource.

The SSA will disregard and not count some types of resources, or a portion of the resources, when deciding if an individual can get SSI.

Exclusions from Resources

The following items are excluded from the individual’s resources when determining SSI eligibility:

• The individual’s home, the land it is on and other buildings on that land.
• Household goods and personal property
  • Household goods are items used on a regular basis or needed by the householder for maintenance, use and occupancy of the premises as a home. Furniture, appliances, personal computer, television set, and dishes are some of the items considered household goods.
  • Personal property refers to items ordinarily worn or carried by the individual and includes personal jewelry as well as educational and recreational items such as books or musical instruments. SSI does not exclude items acquired or held for their value or as investments.
• One car if it is used for transportation of the individual or a member of the individual’s household
• Exception trusts (also known as supplemental needs trusts)
  • SSA must be sent a copy of the trust agreement for review.
  • If the agreement does not include a statement that all amounts remaining (up to the total medical assistance paid on behalf of the individual) will be returned to Medicaid, SSA will not exclude the trust.
• An irrevocable pre-need burial agreement
• Burial funds, spaces, or burial space items for the individual or their spouse
• An SSA-approved Plan to Achieve Self Support (PASS) that allows the individual to save money over and above the SSI resource limit without affecting their SSI eligibility
• Retroactive SSI or Social Security benefits for nine months following the month of receipt, including payments received in installments (retroactive payments of Social Security benefits are countable income in the month of receipt and exempt resources for the next nine months)
• An Individual Development Account (IDA) can be used to save for expenses for education, purchase of a first home or to start a business; additional information can be found at https://www.ssa.gov/ssi/spotlights/spot-individual-development.htm.

Additional information about resources is available in the booklet “Understanding Supplemental Security Income”, which can be found at https://www.ssa.gov/ssi/text-eligibility-ussi.htm. www.ssa.gov

Burial Spaces

SSI has a resource exclusion solely related to a burial plot or space for the recipient or their spouse. This is known as the burial space exclusion. This exclusion is in addition to, and has no effect on, a burial fund exclusion. Unlike the burial fund described below, the burial space exclusion has no dollar limit. Burial space exclusions include the following items:

• Burial Plot
• Gravesite
• Crypt
• Mausoleum
• Casket
• Urn
• Niche
• Other repository customarily and traditionally used for the deceased’s bodily remains

The burial space exclusion also includes any necessary and reasonable improvements to the space, such as (but not limited to):

• Vaults
• Headstones
• Markers
• Plaques
• Burial containers
• Arrangements for opening and closing the gravesite
• Perpetual care of the gravesite

Burial Funds

A burial fund is money or other resources that can be readily designated or converted to cash for paying for a person’s burial expenses or those of their spouse. This money is excluded by SSI as a resource up to a maximum of $1,500.00 in principal. Additional information on burial funds is available at https://www.ssa.gov/ssi/spotlights/spot-burial-funds.htm.

Within this limit, burial funds can be designated for the following:

• The burial expenses of the SSI recipient
• The burial expenses of the SSI recipient’s spouse (whether or not the spouse is eligible for SSI)

Any appreciation in the value of an excluded burial fund is excluded from resources (and from income), even if the total of the burial fund thus excluded exceeds $1,500.00. This includes interest earned by the burial fund, provided the interest is left to accumulate as part of the fund.

Once a fund is designated as a burial fund, it remains such for SSI purposes until either of the following occurs:

• SSI eligibility ends
• The individual uses the fund for another purpose (A penalty may apply in this situation)

A burial fund should not be commingled with resources intended for other purposes. If such funds are commingled, the burial fund resources will not be excluded.

Inappropriate Use of Excluded Burial Funds

A penalty will be applied, except as noted below, if an individual uses an excluded burial fund for a purpose other than the burial arrangements of the individual or the individual's spouse for whom the fund was set aside. The amount of the penalty, which cannot be appealed, is equal to the amount used for non-burial purposes. The penalty will be withheld from future SSI payments.

No penalty applies if, as of the first day of the month in which the excluded funds were used for another purpose, the individual's resources would not have exceeded the limit, even if the burial fund were not excluded.

