TN 12 (09-03)

SI 00601.010 Filing Applications

Citations:

Section 1611 and Section 1631 of the Social Security Act; 20 CFR 416.301-416.335 and 416.1476(b)

A. Introduction

Filing a valid application gives the claimant the right to:

  • receive a written determination of eligibility, and

  • appeal the written determination.

B. Policy — Requirements

1. Valid Application

The requirements for a valid application in GN 00204.001 must be met for the claimant to receive SSI benefits.

A SSI prescribed application form is a SSA-8000-BK, SSA-8001-F5 or Modernized Supplemental Security Income Claims System (MSSICS) application.

See the following references for additional information:

  • GN 00204.003A. for the definition of a proper applicant,

  • GN 00204.002 for the policy on applications produced by personal computer, and

  • MSOM MSSICS 001.001 - MSOM 184 for processing applications through MSSICS.

NOTE: If a valid application is taken on a prescribed paper application form and subsequently entered into MSSICS, the valid paper application should be returned to the proper applicant. When a signed amended MSSICS application is obtained and entered into MSSICS, it should be returned to the proper applicant.

Once a valid application is filed, SSA must issue a formal written eligibility determination. See MSOM MSSICS 007.003 for establishing a start date record whenever an ineligible spouse files an application.

2. Application Not Required

A SSI application is not required in the following situations:

  1. An existing determination is reopened under the rules of administrative finality (see SI 04070.001 - SI 04070.080 for the policy on title XVI administrative finality).

  2. Eligibility was established by conversion from a former State program unless eligibility was subsequently terminated (see SI 01410.001A.3. for the policy on conversion cases).

  3. Eligibility is reestablished within 12 months following a suspension or 24 months following a suspension only for blind and disabled children of military personnel stationed overseas (see SI 02301.205 for the policy on reinstatement).

  4. Members of an eligible couple separate or divorce (see SI 02005.030 for the policy requirements).

  5. One member of an eligible couple:

  6. A disabled or blind recipient attains age 65.

  7. A disabled or blind recipient ceases to be disabled or blind after attaining age 65 (see SI 00501.300 for the policy on multicategory eligibility).

  8. An aged or disabled recipient becomes blind and the individual lives in a multicategory State where the blind rate is higher (see SI 00501.300 for the policy on multicategory eligibility).

  9. An aged individual becomes disabled or blind and is potentially eligible under section 1619(b) of the Social Security Act (see SI 02302.030C.5. for the policy on disability determinations for aged individuals).

  10. An individual's request for reinstatement of SSI disability benefits is denied because the individual is found medically improved and able to perform substantial gainful activity.

3. Filing Prior to Eligibility

a. General

The earliest point at which an application may be taken before eligibility, and effectuated as an allowance, is in the month before the month of eligibility (see SI 00520.900 - SI 00520.930 for the exception related to prerelease cases and SI 00601.011 for the exception related to disabled youth transitioning out of foster care).

NOTE: No payment is due for the first month of eligibility. (See SI 00601.009 for the policy on application effective date.)

EXAMPLE 1: Mr. Jones, who is 66 years old, visits the field office (FO) and files a supplemental security income (SSI) application on 9/10. He has excess resources on 9/1 that makes him ineligible for September. He submits his bank statement dated 9/9, which shows he is under the resource limit as of 9/9. Mr. Jones alleges he withdrew additional money from his savings account in September to meet his living expenses. He meets all other eligibility requirements. The claims interviewer effectuates Mr. Jones' application as an allowance since he meets all factors of eligibility in October. The claims interviewer enters 9/10 in the EFFECTIVE FILING DATE field on the ACLM screen and 9/10 in the RECEIVED field on the DW01 screen for the APPLICATION issue. The claims interviewer also enters into the system that the claimant's payment status is N04 for September and C01 for October. The system will convert the C01 to E02. Payments will begin 11/1.

