Manual on Social Security Beneits for Prisoners

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Legal Services for Prisoners with Children
1540 Market Street, Suite 490
San Francisco, CA 94102
(415) 255-7036
fax: (415) 552-3250
info@prisonerswithchildren.org
www.prisonerswithchildren.org

A MANUAL ON SSI/SSDI
FOR PRISONERS
AND THEIR ADVOCATES

2004 Edition prepared by:

CASSIE M. PIERSON
Staff Attorney

MATT SAVINAR
Legal Intern, Summer 2002
U.C. Hastings College of the Law

DISCLAIMER
This manual is not intended to be a source of advertising, solicitation, or legal advice. As a
result, you should not consider this information to be an invitation for an attorney-client
relationship, you should not rely on information provided here as constituting legal advice, and
you should always seek the advice of competent counsel in your own state. Because individual
circumstances differ, you should not rely on any information here as being applicable to your
given factual situation.

A Note on Reproduction:
LSPC is interested in the widest distribution of this material. You are welcome to make
photocopies of this material but, if you do so, please copy the manual in its entirety and please
do not charge for copies. For questions about this manual, please contact Legal Services for
Prisoners with Children at 415-255-7036; fax: 415-552-3150; info@prisonerswithchildren.org ,
1540 Market Street, Suite 490, San Francisco, CA 94102; www.prisonerswithchildren.org

TABLE OF CONTENTS
I. INTRODUCTION: WHY THIS MANUAL? .
II. SSI/SSDI BENEFITS: AN OVERVIEW .

1
2

2. How much will I receive per month in benefits? .

3. What does SSA consider as a “disability”?

. 2

4. How can I tell if I will be found disabled by Social Security?

. 2

1. What is SSI/SSDI? .

5. Can you receive Social Security disability benefits for _____________ (insert the name of
whatever disease you are interested in)? . . . . . . . . . .
3
6. Do you have to be permanently disabled to get Social Security
disability benefits? . . . . . . . . . . . . .

. 3

7. I have several health problems, but no one of them disables me. It is the combination that
disables me. Can I get Social Security disability benefits? . . . . . .
3
8. I am disabled now, but I expect that I will be able to return to work after I recover. Should
I file for Social Security disability benefits? . . . . . . . . .
3
9. I am disabled by mental illness. Can mental illness serve as the basis for a Social Security
disability claim? . . . . . . . . . . . . . . . .
3
10. How does Social Security determine if I am disabled? .

11. Who decides if I am disabled?

. 4

12. Why does Social Security consider my age in determining whether
I am disabled? . . . . . . . . . . . . . . . .

13. Is there a list of illnesses that Social Security considers disabling? .

14. What can I do to improve my chances of winning my Social Security disability claim?
. . . . . . . . . . . . . . . . . . . .
4
15. What do I do if Social Security denies my claim for Social Security disability benefits?
. . . . . . . . . . . . . . .
4
16. Why does Social Security turn down so many claims for disability benefits? .

17. If Social Security denies my claim, can I appeal it? .

18. Who makes the reconsideration determination? .

19. What are my chances of winning at reconsideration?

20. Do I have to go through reconsideration?

. 5

21. What happens if Social Security denies my claim at reconsideration? .

22. How long does it take to get a hearing on a Social Security disability claim? .

23. What is the Social Security hearing like?

. 5

24. What are my chances of winning at a hearing? .

. 6

25. If the Administrative Law Judge denies my claim, can I appeal any more?
26. What is the Appeals Council? .

27. Can I appeal a case beyond Social Security to the Federal Courts? .

28. If I get on Social Security disability benefits and get to feeling better and want to return
to work, can I return to work?
. . . . . . . . . . . .
6
29. Where can I go to get help with my Social Security disability claim? .

30. Do I really have to hire a lawyer to represent me in my Social Security disability
claim? . . . . . . . . . . . . . . . . . . . . .

31. How do lawyers who represent Social Security disability claimants get paid? .

32. What if I can’t find a lawyer who will represent me?

33. Can alcoholics and drug addicts really get Social Security disability
benefits?
.
. . . . . . . . . . . . . . .

34. I know someone who is on Social Security disability and he does not look a bit disabled.
Why do they put all of these freeloaders on benefits? . . . . . . .
7
35. I am disabled, but I have never worked at public work. Can I get Social Security
disability benefits? . . . . . . . . . . . . . . . .

36. I am a widow. I have not worked in public work in many years. I am disabled. Can I get
Social Security disability benefits? . . . . . . . . . . . .
7

37. I have a daughter who is disabled and unable to work. Can she get disability benefits
from Social Security? . . . . . . . . . . . . . . .
7
38. My doctor says I am disabled so why is Social Security denying my Social Security
disability claim? . . . . . . . . . . . . . . . .
7
39. VA says I am disabled, so why is Social Security denying my Social Security disability
claim? . . . . . . . . . . . . . . . . . . .
8
40. I am 60% disabled. Do I get 60% of my Social Security disability benefits?

