Identification Number:
SI 00870 TN 42
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ORDES
Title:Plans to Achieve Self-Support for Blind or Disabled People
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part SI – Supplemental Security Income

Chapter 008 – Income

Subchapter 70 – Plans to Achieve Self-Support for Blind or Disabled People

Transmittal No. 42, 01/11/2024

Audience

PSC: PASS SPECIALIST;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ORDES

Effective Date

Upon Receipt

Background

Continuation of an ORDES endeavor from February 2019 to replace Exhibit 1 with the newest version of Form SSA-545-BK, as well as to delete Exhibit 2 (Routing Slip from FO) and move it to the PASS Clusters area of PolicyNet. This slip is rarely used, now that WorkTrack is the preferred method of movement of documents between SSA offices. Routing Slip for Hearing retained due to its continued use and moved from Exhibit 3 to Exhibit 2, while also posted to the PASS Clusters. Deletion of Exhibit 4 (PASS Expenditure/Savings Record) as this form is already present in the PASS Clusters, and deletion of Exhibit 5 – A Guide to Preparation of the Plan to Achieve Self-Support (PASS) Application Form (SSA-545-BK) For People Who Are Blind or Visually Impaired – as this publication is from 2009 and no longer available.

 

Summary of Changes

SI 00870.100 Exhibits

Replaced the 11/2005 version of SSA-545-BK (Exhibit 1) with the most recent 02/2020 version. Deleted Exhibits 2, 4 and 5.

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:

_____

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

 


SI 00870 TN 42 - Plans to Achieve Self-Support for Blind or Disabled People - 1/11/2024