Five months ago, Mrs. Cynthia Williams had to stop working due to a disabling condition.
Today, she filed for SSI benefits. She reported as her only income a $300 monthly
disability check from her former employer. Mrs. Williams lives with her unemployed
husband and their three young children, none of whom has any income. The family receives
food stamps worth $150 each month.
The couple has no bank accounts and they own their own home. Their monthly mortgage
payments are $575.
The CR asks Mrs. Williams how she is meeting her expenses on an income of $300 per
month plus food stamps. She replies that she pays “one bill now and another bill later”
but has been able to keep the mortgage and utilities up to date. The CR asks Mrs.
Williams for proof of past due bills to substantiate the unpaid bills or that the
bills are paid from time to time. However, Mrs. Williams does not provide additional
proof of their bills. Finding the explanation unsatisfactory and with no proof of
bills, the CR queries the NDNH database. The query uncovered no additional sources
of income. Failing to uncover another source of income or support, the CR treats the
income or support received as unstated income.
The CR completes an SSA-795 (Statement of Claimant or Other Person) or Person Statement
page with Mrs. Williams, containing her explanation of how she meets expenses and
listing her usual monthly expenses, which total $900. The CR determines that the couple
has monthly unstated income of $600 ($900 expenses minus $300 stated income), making
Mrs. Williams eligible. After determining, the portion of chargeable unstated income
allocated to Mrs. Williams and her husband each month is $300 ($600 divided by two),
the CR prepares a Report of Contact comparing expenses with income and explaining
the determination of chargeable unstated income.
THE FOLLOWING EXAMPLE IS BASED ON THE 2016 FEDERAL BENEFIT RATE (FBR) DOLLAR AMOUNTS:
SSI Federal Benefit with Mrs. Williams monthly disability check from her employer:
Total monthly disability check from Mrs. Williams employer = $300. Mrs. Williams unstated
-20 (Not counted due to the $20 general exclusion)
=$580 (Countable income)
2. $733 (SSI Federal Benefit Rate)
=$153 (SSI Federal Benefit)
The CR then inputs the $300 disability check amount Mrs. Williams receives monthly
from her former employer on the Sick Pay (Unearned) page. $300 unstated income is
also entered both, Mrs. Williams’ and her husband’s IOTH pages in the SSI claims system
(i.e., MSSICS/SSI Claim).
For non-SSI Claims System cases, the CR would input this as type “S” income, coding
it as “UNSTATED,” suppress the automated notice and issue a manual denial notice.