Transferring an excluded burial fund from one form to another (e.g., from a designated bank account to a burial contract) is not considered use of a burial fund for another purpose.

Only actions (i.e., use for another purpose) by the individual who designated the excluded burial fund or by someone acting as that individual's agent result in a penalty. Actions by a joint owner of a financial instrument who is not the individual or agent (e.g., a joint owner of a designated bank account who withdraws funds for their own use) do not result in a penalty.

A loan against the cash surrender value of a life insurance policy that has been designated for burial expenses is not use for another purpose if the loan is for the purchase of another burial fund. Use of a burial fund as collateral for a loan is use for another purpose because the loan creates an encumbrance on the funds. Since the funds are not available for the individual's burial as long as they are encumbered, the funds cannot be considered set aside for the individual's burial. This is true even if the loan is used for burial purposes.

If a burial fund is used for another purpose, a re-designation of the funds may be necessary. Re-designation does not mean that the burial fund exclusion is lost and reapplied, but that the dollar amount in the original designation must be changed or corrected. Re-designation becomes necessary at the point that there is a change in the amount of funds originally designated (not including accumulated interest or appreciation).

To determine an individual’s eligibility for SSI, SSA confirms the value of the individual's resources at the first moment of the month. The determination of resources is made at the time of application for SSI and is evaluated periodically for each month that SSI payments were made.

Transferring ownership of a resource may affect the amount of an individual's countable resources and their SSI eligibility. When an asset is validly transferred, the individual no longer owns it. For SSI purposes, if the individual no longer owns the asset, it is not counted as a resource. An invalid transfer is one in which the person appears to have transferred the resource but actually continues to own it. For SSI purposes, the invalidly transferred resource is counted as a resource for the individual.

A valid transfer of resource ownership may occur through any of the following:

• Sale of property
• Trade or exchange of one asset for another
• Spending - absent evidence to the contrary, SSI assumes that an individual gets fair market value when they spend cash resources
• Giving away cash (e.g., a gift)
• Transferring any financial instrument (e.g., stocks, bonds)
• Giving away a resource including adding another person's name as an owner of the resource
• Transferring an inheritance (in the month it is received)

A valid transfer of ownership of a resource for less than fair market value will result in a period of ineligibility for SSI. The period of SSI ineligibility may be up to 36 months. When the Social Security Administration is advised that an individual transferred a resource, they determine the effect of that transfer on the individual’s SSI eligibility. SSA must also notify state Medicaid agencies about resource transfers, regardless of when the transfer occurred.

Note: If the transfer violates the Medicaid rules, the individual may remain eligible for an SSI cash benefit but be ineligible for Medicaid.

When a transfer has occurred, SSI obtains a signed statement from the applicant or beneficiary to determine whether the transfer of a resource was valid. The individual’s signed statement must provide information regarding the following:

• The nature of the transfer (sold, given away, traded, etc.)
• The method of transfer (sold on open market, transferred without compensation, etc.)
• The date of the transfer
• A description of the transferred resource
• The amount of cash transferred or the current market value of the transferred resource
• The amount and type of compensation received
• Any remaining ownership interest

If the individual is not sure of the exact date of the transfer, SSI will verify the date and validity of any transfer that is alleged to have occurred on or after December 1, 1999. SSI will request copies of available evidence of the transaction such as:

• Bills of sale
• Receipts for prepayment of rent
• Signed statement by the person to whom the property was transferred
• A signed statement by the person transferring the property and only if the evidence above cannot be obtained and the sale was on the open market (that is, not to a relative)

For transfers alleged to have occurred before December 1,1999, SSI will verify the transfer only if the individual’s allegation is questionable or the individual cannot remember the date of transfer.

