Effective Dates: 01/11/2024 - Present Previous | Next

TN 42 (01-24)

SI 00870.100 Exhibits

 

Exhibit 1 - SSA-545-BK (PLAN TO ACHIEVE SELF-SUPPORT)

This is a PDF of the SSA-545-BK for your use:

View In PDF

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SSA-545-BK Page 1 of 12 - Part A - Your Work Goal and Part B Med/Voc/Edu background
SSA-545-BK Page 2 of 12 - end of Part B
SSA-545-BK Page 3 of 12 - Part C - Your Plan
SSA-545-BK Page 4 of 12 - Part D - Expenses
SSA-545-BK Page 5 of 12 - End of Part D and Part E - Funding your PASS Plan.
SSA-545-BK Page 6 of 12 - Part F- Current Living Expenses
SSA-545-BK Page 7 of 12 - Part G - Other Contacts and Part H - Remarks
SSA-545-BK - Page 8 of 12 - Part I - Agreement
SSA-545-BK Page 9 of 12 - Signature Page
SSA-545-BK Page 10 of 12 - Signature Page
SSA-545-BK Page 11 of 12 - Privacy Act Statement
SSA-545-BK Page 12 - Part J - Receipt

Exhibit 2 - PASS ROUTING SLIP FOR HEARING

 

1

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500870100
SI 00870.100 - Exhibits - 01/11/2024
Batch run: 01/11/2024
Rev:01/11/2024