41. Will it help if I ask my Congressional Representative to help me get Social Security
disability benefits?
. . . . . . . . . . . . . . . . . 8
42. How long does it take before Social Security makes a decision once I file a claim for
Social Security disability benefits? . . . . . . . . . . . . .
8
43. How long does it take for Social Security to make a reconsideration determination on my
Social Security disability claim?
. . . . . . . . . . .
8
44. How long does it take for Social Security to act upon a request for Appeals Council
review? . . . . . . . . . . . . . . . . . .
8
45. I am disabled. I need help with medical bills even more than I need a cash income.
How do I get help with medical bills? . . . . . . . . . . . . .
8
46. What is the difference between Medicare and Medicaid? . .

47. If I get Social Security disability benefits will I get Medicare? .

48. If I get Social Security disability benefits will I get Medicaid? . .

49. My child is disabled. Does s/he qualify for SSI benefits? .

50. Does where I live affect how much SSI I get?

. 9

51. Do my living expenses affect my SSI benefit? .

. 9

52. What if someone else helps pay my living expenses?

. 9

53. What about people in institutions?

54. What about the homeless?

. 10

55. Under what circumstances can an Non-Citizen be eligible for SSI? .

56. Who is a Qualified Non-Citizen?.

. 10

57. Under what conditions may a Qualified Non-Citizen be eligible for SSI? . . .

58. Am I eligible for Food Stamps or Public Assistance if I receive SSI/SSDI? . . .

III. INCARCERATION AND SSI/SSDI
When Prisoners Lose SSI .

How Time in Jail Affects Benefits

When Prisoners Lose SSDI

Qualifying for SSI/SSDI Upon Release .

Why Benefits Are Lost And What Can Be Done About It

Pre-Release Agreements . .

Health Care Coverage

Medicaid Rules on Prisoners .

Federal Rules on Medicaid Reinstatement . .

Coverage After Release .

. 18

Medicaid . .

Medicare

.
.

IV. INITIAL APPLICATION PROCESS

Overview of the Initial Application Process .

Initial Application: Forms

. 21

1. Appointment of Representative Form .

2. Disability Report .

. 22

3. Release Forms .

. 22

4. Daily Questionnaire Form .

5. Third Party Questionnaire Form .

6. Community Outreach Form

. 23

7. Tips for Filling out the Forms .

Initial Application: Medical Records .

. 25

1. Treating Doctor’s Report Request Letter .

2. Questionnaires for Doctor .

3. The Listings of Impairments .

Initial Application: Persuasive Letter .

1. Overview of Writing a Persuasive Letter .

2. Sample Questions to ask Applicant
V. RECONSIDERATION .

. 31

1. Overview of Reconsideration .

VI. ADMINISTRATIVE LAW JUDGE HEARING .

. 32

VII. APPEALS COUNCIL

. 33

. 34

. 35

X. CHART: WHAT YOUR ELIGIBLE FOR IN BENEFITS .

. 36

XI. SAMPLE LETTERS

VIII. FEDERAL DISTRICT COURT

IX. FINDING YOUR LOCAL SSA OFFICE

. 37

XII. SSI/SSDI ATTORNEYS/AGENCIES

. 42

ENDNOTES .

. 46

A. Sample Letter to Treating Doctor
B. Sample Persuasive Letter .

I. INTRODUCTION: WHY THIS MANUAL?
A growing number of men and women with severe physical and/or mental illnesses are in jail or
prison. Many cycle through corrections facilities repeatedly, costing criminal justice systems
and communities significant resources and causing great pain to themselves and their families.
Often the event precipitating their arrest is linked to both their lack of income and their unmet
need for services that are essential if they are to maintain themselves in the community.
The resulting poverty and lack of access to health care can lead to incidents that greatly increase
the likelihood that these individuals will have further contact with law enforcement. Without
income support or health coverage, many people with severe mental illnesses become caught in a
cycle of recidivism.1
The Social Security Administration administers two programs, Supplemental Security Income
(SSI) and Social Security Disability Insurance (SSDI), which pay benefits to men and women
who are too disabled to work.
Unfortunately, many people who are eligible and would benefit from these programs do not
apply for them. Often they do not know about these programs or are intimidated and/or confused
by them. When it comes to SSI/SSDI, an unfortunate Catch-22 exists. The application process
can be so long and confusing that anybody who is disabled severely enough to qualify is
probably too disabled to navigate the application process.
Thus, this manual is designed not so much for the SSI/SSDI applicant, but rather the applicant’s
advocate.
You do not need to be an attorney to be an effective advocate. Of course, retaining an attorney
increases an applicant’s chances of being approved for benefits. Unfortunately, there are not
enough attorneys willing and able to serve the disabled population. Even fewer attorneys serve
the disabled, incarcerated, population. Thus, the responsibility often falls on the shoulders of
non-attorney legal advocates, as well as friends and family of the disabled person.
The SSI/SSDI application process can be challenging. We hope this manual will assist you in
advocating for your friend, family member or client.

