i know what it is… - transformation center · that look towards a gradual, linear movement from...

I know what they are...

But not how to DO them !

A HANDS-ON WORKBOOK

USING THE SOCIAL SECURITY

AND SSI WORK INCENTIVES

© 2010, Lyn Legere & Work Without Limits – Use this workbook as a guide. Always work with a benefits

counselor to make sure you have the most updated Social Security information. www.transformation-center.org

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Introduction

The Social Security and SSI work incentives have been around for many

years now, and most of us have sat through repeated trainings and forums

to learn what they are and how to use them. Just the same, when it

comes time to make a decision that includes work and benefits, many of

us still feel lost and confused. Then, we either become paralyzed and

decide we just can’t work because of our benefits, or we decide to just

go to work without dealing with the benefits issue. Either way, we get

hurt in the end.

This workbook is meant to support people in using the Social Security and

SSI Work Incentives by providing fact sheets and work sheets to make the

process more clear. It also provides guidance on what pieces you can do,

and when to ask for assistance from more qualified specialists.

This workbook only provides the basic level of information on each work

incentive, but provides links to other resources for more in-depth

information. The key purpose of this Workbook is to provide some hands-

on tools to make the work incentives more useable for people on benefits

and their supporters.



3

Table of Contents Chapter 1 Quick Facts on SSI & SSDI p. 4–10 Chapter 2 Working with the Work Incentives p. 11-15 Chapter 3 SSDI Work Incentive Overview & Trial Work Period (TWP) p. 16-21 Chapter 4 The Extended Period of Eligibility, Part 1: The Basics (EPE) p. 22-23 Chapter 5 The Extended Period of Eligibility, Part 2: Earning More

And Counting Less (EPE) p. 24-35 Chapter 6 The Expedited Reinstatement Period (EXR) p. 36-37 Chapter 7 Extended Medicare Coverage (EMC) p. 38-39 Chapter 8 Transitions p. 40-45 Chapter 9 SSI Work Incentives p. 46-56 Chapter 10 I’m 17 going on 18 p. 57-59 Templates Section p. 60–85 Resource Links p. 86-87

“We are continually faced by great opportunities brilliantly disguised as insoluble problems.“

(Author Unknown)

I hope this Workbook helps your Vocational Recovery Journey become a great opportunity rather than impossibility due to the barriers related to disability benefits.



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Chapter 1: Quick Facts on SSDI versus SSI

Before we can begin to talk about the Work Incentives, it’s important to

understand the two primary disability programs – SSDI & SSI. It’s easy to

confuse the two programs. They’re both administered by Social Security, have

similar initials, have insurance that sounds alike (Medicare & Medicaid), and

are both disability programs. For these reasons, people often think that SSI

and SSDI are both part of a single program.

SSDI and SSI are actually two very different programs that happen to be run by

the Social Security Administration. There are key differences between the two

programs, and these differences explain the how and why each program has



5

certain work incentives and how the Social Security Administration (SSA)

evaluates work.

Social Security Disability Insurance – SSDI

Social Security benefits, including SSDI, are WORKER benefits. Social Security

is INSURANCE with people paying the “insurance premium” through the FICA

taxes1 taken out of the person’s paycheck. All Social Security benefits stem

back to a person who worked and paid FICA taxes.

Because SSDI is an insurance program, a person:

- Can have unlimited assets

- Can have income other than wages

- Must be disabled under Social Security rules

1 FICA – “Federal Insurance Contribution Act” passed by Congress with the Social Security Act

in 1935 as a way to fund Social Security benefits.



6

Social Security Definition of Disability: To be disabled, a person must be:

Unable to do any significant work (substantial gainful activity)

Due to a physical or mental impairment;

That is documented by medical evidence; and

Is expected to last at least 12 months or result in death.

Other Quick Facts About SSDI

Amount of Benefit – The amount is based loosely on the worker’s income

when they were working.

Work Incentives – The work incentives are based on a set of timelines

that look towards a gradual, linear movement from total disability to

total self-sufficiency.

Work Evaluation – The amount and quality of work is evaluated to see if

the person remains disabled under the rules. It has nothing to do with

how much money the person is accumulating, but instead, if the person

is doing or able to do “substantial work” which makes the person

ineligible for SSDI benefits.

Health Insurance – Medicare, the same health insurance that retirees

get, comes with SSDI benefits.

So, in summary, workers can get SSDI if they’ve paid into the system via FICA

taxes and the person is disabled under the SSA rules. If a worker is disabled,

he/she is entitled to SSDI, so factors such as the amount of savings, etc.,

aren’t considered. When a person goes back to work, Social Security evaluates



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if the amount of work means the person is no longer disabled and, therefore,

no longer qualified for benefits. The work incentives become the avenue to try

work without losing benefits.

Supplemental Security Income – SSI

SSI is a ‘benefit of last resort’ for people who have disabilities AND significant

financial need. At one point, each state had it’s own ‘welfare’ program for

people with disabilities. In the early 1970’s, all the programs were brought

together as a single national program – SSI – as a cost-saving measure. Even

though the Social Security Administration manages the SSI program in Social

Security offices, SSI isn’t funded by the Social Security Trust Fund and is not

part of the Social Security program. It remains a “welfare” or “needs-based”

program. It only supplements any other financial support available to the

person in order to give him or her enough money to meet basic needs of food,

shelter and clothing. This is why it’s called Supplemental Security Income or

SSI.

SSI supplements income up to a cap, called the Federal Benefit Rate

(FBR) that is set each year. This full FBR cap is for people that live on their

own and have to pay all of their own expenses for housing, food and clothing.

Alternative FBR rates, or caps, are created for people that live with other

people or in institutions, situations in which people pay less than the full

expenses for food, shelter and clothing. If all other available income is less

than the SSI cap, a person with a disability is also eligible for an SSI check. For

example, Mary lives with a roommate and her cap is approximately $500.00.2

She gets a $200.00 check each month from her inheritance from her

grandmother. To bring her up to the cap, SSI gives her a $300.00 check.

Another example would be Sally. She also shares an apartment and has a cap

2 Figures in examples do not represent current SSI Federal Benefit Rates. They’re being used for

example only.



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of $500.00. She has a limited work history and gets $250.00 in SSDI benefits.

SSI supplements her $250.00 up to the cap of $500.00, issuing an SSI check of

approximately $250.00 per month.

As with SSDI, a person must be “disabled” under the Social Security

rules. That is, the person must have a physical or mental impairment that also

impacts his or her ability to do any significant work.

Other Quick Facts About SSI

Eligibility – SSI requires that a person with a disability have financial

need:

o Person must have little to no income.

o A person cannot have more than $2,000 in “resources,” and a

couple must have less than $3,000. “Resources” are assets such as

money in the bank, IRA’s, stock and bonds, etc. There are some

basic resources that are not counted, including a house that a

person lives in, a car, and funds for burial ($1500). See

http://www.workworld.org/wwwebhelp/ssi_resources_exclusions.

htm for the full list of allowable resources.

Amount of Benefit – The amount is based on the Federal Benefit Rate

(FBR) and a person’s living situation. The SSI amount for a person living

on their own and paying all the bills is more than for someone who is

http://www.workworld.org/wwwebhelp/ssi_resources_exclusions.htm




9

living with others and paying only part of the total bills. The rate is

based upon the Federal Benefit Rate and any state supplements (See

http://www.workworld.org/wwwebhelp/fbr.htm for a chart of past FBR

levels.)

State Supplements - Some states provide additional funds to supplement

the Federal Benefit Rate. In 2010, these states are California, The

District of Columbia, Hawaii, Massachusetts, Nevada, New Jersey, New

York, Pennsylvania, Rhode Island and Vermont. See

www.ssa.gov/pubs/statessi.html for more information on state

supplements.

Work Incentives – The SSI work incentives are designed to encourage

people to work if possible. In most cases, a person does better

financially if they are working under the SSI rules.

Work Evaluation – Work is considered on two levels – disability status and

the amount of money a person is earning. SSI is a disability program, so

the status of the person’s ongoing disabled status is evaluated. Also,

because SSI is a needs-based program, SSI constantly monitors a person’s

finances. However, SSI counts wages from work different from any other

income, and people often end up with more in-pocket cash when they

work.

In summary, SSI is, first and foremost, a ‘welfare’ program for people with

disabilities. As such, the primary concern is how much money a person has.

SSI and SSDI are very different programs, even though the SSA administers them

both. As we begin to look at the work incentives, we’ll see how each program

evaluates work in relation to its’ primary purpose and goal.

http://www.workworld.org/wwwebhelp/fbr.htm

http://www.ssa.gov/pubs/statessi.html



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Table 1: SSDI vs. SSI

Social Security Disability Insurance

The Worker’s Insurance

Supplemental Security Income For Those in $$ Need

Eligibility Disabled by Social Security Rules

Disabled by Social Security Rules

Substantial Work Background

Little or no work background

FICA tax pays “premium” –

Entitled to the benefit Must show financial need – a federal “welfare’ program

Benefit Amount

Based loosely on earnings Based on living situation and the Federal Benefit Rate

Goal To support worker with disability and immediate

family members

To provide for basic needs of food, clothing, and shelter for people

with disabilities

Medical Insurance

Medicare (after 2 years) Medicaid ((called different things in different states, e.g. MediCal in

California)

Purpose of work

evaluation

Is the person still disabled under the rules? Does current work represent the ability to work at a substantial level?

How much money does the person now have? Is the person still

disabled under the rules?

Adapted with permission from “Stepping Into Work with the Social Security Work Incentives” © 2006, Legere, L.,

Kugler, R. and the Institute for Community Inclusion, Boston, MA.



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Chapter 2: Working with Work Incentives

What are Work Incentives?

Let’s think back to the definition of “Disabled” Under the social Security rules…

Before “work incentives” came into play,

people would lose their benefits almost

immediately if they started to work.

Many people who wanted to work were afraid to even try, and very few people

left the SSDI or SSI rolls once they had been approved for benefits.

The “Work incentives” are specific provisions within the social security

regulations created by Congress to give people opportunities to test out and

experience work without losing benefits immediately. SSA had to create these

work incentives because the definition of disability includes the “inability to do

any substantial...” work. Some “incentives” reduce the amount of work

income that SSA actually counts or considers when making decisions about your

ongoing eligibility for benefits, while other “incentives” fully protect your

ongoing SSI or SSDI benefits. Some “incentives” affect your cash benefits while

others protect your ongoing health coverage under Medicaid or Medicare. They

also provide a way to get “credit” for out-of-pocket money spent for disability-

related supports needed to get to and perform in your job.

Communicating with Social Security

Communicating with the Social Security Administration (SSA)3 is the most

important step to implementing the Social Security Work Incentives. There are

3 SSA – Social Security Administration. This term generally means “your local Social Security office.”

Because SSI is also administered through this office, it is referred to as SSA rather than ‘social security.’



12

things that you are required to tell SSA, as well as things that you want to tell

them because it will benefit you.

Important Things to Know:

1. SSA claims representatives tend to be overworked, especially in cities

and large suburbs. This can mean:

a. Long lines in offices;

b. Getting answers that are confusing or too

short to be helpful; or

c. Misinformation because the person hasn’t taken the time to assure

that they have the correct information.

2. The SSA office is divided into two parts: SSDI and SSI. If you receive

both benefits and have information to report, you need to do this with

both the SSDI person and the person from SSI.

3. There are penalties and consequences for not providing information to

SSA that you “knew or should have known” needed to be reported, so it’s

important to report everything about your work to them.

To ensure that you get credited for reporting information to SSA,

send your information via certified mail, return receipt requested. When you

send things this way, the receiver (SSA) signs a green card that is mailed back

to you. Save a copy of your communications and this card. It is your proof that

your information was received. Even if your local SSA office is small, you want

to take this extra precaution to make things easier for you in the long run.

