SI 02901.610 Exhibits

Exhibit 1: Incremental Unit Cost Schedule

Exhibit 2: Form SSA-1036, Billing Covering Reimbursable Services Performed

Exhibit 3: Form SSA-1036, Billing Covering Reimbursable Services Performed (Texas only)

Exhibit 1 - Incremental Unit Cost Schedule

 

Incremental Unit Cost Schedule

 

Charges to the States are one-half the incremental cost to SSA for providing the Services, per section 1634 of the act. The current rates are as follows:

 

ServiceTotal Cost to SSACharges to States
One question on SSI application about Medicaid status1 $0.74$0.37
SDX Records (Texas Only).0093 per record.0047 per record

1Cost per question is calculated annually.

Exhibit 2 - Form SSA-1036, Billing Covering Reimbursable Service Performed - All States Except Texas

G-SI 02901.610-2

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Exhibit 3 - Form SSA-1036, Billing Covering Reimbursable Services Performed For the State of Texas

G-SI 02901.610-3

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To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502901610
SI 02901.610 - Exhibits - 02/10/1997
Batch run: 01/27/2009
Rev:02/10/1997