Use Form SSA-871(State Agency Schedule for Equipment Purchases for SSA Disability Programs) to report equipment purchases utilizing SSA funds within a quarter.

We require submission of the Form SSA-871 only if the Disability Determination Service (DDS) purchased equipment during the quarter reported.

Submit copies as follows:

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  Send the original (with signature) to Disability Adjudication (DA).

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  Send to the SSA Disability Adjudication (DA) State Disability Resource Management Division mail box ^DA SDRM Funding.

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  Copies due on the 25th of the month after the quarter ends. For example, for the quarter that ends 9/30/2025, reports are due by 10/25/2025.