Often, it may be obvious to the FO interviewer, based on the person’s impairment(s) and description or his or her work activity, that an item or service is impairment-related and needed to enable him or her to work. When there is agreement between the IRWE, the impairment(s) and the work activity, record the justification for this conclusion on a Report of Contact (SSA-5002) or in the DCF REMARKS screen.

If a comparison of the IRWE, the impairment(s), and/or work activity does not indicate agreement, it will be necessary to verify that the item or service is actually required to control a disabling condition, or is necessary for the person to travel to and from work, or that it is essential for him or her to perform the physical and/or mental demands of his or her job.

When it is necessary to verify agreement between the IRWE and the work activity, obtain a signed and dated SSA-827 (per DI 11005.055) from the person with a disability and document the following information, as appropriate, on an SSA-5002:

• •

  a thorough description of the physical and mental activities required in the person’s job;

• •

  a description of the drug, item or service and for which impairment it is needed; and

• •

  the name and address of the treating physician or health care provider.

When contacting the verifying source concerning the person’s need for an item or service, send an SSA-L732 with the signed and dated SSA-827 to the physician or health care provider and request the following information as appropriate and personalized to the person’s situation:

• •

  the impairment(s) for which the person is being treated;

• •

  is this drug, item or service necessary for the person to have the physical and/or mental capacity to perform the job duties as described, or to travel to and from work (describe job duties).

When the question regarding need is still unresolved after all efforts to verify the person’s need for an item or service through a physician or other authoritative source, consult the regional office before disallowing the IRWE. If the regional office should require any assistance in making the IRWE determination, it may contact DCRDP, OPDR, Employment Policy Team.

There are several issues relating to payment which must be resolved:

1. a. 

   For determinations of SGA, is payment made in a month the person with a disability is working? (See DI 10520.030 for rules regarding payments made on durable items before the person started working, or payments made on items or services after the person stopped working.)

2. b. 

   For determinations of SSI countable earned income, is payment made in a month earned income is received? (See DI 10520.030.)

3. c. 

   Does the payment pertain to an item that is used, or a service that is received, in a month in which the person with a disability is working?

4. d. 

   Is the payment within reasonable limits? See DI 10520.025D.

5. e. 

   Is the payment made by the person with a disability?

The person with a disability must provide proof that he or she paid for the item or service. A verifying statement signed by the person (SSA-795) and copies of cancelled check(s), or paid receipt(s), etc., would be adequate to prove payment. The SSA-795 should include a statement that no reimbursement was or will be received for the IRWE and that no agency or other source is underwriting the expense for the person.

1. a. 

   Where the person with a disability is unable to provide proof of payment, contact the prescribing source (if also the supplier) or the supplier of the item or service to verify payment.

2. b. 

   Diary for future review, either in the month the IRWE are expected to end, or 12 months from the date of the determination, cases in which IRWE are material to a determination of either SGA or SSI countable earned income (See DI 10520.065.). At the time of review, the beneficiary must provide proof that he or she did, in fact, pay the IRWE on the basis of which the determination of SGA or SSI countable earned income was made. The FO should advise the claimant or beneficiary that his or her records will be reviewed, and he or she should, therefore, retain all appropriate receipts and proofs of payment in order to be able to demonstrate that payments were made during the diaried period.

Whenever services (attendant care, transportation) are involved, document the file if the provider is a family member. The following documentation must also be included on an SSA-795 signed by the person with a disability and the family member:

1. a. 

   A statement of family member’s duties and periods of time when performed;

2. b. 

   Certification that services have been rendered and that payment in cash (including checks or other forms of money, but not payment in-kind) is being received from the person with a disability;

3. c. 

   Evidence that payment was made (e.g., cancelled checks);

4. d. 

   Information which establishes prior ongoing employment of the family member before the issue of attendant care became relevant to the person with a disability;

5. e. 

   A statement that establishes how the family member suffers an economic loss by serving as attendant or driver (e.g., identify the job that the attendant relinquished, or document the reduction of hours in other remunerative work, and record the date that work stopped or hours were reduced).

Where appropriate, ascertain whether or not these payments have been reported under the Federal Insurance Contributions Act (FICA). Such reporting helps establish the credibility of attendant care payments and protects the interest of the person rendering such services.

Deduction of IRWE is not allowable to the extent that the person with a disability has been, could be, or will be, reimbursed for such expenses by any source (such as through a private insurance plan, Medicare or Medicaid eligibility, or other plan or program).

1. a. 

   Any portion of IRWE the person with a disability pays that is not reimbursed or not reimbursable is allowable as a deduction. If, for example, a person pays $80 for crutches and receives no reimbursement, the full $80 is allowed as a deduction. But if an agency, plan, or program reimburses him $64 of the $80 purchase price, his IRWE deduction is only $16. (If, pursuant to the reasonable limits provision, it is found that the standard cost of these crutches is $70 rather than $80, only $6 ($70 minus $64) is deductible.)

2. b. 

   If the person with a disability reports there is no possibility of reimbursement from a private insurance plan, obtain a signed statement to that effect.

3. c. 

   Verification of Medicare or Medicaid eligibility should be obtained from appropriate queries and records.

4. d. 

   When the person with a disability alleges that Medicare did not pay 80 percent of the reasonable charges, or that the charge for the item or service satisfied part or all of the annual deductible, the person must provide proof of these allegations.