SSI Facilitation-Application

Created on: 
Dec 19 2014

Clarifying Information

Clients who are age 65 or older, terminally ill (TERI cases), compassionate allowances, and those that meet presumptive listing criteria should be immediately referred to SSA. Do not submit an SSI application. SSA must process these claims directly.

Social Security Disability Insurance (SSDI)

  1. SSA determines SSDI eligibility for every person who applies for SSI.
  2. A concurrent claim means that a person has applied for both SSI and SSDI.
  3. To be eligible for SSDI, a person must have worked and contributed to Social Security for a required number of work quarters.
  4. States do not receive interim assistance reimbursement for SSDI payments.

 Benefits of Receiving SSI

  1. ABD cash or TANF recipients who are approved for SSI typically receive:
    1. Increased income,
    2. Access to vocational retraining programs and supported work programs, and
    3. Long term eligibility for cash and medical assistance.
  2. DSHS benefits through recovery of interim assistance and reduced caseloads.
  3. Households receiving TANF receive higher income because SSI payments are not counted as income to the rest of the household.

Presumptive Disability

SSA may find that persons who meet certain severe disability criteria are presumptively disabled.  The list of allegations that meet Social Security Administration (SSA) presumptive disability criteria are maintained on the SSA website.

Worker Responsibilities

When a client appears to meet SSA presumptive disability criteria:

  1. Refer the client directly to SSA and instruct them to claim financial hardship.
  2. When SSA decides the person has a presumptive disability, they authorize SSI benefits for up to six months while the Division of Disability Determination Services (DDDS) reviews the disability.
  3. Presumptive payments may end if DDDS is unable to make a determination within the review period, but DDDS will continue to process the case until a final determination is made.
  4. It is critical that the person's payment status is tracked and cash assistance not provided while a person is receiving presumptive disability payments. SSA provides these payments as emergency assistance (which is why the person must claim financial hardship to get them), which excludes them from reimbursement as interim assistance.
  5. Notify financial services to terminate an ABD cash recipient’s benefits when the person begins receiving presumptive SSI benefits.

Compassionate Allowances

SSA has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that they clearly meet disability standards.  Compassionate Allowances allow SSA to target the most obviously disabled individuals for allowances based on minimal objective medical evidence that can be obtained quickly.

The List of Compassionate Allowances Conditions can be found on the SSA website.  Be sure to check the list regularly for new conditions.

Worker Responsibilities

When a person appears to meet SSA Compassionate Allowances criteria:

  1. Refer the client directly to SSA for a Compassionate Allowances determination.
  2. Notify financial services to terminate an ABD cash recipient's benefits when the person begins receiving SSI benefits.

Disability Listings

SSA refers to their disability criteria as the “Listings” and publishes them in Disability Evaluation Under Social Security. SSA considers a person disabled when the medical disorder meets or equals the listed disability criteria.

Disability Decision

The Division of Disability Determination Services (DDDS):

  1. Decides if a person applying for SSI, SSDI, or Non-Grant Medical Assistance (NGMA) meets disability criteria;
  2. Uses a sequential evaluation similar to the ABD cash process to determine the effect of the physical and/or mental impairment and the combined effect of multiple impairments; and
  3. Considers the effect of the following on the person’s ability to work:
    1. Current and past work activity.
    2. Severity of impairment.
    3. Residual functional capacity.
    4. Age.
    5. Education.