EXAMPLE 2: Ms. Stone will attain age 65 on 10/29. On 9/1, she visits the local Social Security office to file for Social Security benefits. Because Ms. Stone is within 2 months of age 65, the claims interviewer discusses SSI benefits. Ms. Stone decides to file. The claims interviewer effectuates the SSI application as an allowance because the application was filed in the month before the month of eligibility. The claims interviewer enters 9/1 in PROTECTIVE FILING DATE on ACLM, 10/29 in EFFECTIVE FILING DATE on ACLM, and 9/1 in RECEIVED on DW01 for application. Based on Ms. Stone's EFFECTIVE FILING DATE of 10/29 (E02 month), payments will begin 11/1.

NOTE: The age 65 exception discussed in SI 00601.009C.2. applies to this example.

b. Timeframe to Consider for Eligibility/Ineligibility When Scheduling an Application Appointment

When scheduling an application appointment, if the claimant is clearly ineligible, based on the non-disability factors of eligibility, in the inquiry month and the following month, the timeframe for considering whether eligibility is possible is the inquiry month through the end of the next 2 months. If the claimant appears eligible in the second month following the inquiry month (i.e., the E02 month is the second month following the inquiry month), the earliest month in which the interviewer should schedule an application appointment is in the month following the inquiry month so the claim can be effectuated through the system as an allowance.

EXAMPLE: Mr. Wilson calls the Social Security office on 9/1 to inquire about SSI benefits. He has excess resources in September. During the interview Mr. Wilson states that he is using the money in his bank account to meet his monthly living expenses. Based on the monthly amount he is withdrawing, he will be under the resource limit on 11/1. The claims interviewer establishes a protective filing date of 9/1 on the 800 Number System and schedules a teleclaim appointment for 10/15 so the claim can be processed as an allowance. If he meets all other eligibility requirements on 11/1 (E02 month), payments can begin 12/1.

C. Policy — Life of Application

1. Time Period

The life of a SSI application extends from the filing date through the date the FO or the disability determination services (DDS) makes the systems input to pay or deny the claim. (See GN 00204.007 for determining the application filing date.)

2. Extending the Life of the Application

The life of an application continues based on a timely appeal, or if good cause is established for late filing of an appeal request, but only through the date of the administrative law judge (ALJ) decision. The life of an application also continues when it is remanded to an ALJ by the Appeals Council (AC) or court. (See SI 00601.020A.2. for establishing a protective filing based on a request for AC review and DI 12045.027 when a new claim is filed while an appeal is pending before the ALJ or AC.) The appeal information must be annotated on the Supplemental Security Record (SSR) to keep the record current.

EXAMPLE 1: Mary Sullivan filed an application on 10/17. She had excess resources in October and on 11/1. The FO made the systems input to deny her claim on 11/2. The life of her application would have ended on 11/2, however, Ms. Sullivan filed a timely request for reconsideration on 12/3. The life of her application continued based on her timely request for reconsideration. The FO made the reconsideration determination 12/13 and determined that she had excess resources in October and November but that her resources were below the limit as of 12/1. The FO made the systems input on 12/14 to pay Ms. Sullivan SSI benefits beginning 1/1 based on the 10/17 application.

EXAMPLE 2: Sally Johnson filed a SSI application on 9/5. She was determined not disabled. The DDS made the systems input on 10/30, denying her claim. The life of her application would have ended 10/30, but Ms. Johnson appealed the initial SSA determination. The reconsideration determination of 11/10 and a subsequent ALJ decision of 4/2 affirmed the initial determination that Ms. Johnson was not disabled. The life of her application continued based on her timely appeal but only through 4/2, the date of the ALJ decision. She requested AC review on 4/4. The AC decided that Ms. Johnson was disabled as of 9/5. Since the AC decision reversed the ALJ decision, she is eligible for SSI benefits continuously from 9/5 because she was found disabled as of a date before 4/2, the date the life of her application ended.