The individual’s living arrangement is another factor SSA will use to determine the maximum amount of SSI that they can receive. There are specific SSI payment levels for each of the following living arrangements:

• Living alone – the individual’s own place, such as a house, apartment, or trailer
• Someone else’s household (living with others, living in the household of another)
• A congregate care or board and care facility (OPWDD, OMH, OASAS certified residence)
• Congregate Care Level 1 – Family Care
• Congregate Care Level 2 – Community Residence, Individualized Residential Alternative
• Congregate Care Level 3 – Enhanced Residential Care including OPWDD certified Schools for the Developmentally Disabled
• An institution where Medicaid provides more than 50% of the cost, including Intermediate Care Facilities and Developmental Centers

Because where a person lives affects the amount of their SSI payment, when an individual moves between certified residences, their SSI payment may increase or decrease. When a person moves from one living arrangement to another in the middle of a month, they are eligible to be paid at the higher level.

The SSI benefit levels for each category of living arrangements for individuals are provided on the OPWDD website at: https://opwdd.ny.gov/system/files/documents/2022/11/2023-ssi-ssp-benefit-levels.pdf. The charts also show the federal benefit rate and the state supplements.

Under certain living situations, the recipient’s SSI payment level may be reduced. The following are some examples of those situations:

• The recipient lives in another person’s house, apartment, or trailer, and pays less than their fair share of food or housing costs (living in the household of another)
• The recipient lives in their own house, apartment, or trailer, and someone else pays for all or part of the recipient’s food, rent or mortgage, and other shelter costs such as electricity and garbage removal
• The recipient is in a hospital or nursing home for the whole calendar month and Medicaid pays for more than one-half of the bill

Note: To continue SSI benefits for a recipient who will be hospitalized or in a nursing home for 90 days or less a physician must submit a written statement to SSA indicating that continued SSI benefits are needed to maintain the recipient’s home or living arrangement during the period of hospitalization or nursing home confinement. If the individual will not be returning to the same living arrangement, such as a Family Care home, the individual’s funds should not be used to pay the Family Care Provider.

In most government institutions, a person cannot get any SSI unless Medicaid is paying more than one-half of the bills.

Although people who live in city or county rest homes, halfway houses or other public institutions usually cannot receive SSI, there are some exceptions. An otherwise eligible individual may receive SSI if they:

• Live in a publicly-operated community residence that serves no more than 16 people
• Live in a public institution mainly to attend approved educational or job training that will help the individual get a job
• Live in a public emergency shelter for the homeless
• Are in a public or private institution and Medicaid is paying more than half the cost of their care

The SSI monthly benefit is made up of a federal payment and a supplement financed by New York State. Under the SSI program, states may provide additional benefits to their own recipients in recognition of the variations in living costs from one state to another and for the special needs of some individuals. In NYS, the state supplement payment (SSP)is based on the individual’s living arrangement. The NYS Office of Temporary and Disability Assistance (OTDA) provides state-funded financial assistance to aged, blind and disabled individuals. This payment is received from OTDA in a separate check and is part of the monthly benefit paid to most Supplemental Security Income (SSI) recipients. Information about the New York State Supplement Program (SSP) can be found at: http://otda.ny.gov/programs/ssp/.

To determine eligibility for the SSP, countable income is compared to the Federal Benefit Rate (FBR) amount. If it exceeds the FBR amount, the amount by which it does is compared to the state supplement level for the applicable living arrangement. The following determinations may be made:

• If an individual or couple meets the federal eligibility test, the individual or couple is eligible for the state supplement.
• If the excess income is less than the computation month state supplement payment level, the individual or couple is eligible for the state supplement.
• If the excess income is equal to or more than the computation month state supplement payment level, the individual or couple is not eligible.

Changes to an individual’s circumstances must be reported to SSA and/or NYS SSP.  Please refer to: http://otda.ny.gov/programs/ssp/ for the SSP reporting requirements.

Note: The Social Security Administration pays the Congregate Care Level 2 only if the VOIRA or VOCR program site is listed in the Congregate Care Directory. When a new Congregate Care Level 2 site is first opened, it takes between 8 and 12 weeks for the site to be added to the directory. Once the site is listed in the directory or the SSA Region 2 contact has confirmed the site as a Congregate Care Level 2 program, the individual will be paid at the Congregate Care Level 2 amount retroactive to the month of placement if the individual was already receiving an SSI benefit or the month following the month the SSI application was filed if the individual was not an SSI recipient prior to placement. If the application was filed before the month of placement, the individual will be paid SSI the month following the month of eligibility (generally the month of placement). Free-Standing Respite Homes do not appear in the Congregate Care Directory and individuals residing in them are not eligible for the Congregate Care 2 level payment.