Worker Responsibilities

  1. Assist ALL ABD or TANF recipients who appear to be eligible for SSI.

    Assistance includes:

    1. Assessing client needs and appropriateness for SSI facilitation.
    2. Helping complete SSA application forms.
    3. Tracking SSA applications.
    4. Coordinating services.
  2. Provide facilitation services to All:
    1. ABD cash recipients who meet SSI citizenship/immigration requirements.
    2. TANF recipients who appear to meet SSI disability criteria
    NOTE: Refer all non-citizen ABD recipients directly to SSA to determine whether they meet SSI citizenship/immigration requirements. When SSA verifies the non-citizen is eligible to apply for SSI, provide SSI facilitation.
    NOTE: Clients who are age 65 or older, terminally ill (TERI cases), Compassionate Allowances, and those that meet presumptive listing criteria should be immediately referred to SSA. Do not submit an SSI application. SSA must process these claims directly.
  3. Develop professional working relationships with:
    1. Social Security District Office (SSADO).
    2. Division of Disability Determination Services (DDDS).
    3. Home and Community Services (HCS).
  4. Provide Equal Access (EA) assessment, planning, and services as appropriate.
  5. Adhere to the following timeframes and procedures:
    1. Assist the person with filing the initial SSI application within 60 calendar days of an ABD cash approval and within 90 days of the date a person receiving TANF is referred for facilitation services.
    2. Meet filing deadlines for reconsideration requests and hearings.
    3. Verify that a current DSHS 18-235, Interim Assistance Reimbursement Authorization (IARA), is on file with Social Security Administration (SSA) within 10 working days after approval for ABD cash, or 30 days after the date the form is signed by the person (whichever date comes first).

Social Security Links:

  • Social Security Listings
  • Evidentiary Requirements
  • Social Security Administration
  • SSDI
  • Social Security Employment Programs

Process Overview

The facilitation process includes the following activities:

  1. Preparing for the SSI application interview by reviewing available documents to learn about the person's medical, education, and employment history.
  2. Interviewing the person.
  3. Documenting personal observations of the individual’s appearance, speech, mobility, and activities of daily living.
  4. Preparing and submitting a TANF disability referral packet that:
    1. Contains all relevant medical evidence to support a claim of disability.
    2. Meets SSI evidentiary requirements.
  5. Verifying a signed IARA is on file with SSA for all ABD cash clients.
  6. Obtaining additional medical records when necessary.
  7. Completing SSI application forms and filing the application packet with SSA.

Preparing for the Interview

  1. Research available information to become familiar with the person's situation such as:
    1. Medical records.
    2. Social services assessment of Health, Education, and Employment.
    3. Case notes.
  2. Include information the person should bring to the interview in the appointment letter such as medical sources, completed activity of daily living forms, or a list of medications with:
    1. Name of medication.
    2. Dosage.
    3. Condition.
    4. Who prescribed the medication.


Revised on June 14, 2016
  1. A face to face interview with the person is preferred and can be held:
    1. In the office; or
    2. In a hospital or nursing home.
    3. When a face-to-face interview is not possible, conduct a telephone interview.
  2. During the interview gather information about the person including:
    1. A contact person or advocate, including the address and phone number. This is important for all individuals and essential for people who are homeless;
    2. Onset date of impairment;
    3. The date the individual became unable to work;
    4. Educational history; and
    5. Sources of other information about the person's impairment.
  3. Record all sources of medical information. Use this information to complete the i3368 (Internet Adult Disability Report).
  4. Explore employment history for each type of job the person has held in the last 15 years. Use this information to complete the i3368 (Internet Adult Disability Report) and the SSA-3369 (Work History Report).
  5. Ensure there is a signed DSHS 18-235, Interim Assistance Reimbursement Authorization on file with SSA for each ABD recipient.