When you discuss information with SSA by phone or in person, you

want to send a letter confirming the information and your

understanding of it. This should also be sent certified with a return receipt for

TIP

TIP



13

your records. This simple step can help you to avoid many problems by giving

you a clear record of what you reported, when, and to whom. It also gives SSA

a chance to correct your understanding if you are wrong. Here’s an example

and there is a template for this letter in the Letter Templates section:

December 3, 2010

Ms. Chin, Claims Representative

Social Security Administration

10 Causeway Street, Suite 101C

Boston, MA 02210

RE; Lyn Anderson, SSDI claim

SSN: 123-45-6789

Dear Ms. Chin,

I am writing to confirm our conversation on Monday, November 28th

.

As you recall, we discussed my current work at Sunnybright Day Care Center. I

told you that I received 5 paychecks in October, making it look like I had earned

more than SGA this month.

We agreed that my earnings should be averaged because they’re the same each

month. This means that I won’t be over SGA even in a month with an extra

paycheck, and I’m still entitled to my SSDI check.

If I misunderstood this information, please let me know right away. Otherwise, I

will assume I’ve understood this correctly.

Thank you very much.

Sincerely

Lyn Anderson

47 Sunny Drive

Happyville, MD 12345

617-234-2345

[email protected]

mailto:[email protected]



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As you can see, this letter can help you remember what was discussed, and can

address any misunderstandings later. The few minutes it takes can be a

lifesaver in the long run !!

Using Your Resources

Knowing about the work incentives helps you to be in control of, instead of

victim of, your benefits as you make choices about work. However, unless you

work with these benefits all the time, they can be confusing. It’s best to

partner with someone who understands all the complexity of the rules. This

person can explain the rules at different stages of the process, while you take

steps on your own to assure that you’re in the driver’s seat with your benefits

and work choices.

WIPA – Work Incentive Planning Assistance

Every state has a program for benefits planning, called the Work Incentives

Planning and Assistance project, or WIPA. Each WIPA is staffed with

Community Work Incentive Coordinators (CWICs) who fully understand the

SSI/SSDI rules, as well as how other benefits offered by the State or Federal

government may benefit the person or be impacted by work. CWICs can create

a benefits plan with you that takes into consideration all the benefits you

currently receive, and can give you information to help you make informed

choices about work. WIPAs are authorized to serve all SSA beneficiaries with

disabilities, including transition-to-work aged youth, providing benefits

planning and assistance services on request and as resources permit. For more

information on WIPA programs and how to locate them in your state, go to

http://www.ssa.gov/work/wipafactsheet.html.

Work Incentives Liaison

Each SSA office or regional office is supposed to have a person know as the

“work incentives liaison.” The level of skill of work incentive liaisons vary

http://www.ssa.gov/work/wipafactsheet.html



15

office to office, so you want to make sure the person in your SSA office is

knowledgeable about the work incentives. This person can be a support and

ally if he or she understands them well.

Filling out Forms

SSA asks you to fill out forms from time to time. Most ask for information like

name, who your doctors are, and other factual type of information.

Occasionally, you will get a form that asks you more in-depth information

about your work or about your daily activities. These forms are meant to

gather information to help SSA make a decision, so it’s important that you

answer questions in detail.

Example:

Question: Are you able to clean your house and cook your meals?

Bad Answer: Yes (thinking that I’m physically able to do these

things)

Good Answer: I’m physically able to do these things, but due to my

depression, I have a hard time getting out of bed or

doing anything in my house. I often don’t eat, and

when I do I just walk to the sub shop next door and get

something to go.

As you can see, forms are a way of giving SSA the best information about you,

your disability, and your work. It’s always best to connect with your resources

when you have to complete a form that asks these types of questions.



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Chapter 3: SSDI Work Incentives Overview and Trial Work Period

SSDI Work Incentives Overview

The SSDI work incentives are a series of timelines gradually reduce the amount

of cash and medical insurance as you increase work activity. The SSDI work

incentives were created from the mindset of physical conditions that were

sustained in adulthood, after a period of working. These timelines anticipate a

straightforward linear move from disability to wellness. The first timeline, the

Trial Work Period, allows people to work and maintain their full check

regardless of earnings. The second timeline, the Extended Period of Eligibility,

follows the first. It allows people to work and continue receiving a check if

their income is below a certain amount, but receive no check if the income is

above.

The Expedited Reinstatement period, the next timeline, allows people to

return to benefits if needed due to an exacerbation of a person’s condition.

The final timeline is for Medicare coverage, allowing at least 7 1/2 years of

coverage after the end of the Trial Work Period.



17

Each of the different time-lines, how they work, and how they benefit people

who wish to work are briefly discussed. Each section also describes what you

need to tell SSA, when, and provides sample letters for your reference. For a

more detailed discussion of each of these timelines, see the highlighted links

SSDI The Trial Work Period

The trial work period (TWP) allows you to work without any changes in your

cash or health benefits. A Trial Work Period consists of 9 months, not

necessarily in a row, within a 5-year period during which a person earns above

the trial work amount. SSA increases the Trial Work figure (TWP $) whenever

there’s an increase in the consumer price index. The figure for 2011 is

$720.00.

When you’re thinking about getting a job Things

to Do



18

Look up the current TWP amount4 and decide for yourself if this is a good

time to use those months given your personal recovery.

If you’ve worked at some point since beginning to receive benefits (or even

if you MAY have worked), call your local Social Security

office to find out how many trial work months they have

in the record for you.5 Ask them to send you a printout

so you can check to make sure their information is

correct.

Once you know if any past work has counted towards

your Trial Work, set up a chart so you can track your

Trial Work from this point on. This allows you to make

choices about your work as you proceed through your

Trial Work.

Date Place Wages TWP $$

Above TWP ?

TWP Month #

(Chart for your use in the Templates Section)

Example: Jade is considering returning to work. It’s been a long time since

she worked more than a few hours, so she wants to make sure that she doesn’t

jeopardize her benefits by returning to work. She knows she’s done some work

since she began getting benefits, and even though she doesn’t think any of

these would count as Trial Work, she calls Social Security to find out what their

4 To get TWP figures, go to http://www.ssa.gov/oact/cola/twp.html

5 To find your local Social Security office, go to https://secure.ssa.gov/apps6z/FOLO/fo001.jsp

You only get ONE

Trial Work Period.

Once you have used

9 months in a 5-year

period, it has been

completed, and you

do not get another

one.



19

records say. She’s surprised to hear them say she’s already used 4 Trial Work

months, and asks for a printout. When she receives the printout, she agrees

with the information and puts it into a table:

Date Place Wages TWP $$ Above TWP?

TWP Month #

March, 2004 Dunkin Donuts $645 $580 Y 1 (per SSA) April, 2004 Dunkin Donuts $651 $580 Y 2 (per SSA) May 2004 Dunkin Donuts $486 $580 N -- August 2006 UMass $358 $620 N -- Sept 2006 UMass $525 $620 N -- Oct 2006 UMass $725 $620 Y 3 (per SSA) Nov 2006 UMass $725 $620 Y 4 (per SSA) Dec 2006 UMass $567 $620 N --

As you can see, plotting your Trial Work is pretty straightforward. If the gross

earnings are above the TWP amount, it counts as one month. If it’s below the

amount, it doesn’t count as a TWP month.

Date Place Wages TWP $$

Above TWP?

TWP Month #

March, 2004 Dunkin Donuts $645 $580 Y 1 (per SSA) April, 2004 Dunkin Donuts $651 $580 Y 2 (per SSA) May 2004 Dunkin Donuts $486 $580 N -- 2005 NO WORK -- August 2006 UMass $358 $620 N -- Sept 2006 UMass $525 $620 N -- Oct 2006 UMass $725 $620 Y 3 (per SSA) Nov 2006 UMass $725 $620 Y 4 (per SSA) Dec 2006 UMass $567 $620 N -- 2007 NO WORK --



20

The Trial Work Period is also 9 months within a “rolling” 5-year period. What

this means is that the first month of Trial Work and the 9th month of Trial Work

have to happen within 5 years. As you can see in Jade’s chart, from 2004 to

2009 is 5 years and she’s only worked 4 Trial Work months during this five

years. If she were to work in 2010, the work from 2004 would no longer count

as no 9 months of Trial Work occurred within 5 years. This window of five-

years continues to move forward until a 9th Trial Work month

is worked, ending the Trial Work Period.

During your Trial Work Period, you receive your full check,

so you can work as many hours as you want and earn any

amount. But remember that you only get one TWP, and

completion of your 9th TWP month will also start the next

timeline. This means you really want to evaluate what you want and need to

do with respect to continuing work, or continuing to work at the same level no

later than your 8th TWP month.

When you get a job

Continue to use the Trial Work chart to track your TWP

Evaluate your experience with working so you can make an

informed choice as you near the end of your Trial Work Period (more

about this below).

Connect with your local WIPA for more in-depth information about the

impact of work based on your own wages, etc.

Write a letter to Social Security to inform them that you’re working.

How Do I Do This?

2008 NO WORK -- 2009 NO WORK -- 2010

Things

to Do



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A simple letter will do the trick, along with 2 pay-stubs. Often, SSA will follow-

up by sending you a letter for more information and sending a request for your

wages to your employer. If you don’t want Social Security to contact your

employer, you can ask them to let you provide the wage information instead.

If you don’t follow-through, they will go to your employer.

Example: It’s January 2010, and Jade decides to get a job. Although she has

used 4 of her Trial Work months, she realizes that the work from 2004 is now

beyond 5 years ago, so these don’t count anymore. In March, she got a part-

time job at Boston University earning approximately $650.00 per month. As

this amount is below the TWP amount, she will not be using up any months.

She notifies Social Security that she’s working in the letter below.6

April 3, 2010

Ms. Chin, Claims Representative


55 Pleasant Street

Any Town, USA 34343

RE; Jade Smith

SSN: 012-34-5678

Dear Ms. Chin,

I am writing to inform you that I have begun working. I am currently working at Boston

University. I am working 10 hours per week, earning $15/ hour. Attached you will find

that last tow (2) pay stubs to verify my earnings. As I have not disclosed my disability to

my employer, I would appreciate your requesting further verification of my income

directly from me.

If you need any further information, please feel free to contact me.

Thank you.

Sincerely,

6 A blank template of this letter is available in Appendix 4.



22

Jade Smith

There are letters in the Template Section that can be used as a guide to inform

SSA of your working or not working, as well as increasing/decreasing your

hours.

The Trial Work Period is an opportunity to really try working without any fear

of losing your cash benefits or medical coverage. As long as you keep track of

where you are, you should be able to fully pace your return to work according

to your own needs.

Chapter 4: The Extended Period of Eligibility: Part I, The Basics What it is: The Extended Period of Eligibility is a 3-calendar-year safety net

that immediately follows the Trial Work Period. It allows you to continue to

work while staying on the Social Security rolls and receiving your Medicare

benefits. Depending on how much you’re earning, you may or may not also

continue to receive your monthly Social Security check.

How it Works: As you know, Social Security’s definition of “disabled” is the

inability to do any significant work, which they call “substantial gainful

activity.” SSA assigns a money figure to represent this. If your earnings are

above “substantial gainful activity” or “SGA,” you will not receive your SSDI

check. If your earnings fall below this figure, you will receive your full check.

The figure for SGA changes almost every year, so see the chart in the

Templates Section for the amount each year.