The amount of SSI paid to an eligible individual is usually calculated using the person’s actual income from two months earlier. This is known as “retrospective monthly accounting” (RMA) and is an accounting method implemented to minimize incorrect SSI payments caused by income changes. Using RMA, SSI payment computation is based on income received in the second month before the month for which payment is being computed. The month for which the payment is being computed is called the computation month. The earlier month from which income amounts are used is referred to as the budget month. For a detailed description of RMA please see https://www.ssa.gov/OP_Home/handbook/handbook.21/handbook-2183.html

To calculate SSI payments:

Identify all sources and amounts of income actually received two months earlier.

For each source of income, determine whether the income is unearned (e.g., Social Security disability or retirement), earned (e.g., wages or salary), or in-kind.

Compare the actual income amounts with the amounts stated in the most recent SSI payment notice for the individual. If income changes have not been reported promptly to SSA or processed promptly by SSA, the previously estimated income amounts (rather than the actual income amounts) will have been used to calculate the current SSI payment. SSI payments will be adjusted retroactively when SSA enters the actual income amounts into the person’s SSI budget.

Apply all disregards and exclusions to the income to determine the individual’s countable income. Calculate the countable income by subtracting the total applicable disregards and exclusions from the total income.

Subtract the countable income from the SSI payment level for the individual’s living arrangement to determine the SSI payment amount.

Calculate the SSI payment by subtracting the countable income from the applicable SSI payment level for the individual’s living arrangement:

Except as described below, when computing the SSI payment, SSA subtracts the countable income in the budget month from the FBR of the computation month. For individuals in Title XIX facilities, which include developmental centers, intermediate care facilities and special units, the countable income is compared to the $30 payment cap and not the FBR.

If countable income is less than the FBR, a federal SSI payment is due and the full state portion would be paid.

If countable income is greater than or equal to the FBR, no federal SSI payment is due. The process then determines eligibility for the state supplement by calculating the excess income (the difference between countable income in the budget month and the FBR of the computation month):

If the result is no excess income, the full state supplement amount is payable.

If there is excess income, it is subtracted from the state supplement payment level for the computation month and the remainder is the state supplement payment.

If the excess income exceeds the state supplement payment level for the computation month, no state supplement is payable.

Examples of calculations can be found at: https://www.ssa.gov/ssi/text-income-ussi.htm.

View Examples of Calculations for Medicaid and SSI 

Value of the One-Third Reduction

The applicable FBR is reduced by one-third when an individual or couple lives throughout a month in another person’s household and receives both food and shelter from others living in the household. This reduction in FBR has an income value, known as the value of the one-third reduction, or VTR.

There is no partial VTR. The VTR applies in full or not at all. No income exclusions apply to the VTR.

When the VTR applies, no additional in-kind support and maintenance is chargeable against the individual’s SSI payment. The VTR may apply even if the individual receives part of their food and shelter from inside the household and part from the outside. It is not necessary that an individual receive food and shelter from inside the household on each day of the month for the VTR to apply.

The VTR rate for a couple can continue to apply to both members of a separated eligible couple in the month that they separate.

The VTR does not apply if the individual:

• Lives in their own household
• Lives in the household of another but does not receive both food and shelter
• Does not live in a household
• Does not live throughout the entire calendar month in the household of another
• Lives alone

In-kind Support and Maintenance

When a claimant or couple receives in-kind support and maintenance (ISM), but does not receive both food and shelter from the household in which the claimant or couple lives, the value of the one-third reduction (VTR) rule does not apply and the ISM is valued under the Presumed Maximum Value rule. See https://secure.ssa.gov/apps10/poms.nsf/lnx/0500835001 for more information on ISM and PMV.

Making an Appointment

To apply for SSI, an individual or their representative makes an appointment with the local SSA office. The appointment can be made in person at the local SSA office or by calling 1-800-772-1213.

Submitting an Application

The applicant or their representative must submit a signed application and work with the SSA office to supply all documents needed for determining SSI eligibility. Many of the forms needed to apply for SSI are not designed for self-completion. An SSA claims representative conducts the interview and completes the forms with information provided by the applicant.

