Effective Dates: 1/08/2025 - Present

Identification Number:
SI 00520 TN 62
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Institutionalization
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part SI – Supplemental Security Income

Chapter 005 – Eligibility

Subchapter 20 – Institutionalization

Transmittal No. 62, 01/08/2025

Audience

OCO-OEIO: CR, FCR, FDE, RECONE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a new model agreement for prerelease agreements. This is an updated example of what states should be using to establish a prerelease agreement

Summary of Changes

SI 00520.930 Exhibits of Prerelease Agreements, Referrals, and Forms

In exhibit 1 the prior model agreement was deleted and replaced with a PDF version of the new model agreement.

SI 00520.930 Exhibits of Prerelease Agreements, Referrals, and Forms

 

EXHIBIT 1 - Model Prerelease Agreement between SSA and non-BOP Institution

EXHIBIT 2 - Model Prerelease Referral

EXHIBIT 3 – Modified Form SSA-3288 (Consent for Release of Information) for use in BOP prerelease claims

 

EXHIBIT 1 - Model Prerelease Agreement between SSA and non-BOP institution

View In PDF

NOTE: This agreement is just a model; it can be modified to meet the needs of the local institution. All new agreements should be sent to the RO for review and any, substantial deviations from the model should then be sent to Office of the General Counsel (OGC) for review prior to enacting a new agreement. For more information about establishing prerelease agreements with non-BOP institutions, including time frames for processing claims using prerelease procedures, see SI 00520.910C.

FOs and ROs must establish operating procedures to store and maintain prerelease agreements.

EXHIBIT 2 - Model Prerelease Referral from Facility to SSA Office

 
Agency: ___________________________ Social Worker: _______________
Building/Unit: ______________________ Phone: ______________________
​ ​
Name of 

Resident:  _________________________		 Anticipated Date of

Release: _____________________
​ ​
Social Security Number: _____________ ​
​ ​
Date of Birth: ______________________ ​
​ ​
Reason for Referral:_________________ ​

 

EXHIBIT 3 - Modified Form SSA-3288 (Consent for Release of Information) for use in BOP prerelease claims

View In PDF

 


SI 00520 TN 62 - Institutionalization - 1/08/2025