Medical Records

Revised on June 22, 2016

  1. The diagnosis of a disabling impairment must be made by an acceptable medical source within 5 years of the SSI application. Once the impairment has been established, SSA considers evidence from other treating providers. Acceptable sources of medical evidence include:
    1. Licensed physicians (medical or osteopathic doctors);
    2. Licensed psychiatrists or psychologists;
    3. Optometrists (for purposes of establishing visual disorders only);
    4. Licensed podiatrists (for purposes of establishing impairments of the foot, or foot and ankle only); and
    5. Qualified speech-language pathologists (for purposes of establishing speech or language impairments only).
  2. DDDS uses the Medical Evidence of Record (MER) as the primary source of medical evidence to determine disability. This includes:
    1. Hospital and clinic records;
    2. Records from the treating physician;
    3. Evaluations by specialists; and
    4. Clinical and laboratory findings (such as: x-rays, lab tests, and psychological testing).
  3. DDDS arranges consultative examinations with contracted physicians and psychologists (including transportation when requested) when medical evidence does not contain sufficient information to make a disability decision.
  4. When completing the Internet Adult Disability Report i3368 for initial applications and the iAppeal for appeals, list the CSO as a source of medical records. All DDDS offices have access to the client's CSD Electronic Case Record.
  5. For TANF clients, use Support Services (see WorkFirst Handbook: Support Services Directory) to obtain additional objective medical evidence when the available evidence does not provide enough information to determine if the client appears to meet SSA disability criteria.

Attorney Requests for Records

When an attorney representing a client that is receiving SSI Facilitation services makes a request for additional medical records to assist with the SSI appeal process:

  1. Ensure that a complete and current DSHS form 17-211 (Authorization for SSI Facilitation Records) is on file.
  2. Determine whether the additional medical evidence is needed to support the SSI application.
  3. If there is not enough information to determine if the medical evidence requested by the attorney is necessary to support the SSI application, the following should be done:
    1. Deny the request; and
    2. Contact the attorney for more information. 
  4. If the records aren’t necessary to support the client’s SSI application:
    1. Send a written notice to the attorney stating the reason that the department has denied their request; and
    2. Document the action taken in ICMS notes.
  5. If the records are necessary to support the client's SSI application, and aren't already in the ECR:
    1. Request the records from the medical provider;
    2. Document the action taken in ICMS notes; and
    3. Provide copies of the medical evidence to the attorney.
NOTE: The medical evidence provider must send records directly to DSHS. Do not authorize or pay for copies of records to be sent directly to an attorney under any circumstances.

Medical Evidence to Support SSI Applications

Revised on August 31, 2016

Special Report for SSI Hearing Purposes

This is medical evidence used at an administrative hearing when an ABD recipient is involved in the Social Security disability determination appeal process. These reports are a supplement to medical evidence already obtained by the Department and any consultative exams obtained by DDDS. A Special Report from a medical provider is defined as:

  1. Verbal information provided to the attorney, followed by a written report; or
  2. In person testimony at an administrative hearing.

Reimbursement for special reports must be pre-approved by the Exception to Rule (ETR) process in Barcode.

Medical Evidence at the SSI Initial, Reconsideration, or Hearing Level

When an additional evaluation or testing is necessary to support a SSI application at any level of the determination process, and DDDS will not pay per their policy, use the following procedures:

  1. If payment is within the medical evidence fee schedule, generate a referral in ICMS using the appropriate DSHS 14-150 to authorize payment, and document the reason for the referral in ICMS case notes.
  2. If payment for medical evidence is outside of the medical evidence fee schedule, submit a request for an expenditure approval through the ETR process in Barcode. Please include the following information in the request:
    1. The specific evaluation or testing being requested, including the credentials of the provider needed to perform or author the evidence (e.g. physician, psychologist, neurologist, etc.);
    2. An explanation of why the evaluation is necessary;
    3. An explanation of why DDDS will not pay for the evaluation or testing; and
    4. If the SSI application was denied, the reason(s) for the denial.
  3. If approval is obtained from CSD Headquarters through the ETR process, clearly document the approval in ICMS case notes.
  4. In order to receive reimbursement for an approved evaluation or additional testing, the provider must send the CSO an invoice for the services being billed.  Upon confirmation that the medical evidence has been received and is complete, social services staff will submit the reimbursement request through SSPS using the appropriate service codes detailed in the CSD Procedures Handbook.

EXAMPLE: An ABD recipient with a mental illness has missed multiple DDDS consultative exams despite coordination with DDDS to arrange transportation. DDDS has refused to schedule another consultative examination. Submit an expenditure request through the Barcode ETR process for an evaluation that meets DDDS consultative examination criteria.

