TN 34 (03-12)

SI 00520.930 Exhibits of the Prerelease Procedure, Agreement, and Referral

Exhibit 1 - Summary of the Prerelease Procedure

Exhibit 2 - Model Prerelease Agreement

Exhibit 3 - Model Prerelease Referral


Exhibit 1 - Summary of the Prerelease Procedure


Social Security’s (SSA) prerelease procedure can help individuals whose Supplemental Security Income (SSI) or Social Security benefits have been reduced, suspended, or terminated because of institutionalization and who are being discharged from a public or private institution.

An application filed before release allows SSA to make a determination based on what the situation will be after the institution releases the individual. This allows eligible individuals to receive SSI or Social Security payments shortly after they reenter the community. The prerelease procedure can help prevent homelessness and reduce recidivism.

The prerelease procedure can apply to people who are:

  1. ineligible for SSI due to institutionalization; or

  2. receiving the $30 SSI payment limit, while in a public or private institution where Medicaid pays for more than half the cost of the care; or

  3. not getting Social Security benefits because we suspended them due to incarceration. For more information about Social Security prisoner suspension, see GN 02607.160.

A prerelease agreement usually includes the following procedures. However, SSA can modify prerelease procedures to meet local conditions and needs.

  1. The institution and the local SSA office establish a communication procedure to expedite the exchange of information.

  2. The institution identifies potential prerelease claimants and provides the local SSA office with a list. The list includes the name, social security number, date of birth, date of admission to the institution, and scheduled date of release.

  3. The SSA office and the institution schedule appointments to complete the SSI or Social Security application and other appropriate forms.

  4. The institution notifies the local SSA office of the discharge date in order to expedite payment of SSI.

  5. With the claimant’s permission, SSA notifies the institution when the Disability Determination Services office makes a medical determination.


Exhibit 2 - Model Prerelease Agreement

Parties: _____________________(called the “facility”)
______________________________(called the “local office”)


The facility:

  1. Identifies patients or residents scheduled or considered for discharge from the facility within 30 days after the notice of the SSI eligibility decision or for whom eligibility for Social Security benefits has been established;

  2. Provides the local SSA office with the names of potential prerelease applicants, as well as their social security number, date of birth, and anticipated discharge date;

  3. Refers only those individuals who appear to meet the SSI income and resource criteria or those potentially entitled to Social Security benefits;

  4. Provides nonmedical information for development of whether the individual meets all eligibility requirements;

  5. Provides current medical evidence consistent with SSA guidelines and recommendations of the Disability Determination Services (DDS) and a statement about the individual’s ability to handle funds;

  6. Notifies the local SSA office of any changes that could result in discharge over 30 days after the notice of the eligibility decision;

  7. Notifies the local SSA office as soon as the facility discharges the patient or resident; and

  8. Designates a liaison to:

    • handle all referrals;

    • notify the local SSA office of any pertinent changes; and

    • respond to any local SSA office inquiries.


The local SSA office:

  1. Provides guidelines for the kinds of information requested from the facility;

  2. Reviews with facility personnel the prerelease procedures at least once a year and whenever procedures or the facility liaison changes;

  3. Designates a local SSA office liaison to:

    • assist the facility’s staff in initiating and completing prerelease applications; and

    • respond to the facility’s inquiries.

  4. Processes all prerelease claims in an expeditious and timely manner;

  5. With the individual’s permission, notifies the facility of the eligibility decision.

Manager _________________________


Social Security Field Office


Date ________






Superintendent ____________________


Facility Name


Date ________








EXHIBIT 3 - Model Prerelease Referral from Facility to SSA Office  

Agency: ___________________________Social Worker: _______________
Building/Unit: ______________________Phone: ______________________
Name of 
Resident:  _________________________
Anticipated Date of
Release: _____________________
Social Security Number: _____________ 
Date of Birth: ______________________ 
Reason for Referral:_________________ 

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SI 00520.930 - Exhibits of the Prerelease Procedure, Agreement, and Referral - 03/12/2012
Batch run: 03/12/2012