TN 9 (07-00)
SI 00870.025 Documenting And Reviewing A PASS - PASS Expert
A. Procedure - General PASS Review Requirements
1. Discuss PASS with the Individual
Contact the individual as soon as possible after receiving the PASS, even if you have not reviewed it. Give the individual an overview of the PASS process. Make sure that the person understands how it works, what can be expected of SSA, and what will be expected of him/her, particularly with respect to adhering to the savings/spending schedule of the PASS and reaching the plan's milestones. If the individual still wishes to pursue the PASS, proceed with SI 00870.025A.2. If the individual no longer wishes to pursue the PASS, document the file and see SI 00870.025A.7.
2. Review the PASS
Review the PASS as soon as possible. Remember that a delay can result in loss of a job or training opportunity for the individual. Take a common sense approach when evaluating a PASS. Make sure the necessary release forms have been obtained per SI 00870.004B.2.c.
Determine whether all elements of a PASS are present and addressed per SI 00870.006. You may use available aides, such as the VR assessment software and the internet, to help you with this evaluation. You may allow a PASS in which you have confidence, despite all of the elements of a PASS not being present or adequately addressed, provided that your approval reflects the congressional intent for the PASS provision mentioned in SI00870.001A. Be sure to document the PASS your rationale in such instances.
3. Modify the PASS
If a modification is needed, follow the instructions in SI 00870.030. Be sure to explain to the person why the PASS can't be approved as submitted.
4. Determine the Starting Month
Determine the starting month per SI 00870.007.
5. Determine the Exclusion
Compute the income and/or resources exclusion as follows:
Determine total estimated PASS expenditures.
From this total, subtract the value of current resources to be used for the PASS. The remainder is the amount that must be paid with income that will be excluded under the PASS.
Determine the income exclusion that is most advantageous to the individual, considering countable income (including any known SSDI COLA, interest on excluded resources, etc.), fluctuations in income (seasonal or otherwise), and the schedule of planned expenditures.
NOTE: If SSDI benefits or RSI benefits based on a disability will be excluded, you may need to estimate when they might cease due to a finding of SGA. Check the TWP on the MBR. Also be sensitive to the need to amend a PASS due to changes in expenditures or income (including COLAs). (See SI 00870.050.)
Determine the highest amount of excluded resources expected to accumulate in any month prior to the first progress review. This is the amount of resources to be excluded under the PASS until it is amended, extended, reviewed, terminated, or completed.
6. Making Systems Input
a. PASS Approved
If the individual is receiving SSI, follow the instructions in SM 01005.170, SM 01305.105, and SM 01301.820 and input in the EN field of the SSR as type “D” income:
If an SSI application is pending, advise the FO of the appropriate inputs to make. See MSOM section 137-A for instructions on inputting PASS information onto MSSICS.
b. PASS Not Approved
Input type “D” income of $.01 (1 cent) with an “N” frequency code for the month the denial notice is dated.
7. Issuing Notices
a. Individual Receiving SSI
Send a manual notice of approval or disapproval per SI 00870.040. For approvals, enclose a PASS Expenditure/Savings Record (see SI 00870.100 Exhibit7), if available.
b. SSI Application Pending
Provide the FO with language it should use when it sends the notice about SSI benefits to the person. If the PASS is approved and the person will receive SSI benefits, remind the FO to send the materials identified in SI 00870.025A.7.a. to the person and to send a copy of the notice to you.
8. Scheduling Reviews
a. Progress Checks
Schedule a progress check within 30-60 days of approval, or the first milestone, if earlier. A brief telephone call to see how things are going can be sufficient. Set up a schedule of subsequent progress checks between progress reviews based on the circumstances of each PASS. Experience shows that PASS participants frequently run into problems when starting out. (See SI 00870.055.)
b. Progress Reviews
Schedule progress reviews (see SI 00870.055) on the basis of:
the end of the time allowed for “VR evaluation;”
6-month intervals during which funds will be accumulated for PASS expenses but not disbursed;
when the individual files a self-employment tax return;
when achievement of the occupational goal is expected;
any other factor you consider appropriate.
B. Procedure -- Special Considerations
1. Prior PASS
Advise the person that a new PASS may not be considered until an explanation is provided as to why he/she is not working in the occupational goal of a previously completed PASS. Before a new PASS can be allowed, the individual must provide evidence that he/she is unable to work in the prior occupational goal. This might be evidence that his/her condition has worsened to the point that the prior goal is no longer feasible, or that the person was unable to find employment. Allow a reasonable period of time for the individual to provide such evidence.
If the individual cannot provide the evidence and the prior PASS was allowed before 12/97, review the prior PASS. If the prior PASS is unavailable or, upon review, the approval did not mandate any milestones necessary for achieving the goal, and the individual wishes to pursue the same work goal, you may approve a new PASS with the same goal.