EXAMPLE: The SSIF receives a phone call from an attorney asking DSHS to pay for copies of medical records from the local community hospital. The attorney asks for the complete medical records (e.g. "all records" or "all history") and says that they are being used to "prepare the case for hearing." The SSIF asks what specific records are needed, why those specific records are needed, and if all or part of them are included in the DDDS or CSO records already provided to the attorney. The attorney responds by saying they just want to make sure they have everything. The SSIF denies the request because the need for the records has not been clearly demonstrated.

Personal Observation

  1. A personal observation of the individual is an important piece of the SSI application packet. The SSI Facilitator is the eyes and ears of the DDDS adjudicator.
  2. Focus on writing an objective description of the person's appearance and behavior during a face-to-face interview and avoid value judgments or subjective analysis. Be specific and quantify responses.
  3. Some areas to consider when writing your personal observations:
    1. Deficits in hygiene or grooming.
    2. Difficulty using legs, arms, hands, or shifting position to alleviate pain.
    3. Unusual speech patterns.
    4. Difficulty with long or short term memory.
    5. Unusual surroundings if interviewing the person in their home.
  4. Photographs may be helpful in depicting a person's situation or physical condition. Only take or use photographs with the individual's permission.

Include your personal observation statement within the i3368PRO. (Sign and date the personal observation statement and include it in the application packet if unable to access the i3368 PRO).


Revised on June 24, 2016

  1. The initial SSI application packet includes the following:
    1. SSA Cover Letter;
    2. DSHS form 18-235 Interim Assistance Reimbursement Authorization (signed original);
    3. SSA-8001 (Title 16 application);
    4. Internet iClaim (Title 2 application);
    5. Internet Adult Disability Report i3368;
    6. SSA-3369 Work History Report;
    7. SSA-3373 Function Report;
    8. SSA-827 Authorization to Disclose Information to SSA (signed original, copy, or electronic signature);
    9. Personal Observation Statement;
    10. SSA-3288 Consent for Release of Information (signed original or copy); and
    11. A return envelope.
  2. Refer to SSI Forms for a description of documents used.
  3. Send the completed SSI application packet to the local SSA District Office (SSADO) within 60 calendar days of ABD cash approval.
  4. Send the completed SSI application packet to the local SSADO within 60 calendar days of the referral of a TANF client.
  5. Verify that the SSADO has received the application packet.


SSA Teleservice

Revised on June 24, 2016

Teleservice is available for clients when a face to face interview is not possible. Clients may schedule an appointment to apply for SSI by calling SSA Teleservice at 1-800-772-1213, or CSO staff may call and arrange a telephone appointment for the client.


NOTE: For all ABD cash recipients, verify a DSHS 18-235 Interim Assistance Reimbursement Authorization is on file with SSA.


NOTE: If a non-facilitated client is interested in applying for Social Security Disability or SSI, refer them to SSA Teleservice or the website to access the online application for benefits.

Case Transfers

When a person transfers from one CSO to another, the SSI facilitator in the receiving CSO:

  1. Notifies DDDS and SSA of the person's new address and phone number.
  2. Contacts the individual by telephone or schedules an interview to update the person's information.
  3. Inputs new information in the ICMS record.
  4. Notifies DDDS of any updated information.

Death of a Client

Revised August 31, 2016

  1. Pursue the SSI application when an ABD recipient dies and SSA has a signed:
    1. Initial application; and
    2. DSHS 18-235, Interim Assistance Reimbursement Authorization (IARA).
  2. Send written notice of death and intent to pursue the application, along with a copy of the signed IARA, to SSA and DDDS.
  3. When the application is at the Hearing or Appeals Council Review level at the time of the ABD recipient's death:
    1. Send a fax or a letter to the Office of Hearing and Appeals indicating that the State has an interest in the claim; and
    2. Include a copy of the signed IARA.
  4. Leave the SSI Tracking screen open in ICMS until SSA approves of denies the case.