Protective Filing Date

If the individual or their representative is unable to submit a completed SSI application immediately, they should contact Social Security to establish a protective filing date for the individual’s SSI application. This action, which puts the Social Security Administration on notice that an individual intends to file for benefits even though an application is not yet complete, may benefit the individual by enabling him or her to receive benefits retroactive to the date when the intention to file is announced (protective filing date) rather than the date when the completed application is actually filed. Generally, SSA will require the following information about the applicant:

• Name
• Social Security number
• Birth date
• Citizenship
• Income
• Resources

When a protective filing is required, SSA sends a letter to the individual confirming the appointment and uses the protective filing date as the SSI application date as long as the completed application is filed within 60 days.

Effective Dates

The SSI benefit will be effective the month after the application is filed or the month after the first month the individual is eligible for SSI, whichever is later.

Notice of Award

Once the SSI application is approved, SSA will send an award notice - SSI Payment Decision Notice (Form SSA-8025), which will include:

• The monthly payment amount
• The SSI claim number
• The effective date of the benefit

If the individual or their representative discovers incorrect information contained in the award notice, they should immediately contact SSA.

If the individual or their representative has not received a decision within 90-120 days, they should contact SSA to determine the reason for the delay of the application.

Appealing an Adverse Decision

If an individual disagrees with an initial Social Security or SSI determination or decision, they may appeal the decision. There are strict timeframes for doing this, so pay attention to the information in the decision letters. Please see the appeal section of the toolkit or the Social Security website at: https://www.ssa.gov/benefits/disability/appeal.html.

Denial of Application

If the application has been denied, an individual, representative, or the agency has the right to appeal the decision made about their eligibility or payment amount. The SSI notice will advise the individual of the further steps and timing of the appeal process information on appeals can be found at https://www.ssa.gov/appeals/.

Documentation for SSI Application

The following is a list of some of the documents that SSA may request when applying for SSI. The individual will not need to present all of the documents; sometimes one document can substitute for another and documents other than those listed here may be required. SSA will tell the applicant what they need and what other documents are acceptable. Documents presented to SSA must be originals. If the individual does not have an original document, SSA can accept a certified copy from the office that issued the original document, but photocopies are not acceptable. SSA will return the original documents to the applicant.

SSA may ask the individual to present the following documents:

• Social Security Information
• Social Security card or number
• Proof of Age
• Birth record or religious birth record
• Other documents showing individual’s age or date of birth
• Citizen or Non-Citizen Status Record
  • Birth certificate showing that individual was born in the U.S.
  • Religious record of birth or baptism showing the place of birth in the U.S
  • Naturalization certificate
  • U.S. passport
  • Certificate of citizenship
  • Current non-citizen immigration document such as:
    • Permanent Resident Card (I-551)
    • Arrival/Departure Record (I-94)
  • If an individual is a non-citizen who has served in the U.S. Armed Forces, they may need their military discharge papers (DD-214)
• Proof of Income
  • Earned income:
  • Payroll stubs
  • If self-employed, a tax return for the last tax year, and work expenses
  • Unearned income:
  • Any records which show how much the individual receives (e.g., award letters, bank statements, court orders), how often, and the source of the payment
• Proof of Resources
  • Bank statement(s) for all checking and savings accounts
  • Deed or tax appraisal statement for all property the individual owns besides the house they live in
  • Life or disability insurance policies, burial contracts, plots, etc.
  • Certificates of deposit, stocks, or bonds
  • Titles or registrations for vehicles like cars, trucks, motorcycles, boats, campers, etc.
  • Trust documents
• Proof of Living Arrangement
• If the individual is not residing in a congregate care facility or certified living arrangement, SSA may ask to see some of the following documents:
  • 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 Information (Blind or Disabled Individuals)
  • Medical reports
  • Psychological reports
  • Clinical reports
  • Names, addresses and telephone numbers of doctors, hospitals and other providers of medical services and the approximate dates of treatment
• Work History
  • Job titles
  • Types of businesses
  • Names of employers
  • Dates worked
  • Hours worked per day and hours worked per week
  • Days worked per week, and rates of pay for work for the 15 years before the individual became unable to work because of illnesses, injuries, or conditions
  • Description of job duties for the type of work performed