2. Earnings Requirements
Determine whether the occupational goal satisfies the earnings requirements in SI 00870.006A.5. If it does not, follow the instructions in SI 00870.030 for modifying the PASS. If the individual won't modify the plan, deny per SI 00870.025A.6.b. and SI 00870.025A.7.
3. Feasibility of Goal and Viability of Plan
a. Assuming Feasibility and Viability
Absent evidence to the contrary, assume that an occupational goal is feasible and the plan for achieving it is viable per SI 00870.006A.3 and SI 00870.006A.4. if the goal is “VR evaluation,” or if the PASS was prepared by any of the following:
a State VR counselor;
a public or private vocational counselor, case manager, social worker, or other individual who is licensed or certified by: (1) a government agency, (2) the Commission on Rehabilitation Counselor Certification (CRCC), or (3) the Certification of Insurance Rehabilitation Specialists Commission (CIRSC); or
an individual acting on behalf of an agency that has been certified by the above or accredited by an appropriate but unrelated local or nationally recognized organization such as the American Association for Counseling and Development or the National Rehabilitation Association.
If in doubt, ask for evidence of the preparer's credentials or those of the organization for which the preparer works and create a precedent file.
b. Evidence to The Contrary
Do not apply the assumption in SI00870.025B.3.a. if there is evidence to the contrary. Some examples of such evidence are:
an obvious mistake or oversight on the part of the preparer that could jeopardize successful completion of the PASS;
a history of problems with PASSes developed by the preparer; and
the individual would have insufficient income and/or resources to pay for usual living and PASS expenses if PASS is approved.
c. Evaluating Feasibility of the Goal
If the assumption in SI 00870.025B.3.a. does not apply, consider the work goal in terms of:
the nature of the individual's impairment and the limitations imposed by it, based on available evidence, including medical evidence in the FO or the diagnostic code on the SSR or MBR;
the individual's age (extreme youth or advanced age may contribute to making some occupational goals unrealistic);
the individual's strengths and abilities, based on available indicators; and
any observations made by the CR who conducted the initial PASS interview.
If the person has had 2 or more unsuccessful PASSes, follow the instructions in SI 00870.025B.3.e.
d. Evaluating Viability of the Plan
Do not routinely question the feasibility of a work goal or the viability of a plan if the assumption in SI 00870.025B.3.a. does not apply. Evaluate the viability of the plan based on consideration of the factors in SI 00870.025B.3.c. and:
the person's prior work history, education, and training;
how milestones, and target dates for completing them, relate to the occupational goal; and
the individual's familiarity with the requirements and duties of the occupational goal.
For a self-employment goal evaluating the viability of the plan includes evaluating the business plan. See SI 00870.026 for more information about business plans and examples of knowledgeable third parties that might help you evaluate the business plan.
e. Feasibility or Viability is Questionable
If you doubt the feasibility of the occupational goal or the viability of a plan, or the individual has had 2 or more unsuccessful PASSes, proceed as follows:
Discuss your concerns with the individual and/or the preparer, if the individual has given permission to contact the third party. If you continue to believe that the PASS should not be approved as it is at present, discuss possible modifications.
If the individual is unwilling to modify the PASS, ask his/her permission to have a knowledgeable third party evaluate the PASS.
With the individual's permission, contact a rehabilitation agency, preferably one that has worked with the individual in the past, or another knowledgeable source (e.g., a therapist or the individual's physician) to evaluate the PASS. Provide the third party with all pertinent information including your concerns.
NOTE: Any cost for this “second opinion” can be included as a PASS expense if the PASS is approved. If the individual will not agree to either a third-party evaluation or necessary modifications, explain why the PASS application cannot be allowed before issuing a denial notice.
Make sure that the plan specifies when:
all PASS activities began or will begin;
each milestone that marks progress toward the goal is to begin and be completed;
the goods and services will be obtained; and
the individual expects to begin working in the goal.
If no disbursements will be made within the first 6 months and the reason is not obvious, obtain an explanation for the delay. If warranted, ask the individual to submit any readily available documentation that supports the explanation.
Decide whether the timetable is acceptable. If the timetable is not acceptable, follow the instructions in SI 00870.030 for modifying a PASS.
EXAMPLE: Acceptable Timetable
FACTS: John Myers is a 16-year-old 11th grader who receives SSI. His only source of income is the income deemed from his parents. John wants to become a computer programmer and plans to take a 2-year programming course at a community college after high school. His career counselor submits a letter indicating that he can handle a college curriculum.
CONCLUSION: You help John set up a PASS under which he can save money for his college tuition and the purchase of a computer after his graduation from high school. Under the PASS, John's parents will set aside money in a separate bank account to save for John's college expenses. The amount set aside will be deducted from John's deemed income.
