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.