Windfall Offset Provision

When making retroactive Social Security benefit payments to an SSI recipient, SSA applies an offset to the individual’s retroactive Social Security benefits based on the total SSI amount paid to the individual during the retroactive period. The total amount of SSI paid during the months covered by a retroactive Social Security benefit is more than the amount of SSI that would have been paid to the individual if they had received Social Security benefits in each of those months. The retroactive Social Security payment is therefore reduced by the difference between the two SSI amounts, known as the offset.

The offset is calculated by subtracting the total SSI amount that would have been due if the Social Security benefit had been paid during the period from the total SSI amount that was actually paid. The amount of the offset is then subtracted from the retroactive Social Security payment:

SSI amount paid

- SSI that would have been paid

Offset amount

Retroactive Social Security benefit amount

- Offset amount

Net lump sum payment

If the retroactive Social Security benefit is less than the SSI offset amount, the retroactive payment will be the $20.00 general income disregard for each month of the retroactive period.

Representative Payee Program

Information regarding the duties of a representative payee can be found at the Social Security website, https://www.ssa.gov/payee/. Staff of agencies that serve as representative payees should review The Guide for Organizational Representative Payees.

Agency Representative Payee Application

If the agency files to receive benefits on behalf of an individual (become a representative payee), SSA-11 BK (Request to be Selected as a Payee) must be completed.  A more detailed discussion about the representative payee program is available on the Social Security Administration website at https://www.ssa.gov/payee/.

Individuals moving to or living in OPWDD certified settings may need a representative payee. The residential agency must determine whether a person needs a representative payee. This evaluation must be completed within 10 days upon admission, any time a person moves, if there is a change in their circumstances or ability to manage funds, and if the person or someone else requests a review on their behalf. If the agency determines a person needs a representative payee, and they did not have one before, a healthcare professional must conduct an evaluation and submit their findings to SSA. For additional information about OPWDD residential providers responsibility to assist an individual in managing benefits see the OPWDD Personal Allowance manual.

Planning for Discharge from a Public Institution

An individual in a public institution where Medicaid does not pay more than 50% of the costs will not be eligible for SSI until they leave the institution. The individual may, however, be able to apply for SSI before release so that SSI payments can begin as soon as possible. The individual or their representative should check with the institution about release plans and with SSA about filing an application under the prerelease procedures.

SSA periodically reviews the individual’s income, resources, and living arrangement to make sure that they are still eligible for SSI and receives the right amount of SSI benefits.  SSA will send inquiries and verification requests to the individual.

SSA will also review the income, resources and living arrangements of the individual’s spouse or of the parents of a disabled child under age 18 living with them.

Note:  SSA initiates a disability redetermination when a child receiving SSI reaches age 18. This disability determination uses adult disability rules.

If medical improvement is expected for an SSI individual, a redetermination may be scheduled within six to 18 months after benefits are awarded. After that, the redetermination of eligibility and payment amount for most SSI recipients is completed every 1 to 7 years.

When an individual or their representative reports a change that affects eligibility or payment, SSA reviews the individual’s income, resources, and living arrangements.  For example, a review is often completed when the recipient reports a change in marital status.

SSA completes the redetermination process by telephone interview, in person (during a scheduled appointment), or by mail. SSA will send forms SSA-8202BK or SSA-8203BK (Statements for Determining Continuing Eligibility for Supplemental Security Income Payment) to determine future eligibility for SSI benefits.

SSA may ask for one or more of the following documents when reviewing an individual’s benefits:

• Savings account, checking account, or other bank statements
• Pay stubs or income tax returns
• Proof of other income (e.g., pensions, annuities, unemployment)
• Life insurance policies
• Burial contracts
• Household receipts (lease, utilities, etc.)

Continuing Disability Review

SSA completes a periodic review of continuing eligibility for SSI benefits, based on disability or blindness. This review is called a continuing disability review (CDR). The frequency and methods of CDRs are based on the specific circumstances of each individual. SSA requires CDR for disabled individuals at least every three years except for cases with permanent disability (SSA determines the appropriate review time for cases involving permanent disability).