When deeming stops, John's parents intend to give the money directly to him and have him put it in the separate account. John expects to begin using the funds for his college expenses beginning with his first semester.
Because John may change his college plans, this PASS should be monitored closely. A progress review (with an accounting) should be conducted every 6 months until disbursements begin.
Make sure the PASS contains the following:
a list and, if necessary, description of the items and services to be purchased (broad categories or groupings as listed in g. below are sufficient unless you question the expense);
an estimate of the cost for each article on the list (if the estimate seems unreasonable, obtain verification per d. below);
an explanation of why each article is needed to achieve the occupational goal (unless the reason is obvious);
an indication that SSI and the individual's other income and resources will cover both the individual's PASS expenses; and
living expenses (documenting living expenses on an SSA-632, or SSA-8006-F4 or SSA-8011-F3, per SI 00835.600 or SI 00835.625, respectively, may be helpful).
NOTE: Because forms SSA-8006-F4 and SSA-8011-F3 reflect a limited definition of shelter under the in-kind support and maintenance rules, the individual's ordinary living expenses may include expenses not listed on these forms.
b. Business Start-up Costs
Treat all expenses, including ongoing costs, to be incurred during the first 18 months, or longer if warranted, of a PASS that involves starting a business as excludable start-up costs if the expenses meet the necessary and reasonable criteria. You may approve expenses the person incurs after the start-up period if the individual would not otherwise have sufficient remaining income and resources to cover living expenses, medical expenses, and work expenses as described in SI 00870.006A.1.
EXAMPLE: In 8/2000 a State VR counselor contacts a PASS expert about setting up a PASS for Joan King. Joan is a blind SSI recipient who has a private insurance benefit of $425 a month and plans to open a candy shop in 12/2000.
To open the shop, Joan will need: $15,000 worth of stock and counter supplies; $350 for the first year's liability, fire, and theft insurance; $150 for utilities hook-up; $250 for the first month's rent; and a security deposit of $500. Thereafter, costs will be an estimated $1,000 a month for stock, $350 a year for insurance, $250 a month for rent, and $125 for utilities.
The counselor says that VR will provide the initial stock and counter supplies, and that the PASS will be to help with the other items.
You advise Joan that she can set aside funds under her PASS to cover, ata minimum, the first 18 months of the business' operation, 12/2000 – 5/2002, that are not otherwise paid by VR. Her start-up costs include:
the $350 for the first year's insurance plus any additional insurance premiums for coverage due through 5/2002;
the $750 for the security deposit and rent due through 5/2002 ($250 a month);
the $150 for utilities hook-up plus the cost for utilities through 5/2002; and
re-stocking of inventory at $1,000 a month through 5/2002.
You advise Joan that you will exclude $405 of her insurance benefit, since $20 would be otherwise excluded, and any earnings from the store she chooses to set aside for her PASS until either:
she has paid for all of the start-up costs; or
beginning 6/2002 or later, she earns a sufficient income from the store to cover her living, medical, and work expenses (see SI 00870.006A.1.).
c. Relation of Expenses to Occupational Goal
Determine whether each of the planned expenditures is needed to achieve the goal. Allow only those, or that part of the cost of the expense, that did not exist before the individual began actively pursuing the goal (which may have been before the individual submitted the PASS itself). See SI 00870.006B.11. for when it may be appropriate to defer the decision on a particular expense.
If you doubt the need for a particular expense, contact any provider or agency involved for an explanation. If no provider or agency is involved, obtain an explanation and any available related documentation from the individual.
d. Reasonable Cost
Determine whether a less expensive alternative would meet the individual's needs. If not, check the precedent file for the cost of similar items. If the cost is excessive by comparison, or you can find no similar item, determine the item's current market value (CMV) per SI 01110.400.
Fees for services must be based on actual time spent providing the services. If the PASS indicates that necessary services were provided before the PASS was submitted, document the file with the individual's signed statement (e.g., on an SSA-795 or on the SSA-545-BK) confirming that the services were provided. If the individual has already paid for these services, obtain proof of payment.
For items rented or leased by the hour, day, etc., allow only charges for units of time related to the PASS unless:
EXAMPLE: An individual who runs a cleaning service uses a floor buffer two days a month. The daily rental rate is $40, which equates to $960 a year. The individual could buy the buffer for $600. You may allow the cost of buying the buffer. If the individual cannot afford to buy it, or wishes to rent until he/she is better established, you may allow the expense for renting it.
e. PASS Preparation Fees
In conjunction with d. above, document the file as to whether the fee (or some portion of it) for preparing a PASS is reasonable. In assessing the reasonableness of the fee, consider the overall involvement the preparer had in the development of the PASS, such as aptitude testing, counseling, and any other pertinent services.