II. SSI/SSDI BENEFITS: AN OVERVIEW
The following question and answers are designed to give you a general overview of SSI.
1. What is SSI/SSDI?
People who are severely disabled may be eligible for monthly benefits under one or more of the
programs administered by Social Security Administration (SSA).
The Supplemental Security Income (SSI) program provides monthly income to people who are
age 65 or older, or are blind or disabled, and have limited income and financial resources. You
can be eligible for SSI even if you have never worked in employment covered under Social
Security. No SSI benefits are paid to family members, only to the disabled person.2
The Social Security Disability Income (SSDI) program medical requirements and application
process are largely the same as they are for SSI. However, unlike SSI, a person’s eligibility for
SSDI is based on prior work under Social Security.
Generally, to be eligible for SSI/SSDI, an individual also must be a resident of the United States
and must be a citizen or a noncitizen lawfully admitted for permanent residence. Also, some
noncitizens granted a special status by the Immigration and Naturalization Service may be
eligible.
2. How much will I receive per month in benefits?
It depends. Consult the chart on page 39. Note: This chart applies only to California.3
3. What does SSA consider as a “disability”?
Under the Social Security Act, “disability” means “inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment which can be
expected to result in death or has lasted or can be expected to last for a continuous period of not
less than 12 months.”4
4. How can I tell if I will be found disabled by Social Security?
Unless your disability is catastrophic (for example, terminal cancer, a heart condition so bad that
you are on a heart transplant waiting list, total paralysis of both legs), there is no easy way for
you to tell whether you will be found disabled by Social Security. In the end, the decision of
whether or not to apply for Social Security disability benefits should not be based upon whether
or not the person feels that Social Security will find them disabled. Attorneys familiar with
Social Security disability can make predictions about who will win and who will lose, but even
they can seldom be sure. An individual should make the decision about whether or not to file for
Social Security disability based upon their own belief about their condition. If the individual
feels that he or she is disabled and is not going to be able to return to work in the near future, the
individual should file for Social Security disability benefits. If denied, the individual should
consult with an attorney familiar with Social Security disability to get an opinion as to the
chances of success on appeal.5
2

5. Can you receive Social Security disability benefits for _____________ (insert the name
of whatever disease you are interested in)?
In almost every case, no matter what the disease is, the answer is the same: "Maybe, it just
depends upon how badly you are affected by the disease." One example might be cancer. The
word "cancer" is scary to anyone, but there are many cancers that can be treated and cured very
quickly, with little or no lasting effect. On the other hand, of course, there are cancers that cause
great suffering and ultimately death. The question in each individual case is, "How sick is this
particular individual with cancer and how long is this person going to remain sick?" Skin
diseases are another example. The vast majority of skin diseases, while annoying, would not be
considered disabling. On the other hand, there are some uncommon, very severe skin problems
that are clearly disabling. In extreme cases, psoriasis, which is not rare, may be disabling. Thus,
almost without exception, the mere fact that an individual has a disease with a certain name does
not guarantee that the individual either will or will not be found disabled. It all depends upon
how sick the person is.6
6. Do you have to be permanently disabled to get Social Security disability benefits?
No. You have to have been disabled for at least a year or be expected to be disabled for at least a
year or have a condition that can be expected to result in death within a year. 7
7. I have several health problems, but no one of them disables me. It is the combination
that disables me. Can I get Social Security disability benefits?
Social Security is supposed to consider the combination of impairments that an individual suffers
in determining disability. Many, perhaps most, claimants for Social Security disability benefits
have more than one health problem, and the combined effects of all of the health problems must
be considered.8
8. I am disabled now, but I expect that I will be able to return to work after I recover.
Should I file for Social Security disability benefits?
If you expect to be unable to work for a year or more because of illness or injury, you should file
for Social Security disability benefits. 9
9. I am disabled by mental illness. Can mental illness serve as the basis for a Social
Security disability claim?
Yes. Mental illness is a frequent basis for awarding Social Security disability benefits.
10. How does Social Security determine if I am disabled?
Social Security is supposed to gather your medical records and carefully consider all of your
health problems, as well as your age, education, and work experience. In general, Social Security
is supposed to decide whether you are able to do your past work. If Social Security decides that
you are unable to do your past work, they are supposed to consider whether there is any other
work you can do considering your health problems and your age, education, and work
experience. 10
3

11. Who decides if I am disabled?
After an individual files a Social Security disability claim, the case is sent to a disability
examiner at the Disability Determination section of Social Security agency in your state. This
individual, working with a doctor, makes the initial decision on the claim. If the claim is denied
and the individual requests reconsideration, the case is then sent to another disability examiner at
the Disability Determination section, where it goes through much the same process. If a claim is
denied at reconsideration, the claimant may then request a hearing. At this point, the case is sent
to an Administrative Law Judge who works for Social Security. The Administrative Law Judge
makes an independent decision upon the claim. This is the only level at which the claimant and
the decision maker get to see each other. 11
12. Why does Social Security consider my age in determining whether I am disabled?
Social Security has to consider age, because that is what the Social Security Act requires. As
people get older, they become less adaptable, less able to switch to different jobs to cope with
health problems. A severe foot injury that might cause a 30-year-old to switch to a job in which
he or she can sit down most of the time, might disable a 60-year-old person who could not make
the adjustment to a different type of work. 12
13. Is there a list of illnesses that Social Security considers disabling?
Not really. Because most types of illness can vary from minor to severe, there is no one simple
list of illnesses that Social Security considers to be disabling. However, if an illness has reached
a very severe level with certain medical hallmarks, Social Security will award benefits on the
basis of medical considerations alone. 13
14. What can I do to improve my chances of winning my Social Security disability claim?
Be honest and complete in giving information to Social Security about what is disabling you.
Many claimants, for example, fail to mention their psychiatric problems to Social Security
because they are embarrassed about them. In almost all cases, individuals who were slow
learners in school fail to mention this fact to Social Security, even though it can have a good deal
to do with whether or not the Social Security disability claim is approved. Beyond being honest
and complete with Social Security, the most important thing that you can do is just keep
appealing and hire an experienced person to represent you. It is important to appeal because most
claims are denied at the initial level, but are approved at higher levels of review. It is important
to hire an experienced person to represent you because you do not understand the way Social
Security works. Statistically, claimants who employ an attorney to represent them are much more
likely to win than those who go unrepresented. 14
15. What do I do if Social Security denies my claim for Social Security disability benefits?
First, do not be surprised. Only about 40% of Social Security disability claims are approved at
the initial level. If you are denied at the initial level, unless you have already returned to work or
expect to return to work in the near future, you should appeal, that is, file a request for
reconsideration. You should also consider employing an attorney to represent you. 15
4

