Social Security Overview

December 2003

Terminology Social Security Benefits

Title II Supplemental Security Benefits

Title 16 SSI

Social Security BenefitsQuarters of Coverage Quarter of coverage in 2003= $890

2004 = $900 Fully insured -- 40 quarters

Or one quarter for each year after age 21 Currently insured: 6 quarters within a

13 quarter period ending with the quarter you: a) die or b) become entitled to disability or old age insurance benefits.

Retirement Must be Fully Insured Early Retirement

Age 62 2004- apx. 20% reduction Born 1960 or later – 30% reduction

Regular Retirement 2004 – Age 65 and 4 months

Maximum benefits $1,825 Born 1960 or later – age 67

Dependent Benefits Children

Insured entitled to old age or disability benefits or deceased

Natural, adopted child, stepchild or grandchild/step grandchild (parents must be deceased or disabled at time insured became eligible for benefits or died)

Under 18 or In secondary school under 19 or Disabled before age 22

Benefits for Spouses Spouses

Insured entitled to old age or disability benefits

Valid marriage and married at least one 1 year or child in common

Age 62 or older or Caring for child of wage earner who is under

age 16 or disabled Divorce Spouses may qualify

Widow(er)s Insured was fully insured Valid marriage and Marriage lasted 9 months (some exceptions)

or Natural or adoptive parents of a child and age 60 or age 50 and disabled

disability must have began within 7 years of the wage earner's death

Unmarried or remarried after age 60 or age 50 if entitled as a disabled widow(er)

Benefits for Widowed Parents Insured was fully or currently

insured at time of death Widow or widower and marriage

lasted at least 9 months and Unmarried Caring for child of the insured who

is under age 16 or disabled

Surviving Parents of Wage Earner Insured was fully insured and is

deceased 62 years old Not married since insured person

died Must have been dependent on

insured for at least half of your support

Disabled Fully insured Disabled within last date of

insurance -- 20 quarters in a 40 quarter period and disabled within that period unless: Under age 31 when become disabled or Previously disabled under age 31 or Statutorily blind and fully insured

SSI Age

65 and Meet the citizenship criteria

Disabled

Appeals Process

Initial Reconsideration Hearing Appeals Council Federal Court

Appeal Deadlines

60 days unless good cause shown SS presumes receipt 5 days from date of mailing 10 day rule for continuing benefits

Applies for both reconsideration and hearing request

Reopening 12 months of the initial decision for any reason Good Cause

2 years SSI 4 years SS

Adult Disability Definition The inability to do any substantial

gainful activity by reason of any medically determinable physical or mental impairment which: has lasted or can be expected to last

for a continuous period of not less than 12 months

or can be expected to result in death.

Adult Sequential Evaluation

Ability To Perform Other W orkG rid

or Vocational Expert

PAST W O RK

LISITING

SEVERE IMPAIRM ENT

SUBSTANTIAL G AINFUL ACTIV IT Y

NO

Yes

No

No

Resources Used by SSA in Disability Determinations Listings Grid Bureau of Disability

Determinations Services – BDDS Medical Experts Vocational Experts

Rules Statute

42 U.S.C. §§ 401 et seq., 1381 et seq. Regulations

20 C.F.R. §§404 et seq., 416 et seq. Rulings POMS HALLEX

Definition of Disabilityfor Children A physical or mental condition (or

a combination of conditions) that results in marked and severe functional limitations and: The condition must last or be

expected to last at least 12 months or be expected to result in the child's

death.

Children’s Sequential Evaluation

L is ting F u n ctio na l E qu iva le n tT o L is t in gs

S e vere Im p a irm e nt

S u b sta n ita l G a in fu l A c tiv ity

Functional Equivalence - Six Domains Acquiring and using information Attending and completing tasks Interacting and relating with others Moving about and manipulating

objects Caring for yourself Health and physical well-being

Functional Equivalence Need one extreme limitation or Two marked limitations Can also be functional equivalent if

no listing exists for condition or combination of impairments “equals” a listing

Medical Improvement All cases are given a diary date Sequential evaluation different Appeal within 10 days to preserve

benefits

Drug and Alcohol Cases Basis for the disability must be

independent of drug or alcohol condition

Payee will be appointed Can require treatment

Amount of Benefits - 2004 SSI-

$564 individual $846 disabled couple

Couple includes “holding yourself out as married” Paid on the first of the month

Title 2 Maximum $1825 Usually at least $20 more than SSI if disabled or

aged Medicare deduction – $66.60

Don’t forget IDHS programs to pay premium Payments dates vary

Reduction/Nonpayment of Benefits -SSI

Income Unearned income disregard ($20) Child support disregard (1/3 of support) Earned income disregard ($65, and ½ of balance.) Inkind Income Deeming

Asset limitation $2000 individual $3000 eligible couple

Residents in public institutions Failure to comply with drug or alcohol treatment Fleeing felons

Reduction/Nonpayment of Benefits – Social Security

No asset limitation Earned income

Does not affect Retirement benefits if 65 or older Disability benefits

Trial work period- any 9 months where you earn $580. Extended period of eligibility- 36 months, no payment if earn more than $810

Receipt of Other Title 2 benefits -reduced $ for $ Workers’ compensation Aliens who leave the country for more than 6 months Failure to comply with drug or alcohol treatment Nonpayment while serving time for a felony

Payment of Benefits Lump Sums

Transitional Assistance and P3 offset- both SSI and SS disability

SSI only Reduction for receipt of TANF Restricted account for children’s lump

sum

Overpayments Reconsideration

60 day time limit Appeals within 30 days stays action until

reconsideration issued. Appeals after 30 days stops action until

reconsideration issued. Amount Recouped

SSI – 10% SS- No limit, but can be negotiated

Waivers No time limit All recouped money returned if successful Must establish not at fault and

Defeat the purposes of the SSI program to collect the overpayment or

presumed for an individual receiving SSI Against equity and good conscience or Impede efficient or effective administration of

program

Ticket to Work Voluntary program to assist Title II

disability and SSI disability recipients Using a ticket will not result in a

continuing disability review (“CDR”) No CDR for working after 24 months on

benefits Expedited Reinstatement for Individuals

whose benefits stop due to working Expanded medical coverage

Immigrant Restrictions -Qualified Immigrants Legal Permanent Residents Refugees, Asylees, Cuban/Haitian entrants,

Amerasians, victims of trafficking, and those whose deportation is being withheld.

Lawfully present active duty members of the U.S. Armed Forces and their spouses and dependent children.

Lawfully present veterans with an honorable discharge and their spouses and dependent children.

Qualified Immigrants Who Arrived on or Before 8/22/96

Eligible for SSI Eligible for SS

Immigrants Who Arrive After 8/22/1996

SSI - Distinction between LPRs and other Qualified Immigrants

SS - Qualified Immigrants Eligible

LPR’s Who Arrive After 8/22/96 Bar on SSI

Only eligible if can be credited with 40 quarters (after a 5 year wait)

Credits can be from worker, spouse, or parents while they were children

No quarters counted after 12/31/96 if individual received “federal means tested public benefit” during the quarter

Includes TANF, Medicaid, KidCare, Food Stamps

Resources Social Security Website

http://www.socialsecurity.gov/ Includes Handbook, POMS, Rulings, HALLEX,

CFR Dictionary of Occupational Titles (DOT) Diagnostic and Statistical Manual IV-TR Social Security Claims and Procedures -

McCormick Medical Proof of Social Security - Hirshman Video tape library