2003 RED BOOK

A SUMMARY GUIDE TO EMPLOYMENT SUPPORT FOR PEOPLE WITH DISABILITIES UNDER THE SOCIAL SECURITY DISABILITY INSURANCE (SSDI) AND SUPPLEMENTAL SECURITY INCOME (SSI) PROGRAMS

TABLE OF CONTENTS

Page
INTRODUCTION

4
WHAT'S NEW FOR 2003

5
Amount Adjustments For 2003
5
The Disability Program Navigator

5
ONGOING ACTIVITIES

7
Benefits Planning, Assistance, And Outreach Program
7
Protection And Advocacy

8
HOW TO REACH SOCIAL SECURITY

9
Contact Us By Telephone
9
Find A Local Office
9
Contact Us By Mail
9
Find Us On The Internet
9
Send Us Comments About The Red Book
10
Request Public Information Materials

10
HOW WE CAN HELP WITH VOCATIONAL REHABILITATION AND OTHER EMPLOYMENT SUPPORT SERVICES

11
Ticket to Work Program
11
Referring People With Disabilities To State Vocational Rehabilitation Agencies

11
BASIC SSDI AND SSI INFORMATION

13
What Are SSDI And SSI?
13
Are You Eligible?
13
When and How Do You File For Benefits?
14
What Records Do You Need?
15
How Do We Define Disability?
16

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What If You Are Self-Employed?
17
How Do We Decide If You Are Disabled?
18
Who Decides If You Are Disabled?
19
How Do We Figure Your Payment Amount?
20
Will You Get Health Insurance Coverage?
20
Will You Have To Wait For Benefits To Start?
21
When Will We Review Your Disability?
22
When Will Your Benefits Stop?
23
Can You Get Benefits Again If Your Benefits Ended Because Of Work?

24
OVERVIEW OF EMPLOYMENT SUPPORT

26
How Does Employment Support Help People?

26
SSDI EMPLOYMENT SUPPORT

28
Impairment Related Work Expenses (IRWE)
28
Subsidy and Special Conditions
32
Unincurred Business Expenses
32
Unsuccessful Work Attempt
33
Continued Payments Under A Vocational Rehabilitation Program (also known as Section 301)
34
Trial Work Period (TWP)
34
Extended Period Of Eligibility (EPE)
35
Continuation Of Medicare Coverage
36
Medicare For People With Disabilities Who Work

36
SSI EMPLOYMENT SUPPORT

39
Impairment Related Work Expenses (IRWE)
28
Subsidy and Special Conditions
32
Unincurred Business Expenses
32
Unsuccessful Work Attempt
33
Continued Payments Under A Vocational Rehabilitation Program (also known as Section 301)
34
Earned Income Exclusion
39
Student Earned Income Exclusion
40
Plan For Achieving Self-Support (PASS)
40
Property Essential To Self-Support
42
Special SSI Payments For People Who Work - Section 1619 (a)
42
Continued Medicaid Eligibility - Section 1619 (b)
43
Special Benefits For People Eligible Under Section 1619 (a) Or (b) Who Enter A Medical Treatment Facility
45
Reinstating Eligibility Without A New Application
46

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SPECIAL RULES FOR PEOPLE WHO ARE BLIND
48
How SGA Is Applied Under SSDI To People Who Are Blind
48
SGA Is Not Applied Under SSI To People Who Are Blind
49
Blind Work Expenses (BWE) Under SSI
49
EXAMPLE OF CONCURRENT BENEFITS AND EMPLOYMENT SUPPORT
51
ACCOMMODATIONS FOR PEOPLE WHO ARE BLIND
57
ADDITIONAL HELP WITH HEALTH CARE FOR PEOPLE WITH DISABILITIES
58
Medicaid Protection For Working People With Disabilities
58
Help With Medicare Part A Premiums

58
GLOSSARY

60
ADDRESSES FOR SOCIAL SECURITY REGIONAL OFFICES
65

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  INTRODUCTION
Purpose of this Book

One of the Social Security Administration's (SSA) highest priorities is to help people with disabilities achieve independence by helping them to take advantage of employment opportunities. This book is a general reference source about the employment-related provisions of Social Security Disability Insurance and the Supplemental Security Income programs. We wrote the book for educators, advocates, rehabilitation professionals, and counselors who serve people with disabilities. It's purpose is to provide a working knowledge of the technical provisions involved so that they can advise people with disabilities appropriately and recognize when to seek case-specific guidance from SSA. We also expect that many applicants and beneficiaries will use this book as a self-help guide to the employment-related provisions under our programs.