16. Why does Social Security turn down so many claims for disability benefits?
There is no simple answer to this question. One reason is that there is no simple way to
determine whether an individual is disabled. Most people who are disabled suffer from pain.
There is no way of determining whether or not another individual is in pain, much less how
much pain they are in. A second reason is that Social Security over the years has been more
concerned with making sure that everyone who is receiving Social Security disability benefits is
"truly" disabled than with making sure that everyone who is disabled receives Social Security
disability benefits. An underlying reason is that Congress has always believed that, given a
chance, many people will "fake" disability in order to get benefits. 16
17. If Social Security denies my claim, can I appeal it?
When a claim for Social Security disability benefits is denied at the initial level, the claimant
may then request "reconsideration" of that decision. The case is then sent to a different disability
examiner for a new decision. Unfortunately, about 80% of the time the reconsideration decision
is the same as the initial decision - a denial. 17
18. Who makes the reconsideration determination?
A disability examiner at the Disability Determination section makes the reconsideration
determination. Most of the time, the claimant does not see the disability examiner or even know
his or her name. 18
19. What are my chances of winning at reconsideration?
Statistically about 20% of the time a claimant wins at reconsideration.19
20. Do I have to go through reconsideration?
If want to appeal a denial of Social Security disability benefits, you have to go through
reconsideration. There is no way to avoid it.20
21. What happens if Social Security denies my claim at reconsideration?
If Social Security denies your claim at the reconsideration phase, you may request a hearing
before an administrative law judge (ALJ). You cannot request a hearing until after having been
denied at the reconsideration phase.21
22. How long does it take to get a hearing on a Social Security disability claim?
There is much variation around the country. In California, the wait can be 6-9 months.
23. What is the Social Security hearing like?
The hearings are fairly informal. The only people likely to be there are the judge, a secretary
operating a tape recorder, the claimant, the claimant's attorney, and anyone else the claimant has
brought with him or her. In some cases, the Administrative Law Judge has a medical doctor or
vocational expert present to testify at the hearing. There is no jury nor are there any spectators at
the hearing. There is no attorney at the hearing representing Social Security trying to get the
judge to deny the disability claim. 22
5

24. What are my chances of winning at a hearing?
Statistically, over half of the claimants who have a Social Security disability hearing win.
25. If the Administrative Law Judge denies my claim, can I appeal any more?
Yes. You can appeal to the Appeals Council which is still within Social Security.
26. What is the Appeals Council?
The Appeals Council exists to review Administrative Law Judge decisions. The Appeals Council
is located in Falls Church, Virginia, and neither the claimant nor the attorney sees the people at
the Appeals Council who are working on the case. 23
27. Can I appeal a case beyond Social Security to the Federal Courts?
Yes. After being denied by the Appeals Council, it is possible for a claimant to file a civil action
in the United States District Court, requesting review of Social Security's decision. A Social
Security disability claim can go all the way to the Supreme Court. Perhaps once every year or
two years, the United States Supreme Court actually hears an appeal about a Social Security
disability case. 24
28. If I get on Social Security disability benefits and get to feeling better and want to
return to work, can I return to work?
Certainly you can return to work. Social Security wants individuals drawing disability benefits to
return to work and gives them every encouragement to do so. For persons receiving Disability
Insurance Benefits, Disabled Widow's and Widower's Benefits, and Disabled Adult Child
Benefits, full benefits may continue for a year after an individual returns to work. Even
thereafter, an individual who has to stop work in the following three years can get back on Social
Security disability benefits immediately without having to file a new claim. In SSI cases, things
work differently, but there is still a strong encouragement to return to work. 25
29. Where can I go to get help with my Social Security disability claim?
For help, go to a lawyer or legal advocate who represents Social Security disability claimants on
a regular basis. See page 45 for a list of agencies that may be able to help you.
30. Do I really have to hire a lawyer to represent me in my Social Security disability
claim?
No. You can go through all of the levels of review on your own, if you wish, but statistically
claimants who are represented by an attorney win a good deal more often than those who are not
represented.
31. How do lawyers who represent Social Security disability claimants get paid?
In almost all cases, the attorney receives one-quarter of the back benefits if the claimant wins
and no fee if the claimant loses.
32. What if I can’t find an attorney to represent me?
6