23

Example: Jing and Alex, his peer

support worker, have been

working together. Jing has

been focusing on his

vocational recovery, and

decides to get a job in a

gym, providing fitness

coaching. He earns $800/month, under the 2010 SGA figure, so continues to

receive his monthly SSDI check. He really likes the gym he’s working for, and

they like him as well. Within just a couple of months, he’s given a raise and

increases his hours. He becomes concerned, however, when he realizes that

his earnings are now over $1,100/month, over the SGA amount, and he is not

entitled to his SSDI check. He cuts back his hours, but he and Alex also decide

it would be best to check in with the local WIPA specialist to see if there are

any other work incentives that will support Jing.

See Extended Period of Eligibility, Part 2, to learn what might help Jing work more

hours without losing his cash benefits.

Continue to inform SSA whenever you start or stop working. (See

Templates Section for a sample letter) Stay aware of your earnings so you know if you’re going over SGA. (See Chapter 5 for more information on SGA)

Things

to Do



24

Chapter 5: The Extended Period of Eligibility: Part II Earning More & Counting Less: Taking Disability into Account

As we know, the Extended Period of Eligibility is a 3-calendar-year safety net

that immediately follows the Trial Work Period. A person receives their SSDI

check if their countable earnings are below SGA, and does not receive an SSDI

check if countable earnings are above SGA.

Substantial Gainful Activity (SGA)

We often think of this term as just being a level of “work” usually measured by

dollar figure. But it’s really more than just work. It must be work that is both

Substantial and Gainful.



25

Substantial Work requires a significant amount of physical or mental energy to

perform the job. Typically, there is a job description, or at least specific job

expectations. There is an expectation that the person is working

independently without any extra supports, such as a job coach, extra

supervision, etc. It is work where the person’s tasks, expectations and job

structure are parallel to others in that role. The earnings are just one factor in

determining whether or not a job is “substantial work.”

The following jobs are not fully substantial regardless of a person’s earnings:

o TEPs o Supported Employment o Supported Workshop o “Make work” – a specially created job that doesn’t require

independence or adherence to certain responsibilities and expectations, e.g. an uncle hiring his nephew to work in his Dunkin Donuts shop without any specific role other than helping out.

o Peer Roles in certain settings

Gainful Work is that which typically includes reasonable remuneration or pay

for the work. Consequently, most volunteer jobs are not considered to be

‘gainful.’ In addition, SSA takes into consideration the monies spent by a

person with a disability to be able to work. A job may be gainful in terms of

gross income, but by the time someone has paid out of pocket for needed

medical expenses, it is no longer “gainful.”

The SSA work incentives provide different policies and procedures to take into

consideration the different factors that modify both the substantial and gainful

nature of any job. To take each factor into consideration, SSA allows

adjustments to your gross income, reducing the amount that SSA actually

counts as your income. This works in a similar way to the way that annual

taxes are computed. With taxes, people start with gross income and then take

allowable “deductions” or “credits” that are subtracted from the gross income



26

to come to a lower “taxable” income, and lower is better! In SSA, each

different factor gets translated into an earnings “adjustment” that also gets

deducted from the gross income to come to a lower “countable” income.

The SSDI work incentives that look at these factors during the Extended Period

of Eligibility include “Impairment Related Work Expenses,” “Job Coach

Subsidies,” and “Employer Subsidies.”

SGA Adjustments

Impairment Related Work Expenses: Also called IRWEs. These are expenses

paid out-of-pocket for those items or services related to your impairment that

help you go to work. To be an IRWE, the expense must be:

Actually paid

Paid out of pocket

Non-reimbursable from any insurance coverage

Related to the disability

Related to the ability to work

Common examples of IRWEs are:

Co-payments for medications, medical appointments, lab tests, etc. – Most

medical services related to impairment are IRWEs because medical stability

is necessary for ongoing employment.

Payment for job coach, PCA, specialized transportation, etc. – Most

expenses for services that support the ability to work are IRWEs. Some

services, such as a PCA, may serve many purposes. The portion that is

directly related to work support is an IRWE.

Halfway or group home expenses related to support. Most group residences

collect monthly “rent” for room, board and support. The amount of the

support that is related to your ability to work is an IRWE. For example, Jose



27

lives in a group home where he pays $1,000 per month. Of this, $500 is for

room and board and $500.00 is for services. Most of the time with his

counselor at the house supports him in dealing with work, maintaining his

wellness so he can work, and learning skills to get to work on-time etc. It’s

fair to say that about $400.00 of the $500.00 paid for counseling services is

related to work and is, therefore, an IRWE.

Computing IRWEs – IRWEs are computed by adding up the total spent in a

month. This total is subtracted from your gross income.

Example 1: Alexei works three days per week, and earns $1,500.00 per month.

This amount is above SGA. However, during the month, he has regular out of

pocket payments (see below).

Step 1: Adding Up the IRWEs

$15.00 co-pay for 4 medications ($15 X 4) = $ 60.00 $75.00 per visit for job coach, 2x/month ($75 X 2) $150.00 PCA assistance, 3 days/week @ $15/hr. = ($15 X 36) $540.00

o 2 hrs. each am for prep & travel (24 hrs/mo) o 1 hr. each afternoon for travel (12 hrs/mo)

TOTAL IRWEs $750.00

Step 2: Making Adjustments to Gross Income

Monthly Gross Earnings $1500.00 (Over SGA)

Subtract IRWEs $ 750.00

Total Countable Income $ 750.00 (Below SGA)

Example 2: Rosalie works as a bookkeeper 6 hours per day, 3 days per week.

Her hourly pay is $18.00/hr., and she typically earns $1296.00 in a 4-paycheck

month. She lives in a privately run residential home, where she pays $1,000

per month for rent. You learn from the residential facility that the “rent” is

broken down as follows: $200.00 shelter, $300.00 food, and $500.00 for

residential counseling & support services. You’re also able to verify that 75% of



28

the counseling and support she receives is related to increasing her skills in

relation to work (coping with work, wellness, time management, etc.). She

also has out-of-pocket co-pays for medication and doctor appointments.


Counseling and Support Services $375.00

o 75% of $500.00

Medication co-pay, $15 each for

three medications ($15 X 3) $ 45.00

Psychopharmacology co-pay, 1 X per month $ 30.00

Total IRWEs $450.00


Monthly Gross Earnings $1296.00 (Above SGA)

Subtract IRWEs $ 450.00

Total Countable Earnings $ 846.00 (Below SGA)

You need to inform SSA that you have monthly IRWE’s (See

letter in Templates Section.)

If you have the same IRWEs every month, your claims

representative at SSA may tell you that you don’t need to send all

the receipts in. In this case, you should hold onto all your receipts and send a

confirming letter to SSA (See Templates Section).

IRWEs are a way to reimburse yourself for the monies that you actually spend

to allow you to go to work. Other “adjustments” allow you to get “credit” for

the extra time you invest in being able to work

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Job Coach Subsidy: A job coach subsidy is consideration of the amount of

time spent with a job coach. Even if you pay for a job coach out of pocket and

deduct it as an IRWE (see above), you can still consider a job coach subsidy as

well. Traditionally, job coaches have been on-site, but it is worth arguing that

an off-site job coach is the same thing for a person with a psychiatric

impairment. A job coach subsidy is a simple computation: the number of

hours per month spent with your job coach multiplied by your hourly pay.

Example: Marietta works as a legislative aid. She works 22 hours per week,

earning $12.00/hour. She meets with a job coach for 1.5 hours per week. In a

4-week month, she receives $1056.00, over SGA.

Step 1: Computing the Job Coach Subsidy

Time with Job Coach/Month (1.5 hrs X 4.3 weeks)* 6.45 hours

Marietta’s Hourly Wage (multiply) $12.00 per hour

Total Job Coach Subsidy $77.40

*4.3 is the average weeks in a month, even though we get paychecks on 4 or 5

weeks.


Monthly Gross Earnings $1056.00 (Above SGA)

Subtract Job Coach Subsidy $ 77.40


Inform SSA that you receive Job Coaching Services (See

Templates Section for sample letter).

In summary, a job coach subsidy is a way to take your time that you spend

getting support to do your work into consideration. SSA also takes into

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consideration the amount of time your employer invests in your success (but

you get the credit !)

Employer Subsidy: An “employer subsidy” exists when an employer provides

supports and accommodations, and makes certain allowances to maximize a

person’s success. In Social Security lingo, an employer is “subsidizing” or

paying the full salary of someone who is working under the value of that salary.

Hence, if a person is working in a Supported Employment program, Transitional

Employment Program, or any other program where additional support or

variability in performance is allowed, it is considered to be “subsidized.”

Unfortunately, the SSA regulations regarding employer subsidies, also called

“special circumstances,” were drafted when sheltered workshops were

common employment settings for people with psychiatric disabilities. The

language in the regulations talk about comparing the “value” of work of people

with disabilities versus those that don’t in terms of productivity and

performance. Because of this language, many people don’t take advantage of

this very valuable work incentive. By viewing this subsidy as being more about

supporting a person’s success rather than identifying how a person’s work is of

lesser value, the employer subsidy becomes usable in a way that doesn’t strip a

person of his/her dignity in the process.

In reality, it’s not about the employer, but the employee, and the question SSA

is asking is, “could this person with a disability successfully perform this job in

another setting without the supports allowed in the current setting?” If the

answer is “no,” then a subsidy exists as the work might not meet the

“substantial” level needed to be SGA.

Common Examples of Employer Subsidies are:

Extra breaks



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Flexible schedules Working at home Extra supervision and support Instructions given in alternative formats Limited or no deadlines for work product Relaxation of “sick time” rules Allowing variability of performance

An employer subsidy is calculated as a percentage of total work hours. The

percentage is determined in one of two ways, depending on whether the time

for the employer support is something that can be easily measured or not.

Supports that can be measured by time:

The amount of time spent by the employee, the employer or another

employee supporting the person with a disability for extra breaks, extra

supervision, creating instructions in alternative formats, etc., can be

easily counted in time units. After figuring out how many hours are

“subsidized,” this gets translated into the percentage of total hours (See

Example 1).

Supports that cannot be easily measured by time:

Allowing flexibility in schedules, working at home, variability in

performance, etc., can not be easily measured in concrete time units.

These factors are also put into a percentage, but this is much more of a

“fuzzy math” process, looking at the impact of these accommodations on

the job as a whole (Example 2).

Example 1: Lakisha works in the research department of the Boston University

Center for Psychiatric Rehabilitation. She is a 20-hour per week employee,

working 5 hours per day, 4 days per week, and earning $13.00 per hour. Her

usual monthly earnings are $1040 (above SGA). They are fully aware of her

disability and have made the following accommodations for her: She can take

a 10-minute break every hour, and receives 15 minutes of supervision every day

she works. (These supports are not available to her co-workers).



32

Step 1: Computing the Employer Subsidy

Extra 10 minutes break per hour X 5 hours worked each day = 50 minutes Times 4 days worked per week = 200 Times 4.3 weeks per month = 860

860 minutes

(or 14.33 hours)

Extra 15 minutes supervision X 4 days per week = 60 minutes Times 4.3 weeks per month = 250 minutes

250 minutes (or 4.2 hours)

Total Subsidized Time 1110 minutes or 18.5 hours

Step 2: From Hours to Percentage

Total Hours Worked per Month 86 hours Total Hours Subsidied 18.5 hours 18.5 Divided by 86 = 21.5% Total Employer Subsidy 21.5% of gross earnings

$1118.00 X .215 = $240.37


Gross Earnings $ 1118.00 (Above SGA) Employer Subsidy (minus) $ 240.37 Total Countable Earnings $ 877.63 (Below SGA)

Example 2: Archie works in an RLC as a Certified Peer Specialist. He works 25

hours per week and earns $13.00 per hour. He has a variety of duties,

including meeting with peers or providers who come to the resource center,

helping to develop resource lists and networking with local service agencies.