(A note of caution: This book is a general description of our disability-related policies. For information specific to your situation regarding eligibility or benefits, you may need to contact us. You can find contact information on page 9. In addition, different rules may often apply to people who are claiming benefits based on retirement or age. We cover those rules in our other publications.)

SSA's Web Site We post up-to-date information about the latest developments on our Internet web site, www.socialsecurity.gov/work.
"Plain Language" We tried to make this book clear and brief. To that end, we followed "Plain Language" guidelines. We generally use "we," "us," and "our" to refer collectively to the Social Security Administration, the Social Security Act, our regulations, and operating instructions. We use "you" and "your" to refer to the person who is claiming benefits based on disability.
Purpose of Employment Support The Congress intended the employment support provisions to provide you with the assistance you need to move further on the way from benefit dependency to independence. In other words, employment supports help you to enter or re-enter the workforce by protecting your eligibility for cash payments and/or health care until you achieve this goal.
Previous Editions This edition replaces all previous editions.

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WHAT'S NEW FOR 2003?

NOTE: For more information about local contacts and the latest developments, visit our Internet web site, http://web.archive.org/web/20040214134005/http://www.ssa.gov/work/index.html.

Amount Adjustments for 2003

We increased the Substantial Gainful Activity (SGA) amount for people with impairments other than blindness from $780 to $800 for 2003. Details are on page 16.

We increased the SGA amount for people who are blind from $1,300 to $1,330 for 2003. Details are on page 16.

We increased the monthly earnings amount that we use to determine if a month counts for the Trial Work Period from $560 to $570 for 2003. Details are on page 34.

For 2003, we increased the SSI Federal Benefit Rates from $545 to $552 for an eligible individual and from $817 to $829 for an eligible couple. Details are on page 20.

We increased the income amounts that will have no effect on eligibility or benefits for child Supplemental Security Income beneficiaries who are students. For 2003, we increased the monthly amount from $1,320 to $1,340 and the yearly maximum from $5,340 to $5,410. Details are on page 40.

For 2003, the monthly Medicare Part A Hospital Insurance Base Premium is $316, and the 45% Reduction Premium is $174. The Part B Supplementary Medical Insurance monthly Base Premium is $58.70. Details on Medicare for people with disabilities who work are on page 36.

The Disability Program Navigator

SSA and the Department of Labor (DOL) are working together to establish a new position, the Disability Program Navigator, or Navigator, within DOL's One-Stop Career Centers in selected states. The Navigator will work directly with customers with disabilities, including Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) beneficiaries, to:

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The first Navigators will be in place in 2003. DOL may continue or expand the Navigator activity, based on the evaluation of the pilot project. For more information about the Navigator, visit our website at http://web.archive.org/web/20040214134005/http://www.ssa.gov/work/index.html.

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ONGOING ACTIVITIES

Benefits Planning, Assistance, and Outreach Program

As authorized by the Ticket to Work and Work Incentives Improvement Act of 1999, we awarded and currently maintain 116 cooperative agreements to community-based organizations to provide all SSA disability beneficiaries (including transition-to-work aged youth) with access to benefits planning and other assistance. Three rounds of cooperative agreements were awarded in fiscal years 2000 and 2001 throughout every State, the District of Columbia, and the US Territories of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands. The goal of the Benefits Planning, Assistance, and Outreach (BPAO) Program is to better enable SSA's beneficiaries with disabilities to make informed choices about work.