If you cannot find an attorney to assist you, you should try to find somebody who can advocate
effectively on your behalf. Ideally, you should find someone who can communicate effectively
in both writing and speaking. The person who advocates for you should also be able to deal with
considerable amounts of paperwork.
33. Can alcoholics and drug addicts get Social Security disability benefits?
Not anymore. There never were all that many people getting Social Security disability benefits
on account of alcoholism or drug addiction, but Congress has now prohibited Social Security
from paying disability benefits on the basis of alcoholism or drug addiction. However, alcoholics
and drug addicts have heart attacks, get cancer or get sick in other ways just like everyone else.
Alcoholics and drug addicts who become disabled apart from their alcoholism or drug addiction
can become eligible for Social Security disability benefits. 26
34. I know someone who is on Social Security disability and he does not look a bit disabled.
Why do they put all of these freeloaders on benefits?
When it comes to disability, looks can be very deceiving. There are many people who look quite
healthy but who are disabled by anyone's standard. For instance, many individuals who suffer
from very severe psychiatric illness are physically healthy and able to do things such as mow
their yards. 27
35. I am disabled, but I have never worked for wages. Can I get Social Security
disability benefits?
If you are poor enough, you can qualify for Supplemental Security Income (SSI) if you are
disabled, even if you have never worked in the past. It is also possible to qualify for Disabled
Adult Child Benefits on the account of a parent if you became disabled before age 22 or for
disabled widow's or widower's benefits on the account of a late husband or wife. 28
36. I am a widow. I have not worked for wages in many years. I am disabled. Can I get
Social Security disability benefits?
If you are over 50 and became disabled within seven years after your husband or wife died or
within seven years after you last drew mother's or father's benefits from Social Security, you can
get Disabled Widow's or Widower's Benefits. Perhaps more important, if you are poor, you can
draw Supplemental Security Income benefits no matter what age you are or when you became
disabled. 29
37. I have a daughter who is disabled and unable to work. Can she get disability benefits
from Social Security?
Very possibly. If the child is under 18 and you are poor enough, the child may qualify for SSI
child's disability benefits. If the child is over 18, she may qualify for SSI disability benefits
without regard to the income of her parents. If her father or mother is drawing Social Security
benefits of some type or is deceased, the child may be eligible for disabled adult child benefits. 30
38. My doctor says I am disabled so why is Social Security denying my Social Security
7

disability claim?
Social Security's position is that it is not up to your doctor to determine whether or not you are
disabled. It is up to them and they will make their own decision regardless of what your doctor
thinks. 31
39. The Veteran’s Administration (VA) says I am disabled, so why is Social Security
denying my Social Security disability claim?
It is Social Security's position that VA decisions are not binding upon them. Social Security and
VA have very different standards for approving disability claims. 32
40. I am 60% disabled. Do I get 60% of my Social Security disability benefits?
No. There are no percentages of disability in Social Security disability determination. For
purposes of Social Security disability benefits, you are either disabled or not disabled. There are
no percentages of disability, nor any percentages of disability benefits. 33
41. Will it help if I ask my Congressional Representative to help me get Social Security
disability benefits?
Many Social Security disability claimants become frustrated with claim delays and eventually
ask their U.S. Representative or Senator to help. The local Congressional office typically will
have staffers who are experienced with Social Security procedures and personnel. A
“Congressional Inquiry,” as it is called at Social Security, may help to get a stalled process
moving again. Note that the inquiry will have no impact on how Social Security decides the
outcome of the case. 34
42. How long does it take before Social Security makes a decision once I file a claim for
Social Security disability benefits?
In most cases Social Security makes the first decision within three to four months.
43. How long does it take for Social Security to make a reconsideration determination on
my Social Security disability claim?
In most case Social Security makes the reconsideration determination within four months.
44. How long does it take for Social Security to act upon a request for Appeals Council
review?
About a year, maybe longer.
45. I am disabled. I need help with medical bills even more than I need a cash income. How
do I get help with medical bills?
Getting help with medical bills is usually tied up with getting cash benefits. You don't start
getting help with medical bills until after you start getting the cash benefits, so you have to keep
going with the Social Security disability claim in order to get the help with medical bills. 35
8

