Effective Dates: 09/26/2023 - Present Previous | Next

TN 43 (09-23)

DI 39506.250 State Agency Schedule for Equipment Purchases for SSA Disability Programs - Form SSA-871

A. Purpose of Form SSA-871

Use Form SSA-871(State Agency Schedule for Equipment Purchases for SSA Disability Programs) to report equipment purchases utilizing SSA funds within a quarter.

B. How to file Form SSA-871

We require submission of the Form SSA-871 only if the Disability Determination Service (DDS) purchased equipment during the quarter reported.

Submit copies as follows:

  • •

    The original (with signature) will be sent to the Regional Office.

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    The Regional Office will provide the correct email address for the submission.

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    The Regional Office will set the due date for their states to coincide with the 4513 submission, and

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    The Regional Office will review and approve the original (with signature) and send to the SSA ODD Division of DDS Resource and Workload Management mail box ^DCO ODD DDRWM Funding no later than the 5th day of the next month after the close of the quarter

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0439506250
DI 39506.250 - State Agency Schedule for Equipment Purchases for SSA Disability Programs - Form SSA-871 - 09/26/2023
Batch run: 09/26/2023
Rev:09/26/2023