SSA will do a CDR at least every three years for disabled children (under age 18) whose conditions are likely to improve, and at no later than 12 months of age for babies whose disability was based on low birth weight.

SSA mails the Disability Update Report (Form SSA-455-OCR-SM or SSA-455) to the individual or their representative to complete to determine continuing SSI eligibility based on disability or blindness.

Benefits continue in payment status unless there is strong proof that a person's impairment has medically improved and that they are able to return to work. The individual can file an appeal if they disagree with the determination. Otherwise, benefits stop 3 months after the beneficiary is notified that their disability ended. Benefits for dependents continue as long as the disabled worker continues to be entitled to benefits. Please note that SSA contracts with the NYS Office of Temporary and Disability Assistance, Division of Disability Determinations to do the disability determinations and reviews. If correspondence is received from this division, any requests should be responded to promptly.

Reporting Responsibilities

The individual or representative payee must notify SSA promptly of changes that might affect continued eligibility for SSI benefits. The change must be reported within ten days after the end of the month in which the change occurred. The report must include the reporter's name, the name and Social Security number of the individual, facts about the change and date of the change. Additional information on what must be reported is available at https://www.ssa.gov/ssi/text-report-ussi.htm.

The individual or representative payee can call 1-800-772-1213 to report changes, or can visit, write or call the local SSA office; an office locator is available at: https://secure.ssa.gov/ICON/main.jsp.

Prompt reporting of changes is important to prevent the following:

• The individual may be underpaid and there may be a delay in paying the additional amounts due him or her.
• The individual may be overpaid and have to pay back the excess to SSA
• The individual may be charged a penalty for failing to report within the time limit if the individual is managing their own benefits

Overpayments and Underpayments

An underpayment occurs when an individual does not receive their monthly benefit or is not paid the amount to which they are entitled. Careful monitoring of the SSI benefit payments and knowledge of the individual’s payment level can minimize underpayments. The SSI payment levels are available here on the OPWDD website. An overpayment is a payment in a higher amount than was due, or a payment made when none was due.

An SSI beneficiary and/or a representative payee receiving SSI on behalf of a beneficiary may be equally liable for repayment of any overpayment received as follows:

• The beneficiary is liable if they receive the benefit of the monies
• The representative payee is personally liable if they were at fault in creating the overpayment or did not apply the funds for the beneficiary's use and benefit

The agency, SSA, or both, will usually discover underpayments or overpayments when redetermining an individual's eligibility and payment amount.

Causes of Overpayment and Underpayment

Incorrect SSI payments may result from any of the following situations or not reporting changes to SSA timely:

• The individual’s income, earned or unearned, was different from the amount that was estimated
• The individual’s living situation changed
• The individual’s marital status changed
• SSA incorrectly figured the individual’s payments because of incorrect or incomplete information
• The individual had more resources than the limit allowed by the SSI program
• The individual was no longer disabled but continued to receive payments

Notice of Underpayment or Overpayment

SSA sends a written notice to the SSI recipient when an underpayment or overpayment of benefits occurs. The notice states the amount in question, how and when the overpayment or underpayment occurred, and the individual’s right to appeal the decision.  For more about the appeals process, see the appeals section of the SSA website at: https://www.ssa.gov/ssi/text-appeals-ussi.htm.

Some overpayments are not pursued by the Social Security Administration because they are deemed to impede effective or efficient administration. In these situations, the cost associated with pursuing and recovering the overpayment exceeds the actual amount of the overpayment. The recovery of the overpayment is not pursued only if the recipient is found to be without fault regarding the overpayment.

Request for Refunds in Case of Overpayment

In the case of an overpayment, SSA sends a notice asking for a full refund within 30 days. If the individual is currently receiving payments, the notice will contain the following information:

• Details of the amount that was overpaid
• A request for full repayment
• A proposal to withhold the overpaid amount at the rate of 10% of the individual’s total monthly income and the month the proposed withholding would begin
• A full explanation of the individual’s appeal rights and how to appeal the decision
• An explanation of how the individual can ask to have the overpayment reviewed and waived

Depending on circumstances, the person could pay the overpayment back, request reconsideration, or file a request for a waiver of overpayment. If the recipient or representative payee believes that the overpayment determination was in error, they can request a hearing.