46. What is the difference between Medicare and Medicaid?
The short answer is that Medicaid is a poverty program and Medicare isn't. Many disabled
people get Medicaid because they are on Supplemental Security Income (SSI). This is called
“categorical” Medicaid eligibility. To get SSI and thereby get Medicaid you have to be poor and
disabled. Medicaid pays doctors at very low rates. People who have only Medicaid can have a
hard time finding doctors willing to take them on as patients. Medicaid does pay for prescription
medications. Medicaid can go back up to three months prior to the date of a Medicaid claim.
Note: it is possible to apply for Medicaid directly - through a local Medicaid office - without
having a companion claim for SSI. 36
To receive Medicare it does not matter whether you are rich or poor. If you have been on
Disability Insurance Benefits, Disabled Widows or Widowers Benefits or Disabled Adult Child
Benefits for 24 months you qualify for Medicare. Medicare pays doctors at a higher rate than
Medicaid. Almost all doctors are happy to take Medicare patients. Medicare does not begin until
after a person has been on cash disability benefits for two years, and that it generally does not
pay for prescription medications.
47. If I get Social Security disability benefits will I get Medicare?
If you are approved for any kind of Social Security disability benefit (other than SSI) you will
get Medicare after you have been entitled to Social Security disability benefits for two years. 37
48. If I get Social Security disability benefits will I get Medicaid?
If you are approved for SSI you will get Medicaid. It is possible to get both Medicare and
Medicaid if you are entitled to SSI and some other type of Social Security disability benefit. 38
49. My child is disabled. Does s/he qualify for SSI benefits?
Children under age 18 can qualify for SSI if they meet the definition of disability and their
income and resources are within the allowed limits.
50. Does where I live affect how much SSI I get?
Yes it can. If you live in your own house or apartment, regardless of whether you own or rent,
you may get up to the maximum SSI amount payable in your state.
You can also get up to the maximum if you live in someone else’s household as long as you pay
your food and shelter costs. However, if you live in someone else’s household and don’t pay
your food and shelter costs or pay only part of your food and shelter costs, your SSI benefit may
be reduced by up to one-third. See the chart on page 39.
51. Do my living expenses affect my SSI benefit?
Generally, they don’t. Your SSI benefit depends on your income - not on your expenses.
However, if someone else helps you pay your living expenses, your benefits could be lowered
52. What if someone else helps pay my living expenses?
Any food, clothing, or shelter you get from someone else and don’t pay for may reduce your SSI
9

benefits. However, your benefits will not be reduced if these items are provided by a spouse you
live with, or, if you are a child, by your parents with whom you live.
There is a limit on how much SSA may count. The limit is about one third of the maximum
federal SSI amount payable for that month. Items you receive that cannot be used for food,
clothing or shelter are not considered income and therefore, will not reduce your SSI benefit.
For example, if someone buys you a household or personal item, such as a small kitchen
appliance or a piece of jewelry of modest value, it is not income and will not reduce your SSI
benefit.39
53. What about people in institutions?
Generally, people who live in institutions such as hospitals, nursing homes, prisons, or jails are
not eligible for SSI or are only eligible for a maximum of $30 a month (some states supplement
this $30 payment).40
54. What about the homeless?
Having a permanent residence is not a requirement for receiving SSI. If you are homeless, you
may receive up to maximum SSI amount payable in your state. In addition, receiving SSI may
allow you get to permanent housing.
If you live in a public shelter, you can receive SSI benefits for up to 6 months out of any 9
months that you live there.41
55. Under what circumstances can a Non-Citizen be eligible for SSI?
A non-citizen may be eligible for SSI if he or she meets the requirements of the laws for
noncitizens that went into effect on August 22, 1996. In general, beginning August 22, 1996,
most non-citizens must meet two requirements to be potentially eligible for SSI:
1. Be in a qualified category (see question 56 below); and
2. Meet a condition that allows qualified non-citizens to get SSI
A non-citizen must also meet all of the other requirements for SSI eligibility including the limits
on income and resources.42
56. Who is a Qualified Non-Citizen?
There are 8 categories. You are qualified if the INS (now the Department of Homeland Security)
says you are in one of the following categories:
1. Lawfully Admitted for Permanent Residence (LAPR) in the US, including “Amerasian
immigrant;”
2. Granted conditional entry under section 203(a)(7) of the Immigration and Nationality Act
(INA) as in effect before 4/1/1980;
3. Paroled into the U.S. under section 212(d)(5) of the INA for a period of at least one year;
10

4. Refugee admitted to the U.S. under section 207 of the INA;
5. Granted Asylum under Section 208 of the INA;
6. Deportation is being withheld under section 243(h) of the INA as in effect before 4/1/97,
or removal is withheld under 241(b)(3) of the INA;
7. Cuban and Haitian entrant under section 510(e) of the refugee Education Assistance Act
of 1980; or
8. Under certain circumstances, you, your child, or your parent has been subjected to battery
or extreme cruelty.43
57. Under what conditions may a Qualified Non-Citizen be eligible for SSI?
If you are in one of the above 8 categories, you may be eligible for SSI if you also meet one of
the following conditions:
A. You were receiving SSI on 8/22/96 and you are lawfully residing in the U.S.;
B. You are a LAPR with 40 qualifying quarters of work;
1. Work done by your spouse or parent may also count toward the 40 quarters of
work, but only for getting SSI.
2. Quarters of work earned after 12/31/96 cannot be counted if you your spouse, or your
parent who worked received certain benefits from the US government based on limited
income and resources during that period.
IMPORTANT: If you entered the U.S. for the first time on or after 8/22/96, then you
may not be eligible for SSI for the first five years as a LAPR even if you have 40
qualifying quarters or earnings
C. You were lawfully residing in the U.S. on 8/22/96 and you are blind;
D. You may receive SSI for a maximum of seven years from the date INS (now, the
Department of Homeland Security) granted you a status in one of the following categories,
and the status was granted within seven years of
applying for SSI:
1. refugee under Section 207 of the INA;
2. asylee under section 208 of the INA;
3. non-citizen whose deportation was withheld under section 243(h) of the INA or whose
removal is withheld under section 241(b)(3) of the INA;
4. Amerasian immigrant, under section 583 of the Foreign Operations, Export
Financing, and Related Programs Appropriations Act of 1988, as amended.
11

