Social Security Planner

Workshop: A Guide to Applying for SSI, SSDI and Presumptive SSI.

The workshop will cover the following areas:

  • Medical and financial eligibilities
  • Supplemental forms
  • Payment programs
  • Sample answers
  • Step-by-step application guide
  • Medical reports
  • Interview process
  • Application timeline
  • COBRA/OBRA notification requirements

Check Calendar listings for Social Security Workshops

For additional information contact APLA at 231.201.1600 and ask to speak with a Benefits Counselor.

Applying for Social Security

The Social Security Administration (SSA) oversees two disability payment programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSl). The application process for both is essentially the same.

Who Can Apply?

You must have a medical, or mental, condition that prevents you from working for the foreseeable future (usually at least a year). If you are working, you must stop, or be earning less than $980 (2009) a month. Unearned income, such as State Disability Insurance, General Relief, government housing aid, and private income from disability insurance will not necessarily interfere with eligibility.

Legal permanent residents may be eligible if they were legally in this country prior to August 22, 1996. Those who came here after that date may not be eligible for SSI unless they fall into an exempt category. Undocumented residents are not eligible for SSI. They may receive SSDI if they are in their countries of origin. Non-citizens should consult a benefits counselor to determine eligibility.

Medical Eligibility for HIV

  • A disabling HIV diagnosis must be based on infections and symptoms, not T-cell counts or viral loads. Social Security does not consider "under 200 T-cells" a disabling diagnosis.
  • Social Security approves or denies disability by reviewing charts and files from all medical facilities where you have received treatment.
  • The Medical Report (Form #4814) at the end of this packet lists 41 infections or conditions in Box C that meet the definition of a disabling AIDS diagnosis.
  • Box D on the #4814 outlines what Social Security may consider a severe HIV symptomatic diagnosis with "repeated manifestations" of various infections.
  • HIV symptomatic diagnoses may be denied without additional documentation (see Documenting Your Disability Claim in this packet).
  • Other conditions (chronic back pain, psychiatric, etc.) may contribute to an otherwise weak HIV claim.

Financial Eligibility

Social Security Disability Insurance (SSDI):

  • You must have paid into the Social Security Trust Fund through F.I.C.A. payroll taxes.
  • If in your mid-thirties, you must have paid in for at least five of the 10 years before you became disabled; if younger, fewer years of pay-in are required; if older, more than 5 years.
  • Benefit amounts are based on life-time pay in and range from $1 to around $2,600 (2009) a month.
  • No payment for first five months of disability, but the start date of disability can be backdated (State Disability or Presumptive SSI may cover the five-month period before payments begin).
  • SSDI can be applied for and collected together with State Disability; other "unearned" income and assets are not counted against claimant.
  • Dependents and survivors' awards are available.
  • Legal residents who paid in are eligible; undocumented residents may only be eligible in their home country.

Supplemental Security Income (SSI)

  • A federal welfare program; no pay-in through taxes required.
  • Income from any source must be under SSI's current payment level of $870 (2009) for a single individual.
  • Income from friends, family, including help with rent and food, will count against claimant; loans from friends, family, etc., are not counted.
  • Assets (bank accounts, pensions, etc.) must be under $2,000 (single rate).
  • One vehicle and one house are exempt from assets limitations.
  • "Spend-down" of assets to qualify is allowed.
  • Undocumented residents are generally not eligible.

Presumptive SSl and Emergency Advance Payment

"Presumptive" eligibility is a special category available to people with severe HIV symptomatic or AIDS diagnoses. Under Presumptive, Social Security can start paying SSI benefits immediately. Some offices can hand-write same-day checks; these are called "emergency advance payments." Social Security can make Presumptive payments for up to six months while your claim is being processed. If you have no income, you should apply for Presumptive.

  • Financial eligibility is the same as for SSI.
  • For people in "dire need" who have no money and whose health, nutrition or residence will be endangered without immediate income.
  • A completed Medical Report (Form #4814, at the back of this packet) is required for Presumptive applications.
  • Not all offices readily offer Presumptive and emergency advance payment; check with the office where you are applying first.

The Application Interviews

Interviews with claims representative can be done in person or over the phone. Going in person is recommended. You won't have to mail vital documents and can speed up the process.

During the application process, Social Security's claims representatives should investigate your eligibility for SSDI, SSI and Presumptive. Make sure you ask about all three payment programs.

SSDI INTERVIEWS:

The claims representative needs to know about your condition, how it prevents you from working, your work history, if you have been married, or in the military, and whether you will be collecting State Disability. SSDI does not pay for the first five months of disability. Make sure you back-date the start of your disability as close as possible to when you last worked. Apply for Presumptive SSI if you have no income during this period.

