9.6.1.1 SSI/SSDI Application and Appeals

The W-2 agency must maintain staff with a working knowledge of the SSA guidelines used to determine SSI/SSDI eligibility including, but not limited to, the forms needed to apply and the methods used by the SSA when determining eligibility.

An SSI/SSDI application is submitted to the SSA Social Security Administration . To determine whether an individual is disabled according to Social Security regulations, the SSA examines:

The severity of an individual’s impairment(s);

Current age;

Education; and

Work history.

During the SSI/SSDI application process, the local SSA office is responsible for verifying non-medical eligibility requirements (financial and non-financial), which may include age, employment, marital status, or Social Security coverage information. Once verified, the SSA office sends the case to the Disability Determination Bureau (DDB) for evaluation of the disability.

It may take several months for SSA to process a submitted application. During this time, the W-2 agency should maintain contact with the SSA to ensure they have all the necessary information, the application is being processed correctly, and any issues are being resolved in a timely manner.

In some cases, an SSI application may be denied. If this happens, it is essential to support the participant through the appeals process.

The application process includes provisions for an applicant to appeal an SSI/SSDI eligibility decision. There are four levels to the application and appeal process:

Initial application;

Request for Reconsideration;

Request for Hearing with SSA Office of Hearing and Appeals ; and

Appeals Council Review.

The W-2 agency must review, monitor, and document the progress of the SSI/SSDI application and the progress with the assigned activities in CARES and WWP. The FEP should review existing case comments and activity progress every 60 days.