He has the “lived experience” of someone with a psychiatric disability, a

requirement for the position. In his work, he has scheduled work hours, but

these are flexible if needed. When on the job, it is understood that there will

be variability in performance based on his degree of wellness, with some days

being better than others. It is also understood that the peer specialists serve

as peer supports for one another, even during work hours. There is a great



33

deal of latitude around his needs for getting to therapy and

psychopharmacology appointments, and there is no rigid “sick time” policy

applied to him, even though he will only be paid for a certain number of sick

days. The environment as a whole is very specialized and both supports

Archie’s strengths, while allowing him the needed accommodations during

times of distress.


As you can see, this is much more difficult. You can’t just figure out what kind

of time is related to these accommodations, and SSA doesn’t provide any

concrete guidance to help. It’s a matter of looking at the job as a whole and

trying to come up with a ballpark percentage of subsidy.

Things to consider:

o Flexible schedule o Variability in work performance day-to-day o Built in peer support on the job o Ability to leave for medical appointments o Flexible sick time

These are significant accommodations, and if you imagine Archie trying to work

in a different setting without these accommodations, you can see that it would

be very difficult. This means that his work is not nearly as substantial as it

looks at first from looking at his gross earnings, and this is where the subsidy

comes in. It’s a way to communicate with SSA that there are a number of

disability related supports on the job that allow him to work. In a situation like

Archie’s, a subsidy between 30% to 40% might be do-able. But, as you can see,

this is another place that you should be working with your resources.

Gross Earnings (4 week month) $1300.00 (Above SGA)

Subtract 40% subsidy (1300 X .4 = 520) $ 520.00




34

Discuss the employer subsidy with your employer. The letter

must come from your employer so you have to disclose, but in

order to have any reasonable accommodations from an employer,

you would have had to disclose your disability anyway.

If your employer has never written a subsidy letter, give him/her a copy of

the sample in the Templates Section.

Reassure your employer that this is something that benefits you, not hurts

you, so it’s OK to be honest. It would be even better if you work on the letter

together so your employer feels comfortable writing the letter. You can also

reassure your employer that your Social Security file is not shared with other

government agencies.

Putting It All Together

Example: Ramon has received mental health services for many years. Through

working with his peer support specialist two years ago, he decided that he

wanted to return to school and study computers. He also decided that he

wanted to really focus on this goal, so would remain living in the community

residence where he knows people, has a social community and gets a lot of

support.

He just completed his Associates Degree in Computer Sciences and got a part-

time job providing IT support in a law firm. He works 5 days per week, 5 hours

per day, and earns $20.00/hour. In a 4 week month, he earns $2,000.00, and

averages $2,150.00/month (4.3 weeks)


Ramon has ongoing support that requires out-of-pocket payments, including:

Medication co-pays (3 medications @ $35.00 each) $105.00

Group therapy 1X/week @ $10 (4X10=$40.00) $40.00

Therapy co-pay (2 meetings/week @ $15) $120.00

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Portion of “rent” to residence that provides employment support

$280.00

Total Impairment Related Work Expenses $545.00

Step 2: Computing the Job Coach Subsidy

Ramon worked with an educational/employment coach during school, and

continues to work with him now that he’s in a work setting. He sees his job

coach 1 X per week.

4 weeks X 1x/week =

4 hours job coaching X hourly rate of $20.00 =

Total Job Coach Subsidy $80.00


Ramon disclosed his disability to his employer and made arrangements to have

extra supervision for one hour each week, as well as an agreement that he can

take extra breaks as needed, and do certain types of programming work from

at home as long as there aren’t any in-office IT needs during that time period.

Extra supervision X 1 hour/week X 4 weeks per month

4 hours monthly

Extra breaks Can’t measure

Flexibility of schedule Can’t measure

Estimated Employer Subsidy 20% 20% Subsidy

Total Employer Subsidy, 20% of $2,000.00 $400.00


Gross Income (4 weeks) $2,000.00 (Above SGA)

Subtract IRWEs 545.00

Subtotal $1455.00

Subtract Job Coach Subsidy 80.00

Subtotal $1375.00

Subtract Employer Subsidy 400.00

Total Countable Earnings $975.00 (Below SGA)



36

As you can see, the SSDI work incentives give you the opportunity to pace your

return to work. You can become in control of rather than victim of your

benefits. But it does take being an active member of the process, as well as

getting the supports you need.

Chapter 6: Expedited Reinstatement Period

The next timeline in the SSDI Work

Incentives is called the “Expedited

Reinstatement Period” or EXR. The

EXR is another safety net that starts

after the EPE and lasts for 60

months (5 years).



37

The EXR provides protection for people who have lost cash benefits due to

work, but experiences a relapse of the original disabling condition. Rather

than having to reapply for benefits, starting at the beginning of the process,

you can apply for Expedited Reinstatement to benefits. In this process,

benefits start back up immediately, and can continue for up to 6 months while

SSA evaluates if you are again eligible for cash SSDI benefits. Even if SSA

decides that you’re not disabled, you do not have to pay the 6 months of

benefits that you’ve received.

Example: Emmanuel was on benefits for many years and made many attempts

to work. In July 2008, he was nearing the end of his Extended Period of

Eligibility and had been working above the SGA level for about 6 months. He

reflected upon his work, how he was feeling as a worker and how he wanted to

proceed at this critical time. Because he knew about the Expedited

Reinstatement Period, he chose to continue working at the same level, even

though it meant that he would lose his cash benefits safety net with the EPE

ending in October (2008).

In September 2009, Emmanual had been working for several years. But

over the past few months, his work setting was becoming more stressful and he

found himself sinking deeper and deeper into his well-known depression.

Knowing his own needs to best support his wellness and speaking with his

supporters, he made the hard decision to take a medical leave from his work in

December. He went into his local Social Security office and applied for

Expedited Reinstatement. He was told that he should receive a check by

February 3, 2011, and that he’d receive a decision on his benefit application

once they receive the updated medical information, etc. He’s relieved that he

will not have to worry about repaying benefits through July, 2011.



38

Inform SSA that you’re experienced a relapse with your condition requiring

you to stop working.

Complete the paperwork for an Expedited Reinstatement.

Let your doctor’s know that you will need them to provide medical support

for a favorable SSDI decision that you’ve returned to “disabled” status.

Chapter 7: Extended Medicare Period

For many of us, maintaining our Medicare medical benefit is as important, if

not more important, than maintaining cash benefits. Luckily, this is a message

that clearly got through to the SSA and become a key consideration when

designing the work incentives.

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Medicare, the insurance that comes with SSDI, has several parts:

o Part A - Inpatient coverage (Automatic – no premium) o Part B - Outpatient coverage (Premium paid monthly

deducted before you receive your SSDI check) o Part C - Coverage of all services through a behavioral health

Organization (May or may not involve additional premium)

o Part D - Prescription coverage (May or may not involve additional premium)

All of these different types and kinds of coverage are important to people, and

necessary for recovery as well as employment. So, they are an integral part of

the social security work incentives.

When your earnings are above

the SGA level as you enter

your EPE period, you also

trigger the beginning of your

Extended Medicare Coverage

(EMC). This coverage

continues for at least 93

months, or 7 ¾ years, which

means that Medicare coverage continues through the EPE and well beyond.

Even when the EMC is completed, you can continue your Medicare coverage by

paying the Part A premium (which, up to that point has been at no charge).

During your EMC you continue to pay your Part B premiums as you’ve been

doing. (During the Trial Work Period and before, your Part B premium was

taken out of your check.)

Example: Synjoia has been working at various levels over many years. Her

trial work period ended in March 2010 when she worked a 9th Trial Work month



40

in a 5-year period. In April 2010, her EPE AND EMC began. Her EPE will end in

February 2013 (3 years), and her EMC will end in January, 2018.

Continue to keep SSA informed about any changes in your work.

Complete the paperwork for ongoing Medicare when you receive it

If you do not receive information about ongoing Medicare coverage, contact

your local Social Security office.

Chapter 8: Transitions

Now that we’ve talked about what to do IN each time period

that makes up the SSDI

work incentives, let’s

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talk about those times when someone is transitioning from one time period to

another, for example from the Trial Work Period to the Extended Period of

Eligibility. These are the times when people often fall through the cracks, so

we’ll take them one-by-one. But first, let’s think about how to approach all

transitions. There are five bsic steps you want whenever you are within a

three to six month window of transitioning to a new timeline, depending on

how long the timeline runs. In other words, you want to review these steps

around TWP month 5 or 6, about 2 ½ years into your EPE, about 4 ½ years into

your EXR and about 6 months before your EMC coverage ends.

1. Track: In each SSDI timeline, we’ve talked about the importance of

knowing where you are within the timeline. This is the key to being

supported by rather than victim of the SSDI work incentives.

2. Evaluate: Having tracked where you are within a timeline, you have the

opportunity to do some self-evaluation BEFORE the end of the timeline.

This is a time to reflect on the positive and negative aspects of how

work impacts your disability, think about the supports you currently have

that you may not have in the next timeline, and weigh and balance the

pro’s and con’s of this upcoming shift in level of support. This will allow

you to pace your return to work in a way that best fits your needs, and

truly make an informed choice in how you utilize the SSDI work

incentives.

3. When? It is important to know the month that you enter the next

timeline so you can follow up on anything that you need to do. Because

the SSA is so overburdened, they may or may not be aware that you’re

crossing into a new timeline. Being pro-active in contacting SSA can

save you many headaches later down the road.

4. What Now? There may be special rules that only apply to a month or two

within the transition period, so it’s important to know what these are.



42

5. What’s Next? It’s also important to know what the rules are within the

upcoming timeline because each has its own distinct set of rules. What

was required, when you would get checks, etc., change from one

timeline to the next.

Now that we know how to approach the transitions, let’s discuss each one

individually.

Trial Work Period (TWP) to Extended Period of Eligibility (EPE)

During the Trial Work months, the 9 months do not necessarily run

consecutively, and you receive your full check regardless of how much you earn

above the TWP amount for that year.

The transition from TWP to EPE begins in the 9th month of Trial Work.

The 9th Trial Work is always followed

immediately by the 1st month of the

EPE, and you are in a new timeline

with different rules.

As you go into the EPE, the most

important earnings level becomes the SGA amount rather than the TWP

amount. The SGA level is always higher than the TWP level, so you may have

been working over TWP and using these months, but still not be over SGA.

SSA will not send you a letter telling you that you’re about to leave your TWP

or that you just entered the EPE, so you want to figure out your status for

yourself. This decision tree can help.



43

If you are working over the SGA limit after deducting any IRWEs or subsidies

that may apply, you become “disabled but working” or “working while

disabled.” Remember that the definition of “disability” under the SSA rules

says that you must be “unable to perform any substantial gainful activity…”

This special status created by the work incentives allows you to continue trying

to work and stay on the SSDI rolls. The safety net provided by the EPE lets you

continue to work, but when your work is above SGA you don’t get a check for

that month.

The transition from the Trial Work Period where you are

receiving checks regardless of earnings to the EPE where

you won’t receive checks when you’re over SGA is a three-

month grace period. The first month is the cessation month

and the following two months are grace period months.

You continue to be eligible for checks during these months.

Starting the next month, you are not eligible for a check during any month that

your countable earnings are above SGA.



44

More often than not, SSA will not realize that you aren’t eligible for

checks until sometime later, even though you’ve notified them of all

your work. This means you will still receive checks after you’re eligible for

them.

Write a letter to SSA reminding them that you should no longer be

receiving checks and ask them to stop sending them.

Create a separate bank account and put any SSDI checks in there so

you can immediately repay these funds when SSA catches up.

