SI NY00870.100 Reviewing a PASS - Establishing a PASS File

See SI 00870.100

The national POMS instructs field offices (FO) to maintain a separate file of Plans for Achieving Self-Support (PASS), both approved and disapproved, as a reference.

The Regional Office (RO) also has a reference file of PASSes which have been filed in the Region. Therefore, when preparing the copy of the PASS for the FO file, please make a copy for the RO files. Mail the copy to:

Social Security Administration
RSI/SSI Programs Branch
26 Federal Plaza Room 4032
New York, New York 10278
   
ATT: PASS File

    

The following exhibits are to help FOs when they are preparing PASSes.

SI NY00870.100 Exhibit I - PASS COMPLIANCE LISTING

Exhibit I is a list of data required when completing a PASS. It can be used as a guide for claims representatives when they are preparing PASSes.

SI NY00870.100 Exhibit II - PASS ACCOUNTING SHEET

Exhibit II is an accounting sheet that may be used by FOs to assist them when doing PASS calculations.

   

EXHIBIT I - PASS COMPLIANCE LISTING

The following is a list of data required when completing a PASS. This listing should be completed before mailing out the PASS notice, one copy should be retained in the recipient's file and one copy should be retained in the FO. Also, a copy of every PASS should be mailed to:

Social Security Administration
RSI/SSI Programs Branch,
26 Federal Plaza, Room 4032,
New York, New York 10278
   
ATT: PASS File

1.) Name_____________________

2.) SSN____________________________

3.) Disability_______________________________

4.) Occupational Objective____________________

5.) Start Month: EN D1 MM YY______________

(SM 01005.170)

6.) Completion Month_____________________________________

7.) Total Monthly Income_____________________________________

8.) Excluded Monthly Income_____________________________________

9.) Amount of Income for Living_______________________________

10.) Total Resources_____________________________________

11.) Excluded Resources_____________________________________

12.) Student? School Verification?_______________________________

13.) Compliance Diary: DA Code MM YY___________________________

14.) First Review Date_____________________________________

(SI 00870.080)

15.) Date Notice Sent_____________________________________

Approved by: _________________________________Date: _____________

(Claims Representative)

  

EXHIBIT II - PASS ACCOUNTING SHEET

   

Name: _________________________Period ____________Thru _________

1.) PASS Savings Balance: $______________A

(Show Resources available at the start of the Plan or the Balance remaining from a previous PASS Accounting Sheet.)

2.) PASS Income: (Show income designated for PASS expenses)

Date

 

Amount:

$

Date

 

Amount:

$

Date

 

Amount:

$

Date

 

Amount:

$

  

TOTAL:

$__________B

3.) PASS Expenses Paid:

(Show "out of pocket" (not reimbursed) PASS expenses paid.)

PASS Expense Description of item/service

Date Paid

Amount Paid

  

$