EXAMPLE 3: Same as Example 2 except that on 4/4 Ms. Johnson submits new evidence with her request for AC review. The new evidence shows that she was disabled as of 4/4. Because the onset of her disability came after the date the life of her application ended (4/2), her request for AC review (4/4) constitutes a protective filing for a new application.

3. When a New Application is Required

If the claimant first meets all factors of eligibility after the date of the ALJ decision, a new application is necessary. Eligibility will be determined based on the filing date of the second application and would not be retroactive. (See Example 3 in SI 00601.010C.2.)

NOTE: If the claimant meets all factors of eligibility in any month during the life of the application, the claimant can receive payment without filing a new application.

4. Subsequent Application Is Filed While A Request for AC Review is Pending on the Prior Application

See GN 03104.370 (non-disability applications) and DI 12045.027 (disability applications) for the processing instructions when a subsequent application is filed while an appeal is pending at the AC.

D. Policy — Scope of Application

1. General

A SSI application is also an application for the following benefits:

  • Title II (see SI 00601.035 for adjudicating title II when a title XVI application is filed).

  • Title XIX (Medicaid) in 1634 States (see SI 01730.005 - SI 01730.045. for the policy on State agreements under section 1634 of the Social Security Act). In non-1634 States, the claimant should be referred to the State welfare office to discuss Medicaid eligibility.

  • Federally administered State supplementation. (See SI 01410.001 for the policy on establishing State supplementary payments.)

  • Title VIII benefits if the individual meets the eligibility requirements for Special Veterans Benefits in VB 00102.001 - VB 00102.010.

2. Limiting the Scope

A claimant may choose to limit the scope of a SSI application to exclude one or more of the benefits in SI 00601.010D.1. (See GN 00204.020D. for restricting the scope of a title II application.) However, the claimant must file for other benefits for which he/she may be entitled. Failure to file for these benefits will result in the denial/suspension of SSI benefits. See SI 00510.001-SI 00510.030 for the filing for other benefits. If a title XVI application is taken, follow the procedures in SI 00601.035 for when a separate title II application is also required.

E. Procedure — Death before effectuation

1. Interim Assistance Reimbursement (IAR) Involved

When IAR is involved and an underpayment is possible:

  • Pay any underpayment to the State only if the appropriate signed IAR authorization is received and the information/evidence needed to determine eligibility can be obtained (including the disability determination for disability applications) and establishes eligibility. For an explanation of IAR authorizations, see SI 02003.005 and SI 02003.010. If there is excess money payable to a survivor, see SI 02101.004B. Input the death termination once payment is made.

  • Input the death termination promptly if either the nondisability or disability development cannot be completed or the claim is denied.

2. IAR Not Involved

When IAR is not involved and an underpayment is possible:

  • Continue to develop the information/evidence to adjudicate the claim if there is a survivor eligible to receive the underpayment. If eligibility can be established, pay the underpayment to the survivor and input the death termination per SI 02101.003 - SI 02101.008.

  • Input the death termination if either the nondisability or disability development cannot be completed, or the claim is denied.

  • Input the death termination and discontinue the nondisability development if there is no survivor eligible to receive the underpayment.

3. State Requests Medical Determination

If the State requests a medical determination, ask the DDS to make the medical determination only if:

4. Death in the Filing Date Month

If the FO receives notification that the claimant died in the filing date month, curtail developing the title XVI factors of eligibility. Input the death termination and refer any inquiries about medical expenses to the State Medicaid agency. See GN 00204.007 for determining the application filing date.

If title II retroactivity is involved, follow the procedures in GN 00204.005F.1.b. for adjudicating title II. If retroactivity is not involved, follow the procedures in GN 01010.475 for abating the application.

F. References


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500601010
SI 00601.010 - Filing Applications - 10/20/2016
Batch run: 10/20/2016
Rev:10/20/2016