IMPORTANT: You may be eligible for SSI beyond the seven year period if you are in
one of these categories, and you also meet one of the above conditions.44
58. Am I eligible for Food Stamps or public assistance if I receive SSI/SSDI?
In California, no. However you may be able to receive food stamps or other public assistance
while your SSI/SSDI benefit application is pending, if your application for SSI benefits is
denied, or if you move to another state.45

III. INCARCERATION AND SSI
This section gives you an overview of how incarceration affects SSI/SSDI. This information is
courtesy of the Bazelon Center for Mental Health Law. It was originally published in their
advocacy manual entitled Finding the Key: An Explanation of Federal Medicaid and Disability
Program Rules, which is available on their website http:// www.bazelon.org/findingthekey.html

WHEN PRISONERS LOSE SSI
People who have been getting SSI or SSDI payments when arrested cannot receive benefits
while in jail. But whether and how they remain eligible when released varies.
Generally, the length of time a person is in jail determines whether, or when, federal SSI benefits
will be affected. The monthly payments are nearly always interrupted while someone is in jail,
but benefits are payable up until the time of incarceration and sometimes a little longer, and can
resume shortly thereafter, as long as the person has been in jail less than a year (see box on page
15).
When incarceration is for less than 12 consecutive months, the federal Social Security
Administration (SSA) considers this a "suspension" and payments should resume soon after the
person leaves jail-as long as SSA is informed of the release and the person submits a simple form
with evidence showing that he or she again meets the financial requirements.46 SSA presumes
that these individuals remain disabled under federal rules.
To complete this reapplication process, the Social Security office must be able to verify that the
person has been released. Families, community mental health workers or jail administrators can
assist people in this situation by making sure SSA is alerted to the need to resume benefits and
told where to send the checks.
People who have been incarcerated for a year or more and have had their benefits suspended for
at least 12 months must file a completely new application for SSI upon their release. They will
have to show that they are still disabled under the eligibility standards (see box on next page).

HOW TIME IN JAIL AFFECTS ELIGIBILITY FOR SSI
In jail less than one calendar month: Prisoner remains eligible for SSI and should receive
the full cash benefit. For example, someone who enters jail on February 10 and is released
before midnight March 31 should lose no cash payments.
In jail throughout a calendar month: Prisoner will have SSI payments suspended but not
terminated47. This means that an person who is in jail on the first of the month and stays the
whole month is not eligible for a cash payment for that month.
For example, someone who enters jail on February 10 and is not released until April 1 will not
lose February's payment (not being in jail for the whole month) but will lose the March
payment.
In jail at least one month and then released after the first of another month: Prisoner can
receive an SSI cash payment for part of the month in which he or she is released.48 For
example, someone who enters jail on February 10 and is released May 15 the same year will
not lose the February payment, but will lose March and April benefits. In May, the person will
be eligible for half of the monthly benefit. While this will be paid eventually, it could be
delayed if the Social Security Administration (SSA) is not informed promptly that the
individual has been released.
In jail for 12 consecutive calendar months: Prisoner's eligibility is terminated.49
Technically, termination occurs after 12 continuous months of suspension. Only full months
count.
For example, someone who enters jail on February 1st of one year and is released on February
10th the following year will have SSI eligibility terminated because benefits were suspended
for 12 continuous months. This person will have to file a new application and resubmit
evidence of disability. But someone who enters jail on February 10th of one year and is
released on February 10 a year later has benefits suspended for March through January and
prorated for February of the second year. This person's eligibility will not be terminated
because benefits were not suspended for 12 continuous months.

WHEN PRISONERS LOSE SSDI
People who qualify for SSDI remain eligible as long as they meet the federal definition of
disability. SSDI benefits are suspended following a conviction and confinement in jail for 30
days or longer. But SSDI benefits are not terminated, no matter how long the term. However,
Social Security must verify that the person is no longer in a correctional facility before payments
can resume. Specifically:
1. SSDI benefits are suspended if someone has been convicted and confined in jail longer

than 30 days, w

2. SSDI benefits are suspended for any 30 day period during which an individual is
confined in a jail or prison in connection with a verdict of not guilty by reason of insanity

or guilty but in

3. SSDI benefits what were already payed are recovered. For example, someone arrested on
the fifth of the month who has already cashed that month’s check will have future checks
reduced until the benefits paid for that month are recovered.
Federal rules on payment of SSDI benefits to prisoners were different for people incarcerated
before April 1, 2000.52 The above description applies to everyone incarcerated since that date.
A worker’s dependents, such as spouse or child, sometimes receive SSDI. Those payments are
not suspended or terminated when the worker is in jail and they continue even when the worker
loses benefits.53
QUALIFYING FOR SSI OR SSDI UPON RELEASE
Prisoners not receiving benefits when sent to jail can apply for SSI or SSDI while incarcerated,
in anticipation of their release. They usually need assistance, however, to obtain the appropriate
forms and gather the necessary evidence.
Normally, review of an application takes about three months, so a prisoner should apply as long
as possible before the release date.
SSA will assess eligibility based on the application. If it is approved before the prisoner's release,
payments will begin as of the first day of the calendar month following release.54 If the
application is approved after the prisoner is released, benefits are payable at that time, and SSI
(but not SSDI) benefits are backdated to the first day of the month following release.
An individual with a severe mental illness may also qualify for advance emergency payments.
To be eligible, people must demonstrate:
- a financial emergency;
- that they are likely to qualify for assistance; and
- that they have not already received assistance for that benefit period.

