A written statement may establish the filing date for title XVI benefits if the criteria for written statements in GN 00204.010 are met. (See SI 00601.012 for who may sign a written statement.)

In addition to the documents listed in GN 00204.010F, the following specific supplemental security income (SSI)-related documents may serve as protective writings:

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  Interim Assistance Reimbursement (IAR) Authorization (see GN 00204.010).

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  A title XVI application or redetermination form. The form must name the person and indicate that the person is age 65 or older or will attain age 65 within the evaluation period, or is blind, or disabled. Except for a current or former spouse, the form must also indicate that the person lives with the claimant at the time they are named on the application. If there is no intent to file for a person named, the form must contain a statement to that effect. If this situation applies, treat the naming of that individual as a lead. (See GN 00202.020 for processing leads and SI 00601.020A.4. for the scope of a written statement of intent to file.)

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  A written request for appeal when the request is received after the appeals period and we could not establish good cause for late filing.

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  A plan for achieving self-support submitted for an individual who is not currently receiving SSI.

GN 00204.010 provides the policy for determining the protective filing date based on a written statement. SI 02003.020 contains instructions for when the protective writing is an Interim Assistance Reimbursement (IAR) authorization.

The scope of a title XVI protective writing is determined by the application subsequently filed. See SI 00601.010D for the scope of a title XVI application. Also, anyone named on the title XVI application that meets the criteria in SI 00601.020A.2. second bullet is protected as of the date of the protective writing even if that person is not named in the writing.

GN 00204.005 contains guidelines for when the claimant dies after making a written statement but before filing. Also, SI 02101.003 contains instructions for who may receive a title XVI underpayment.

A written statement must be closed out.