Extended Period of Eligibility to Expedited Reinstatement Period

The EPE provides a safety net for 3 calendar years. If you’re working above

SGA, you stay on the rolls, maintain your Medicare benefit, but don’t receive a

monthly check. But if you’re working below SGA, you also receive your

monthly SSDI check. When you come to the end of the 3-year EPE period, you

will either continue on with your benefits or benefits will end, depending on

whether you’re working and how much you’re working.

End of EPE While Not Working If you are in your EPE, you were working at least above the TWP for 9 months

and may have also worked above SGA for some period of time. However, if you

stopped working and are not working as the EPE ends, you will continue to

receive your cash and Medicare benefits uninterrupted, even though you are

leaving the EPE. You can continue to receive

your benefits indefinitely until you work and go

above the EPE.

TIP

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If you work above SGA, your cash benefits will end. However, your EXR safety

net will kick in at that point giving you another 5 year safety net (See Chapter

6, Expedited Reinstatement Period).

You do not have to do anything if you leave your EPE while you’re not working.

If you return to work at some point, you should contact SSA and let them know you’ve returned to work.

End of EPE While Working Below SGA

You may come to the end of the EPE

while you’re working, but working under

SGA. The same as above, you’ll

continue to receive your cash and

Medicare benefits uninterrupted, even

though you are leaving the EPE. Here,

too, you can continue to receive your

benefits indefinitely until you work and go above the EPE, when the EXR

protections kick in. (See Chapter 6, Expedited Reinstatement Period).

You do not have to do anything if you leave your EPE while you’re working below SGA, as long as you’ve informed them already about your work.

If you increase your hours, you should report this to SSA.

End of EPE While Working Above SGA The EPE provides a significant amount

of time to really return to work at a

pace that makes the most sense for

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46

you. Hopefully, you’ve been tracking your EPE so you can make informed

choices about moving forward.

If you’ve been working over SGA as you near the end of the EPE and choose to

continue working at this level as your EPE ends, you will no longer be entitled

to your SSDI cash benefits. However, your EXR period begins, giving you added

protection, and you may still be eligible for Extended Medicare Coverage (See

Chapter 7, Extended Medicare Coverage).

SSA may not realize that you aren’t eligible for checks until

sometime later, even though you’ve notified them of all your work.

This means you will still receive checks after you’re eligible for them.


receiving checks and ask them to stop sending them.



As you can see, the SSDI work incentives require you to stay on top of the

timelines that are involved. If not, you can easily accrue an overpayment from

receiving checks that you weren’t entitled to. But if you keep track and work

with your resources, the SSDI work incentives can be a powerful support in your

vocational recovery.

Chapter 9: Supplemental Security Income (SSI) Work Incentives As noted at the beginning, SSI is very different from SSDI. The work incentives

are also very different. With SSI, there are no timelines to consider, only

income each month. Most of the time, SSI recipients benefit from working,

with increased money in their pockets and ongoing medical insurance coverage.

TIP

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When people on SSI work, their earnings are reviewed each month using the

same formula each time. This math calculation looks at how much income you

had from all sources, what adjustments will apply to lower how much SSA

counts for the month, and what your monthly SSI check will be.

Let’s look at the overall format first.

The same formula is used if someone just has a small job or if they have a job,

get SSDI, and have other deductions or adjustments that are allowed by SSA.

“Adjustments” refer to certain deductions you’re allowed to use, reducing the

amount (on paper, not out of pocket) that SSA actually counts as your income.

This works in a similar way that you compute your annual taxes. When people

complete their tax forms, they start with gross income and then take allowable

“deductions” or “credits.” These are subtracted from the gross income to

come to a lower “taxable” income, and lower are better!

SSA gives SSI recipients who work some “deductions.” With SSI, you start with

your gross income and, after deductions, get to your “countable income.”

Lower is better here, too, because the final number is what SSA counts as your

The first step is to compute your

“Countable Income.” This is what SSA ends up counting as your earnings for the

month.



48

earnings, even if you made quite a bit more in both gross and net (take home

after taxes) pay.

The SSI deductions that are allowed are the Work Deduction, the General

Deduction, Impairment Related Work Expenses (IRWEs), PASS, and Student

Earned Income Exclusion. Let’s look at a simple example.

Example: Josh receives SSI and recently started working. He works 2 days per

week for 3 hours doing some extra gardening for his neighbor who pays him

$15.00 per hour.

As you can see, even though Josh actually earns $360.00 in the month, SSA will

only count $137.50.

Now, let’s look at the second step – finding out how this will impact Josh’s SSI

check. This part of the formula looks like this:



49

Example (Josh Continued): Josh lives in Massachusetts, a state that adds a

state supplement to the SSI Federal Benefit Rate (FBR). Josh lives alone, so he

gets the highest SSI amount, $788.39. His “countable income,” as we

determined in the steps above, is $137.50. So let’s put it together:

In the end, Josh ends up with his $360.00 check from work plus his SSI check of

$650.89. Now, instead of getting $788.39 a month, he gets $1010.89 and

continues to get his Medicaid medical insurance coverage.

Report your work to SSA when you begin to work or change your

hours. See the sample letter in the Templates Section.

If your hours or pay vary month-to-month, your SSI check will change

as well. If you’re not phobic about doing math, it always helps to

keep track of your income and SSI deductions each month in the blank form provided

in the Templates Section.

SSI is configured using what’s called Retroactive Monthly

Accounting or RMA. What this means is that your SSI check

that you receive is based on your financial status two months ago. For

example, if you get a check in April, it represents your financial status in

Things

to Do

TIP



50

February. If you’re tracking your earnings and the amount of your check,

you should be figuring two months earlier.

Allowable SSI Deductions/Adjustments

General and Work Deductions – These are freebies automatically given by SSA.

The $20.00 general deduction can be applied when a person has income of any

sort. If the income is specifically from work, the $65.00 work deduction can

also be applied.

Impairment Related Work Expenses (IRWEs) – IRWEs are out-of-pocket

expenses related to a person’s impairment that assist a person to be able to

work. (See the full explanation of IRWEs in Chapter 5, Extended Period of

Eligibility, Earning More and Counting Less). Examples of common IRWEs

include co-payments for medications, medical visits, and therapy and group

therapy sessions. IRWEs can also include the portion of payment for PCA

assistance and residential services that directly support someone’s ability to

work.

Example: Evelyn has been working a part-time job, but is surprised to see how

small her SSI check is. She calls her WIPA and they review her income as well

as her expenses, and this is what they learn.

Evelyn works 15 hours per week and makes $12.50/hour. In a month with 4

paychecks, she gets $750.00 per month. When there’s a 5th paycheck, she

receives $937.50.



51

She also has medical expenses each month. She has co-pays for prescriptions

($2.00 for 3 prescriptions, and $75.00 per month for a prescription not covered

under the Medicaid prescription plan), and co-pay for her monthly blood test

for her Depakote ($25.00). Her total IRWEs are $106.00.

When IRWEs are deducted, Evelyn gets an SSI check of $508.39, a paycheck of

$750.00 and continues to get her Medicaid coverage.

If you have IRWEs, you need to report these to SSA. There is a

sample letter that you can use in the Templates Section. SSA may

require you to send them each month, or they may tell you to only

send in the receipts when something changes. Even in this case you should

keep all your receipts.

If you have a conversation with your claims representative about holding your

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52

receipts, you should send a confirming letter (see Templates Section).

Student Earned Income Exclusion (SEIE): This is a deduction or “write-off”

for people receiving SSI who are students under the age of 22. This applies to a

student who is attending school (grades 7–12), a college or university. In 2011,

a student can deduct up to $1,640.00 per month up to a maximum of $6,600.00

per year. (The amount of the deduction changes each year there’s a cost of

living increase, so see http://www.workworld.org/wwwebhelp/seie.htm for

the current rate.) The yearly limit applies to a calendar year, not a school

year or the previous 12 months. You may not spread out this exclusion over the

year by including only a portion of your earnings each month.

Example: Angela is a 19 year-old woman who has been on SSI for the past 10

years. Last fall, she began attending her local Community College. As part of

her financial aid, she got a part-time job at the college. She works 10 hours

per week and earns $15.00 per hour. Her earnings since September, 2010 are

as follows:

Month Earnings

(up to $1640/mo)

Balance from Max

($6,600.00)

September 2010 $600.00 $6,000.00

October $750.00 $5250.00

November $600.00 $4650.00

December $600.00 $4050.00

NEW YEAR Start Again $6,600.00

January, 2011 $750.00 $5850.00

Angela has been earning under the maximum allowed each month so she

continues to receive her full SSI check. If she continues to work at the same

level, she will reach the maximum for the year in August, 2011. Her work for

September – December will get calculated in the usual way. But then, in

January, a new calendar year begins, and she will again have the Student

Earned Income Exclusion.

http://www.workworld.org/wwwebhelp/seie.htm



53

If you are a student who is claiming the Student Earned Income

Exclusion, it’s important to let SSA know that you’re a student.

They will get a record of your earnings from the IRS and will not

know that you’re eligible for this write-off if you don’t let them know. (See

the Sample letter in the Templates Section.)

Program to Achieve Self Support (PASS) A “PASS” allows people to set aside

income to be used to achieve a specific work goal, such as starting a business,

going to school, or taking a course to increase marketability. The money that is

set aside is “deducted” from the person’s gross income after other deductions

and the $1 for $2 calculation is applied, in essence replacing all of those funds

in the person’s special SSI check.

A “PASS Plan” (SSA Form 545) is like a proposal that you make to SSA that

explains your work or business goal, your steps to accomplish the goal, the

expenses related to achieving the goal, and the timeline milestones to get to

your goal. Completing the PASS plan takes some work, but this is a very useful

tool for your own planning, and then for “selling” your plan to SSA.

Example: Juan has decided to start a business painting cars. He’s very artistic

and is often asked by people to decorate their cars with special stripes, etc. In

his pass plan, he outlines his plan and what he will need to accomplish it. The

expenses related to his plan include:

Rent for first 6 months of sharing garage space ($4,300.00 approx) Computer ($2,000.00) Down payment for truck or van to transport materials ($3,000.00) Materials for start up ($5,000.00) Supplies for start up ($2,000.00) Shelving ($300.00) Phone ($100.00) TOTAL $16,700.00

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54

His plan is to put $500.00 aside each month. In the first year, the $6,000.00

will be put in the bank while he continues to work free-lance as he’s been

doing. By mid-way of year two, when he has $9,000.00 in savings, he plans on

purchasing his computer and some basic business supplies, such as invoicing

hardware, etc. and pay for the rent at the garage, which will allow him to

increase the amount of work he does per month. Then he has plans to slowly

increase the business over the next three years.

Unearned Income SSDI $227.00

Earned Income Job add $1,100.00

Subtotal $1,327.00

Work Deduction minus $65.00

General Deduction minus $20.00

Subtotal $1242.00

IRWEs minus $78.00

Subtotal $1164.00

2 for 1 Divide by 2 $582.00

PASS Plan Set-Aside minus $500.00

Countable Income $82.00

Maximum SSI $788.39

Countable Income minus $82.00

Special SSI Check $706.39

In the meantime, he will have his earnings, his SSDI check of $227.00 and will

be putting $500.00 in savings each month. Because he has a PASS plan, he will

be able to exceed the usual $2,000.00 limit on savings.