Each BPAO Project has Benefits Specialists who will:

Cornell University, Virginia Commonwealth University, and the University of Missouri-Columbia provide technical assistance and training to all BPAO Benefits Specialists on our disability programs and work incentives, the Medicare and Medicaid programs, and on other Federal work incentives programs. BPAO Program awardees must provide training and technical assistance to their Benefits Specialists about their own State and local programs and their effects on other programs' eligibility and benefits.

These services are free to persons receiving Social Security Disability Insurance or Supplemental Security Income benefits based on disability. If you want to locate the Benefits Planning, Assistance, and Outreach project nearest you, please call 1-866-968-7842 or 1-866-833-2967 (TTY/TDD) for the hearing impaired. You can also find a list with contact information on our web site at http://web.archive.org/web/20040214134005/http://www.ssa.gov/work/ServiceProviders/BPAODirectory.html.

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Protection and Advocacy

In every State and U.S. Territory, there is an agency that protects the rights of individuals with disabilities. Each Protection and Advocacy System administers the Social Security Administration funded Protection and Advocacy for Beneficiaries of Social Security (PABSS) program. Each PABSS project can:


These services are free to persons receiving Social Security or Supplemental Security Income benefits based on disability or blindness. If you want to locate the PABSS project nearest you, please call 1-866-968-7842 or 1-866-833-2967 (TTY/TDD) for the hearing impaired. You can also find a list with contact information at http://web.archive.org/web/20040214134005/http://www.ssa.gov/work/ServiceProviders/PADirectory.html.

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HOW TO REACH SOCIAL SECURITY

Contact Us By Telephone

We have a toll-free number, 1-800-772-1213, that operates between 7a.m. and 7p.m., Monday through Friday. If you have a touch-tone telephone, recorded information and services are available 24 hours a day, including weekends and holidays.

If you are hearing impaired, you may call our toll-free "TTY/TDD" number, 1-800-325-0778, between 7 a.m. and 7 p.m., Monday through Friday.

Find A Local Office

If you have a problem or question, you should first try our toll-free telephone number. Our telephone representatives will either help you or put you in contact with your local office, if needed. Many local telephone directories list local offices under "Social Security."

If you have access to the Internet, you can use the Social Security Office Locator on our home page, Social Security Online at http://web.archive.org/web/20040214134005/http://www.ssa.gov/locator. Just type in your postal ZIP code and we will give you the address, telephone number, and directions to your local office.

Contact Us By Mail If you have a problem, you should first call our toll-free telephone number or contact your local office. If you still need additional help, you may write to the Office of Public Inquiries:
Social Security Administration
Office of Public Inquiries
6401 Security Blvd. Baltimore, MD 21235-6401
Find Us On The Internet

As mentioned above, our Internet site, Social Security Online is located at http://web.archive.org/web/20040214134005/http://www.ssa.gov/. Most SSA publications and other public information materials are available at this site. We have also included links to the home pages of our regional offices - Atlanta, Boston, Chicago, Dallas, Denver, Kansas City, New York, Philadelphia, San Francisco and Seattle - highlighting regional initiatives, local public information resources, and connections to local offices. There are also links to the home pages of offices within SSA. The following are of particular interest to the community serving people with disabilities:


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  • http://web.archive.org/web/20040214134005/http://www.ssa.gov/work/index.html -- This site provides information on our efforts to help people with disabilities enter the workforce in employment or self-employment. Topics covered include: Vocational Rehabilitation Programs, Employment Support, Legislation, Employment Programs, State Employment Activities, Health Care for People with Disabilities, and much more.
Send Us Comments About The Red Book

Mail your comments or suggestions about this publication to:

Social Security Administration
Office of Employment Support Programs
P.O. Box 17778
Baltimore MD 21235-7778
Attention: Red Book Editor

Fax: 1-410-597-0429, attention: Red Book Editor

Email: red.book.editor@ssa.gov.

See below for information on requesting materials, including this book.

Request Public Information Materials

If you want copies of our public information materials (including this one), send your request to:

Office of Supply & Warehouse Management
Social Security Administration
239 Supply Building
6301 Security Blvd.
Baltimore MD 21235-6301

Fax: 410-965-2037
No shipments will be made to Post Office Boxes.

