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applicant. The signed consent form must be retained in the case file. SSA may need to review this documentation as part of a Quality Control Review or if a question is raised. If an individual refuses to cooperate and will not complete Form SSA-3288 or the individual cannot be located to complete the form the SSR cannot use the automated system. However, the SSA will provide information about such individuals to the Department. See Step 4 below. Step 3: If the consent form has been signed, request a QQ History through the ACEDS interface. If the consent form has not been signed, submit the SSA-513 to SSA (see Exhibit IV-5: SSA- 513). Step 4: If a consent form cannot be obtained from a spouse or parent of an applicant, the SSR should fill out the SSA-513 'Request for Quarters of Coverage (QC) History Based on Relationship' Form (see Exhibit IV-5: SSA-513). This form must indicate the individual on which information is being requested (that is, the spouse or parent of the applicant), that individual's SSN, date of birth, and relationship to the applicant. In addition, the SSR must indicate on the form the years (and quarters) for which the individual's work history can count toward the applicant's 40-quarter requirement. SSA will return the form with information about the QQ the individual earned during the relevant period.

Example Mrs. Santos and her two children are applying for FS. Mrs. Santos is a LPR who came to the United States in 1988. Mrs. Santos' children are U.S. citizens. Mrs. Santos has 20 qualifying quarters based on her own earnings. Mrs. Santos is currently married, but her estranged husband who does not live with her refuses to sign a consent form. (The couple is not, however, divorced.) Mrs. Santos was married in June 1990. The SSR should complete an SSA-513 form to submit to the SSA. On the form, the SSR must indicate the years in which Mr. Santos' earnings can be credited toward Mrs. Santos' 40 quarters requirement. Since they were married in the 2nd quarter of 1990, the SSR should indicate that SSA should provide information from the 2nd quarter of 1990 to the most recent quarter for which data are available. Step 5: Determine whether any quarters earned by the applicant or his/her parent or spouse must be excluded because the quarter was earned in 1997 or after and the individual received a federal means-tested public benefit during the quarter. • Information about SSI receipt will be provided by SSA as part of the query. • The SSR should check whether the applicant or the applicant’s parent or spouse received FS, TANF, or Medicaid (excluding emergency Medicaid) in the District of Columbia in any quarter counted toward the applicant's 40-quarter requirement that was earned in 1997 or after. If the individual did receive such benefits (excluding emergency Medicaid) in D.C., the quarter must be excluded. • For any quarters earned in or after 1997, the SSR should ask the applicant and, if possible, the other individuals whose quarters are being credited to the applicant, whether any of the following were received by the individuals in any part of the U.S.: o Medicaid, other than emergency Medicaid; o TANF cash assistance; o FS; or o Housing assistance (living in public housing or receiving a federal rental subsidy such as through the Section 8 or Section 202 housing programs)