As you can see from this example, people with both SSDI and SSI can also

utilize PASS plans. In some cases, a PASS plan will also work for people who

only receive SSDI benefits and don’t receive SSI benefits, even though the PASS

plan is an SSI benefit. PASS plans are incredibly helpful, and yet they can be

complicated. This is another place that you your local WIPA can be a great

support. Here are some other great resources on PASS plans at:

http://www.disabilitybenefits101.org/ca/programs/income_support/pass/faqs

.htm

http://www.disabilitybenefits101.org/ca/programs/income_support/pass/faqs.htm

http://www.disabilitybenefits101.org/ca/programs/income_support/pass/faqs.htm



55

http://www.wid.org/programs/access-to-assets/fact-sheets/pass-plan-for-

achieving-self-support-plans

http://www.communityinclusion.org/article.php?article_id=66&staff_id=14

http://www.ssa.gov/disabilityresearch/wi/pass.htm

Vocational experts are another good resource for creating PASS

plans. First of all, they’re skilled at creating these kinds of plans. In

addition, when you submit a plan, SSA evaluates if the plan is likely to succeed.

They will often defer to the expertise and opinion of the VR counselor in terms

of both the quality of the plan and the likelihood of success. In Massachusetts,

you can meet with a VR counselor through the Mass. Rehabilitation

Commission,

http://www.mass.gov/?pageID=eohhs2subtopic&L=5&L0=Home&L1=Governmen

t&L2=Departments+and+Divisions&L3=Massachusetts+Rehabilitation+Commissio

n&L4=Vocational+Rehabilitation+Area+Offices&sid=Eeohhs2

Any Employment Network that’s part of the Ticket to Work program will also

have vocational rehab counselors. http://www.yourtickettowork.com/endir

What About my Medicaid?

Going back to work not only involves our cash benefits, but also medical

coverage. This is often more important to people as they consider working.

SSA was well aware of this need, so made several provisions to ensure that

people will have ongoing medical coverage.

Medicaid is the formal name of the insurance that comes with SSI.

However, some states call it by a different name. For example, it’s

TIP

TIP

http://www.wid.org/programs/access-to-assets/fact-sheets/pass-plan-for-achieving-self-support-plans

http://www.wid.org/programs/access-to-assets/fact-sheets/pass-plan-for-achieving-self-support-plans

http://www.communityinclusion.org/article.php?article_id=66&staff_id=14

http://www.ssa.gov/disabilityresearch/wi/pass.htm

http://www.yourtickettowork.com/endir



56

called MassHealth in Massachusetts, MediCal in California and TennCare in

Tennessee.

So long as you are eligible for an SSI check, even if it’s only for $1.00, you

continue to be eligible for your Medicaid. However, even if you lose

entitlement to cash benefits due to your work, you can still maintain your

Medicaid coverage under the 1619b regulations.

1619b

This provision continues Medicaid coverage for most working SSI beneficiaries

even after earnings become too high to allow a cash benefit. To qualify for

this incentive the person must:

Have been eligible for SSI cash payment for a least one month. Still be “disabled” under the SSA rules

Meet the Medicaid “needs” test. This means that you have an ongoing

need for the medical coverage that you couldn’t meet through your earnings at work.

Have GROSS annual earned income less than the current state "threshold

amount." See http://www.ssa.gov/disabilityresearch/wi/1619b.htm for the annual threshold level per state.

Have countable unearned income (for example, SSDI) of less than the

current FBR and resources under the current limit for SSI recipients.

CommonHealth

In Massachusetts, like several other states, there is a program called a

“Medicaid buy-in.” It’s called CommonHealth, and gives people the

opportunity to “purchase” Medicaid at a premium rate far lower than most

insurance policies. For more information about CommonHealth, see

http://www.masschec.org/CHCampaign/CommonHealth.aspx OR

http://www.ssa.gov/disabilityresearch/wi/1619b.htm

http://www.masschec.org/CHCampaign/CommonHealth.aspx



57

http://www.mass.gov/?pageID=eohhs2terminal&L=5&L0=Home&L1=Consumer&

L2=Insurance+(including+MassHealth)&L3=MassHealth+Coverage+Types&L4=Appl

icants+and+Members+Aged+65+and+Older+Living+at+Home&sid=Eeohhs2&b=ter

minalcontent&f=masshealth_consumer_covtypes_trad_commonhealth&csid=Eeo

hhs2

As you can see, SSI work incentives are much easier to calculate, without any

timelines or shifting figures to keep track of. There are many opportunities to

increase the amount of cash that you can have each month, while maintaining

your Medicaid coverage.

http://www.mass.gov/?pageID=eohhs2terminal&L=5&L0=Home&L1=Consumer&L2=Insurance+(including+MassHealth)&L3=MassHealth+Coverage+Types&L4=Applicants+and+Members+Aged+65+and+Older+Living+at+Home&sid=Eeohhs2&b=terminalcontent&f=masshealth_consumer_covtypes_trad







58

Chapter 10: I’m 17 going on 18

If you started receiving either SSI or SSDI benefits as a child, the rules may

change for you as you turn 18. SSI “children’s” benefits and the SSDI benefits

available for people under 18 are very different from one another (See Chapter

1, Quick Facts on SSI and SSDI), so we’ll look at each of these separately.

SSDI Benefit Changes, aged 17 to aged 18

SSDI benefits, as you will remember, are an insurance that is always related to

a worker.

Dependent benefits typically end when you

reach 18. However, these can continue until

you reach 19 if you are unmarried and a full-

time student in a secondary or elementary

school (high school, not college). Your

parent should get a notice 3 months before

you turn 18 saying that your benefits will stop in three months. To continue

benefits, you have to contact SSA to let them know you’re still in school. This

will allow you to continue receiving benefits until you either finish school or

turn 19. If you turn 19 before finishing school, you will get two grace period

months of checks after your birthday and then they will end.

Watch for the letter three months before turning 18. If it

doesn’t come, contact SSA on your own to let them know you’re

turning 18, but are still in school.

Get a letter from your school certifying that you are still a

student to submit to SSA.

Submit letter to SSA as early as possible so there’s no disruption in your

checks. (See the section in Chapter 2 about Communicating with SSA).

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59

SSA may not realize that you are not eligible for checks because you’ve

turned 19 until some months (or years) later, even though you’ve

provided all the documentation required. This means you may still

receive checks after you’re entitled to them.


receiving checks because you turned 19 more than 2 months ago (grace

period) and ask them to stop sending them.



Dependent Benefits to a Person with a Disability

You may have been receiving Dependent Benefits, but also have a disability.

As you turn 18, you become eligible for “Disabled Adult Child” benefits. This

allows you to get Social Security Disability benefits even though you never

worked because you are receiving it on the record of your retired, disabled or

deceased parent. To receive this benefit, your disability had to start before

the age of 22, you must be unmarried, and you apply for SSDI benefits through

your local Social Security office. If you are approved for SSDAC (Social Security

Disabled Adult Child) benefits, you can continue to receive these until you

marry, medically improve, or become ineligible for these benefits due to your

work. All the SSDI work incentives outlined in Chapters 3 – 8 apply to someone

who has SSDAC benefits.

Apply for SSDAC benefits before you turn 18. It often takes a

while for SSDAC to be approved, so apply as early as SSA will allow,

even up to one year before turning 18.

The 5-month waiting period that applies to SSDI does not apply to SSDAC

benefits. This means that your benefits will start on the day your

disability began (if over 18 but under 22) or on your 18th birthday.

Things

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TIP

Things

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60

SSI Benefit Changes, aged 17 to aged 18

As you know, Supplemental Security Income (SSI) is a “needs-based” program

for people who have little to no work history. (See Chapter 1, Quick Facts on

SSDI and SSI). Therefore, if you qualified for SSI when you were under aged 18,

it was because of both your own disability and your parents’ income.

However, when you turn 18, the financial part of your SSI benefit is determined

based on your status instead of the financial situation of your parents. This

means that your SSI check will now be determined based on the allowable SSI

rate in your state, your living arrangement and any work or other income that

you may be receiving each month.

Example: Franklin, who lives in Massachusetts, is living at home as he turns 18

in June, 2010. His SSI amount is recalculated to consider that he is “living in

the household of another” (parents’ home) and not working at all. He starts

receiving a check of $536.92. However, in the fall, he starts attending Bristol

Community College part-time and moves into his own apartment. This qualifies

him to receive the maximum SSI rate of $788.39. His PASS plan and part-time

job makes it possible for him to do this. (See Chapter 9, SSI Work Incentives).

(See also http://www.workworld.org/wwwebhelp/ssi_state_supplement_massachusetts.htm for

2010-2011 SSI living arrangement rates in Massachusetts) and for other states, see

http://www.workworld.org/wwwebhelp/ssi_state_supplements_overview.htm

You or your parents should notify SSA by letter as you are

approaching 18 if you have not received SSA notification by 3

months before you turn 18. (See the “Communicating with SSA Section in

Chapter 2).

As you can see, turning 18 can significantly change your benefit rate, the type

of benefit received and the rules that need to be followed. It’s important that

you work with your resources to prepare for this change.

Things

to Do

http://www.workworld.org/wwwebhelp/ssi_state_supplement_massachusetts.htm

http://www.workworld.org/wwwebhelp/ssi_state_supplements_overview.htm



61

The Template Section provides letter templates for you to use, as well as blank tables or charts that are referenced in the Workbook. Chapter 1: Quick Facts on SSI & SSDI NONE

Chapter 2: Working with the Work Incentives

TEMPLATE !: Sample Letter: Confirming Conversation with SSA (For SSI & SSDI) P. 62

Chapter 3: SSDI Work Incentive Overview & Trial Work Period (TWP) TEMPLATE 2: Chart for Tracking your Trial Work P. 63

TEMPLATE 3: Sample Letter: Notifying SSA of Work (SSDI) P. 64

TEMPLATE 4: Sample Letter: Notifying SSA of Work Changes P. 65 Wage or Hours, No Impact on Benefits (SSDI)

TEMPLATE 5: Sample Letter: Notifying SSA of Work Changes P. 66 Change Job or Working Status, No Impact on Benefits (SSDI)

Chapter 4: The Extended Period of Eligibility, Part 1: The Basics (EPE)

TEMPLATE 6: Chart for Tracking your Extended Period of Eligibility P. 67

TEMPLATE 4: Sample Letter: Notifying SSA of Work Changes P. 65 Wage or Hours, No Impact on Benefits (SSDI)

Chapter 5: The Extended Period of Eligibility, Part 2: Earning More And Counting Less (EPE)

TEMPLATE 7: Chart for Adding up IRWEs (Impairment Related Work Expenses) P. 68

TEMPLATE 8: Chart for Computing Subsidies (Job Coach & Employer) P. 69

TEMPLATE 9: Chart for Computing SSDI Monthly Countable Income P. 70

TEMPLATE 10: Sample Letter: Notifying SSA of IRWEs and/or Job P. 71 Coach Subsidy (SSDI)

TEMPLATE 11: Sample Letter: Notifying SSA of Employer Subsidy P. 73 TEMPLATE 12: Sample Letter: Notifying SSA that you shouldn’t be P. 74

receiving checks

TEMPLATE 13: Sample Letter: Notifying SSA of Work Changes. P. 75

(Change Job, Hours or Income, Impacts Benefits -no



62

longer entitled to checks in EPE)

TEMPLATE 14: Sample Letter: Notifying SSA of Work Changes. P. 76 (Change Job, Hours or Income, Impacts Benefits – re-entitled to checks in EPE

Chapter 6: The Expedited Reinstatement Period (EXR) NONE

Chapter 7: Extended Medicare Coverage (EMC) NONE

Chapter 8: Transitions

TEMPLATE 12: Sample Letter: Notifying SSA that you shouldn’t be P. 74 receiving checks TEMPLATE 7: Chart for Adding up IRWEs (Impairment Related

Work Expenses) P. 67

TEMPLATE 8: Chart for Computing Subsidies (Job Coach & Employer) P. 68

TEMPLATE 10: Sample Letter: Notifying SSA of IRWEs and/or Job P. 70 Coach Subsidy (SSDI)

TEMPLATE 11: Sample Letter: Notifying SSA of Employer Subsidy P. 72

Chapter 9: SSI Work Incentives

TEMPLATE 15: Chart for Computing Countable SSI Income P. 77

TEMPLATE 16: Chart for Computing Special SSI Check P. 78

TEMPLATE 17: Sample Letter: Notifying SSA of Work (SSI) P. 79

TEMPLATE 18: Sample Letter: Notifying SSA of IRWEs (SSI) P. 80

TEMPLATE 19: Sample Letter: Notifying SSA of Student Earned P. 81 Income Exclusion

Chapter 10: I’m 17 Going On 18

TEMPLATE 20: Sample Letter: Notifying SSA of Ongoing Entitlement P. 82 to SSDI Dependent Benefits at 18

TEMPLATE 14: Sample Letter: Notifying SSA that you shouldn’t be P. 75 receiving checks

TEMPLATE 21: Sample Letter: Notifying SSA of Changing SSI Benefit P. 83

Status at 18

TEMPLATE 22: TWP Levels, 1979 – 2011 P. 84

TEMPLATE 23: EPE Levels, 1979 – 2011 P. 85

Resource Links P. 86 - 87



63

TEMPLATE !: Sample Letter: Confirming Conversation with SSA

DATE

_________, Claims Representative


ADDRESS 1

ADDRESS 2

RE; NAME, SSDI or SSI claim

SSN: xxx-xx-xxxx

Dear _________,

I am writing to confirm our telephone/in-office conversation on DATE.

