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|Supplemental Security Income (SSI)
Understanding Supplemental Security Income
WHAT DO WE MEAN BY "DISABLED"?
See the definition of disability for a child under age 18 in the section, WHAT DOES "DISABLED" MEAN FOR A CHILD?
WHAT DO WE MEAN BY "BLIND"?
See the definition of blindness for an adult or child in the section, WHAT IS "BLINDNESS" FOR AN ADULT OR CHILD?
WHAT HAPPENS WHEN I APPLY?
When you file an application for SSI benefits based on disability or blindness at your local Social Security office, we will first decide whether you meet the income and resource criteria and other eligibility requirements.
If you do, we will ask you for the:
It's very important to give us complete information.
As part of the disability determination, the Social Security personnel also look at any work you are doing. Generally, if you are working and earning more than $940 per month (effective January 2008), we will not find you disabled. We call this substantial gainful activity. This does not apply if you are blind.
The local Social Security office personnel do not make the rest of the disability determination. The local Social Security office sends the claim to a State agency that we call Disability Determination Services (DDS). There, a team composed of a disability examiner and a medical or psychological consultant decides whether you are disabled.
OBTAINING EVIDENCE ABOUT YOUR IMPAIRMENT(S) AND
|Please see the SSI Spotlight on Payment for Travel to Medical Exams and Tests.
WHAT IS SUBSTANTIAL GAINFUL ACTIVITY?
The term substantial gainful activity describes a level of work activity that is both substantial and gainful. Substantial work activity involves performance of significant physical or mental duties, or a combination of both, which are productive in nature.
Gainful activity is work performed for pay or profit; or work of a nature generally performed for pay or profit, whether or not a profit is realized. For activity to be substantial, it need not necessarily be performed on a full–time basis; work activity performed on a part–time basis may also be substantial.
For SSI purposes, the substantial gainful activity provision does not apply to blind individuals.
HOW LONG DOES THE DECISION TAKE?
The decision usually takes about three to four months from the date of application.
Sometimes, we can make a presumptive disability or blindness decision and start paying you while the DDS makes its decision. For more information, please see our chapter on EXPEDITED PAYMENTS.
WHO DECIDES IF I AM DISABLED OR BLIND?
After helping you complete your application, your local Social Security office will review it to see if you meet the basic requirements for disability or blindness benefits. The Social Security office will send your application to the Disability Determination Services (DDS) office in your State. The DDS will decide whether you are disabled or blind under the Social Security law.
The DDS will consider all the facts in your case. They will consider what your doctors or other sources have said about your impairment(s), when it began, how it limits your activities, what the medical tests have shown, and what treatment you have received. They will use medical evidence from your doctors and from hospitals, clinics, or institutions where you have been treated, and all the other information they have about your condition.
A trained DDS team, including a medical or a psychological consultant and a disability examiner, looks at the information you have given us. They also review your medical records, information about how you are functioning, and, if applicable, your work history, and then decide if you are disabled or blind for SSI purposes.
If they cannot make a determination based on the information they have, the DDS will schedule a special medical examination or test for you and will pay for this examination or test. They may pay for your travel expenses to this examination or test.
It is important that you go to the special medical examination or test if one is scheduled. If you do not keep the appointment, the DDS could deny your claim.
In deciding if you are disabled, the DDS team uses a process called the sequential evaluation process.
WHAT IS THE SEQUENTIAL EVALUATION PROCESS?
If you appear to meet all the non–medical eligibility requirements (income, resources, residency, citizenship, etc.), we use a step–by–step process to determine if you are disabled. These steps are called the sequential evaluation process. The following sections describe how we use the sequential evaluation for adults and children.
SEQUENTIAL EVALUATION FOR ADULTS AGE 18 OR OLDER
STEP 1: ARE YOU WORKING?
If you are working and doing substantial gainful activity, we cannot consider you disabled, and the process ends here. We make this decision in your local Social Security office.
We decide if your work is "substantial" (significant) and "gainful" (for pay). A general rule is that substantial gainful activity is earnings over $940 per month (effective January 2008) for people who are not blind.
If you are not working or not doing substantial gainful activity, we will send your case to the DDS for a determination concerning your impairment.
STEP 2: DO YOU HAVE A SEVERE IMPAIRMENT?
If you are not doing substantial gainful activity, the Disability Determination Services (DDS) then decides if your impairment or combination of impairments is severe. An impairment is severe if it significantly limits your physical or mental ability to do basic work activities. If your impairment(s) is not severe, the DDS will find that you are not disabled. If your impairment(s) is severe, the DDS will go to the next step.