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HOW WE CAN HELP WITH VOCATIONAL REHABILITATION AND OTHER EMPLOYMENT SUPPORT SERVICES


We can help people with disabilities get the vocational rehabilitation and other employment support services they need to return to work or to go to work for the first time. We can put them in touch with agencies that provide services such as job counseling, training and job placement. We don't provide these services, but we can help pay for them under certain conditions. For more information or help finding providers to help you with the services listed above, call (toll free) 1-866-968-7842 or, for the hearing impaired 1-866-833-2967(TTY/TDD).


Ticket to Work Program

The Ticket to Work Program is new. It increases your choice in obtaining the employment support services, vocational rehabilitation services, and other services you may need to get and keep a job.

This program is being phased-in nationally over a three-year period. The program will be available in all States by 2004. Many SSDI and SSI disability beneficiaries will receive a "Ticket" they can use to obtain services from an approved provider of their choice. We call these approved providers, "Employment Networks". The program is voluntary, and the services will be provided at no cost to you.

We will not conduct a continuing disability review of your medical condition while you are using a Ticket to Work.

You can find current information about the Ticket to Work Program, including a list of approved Employment Networks, at http://web.archive.org/web/20040214134005/http://www.ssa.gov/work/Ticket/ticket_info.html, and at www.yourtickettowork.com, or you can call the toll-free numbers listed above.


Referring People with Disabilities to State Vocational Rehabilitation Agencies

In States where the Ticket program (discussed above) is not yet in effect, we will continue to make referrals to State vocational rehabilitation agencies.

When a person files an application for disability benefits, specially trained employees at the State Disability Determination Services (DDS) office review the application to see whether the person's medical condition qualifies him or her for disability benefits. At the same time, they also evaluate the person's rehabilitation potential. If it appears that the

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person may benefit from vocational rehabilitation services, they refer the applicant to the State vocational rehabilitation agency.

We send information about the applicant's medical condition and work history to the rehabilitation provider. Rehabilitation counselors evaluate this information. They may contact the person to obtain further information and may request that the individual come in for an interview.

At that time, the counselor will try to find out more about the person's interests and employment goals. Clients are given an opportunity to discuss how the counselor can work with them to achieve their job goals. If the counselor believes the vocational rehabilitation agency can provide the rehabilitation services that are needed, the counselor and client will jointly develop a written plan describing the job goal and the services the vocational rehabilitation agency will provide to reach that goal. This written plan is tailored to the needs of the client.

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BASIC SSDI and SSI INFORMATION

 

What are SSDI and SSI?

We manage two major programs that provide benefits based on disability or blindness.

SSDI

Social Security Disability Insurance (SSDI) provides benefits to disabled or blind individuals who are "insured" by workers' contributions to the Social Security trust fund. These contributions are the Federal Insurance Contributions Act (FICA) Social Security tax paid on their earnings or those of their spouses or parents. Title II of the Social Security Act authorizes SSDI benefits. See page 20 for related health insurance information.

SSI

The Supplemental Security Income (SSI) program makes cash assistance payments to aged, blind and disabled people (including children under age 18) who have limited income and resources. The Federal government funds SSI from general tax revenues. Most States pay benefits to some individuals to supplement their Federal benefits. Some of these States have arranged with us to combine their supplementary payment with our Federal payment into one monthly check to you. Other States manage their own programs and make their payments separately. Title XVI of the Social Security Act authorizes SSI benefits. See page 21 for related health insurance information.

SSDI
SSI
These two programs share many concepts and terms. However, there are also many very important differences in the rules affecting eligibility and benefit payments. Keep this in mind, since many people may apply for or be eligible for benefits under both programs at the same time. We use the term "concurrent" when individuals are eligible for benefits under both programs. We have provided an illustration of a "concurrent" beneficiary situation on page 51.
 

 

Are You Eligible?