If the preparer has filed an SSA-1696-U4 to serve as the individual's representative, be sure that no part of the preparation fee is for services performed as the representative. Payments to a representative involve a specific SSA billing process (see GN 03920.001 ff.).
If a PASS must be modified, do not allow charges for preparing the modification. Do not allow fees for monitoring the person's progress towards an approved work goal.
EXAMPLE: A PASS includes a $1,000 expense for a local private VR agency's assistance with the PASS. The PASS expert contacts the agency to determine whether the expense is reasonable.
The PASS expert learns that the agency has been certified by the State, worked closely with the individual in developing the PASS, and conducted an assessment of the individual's interests and abilities to help identify an appropriate occupational goal. The agency also plans to monitor the PASS to ensure that the individual complies with all requirements.
The agency estimates that a counselor spent 12 hours assessing the individual's vocational abilities and an additional 8 hours developing the PASS. It values this assistance at $35 per hour, for a total of $700. The rest of the fee is for the planned monitoring services.
You determine that $420 (12 hrs. @ $35/hr.) is reasonable for a vocational assessment by a State-certified private VR agency. You also determine that $280 (8 hrs. @ $35/hr.) is a reasonable fee for preparing the PASS itself. However, you inform the VR agency and the individual that fees for monitoring a PASS are not allowable expenses, and that the PASS will have to be modified to remove the $300 portion of the overall fee that is for monitoring.
f. Items of Unusual Value
Per SI 00870.025B.5.a, if the PASS calls for the purchase of an item of unusual value, such as a vehicle or a computer, the individual must explain why the item is necessary in order to reach the goal. The individual also must justify the cost of the item if it does not appear to be reasonable. If the PASS does not contain this information, ask for it. If necessary, explain that the expense cannot be allowed without this information.
Determine whether the item is necessary, and whether the cost is reasonable. (See SI 00870.006B.2. and SI 00870.006B.3. for the criteria to use in making this determination.) If you need assistance in evaluating the individual's explanation of why the item is necessary, or justification of the cost (see SI 00870.025B.5.a.), consult an objective, knowledgeable third party (a professional in the field of vocational rehabilitation and employment, someone in computer sales, RO systems staff, etc.).
If the individual cannot justify the need for the item, or can justify the need but not the stated cost, but the PASS can still be allowed, advise the individual that the PASS can be amended to include the item (or revised cost for the item) at such time as satisfactory justification is provided.
When considering whether to defer your decision on an expense pending completion of a particular milestone, take into account any effect that deferral would have on other types of assistance being received, such as Food Stamps. Discuss your reasoning with the individual and explain why deferral may be in his/her best interest. Consider a short-term rental or lease as an appropriate alternative until the individual reaches one or more milestones under the PASS.
g. Examples of Allowable Expenses
The following list, which is not all-inclusive, contains examples of items and services for which expenses can be allowed under a PASS, provided that they satisfy the criteria in SI 00870.006B:
basic living skills training (see SI 00870.006A.8.)
dues and subscription costs for publications for academic or professional purposes
equipment, supplies, operating capital, and inventory required to establish and carry on a trade or business (see SI 00870.026)
equipment and tools, including safety equipment, whether specific to the individual's condition or designed for use by a non-disabled person
finance and service charges connected with obtaining any of the above, including finance and service charges related to a bank account that is set up solely for the purpose of keeping PASS funds separate and identifiable
food and shelter while temporarily absent from one's permanent residence to attend educational, training, employment, trade, or business activities, if there is also a cost associated with maintaining the permanent residence
job coaching/counseling services
job search or relocation expenses
meals consumed during work hours (including job-training and school)
modifications to buildings, vehicles, etc., for operational or access purposes for persons with disabilities
PASS preparation fees
taxes and government-imposed user fees (e.g., permits and licenses) connected with obtaining any item on this list, except that income taxes or government-imposed penalties or fines are not allowable
transportation—-hire of private or commercial carriers, or hire of person to drive the individual's vehicle
transportation—-lease, rental, or purchase of a vehicle, plus associated costs for fuel, insurance, maintenance, registration, taxes, etc. (see SI 00870.006B.7. and SI 00870.006B.8.)
transportation—-public transportation and common carriers
tuition, books, supplies, and all fees and costs imposed by or in connection with an educational or occupational training facility, including fees for tutoring, testing, counseling, etc.
uniforms, specialized clothing, safety equipment, and appropriate attire (e.g., suits, dresses) needed for job interviews or to begin working in an office or professional setting
C. Procedure -- Maintain PASS Library
Notwithstanding paper retention instructions, maintain a library of approved and disapproved PASS cases. Use the material in this library for reviews of PASS changes, progress checks and reviews, expense evaluations, and as models for new plans.