Examples of basic work activities are:
STEP 3: DO YOU HAVE AN IMPAIRMENT WHICH MEETS OR EQUALS A SOCIAL SECURITY "LISTED IMPAIRMENT?"
If your impairment is severe, the Disability Determination Services (DDS) decides if it "meets" or equals a "listed impairment."
The DDS decides if your impairment(s) "meets" one of the Listings by comparing it to the specific requirements in the Listings. (It is not enough just to have a diagnosis named in a Listing). If your impairment meets the requirements of a Listing, the DDS will find you disabled and the process ends here.
If your impairment does not meet the requirements of a Listing, or you have more than one impairment, the DDS looks at whether your impairment(s) is equal in severity and duration to a listed impairment. If your impairment(s) equals the requirements of a listed impairment, then they find that you are disabled and the process ends here.
If your disability is severe, but does not meet or equal a listed impairment, the DDS can still find you disabled at a later step in the process. The DDS decides what you are physically and mentally able to do, despite the limitations resulting from your impairments. They call this decision a "Residual Functional Capacity" or RFC assessment.
STEP 4: ARE YOU ABLE TO DO YOUR PAST WORK?
If, taking into account your RFC assessment, you are able to do work you did in the past (generally the last 15 years), the DDS will find that you are not disabled, and the process ends here.
STEP 5: CAN YOU DO ANY OTHER KIND OF WORK?
If you cannot do your past work, the DDS looks at the limitations described in your RFC assessment, your age, education, and past work experience to decide if you could adjust to other work. If you can adjust to other work, they will deny your claim. If you cannot adjust to other work, they will find you disabled.
STEP 1: IS THE CHILD WORKING?
If a child is working and doing substantial gainful activity, we cannot consider the child disabled, and the sequential evaluation process ends here. We make this decision in your local Social Security office. We define substantial gainful activity for children in the same way that we define it for adults. See the section, WHAT IS SUBSTANTIAL GAINFUL ACTIVITY?
STEP 2: DOES THE CHILD HAVE A SEVERE IMPAIRMENT?
If the child is not performing substantial gainful activity, the Disability Determination Services (DDS) will then decide if the child has a medically determinable impairment or combination of impairments and whether it is severe. An impairment(s) is not severe if it is only a slight abnormality or a combination of slight abnormalities that causes no more than minimal functional limitations. If the child does not have a medically determinable impairment(s), or the child has an impairment(s) but it is not severe, the DDS will find that the child is not disabled. If the impairment is severe, the DDS will go to the next step.
STEP 3: DOES THE CHILD'S IMPAIRMENT MEET OR EQUAL THE LISTINGS?
If the child has a severe impairment(s), the Disability Determination Services (DDS) then decides if it meets or equals the Listings. The Listings cover the major body systems and include descriptions of common physical and mental impairments (such as cerebral palsy, mental retardation, and asthma) along with specific medical severity criteria.
A child is disabled if he or she has an impairment, or combination of impairments, that:
The DDS decides if a child's impairment(s) meets one of the Listings by comparing it to the specific criteria in the Listings. (It is not enough just to have a diagnosis named in a Listing).
The DDS decides whether the child's impairment(s) medically equals a Listing by deciding if the medical findings about the impairment(s) are equal in severity and duration to the criteria in a Listing.
If a child's impairment(s) does not meet or medically equal a Listing, the DDS team then decides whether it functionally equals the Listings. They assess the effects of the impairment(s) on the child's ability to function at home, at school, and in his or her community.
The DDS will consider questions such as:
Once the DDS has a clear picture of the child's activities––what he or she can and cannot do––they decide how much the child is limited in each of six domains. The domains are broad areas of functioning intended to capture all of what a child can or cannot do. They are:
If a child's impairment or combination of impairments causes marked limitations in two of these domains, or an extreme limitation in one domain, then his or her impairment(s) functionally equals a "listed impairment."
We define marked and extreme limitations in several ways in our rules. The most general definition of a marked limitation is an impairment(s) that interferes seriously with the child's ability to independently initiate, sustain, or complete activities. An extreme limitation interferes very seriously with these abilities.
|THIS INFORMATION IS GENERAL. FOR MORE INFORMATION, CALL 1-800-772-1213 (TTY 1-800-325-0778), OR CONTACT YOUR LOCAL SOCIAL SECURITY OFFICE.