As you recall, we discussed ___________ (main content of discussion, including what you said

and what the claims rep told you in return. This should be the main facts, not line by line

discussion.).

We agreed that/You informed me that ____________ (any final resolution of the issue).

If I misunderstood any of this information, please let me know right away. Otherwise, I will

assume I’ve understood this correctly.


Sincerely

Your name

Your address

SEND VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED



64

TEMPLATE 2: Chart for Tracking your Trial Work

Date

(Month

/Year)

Pla

ce o

f

Em

plo

ym

ent

Month

ly W

ages

Earn

ed

Month

ly T

WP

Am

ount

for

that

Year

Above T

WP

Am

ount?

Y/N

TW

P M

onth

#

July, 2010 Fredrickson & Nichols $437.49 $670 N --

August 2010 Fredrickson & Nichols $778.34 $670 Y 1



65

TEMPLATE 3: Sample Letter: Notifying SSA of Work (SSDI)

DATE



ADDRESS 1

ADDRESS 2

RE; NAME, SSDI claim

SSN: xxx-xx-xxxx

Dear _________,

I am writing to inform you that I have begun working.

I am currently working at _______ (Place of Employment). I am working X hours per week,

earning $X/hour OR an annual salary of $______. Attached you will find that last two (2) pay

stubs to verify my earnings.

[Optional] As I have not disclosed my disability to my employer, I would appreciate your

requesting further verification of my income directly from me.

If you need any further information, please feel free to contact me. Thank you very much.

Sincerely

Your name

Your address




66

TEMPLATE 4: Sample Letter: Notifying SSA of Work Changes (Wage or Hours, No Impact on

Benefits) (SSDI)

Note: This letter can be used for informing SSA during the Trial Work Period or during the Extended Period of Eligibility if your work doesn’t impact your benefits.

DATE



ADDRESS 1

ADDRESS 2


SSN: xxx-xx-xxxx

Dear _________,

I am writing to inform you of changes in my current work status. As you know, I have been

working _____________ (brief description of work status before this current change.) As of

___________[date], my work status has changed.

I have increased/decreased my work hours to ________hours per week, which means by gross

earnings are now $ ___________ (See attached pay stub for verification of my earnings.)

OR

My hourly/annual income has change to $___________, which means by gross earnings are now

$ ___________ (See attached pay stub for verification of my earnings.)

I do not believe this change impacts my current benefits. If I am incorrect in this understanding,

please inform me immediately as I continue to have a disability and do not want to accrue an

overpayment or jeopardize my ongoing benefits.


Sincerely

Your name

Your address



67


If your work changes the status of your benefits, use Templates 12 or 13.

TEMPLATE 5: Sample Letter: Notifying SSA of Work Changes. (Change Job or Working

Status, No Impact on Benefits) (SSDI)

DATE



ADDRESS 1

ADDRESS 2


SSN: xxx-xx-xxxx

Dear _________,




I have changed my place of employment. I am currently working at __________ [name of

Employer], earning $___/hour [or annual rate]. I have attached my last two pay stubs for

verification of my earnings.

I do not believe this change impacts my current benefits. If I am incorrect in this understanding,

please inform me immediately as I continue to have a disability and do not want to accrue an

overpayment or jeopardize my ongoing benefits.

OR

I am writing to let you know that I am no longer working.


Sincerely

Your name

Your address



68


If your work changes the status of your benefits, use Templates 12 or 13.

TEMPLATE 6: Chart for Tracking your Extended Period of Eligibility

Month EPE Begins ______________________ (1st month after 9

th Trial Work month)

Month EPE Ends ______________________ (36 months/3 Calendar Years later)

Date

(Month

/Year)

Pla

ce o

f

Em

plo

ym

ent

Month

ly W

ages

Earn

ed

Counta

ble

Incom

e f

or

Month

Month

ly E

PE

Am

ount

for

that

Year

Above E

PE

Am

ount?

Y/N

Enti

tled t

o

Check?

Y/N

July, 2010 The Transformation Center $1150 $958 $1000 N Y



69

TEMPLATE 7: Chart for Adding up any IRWEs (Impairment Related Work Expenses)

Month: _________________

Date Expense related to your

disability AND ability to work

Total Amount Paid Out of

Pocket

Amount of

IRWE*

8/1/10 Peer PCA $150.00 (for week) $100.00

Total Monthly IRWEs



70

* This number may be the same or different, depending on whether the full expense was

also related to your ability to work.

TEMPLATE 8: Chart for Computing Subsidies

Job Coach Subsidy

Month: ____________________ Job Coach (Name) ____________________

Date of Meeting with my job

coach

Length of Meeting (in hours)

My Hourly Wage Total Job Coach Subsidy*

1/4/11 1.5 hours $10.00 $15.00

Total Job Coach Subsidy

*Job Coach Subsidy is your hourly wage X number of hours.

Employer Subsidy Worksheet (This is only computed when a subsidy begins or

when it changes. You do not have to provide monthly records to SSA of an employer subsidy. Your employer must write to document this subsidy.)

The Following Circumstances Related to My Disability Apply In My Work:

Flexible Hours? Peer Support on the Job?

Shorter/Different Hours than others? Freer environment to disclose?

Work at home? More or flexible breaks?

Start later due to medication? More or flexible sick time?



71

Allowed an office? Variability in performance?

Extra supervision for support? Other special accommodation?

Estimated Employer Subsidy: __________% of gross earnings = $_________

TEMPLATE 9: Chart for Computing Monthly Countable Income

Monthly Gross Income Income before taxes are deducted

Above SGA? If “No”

STOP You do not need to go further

Subtract IRWEs (Template 7)

Subtotal Above SGA? If “No”

STOP You do not need to go further

Subtract Job Coach Subsidy (Template 8)

Subtotal

Subtract Employer Subsidy (Template 8)

Total Countable Income You will still receive your SSDI check if below SGA



72

TEMPLATE 10: Sample Letter: Notifying SSA of IRWEs and/or Job Coach Subsidy

NOTE: You can use this letter for IRWEs, for a Job Coach Subsidy, or for both. You can also copy and paste your worksheets from Templates 7 and 8.

DATE

_____, Claims Representative


55 Pleasant Street

AnyTown, USA 34343

RE; My Name

SSN: My Social Security Number

Dear Ms./Mr. __________,

I am writing to report my Impairment Related Work Expenses AND/OR my Job Coach Subsidy

for the month of _________, 201_.

My IRWES for this month are:

Medication co-pays:

Counseling co-pays:

Doctor co-pay:

Group Therapy co-pay:

Job Coach Payment:

Lab-test co-pays:

Other: _____________________

Other: _____________________

Other: _____________________

Total IRWES:

I’ve attached a copy of my receipts. If you need to see the originals, I will be glad to bring these

into the office. If you believe any of these shouldn’t count as IRWEs, please let me know.



73

I am also writing to report my job coach subsidy for this same month, ________, 200_. I met

with my Job Coach, _____________[name, address and phone number] as follows:

Dates Amount of Time

Based on these meetings, I believe my Job Coach Subsidy is:

__________[hours seeing coach from above] X ______[your hourly] = ________

Please let me know right away if I’ve made any mistakes in my understanding of how this work

incentive is done.

Based on the above, I believe that my countable income remains below SGA when these IRWEs,

and Job Coach Subsidy are considered. If I am incorrect in my understanding of these work

incentives or have submitted anything that doesn’t qualify, please let me know right away. I

continue to be disabled and don’t want to jeopardize my SSDI benefits or accrue an overpayment

that would be difficult to repay. If I don’t hear from you, I will assume that I submitted what you

needed and used them the correct way under the Social Security Work Incentives.

Thank you for your consideration in this matter.

Sincerely

Your Name



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TEMPLATE 11: Sample Letter: Notifying SSA of Employer Subsidy NOTE: This must be completed by your employer.

This example contains different possible scenarios in brackets. You can use these or any other specifics that exist for the person. The greater number of accommodations documented, the greater the subsidy. It’s best to work with a WIPA to figure out the best ballpark percentage to submit to SSA.

DATE



55 Pleasant Street

AnyTown, USA 34343

RE: Employee’s Name

SSN: Employee’s Social Security Number

Dear _________,

___________ is my employee at _____________. He/She has been working for me since

___________. He/she works approximately ________ hours per week, and earns

_________________ (Gross Earnings). ________ is a a valued employee, and therefore, certain

accommodations have been approved to maximize ___________’s success at work, despite her

disabling condition.

__________ is allowed to [have flexible hours] [have extra breaks] [go to doctor’s appointments

during work hours] etc.

In addition, __________ has been out for __ extended absences due to hospitalization. This

amount of time is beyond that typically allowed for employees, but is considered a reasonable

accommodation for ________.



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Because of her illness, _________’s performance is variable. He/she [needs extra supervision],

[is less focused], [needs to get more support from other peer staff], [needs to have greater

flexibility in her schedule], [has difficulty maintaining attention and concentration] on certain

days, and may need to take a day or two off during particularly difficult times.

[Based on my understanding of the Social Security Work Incentives, I would estimate that -----‘s

position is subsidized by ___%]. Please feel free to contact me with any further questions or

concerns. Thank you for you consideration in this matter.

Very truly yours,

XXX

Company ABC TEMPLATE 12: Sample Letter: Notifying SSA that you shouldn’t be receiving checks Note: You need to write separate letters to SSI and SSDI if both checks should stop. This template provides the basics of the letter, as well as several of the possible reasons why your checks should have stopped in parenthesis for you. The first three are for SSDI and the last two are for SSI. Delete any of these that don’t apply or delete them all and put in another reason.

DATE



ADDRESS 1

ADDRESS 2


SSN: xxx-xx-xxxx

Dear _________,

I am writing to inform you that I am continuing to receive my SSI OR SSDI checks, even though

I believe I am no longer entitled to these checks.

I believe I should not be receiving checks because _____________ (reason).

[I am now in my ____ month of my EPE and have been working above the SGA level]

[I am in the middle of my EPE and have been working above the SGA level]

[My EPE has ended and I’ve been working above the SGA level]

[I have turned 18 and am not attending any secondary school]

[I turned 19 more than 3 months ago]



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Until these checks end or I am notified that I should be receiving these checks, I will hold them

aside in a separate bank account. If you need any further information, please feel free to contact

me. Thank you very much.