If there is no response to the overpayment notice within 30 days, there will be an automatic check adjustment of 10% of the benefit beginning 60 days after the date of the automated or manual overpayment notice.

Individuals Liable for Refunding Overpayments

SSA may attempt to recover an overpayment only from the following:

• The overpaid individual
• The representative payee
• The spouse of the overpaid individual, but only for that part of the overpayment period when the spouse was a member of the eligible couple
• Under certain circumstances, the sponsor of a non-citizen individual
• The estate (or distributees) of any of the above

When the SSI recipient is paid through a representative payee, both the individual and the representative payee may be responsible for repayment.

The individual is responsible to the extent that the incorrect payments were expended on him or her. Funds conserved by a representative payee to whom the individual does not have direct access are not considered as having been expended on the individual.

If the incorrect payments were expended on the individual and the representative payee is without fault in connection with the overpayment, the individual is solely responsible for repayment.

The representative payee is individually responsible for repayment if the incorrect payments were not used for the support and maintenance of the individual.

The individual and representative payee are both liable when the incorrect payments have been expended on the individual and the representative payee is at fault.

A representative payee's use of an individual's properly conserved funds to repay an overpayment is appropriate only when:

• The overpaid individual is liable for the repayment of the overpayment
• SSA has not waived recovery of the overpayment

Request for Waiver of Recovery of Overpayment

Recipients are presumed to be without fault if the overpayment is $30.00 or less. For amounts over $30.00 and up to $500.00, the recipient is required to request a waiver of overpayment or reconsideration if they would like the Social Security Administration not to pursue the overpayment. In situations involving higher amounts of money, the Social Security Administration makes a determination regarding the recipient’s fault. If the person is found to be without fault, then the recovery is discontinued.

For SSI purposes, fault is:

• A willful misstatement
• A concealment of facts or fraud that directly or indirectly caused the overpayment
• A knowing acceptance of an incorrect payment

The individual can request a waiver of the overpayment at any time during the repayment process. For example, when an individual who is repaying an SSI overpayment is placed in a certified residential setting, a request may be made to SSA for a waiver of the remaining amount. SSA uses the date that the written request is received in the SSA office as the effective date of the waiver. A request for waiver stops the recovery of overpayment effective the month the waiver is entered in the SSA computer records. Recovery will not begin again until SSA makes an adverse waiver determination and the appeal period expires.

Non-Citizens and SSI

In general, most non-US citizens residing in the United States must meet both the following requirements to be eligible for SSI:

• The non-citizen must be in a qualified alien category
• The non-citizen must meet an exception condition for qualified aliens

A person is a qualified alien if they meet one of the conditions and additional requirements listed at : https://www.ssa.gov/ssi/text-eligibility-ussi.htm#qualified-alien.

Additional Information about SSI

Information about SSI is available 24 hours a day, including weekends and holidays, at Social Security’s toll-free telephone number, 1-800-772-1213. A service representative is available between the hours of 7 a.m. to 7 p.m. on business days. Lines are busiest early in the week and early in the month. The caller should have the individual’s Social Security number handy when calling.

People who are deaf or hard of hearing may call SSA’s toll-free TTY number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days.

All calls to the Social Security Administration, whether made to the toll-free numbers or to an office, are treated as confidential.

The following are some SSA publications that may be helpful in understanding SSI:

• What You Need to Know When You Get SSI – SSA Publication Number 05-11011
• A Guide to SSI For Groups and Organizations – SSA Publication Number 05-11015
• Working while Disabled – A Guide to Plans for Achieving Self Support – SSA Publication Number 05-11017
• A Guide for Representative Payees – SSA Publication Number 05-10076
• SSA Your Ticket to Work - SSA Publication Number 05- 10061

The publications can be downloaded from the from the Social Security Administration internet homepage, which is located at www.ssa.gov or www.socialsecurity.gov.