What to take with you for an SSDI Interview:

  • Original or state-certified copy of your birth certificate, or other childhood identification (baptismal certificate, grade school records, etc.)
  • Two years of W-2 forms or tax returns
  • Military discharge papers (DD-214)
  • Social Security card or number
  • State Disability check stubs
  • Completed Social Security Disability Report, Function Report and, depending on diagnosis, Vocational Report
  • Proof of residency status if not a citizen
  • Marriage license, proof of child support

SSI INTERVIEWS:

SSI interviews are more involved. You will be asked about any current income and your assets, including bank accounts, stocks, bonds, pension plans, saleable life insurance policies, etc. You will also be asked about your living arrangements. You must be paying your "fair share" of rent, food, utilities, etc. If someone gives you money for your expenses, or if you are living rent-free, it may be deducted from your benefit. But, if someone loans you money for rent, etc., it will not count against you. You may be asked for signed loan statements indicating you must pay the money back. Government and non-profit assistance for rent or food are not held against you. SSI applications are valid from date of application only and you cannot back-date the start of your disability.

What to take to an SSI interview:

  • Everything required for an SSDI interview except W-2's or tax returns
  • Proof of any other income -- General Relief, State Disability, Unemployment, earned income, etc.
  • Three months of bank statements
  • Signed loan statements if someone is loaning you money
  • A copy of your lease, or rental agreement (if you rent a room, a note from your landlord will do)
  • Proof of government housing assistance
  • Proof of your spouse's income if married and living together
  • Documentation from Immigration for eligible non-citizens

For Presumptive SSI:

  • Same as for regular SSI.
  • The Medical Report, #4814, completed by your physician, is required for all Presumptive applications.

Documenting Your Disability Claim

Your claim will be won, or lost, on your medical files. If possible, take a complete copy of your medical files to your interview. This includes records from your main HIV doctor, from any other doctor you've seen for your conditions, and from hospitals, psychiatrists, therapists, chiropractors, and all other health care providers.

Records of any major opportunistic infections, as listed on the Medical Report at the end of this packet, along with any lab tests, blood cultures, biopsies, sputum tests, etc., are the best documentation you can provide.

If you have not had any major opportunistic infections, you should add the following to your documentation:

  • A detailed disability statement from your doctor(s), listing all of your symptoms and stating how these symptoms keep you from working. Call the Benefits & Insurance Department for a packet of sample disability statements.
  • Third party testimony, or letters from friends, co-workers, former employers, family, or any one who knows about your condition and its effects on day-to-day functioning. The Benefits Department has sample third party letters, but you should avoid copying the samples word for word.
  • All the Supplemental Disability forms in this packet. Where space allows, write about your condition and how it keeps you from being able to work.
  • Include your own "log" of your symptoms and medications.
  • Go over your medical charts with your doctor. Make sure every infection, symptom, ache and pain is thoroughly documented.

Step by Step Application Guide

  • Call Social Security for an appointment through the 800.772.2213 number, or call a local office directly (you will have to get numbers from a benefits counselor, they aren't listed). Ask for a confirmation letter which protects your filing date.
  • Keep a log of your application (write down names, phones numbers, dates of contact, etc.). Make copies of everything you submit.
  • Tell Social Security you are filing an AIDS or HIV-related claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) or both.
  • If you have no income, ask about Presumptive SSI and whether the office can make "same day" or emergency advance payment.
  • Social Security will send you forms to be completed by your appointment. Ask Social Security what to bring in the way of vital documents and ID.
  • You will meet with a claims representative at your appointment. Ask for a "receipt of claim" before you leave. This is proof you applied.
  • Take a complete set of medical records to your appointment if possible. If not, Social Security will write to your doctors and request your records. They will also pay for copying and postage.
  • Your claim goes to a Disability Analyst about two or three weeks after your appointment. The analyst is the person who reviews your medical files. Call Social Security, get the phone number for your analyst, and ask if records, other information, etc., are coming in on time.
  • If your diagnosis is not conclusive, get the analyst a disability statement from your doctor. Ask APLA's Benefits & Insurance Department for sample letters.
  • Continue sending the disability analyst new medical charts, lab reports, etc., until a decision is made. The analyst should come to a decision within three months. You will be notified by letter.

When disability analysts cannot make a decision, based on your medical files, or have not gotten your file, they may send you to a consultative exam with doctors and psychiatrists paid for by Social Security. If you are ordered for a consultative, call the analyst and ask if any additional information from your doctor, or from a private psychiatrist , would be sufficient.

Award Letters: COBRA/OBRA Notification

You will be notified via Award Letter if you have been approved. Keep a copy of this letter. If you are on COBRA, you can apply for an extra 11-month OBRA extension. To qualify, Social Security must decide you were disabled when you left work, and before you took your COBRA option. To apply, you must mail a copy of your Social Security Award letter to your COBRA administrator within 60 days of receiving the letter. Failure to do this could result in the loss of your health insurance after 18 months.

If you are denied by Social Security, contact the Benefits Department for help with your appeal. Appeals must be filed within 60 days of getting a denial letter.