Sincerely

Your name

Your address

Your phone number


TEMPLATE 13: Sample Letter: Notifying SSA of Work Changes. (Change Job, Hours or Income, Impacts Benefits so the person is no longer entitled to checks in EPE period). (SSDI)

DATE



ADDRESS 1

ADDRESS 2


SSN: xxx-xx-xxxx

Dear _________,




I have changed my place of employment. I am currently working at __________ [name of

Employer], earning $___/hour [or annual rate]. I have attached my last two pay stubs for

verification of my earnings.

I believe I am now working above the SGA level and am not entitled to SSDI benefits. Please

discontinue sending my SSDI checks or let me know if I’m incorrect in my understanding about

my entitlement to SSDI checks at this point.

OR



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My hours/wages have increased. I believe I am now working above the SGA level and am not

entitled to SSDI benefits. Please discontinue sending my SSDI checks or let me know if I’m

incorrect in my understanding about my entitlement to SSDI checks at this point.


Sincerely

Your name

Your address


TEMPLATE 14: Sample Letter: Notifying SSA of Work Changes. (Change Job, Hours or Income, Impacts Benefits so the person is re-entitled to checks in EPE period). (SSDI)

Note: This letter template is provided for your reference. However, it’s almost always more effective to go directly into your local SSA office when you need your checks restarted.

DATE



ADDRESS 1

ADDRESS 2


SSN: xxx-xx-xxxx

Dear _________,




I am writing to let you know that I am no longer working OR I’m now working under the SGA

level due to my disability.

I believe I am entitled to SSDI benefits again because my work is under the SGA limit. Please

restart my benefits ASAP.



78


Sincerely

Your name

Your address


TEMPLATE 15: Chart for Computing Countable SSI Income

SSI and Work

Step 1 Enter Gross Earnings Wages before taxes are deducted

Step 2 Subtract Work Deduction ($65.00)

Minus $65.00

Subtotal

Step 3 Subtract General Deduction ($20.00) Minus $20.00

Subtotal

Step 4 Subtract IRWEs

Subtotal

Step 5 Divide Remainder by 2 ÷ 2

Countable Income (Continue if there is a PASS Set-Aside)

Step 6 Subtract PASS Set-Aside Minus

Countable Income

SSI, SSDI and Work



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Step 1 Enter Gross Earnings Wages before taxes are deducted

Step 2 Enter Unearned Income (SSDI)

Step 3 Subtract Work Deduction ($65.00) Minus $65.00

Subtotal

Step 4 Subtract General Deduction ($20.00) Minus $20.00

Subtotal

Step 5 Subtract IRWEs

Subtotal

Step 6 Divide Remainder by 2 ÷ 2

Countable Income (Continue if there is a PASS Set-Aside)

Step 7 Subtract PASS Set-Aside Minus

Countable Income

TEMPLATE 16: Chart for Computing Special SSI Check

Step 1 Enter Maximum SSI Rate (The amount of the most SSI for your living situation in your state)

Step 2 Subract Countable Income (From Template 14)

Step 3 Amount of New SSI Check



80

TEMPLATE 17: Sample Letter: Notifying SSA of Work (SSI)

DATE



ADDRESS 1

ADDRESS 2

RE; NAME, SSI claim

SSN: xxx-xx-xxxx

Dear _________,

I am writing to inform you that I have begun working.




[Optional] As I have not disclosed my disability to my employer, I would appreciate your

requesting further verification of my income directly from me.



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Sincerely

Your name

Your address


TEMPLATE 18: Sample Letter: Notifying SSA of IRWEs (SSI)

NOTE: Job Coach and Employer Subsidies do not apply to SSI benefits.

DATE



55 Pleasant Street

AnyTown, USA 34343

RE; Name, SSI Claim

SSN: XXX-XX-XXXX

Dear Ms./Mr. __________,

I am writing to report my Impairment Related Work Expenses for the month of _________,

201_.

My IRWES for this month are:

Medication co-pays:

Counseling co-pays:



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Doctor co-pay:

Group Therapy co-pay:

Job Coach Payment:

Lab-test co-pays:

Other: _____________________

Other: _____________________

Other: _____________________

Total IRWES:

I’ve attached a copy of my receipts. If you need to see the originals, I will be glad to bring these

into the office. If you believe any of these shouldn’t count as IRWEs, please let me know.

Thank you for your consideration in this matter.

Sincerely

Your Name

TEMPLATE 19: Sample Letter: Notifying SSA of Student Earned Income Exclusion

DATE



ADDRESS 1

ADDRESS 2

RE; NAME, SSI claim

SSN: xxx-xx-xxxx

Dear _________,

I am writing to inform you that I am working, but eligible for the Student Earned Income

Exclusion.






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However, I am also a full-time student at ________________. I have attached

__________________ (letter from school/Work-Study letter, etc.) that verifies my attendance at

school.


Sincerely

Your name

Your address


TEMPLATE 20: Sample Letter: Notifying SSA of Ongoing Entitlement to SSDI Dependent Benefits at 18

DATE



ADDRESS 1

ADDRESS 2

RE; NAME, Social Security Dependents claim

Insured SSN: (Parent’s xxx-xx-xxxx)

Dear _________,

I am writing to inform you that I/my child who receives Social Security Dependents Benefits

will be turning 18 years old on ____________ (18th

birthday.)



84

However, I/he/she is still enrolled in a secondary school, so will remain eligible for these

benefits. I have attached a certificate from my/his/her school verifying my/his/her enrollment.


Sincerely

Your name

Your address


TEMPLATE 21: Sample Letter: Notifying SSA of Changing SSI Benefit Status at 18

DATE



ADDRESS 1

ADDRESS 2

RE; NAME, SSI Claim

SSN: xxx-xx-xxxx

Dear _________,

I am writing to inform you that I/my child who receives SSI will be turning 18 years old on

____________ (18th

birthday.)



85

I understand that my/his/her benefits will be evaluated according to my/his/her own financial

status on this birthday. I/My child is living [here in my home] [in an apartment at _________].

Please make the needed adjustments to the SSI check and let me know what documentation you

need. I’m hoping to make this transition smoothly, so I would like to do anything needed before

his/her/my 18th

birthday.


Sincerely

Your name

Your address


Template 22, TWP Figures

Trial Work Figures (monthly): 1,2

Before 1979 $50.00

1979 – 1989 $ 75.00 1990 – 2000 $200.00 2001 $530.00 2002 $560.00 2003 $570.00 2004 $580.00 2005 $590.00 2006 $620.00



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2007 $640.00 2008 $670.00 2009 $700.00 2010 $720.00 2011 $720.00

1. SGA and TWP figures are higher for people categorized as “Blind” by SSA 2. Effective 1/1/01, Trial Work and Substantial Gainful Activity financial limits increase each year at the same percentage as the cash benefit Cost of Living Adjustment (COLA). See

http://www.ssa.gov/oact/cola/twp.html for TWP figures after 2011.

http://www.ssa.gov/oact/cola/twp.html



87

Template 23, SGA Figures

Substantial Gainful Activity (SGA) Limits (monthly):1, 2

Before 1976 $200.00 1976 $230.00 1977 $240.00 1978 $260.00 1979 $280.00 1980-1989 $300.00 1/1990 – 6/1999 $500.00 7/1999 – 12/2000 $700.00 2001 $740.00 2002 $780.00 2003 $800.00 2004 $810.00 2005 $830.00 2006 $860.00 2007 $900.00 2008 $940.00 2009 $980.00 2010 $1,000.00 2011 $1,000.00

1. SGA and TWP figures are higher for people categorized as “Blind” by SSA. 2. Effective 1/1/01, Trial Work and Substantial Gainful Activity financial limits increase each year at the same percentage as the cash benefit Cost of Living Adjustment (COLA). See http://www.ssa.gov/oact/cola/sga.html for SGA figures after 2011.

http://www.ssa.gov/oact/cola/sga.html



88

Resource Links: General Work Incentives http://www.disability.gov/employment/work_incentives/social_security_disability_insurance_(SSDI)

Work Incentives and Transportation http://www.onestops.info/article.php?article_id=71

Chapter 1: Quick Facts on SSI & SSDI

Full list of allowable resources under SSI:


Chart of past Federal Benefit Rate (FBR) levels


State SSI Supplements.

www.ssa.gov/pubs/statessi.html

Chapter 2: Working with the Work Incentives?

Location of Work Incentive Planning Assistance (WIPA) Offices

http://www.ssa.gov/work/wipafactsheet.html.

Chapter 3: SSDI Work Incentive Overview & Trial Work Period (TWP) Trial Work Period Amounts


Trial Work, General

http://www.disability.gov/employment/work_incentives/social_security_disability_insurance_(SSDI)

Chapter 4 The Extended Period of Eligibility, Part 1: The Basics (EPE)

For Annual SGA Figures


Chapter 5 The Extended Period of Eligibility, Part 2: Earning More And Counting Less (EPE) Information on IRWEs

http://www.workworld.org/wwwebhelp/impairment_related_work_expenses.htm

http://www.alaskaworksinitiative.org/manual/contents/A-1432IRWE.pdf

http://www.disability.gov/employment/work_incentives/social_security_disability_insurance_(SSDI



http://www.ssa.gov/pubs/statessi.html

http://www.ssa.gov/work/wipafactsheet.html





http://www.workworld.org/wwwebhelp/impairment_related_work_expenses.htm

http://www.alaskaworksinitiative.org/manual/contents/A-1432IRWE.pdf



89

http://www.disability.gov/employment/work_incentives/social_security_disability_insurance_(SSDI)

Information on Subsidies http://www.workworld.org/wwwebhelp/subsidy_and_special_conditions.htm

Chapter 6: The Expedited Reinstatement Period (EXR)

http://www.ssa.gov/disabilityresearch/wi/exr.htm

http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1225&context=edic

ollect

http://www.ssdrc.com/disabilityquestionsmain8.html

http://www.workworld.org/wwwebhelp/expedited_reinstatement_of_benefits_ssi_di.htm

Chapter 7: Extended Medicare Coverage (EMC)

http://www.ssa.gov/disabilityresearch/wi/extended.htm

http://www.nls.org/ssassi/extmedcr.pdf

Chapter 8: Transitions NONE

Chapter 9: SSI Work Incentives

Student Earned Income Exclusions (SEIE)

http://www.rrtc.hawaii.edu/documents/products/phase3/06.pdf

Information on PASS http://www.disabilitybenefits101.org/ca/programs/income_support/pass/program.htm

http://www.socialsecurity.gov/disabilityresearch/wi/pass.htm

http://www.ilr.cornell.edu/edi/pass/

http://www.passplan.org/

Chapter 10: I’m 17 going on 18 Benefits while in college

http://www.rrtc.hawaii.edu/documents/products/phase3/06.pdf http://www.disability.gov/employment/work_incentives/social_security_disability_insurance_(SSDI)



http://www.workworld.org/wwwebhelp/subsidy_and_special_conditions.htm

http://www.ssa.gov/disabilityresearch/wi/exr.htm

http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1225&context=edicollect

http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1225&context=edicollect

http://www.ssdrc.com/disabilityquestionsmain8.html



http://www.ssa.gov/disabilityresearch/wi/extended.htm


http://www.disabilitybenefits101.org/ca/programs/income_support/pass/program.htm

http://www.disabilitybenefits101.org/ca/programs/income_support/pass/program.htm

http://www.socialsecurity.gov/disabilityresearch/wi/pass.htm

http://www.ilr.cornell.edu/edi/pass/


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