SSDI To be eligible for SSDI:

The worker must have worked and paid Social Security taxes for enough years to be covered under Social Security insurance; some of the taxes must have been paid in recent years; and you must:

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1. Be the worker, or the worker's widow(er), or the worker's disabled adult child (requirements for a disabled adult child include; the individual must be unmarried, age 18 or over, his/her disability must have begun before age 22);

2. File an application;

3. Meet our definition of medically disabled (see page 16); and

4. Not be working or working but not performing substantial gainful activity (SGA). (See page 16.)

SSI

To be eligible for SSI based on a medical condition:

1. You must have limited income and resources (see pages 61 and 62, for definitions of income and resources);

2. You must be a U.S. citizen or meet the requirements for non-citizens;

3. You must be considered medically disabled or blind (see page 16);

4. You must be a resident of the 50 States, District of Columbia, or Northern Mariana Islands;

5. You must file an application;

6. You must file for any and all other benefits for which you are eligible; and,

7. If your impairment is other than blindness, when you apply, you must not be working or working but not performing SGA. (See page 16.) (Once you are receiving SSI benefits, this requirement no longer applies. Your eligibility will continue until you medically recover or do not meet a non-disability-related requirement.)

If you are blind, only the first six requirements apply to you.

 

 

When and How Do You File for Benefits?

When do you file? You should file for benefits as soon as you believe that you might be eligible. Waiting to file may result in loss of benefits and could make it more difficult to collect the records that you need to support your claim.

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How do you file?

First, always call our toll-free number. We may be able to answer your questions over the telephone. We will then arrange to take your claim either over the telephone or at our office. We will send you a confirmation of this appointment. We will also send you a form to get your claim started. Fill in the form as completely and as accurately as you can. Our claims representative will tell you how to send the form to us. If you visit our office before then, bring the form with you.

If you have access to the Internet, you can file for Social Security disability benefits on our website, http://web.archive.org/web/20040214134005/http://www.ssa.gov/onlineservices.

 
What Records Do You Need?
SSDI
SSI

Do not wait to file for benefits just because you do not have all of the information you need. The Social Security office will be glad to help you. However, you can speed things up by bringing certain documents with you when you apply, if they are available. You can also help by bringing us any other information or medical evidence needed to show you are disabled. These items include:

  • The Social Security number, and birth certificate or other proof of age for each person applying for benefits (This includes your spouse and children, if they are applying for benefits.);

  • Names, addresses, and telephone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment;

  • Names of all medications you are taking and prescribed dosage;

  • Medical records from your doctors, therapists, hospitals, clinics, and caseworkers; · Laboratory and test results;

  • A summary of where you worked in the past 15 years (company names, addresses, supervisors' telephone numbers) and the kind of work you did;

  • A copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year; and

  • Dates of any prior marriages.
If you have a checking or other bank account, you should also bring

 


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something from your bank that shows your account number so we can have your benefits deposited directly into your account.

SSI

If you are applying for SSI, you should have all the documents listed above. In addition, you may need:

  • Information about the home where you live, for example, your mortgage or your lease and landlord's name;

  • Payroll slips, bank books, insurance policies, car registration, burial fund records, and other information about your income and the things you own (including loan notes, stocks, bonds, or other investments); and

  • Proof of U.S. citizenship or non-citizen status, such as a birth certificate, a government-issued passport, or immigration documents (for non-citizens).
 

How Do We Define Disability?

 

SSDI
SSI

Both SSDI and SSI define disability as the inability to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s):

  • That can be expected to result in death, or

  • That has lasted or that we can expect to last for a continuous period of not less than 12 months.

We evaluate the work activity of persons claiming or receiving disability benefits under SSDI, and/or claiming benefits because of a disability under SSI. Under both programs, we use earnings guidelines to evaluate your work activity to decide whether the work activity is SGA, and whether we may consider you disabled under the law. While this is only one of the tests used to decide if you are disabled, it is the critical first step in disability evaluation.

If your impairment is other than blindness, earnings averaging over $800 a month (for the year 2003) generally demonstrate SGA. If you are blind, earnings averaging over $1,330 a month (for the year 2003) generally demonstrate SGA. These amounts are adjusted each year based on the national average wage. Deductions from your earnings that are counted toward this SGA determination may be available. (See pages 28-33.)

 

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