WHY BENEFITS ARE LOST AND WHAT CAN BE DONE ABOUT IT
Jails and prisons have an incentive to inform SSA that a person is confined; they receive federal
payments when they supply information resulting in suspension or termination of SSI or SSDI
benefits. But they have no such incentive to advise SSA when someone is released so that
benefits can be restored.
Jails and prisons can enter into agreements with SSA to provide monthly reports of prisoners’'
names, Social Security numbers, dates of birth, confinement dates and other information. The
institution receives $400 when this information is sent within 30 days of the prisoner's arrival
and $200 if it is sent within 90 days.55
Jails, prisons and hospitals can also enter into pre-release agreements with the local Social
Security office, which will help their staff learn the rules for pre-release processing of
applications and reapplications for SSI .56 When such an agreement exists, SSA processes
claims more quickly, prisoners have assistance in gathering the information needed to support
their application, and benefits are often payable immediately upon release or shortly thereafter.
PRE-RELEASE AGREEMENTS
Jails agree to: notify SSA of prisoners likely to meet SSI criteria who will be released within
the next 30 days; provide to SSA current medical evidence and nonmedical information that
may support the prisoner's claim; provide to SSA the anticipated release date and notify SSA
if that changes; and notify SSA when the prisoner is actually released.
SSA agrees to train jail staff about SSI rules and work with them to ensure that the application
procedures work smoothly; provide a contact person at Social Security to assist jail staff with
the pre-release procedure; process reapplications and new applications as quickly as possible;
and promptly notify the jail of the decision on the released prisoner's eligibility.
HEALTH CARE COVERAGE
Medicare and Medicaid are two sources of health coverage. People eligible for SSDI (and those
over age 65) are covered by Medicare, after a 24-month wait. Low-income individuals qualify
for Medicaid in various ways; in most states anyone who qualifies for SSI is covered. Medicaid
provides better mental health care coverage than Medicare.
MEDICAID
Medicaid is a joint federal-state program. To qualify, a person must fall into one of several
eligibility categories. Once eligible, the individual is covered by a package of services defined
by the state under broad federal requirements. Federal law requires some services to be available,
such as physician services and general hospital care. Others are offered at state option-among
them, various community-based mental health clinic and rehabilitative services. As a result,
Medicaid coverage varies from state to state. However, all states cover a significant array of
mental health services for people with severe mental illnesses.
16

Most prisoners with severe mental illnesses have incomes below the Medicaid limit and may
therefore be eligible for coverage. In California, their eligibility for SSI is what qualifies them
for Medicaid.
Some low-income individuals do not receive SSI or SSDI disability benefits, either because their
disability is not severe enough to meet strict federal standards or because they have not applied.
But they may still be eligible for Medicaid.
Currently, California covers people who become "medically needy" when their income is
reduced by high health care expenses.
MEDICAID RULES ON PRISONERS
Under Medicaid law, states do not receive federal matching funds for services provided to
individuals in jail or prison.57 However, federal law does not require states to terminate
prisoners' eligibility, and prisoners may remain on the Medicaid rolls even though services
received while incarcerated are not covered.58 Accordingly, someone who had a Medicaid card
when incarcerated may be able to use it again immediately after release to obtain needed services
and medication.
However, the situation for prisoners who qualify for Medicaid through their eligibility for SSI
can be complicated. Everyone whose SSI eligibility is terminated will lose Medicaid. When SSI
benefits are suspended due to incarceration, states have the option to - and generally do terminate a prisoner's Medicaid eligibility.
When a prisoner's Medicaid eligibility is not tied to SSI, the state has the flexibility under federal
law to suspend the eligibility status during incarceration. But the federal Medicaid rules establish
only minimum requirements, while states are permitted to impose more restrictive policies.
Under federal rules, eligibility should be reinstated upon release unless the person is no longer
eligible (see box on next page). Before ending someone's Medicaid eligibility, states must make
a redetermination of the person's potential for qualifying under all the state's eligibility
categories.59 This redetermination need not be conducted until release is imminent, but if the
released prisoner still meets the state's eligibility standards for Medicaid, eligibility should not be
ended. Regrettably, this redetermination often does not occur.
Even prisoners who keep their Medicaid eligibility may lose Medicaid coverage unnecessarily
because of procedures in correctional facilities. Something as simple as the loss of a Medicaid
card following arrest can make it impossible to obtain mental health services from Medicaid
providers upon release. This often happens because jails and prisons take possession of all
personal property when booking a person. In many jurisdictions, this property is destroyed if it is
not claimed within a certain time. Prisoners cannot claim the property themselves and if they
have no one to do it for them, their Medicaid card is destroyed.
There is one exception to the rule that no Medicaid reimbursement is available for prisoners.
When someone is transferred from a correctional facility to a hospital for acute health services
(for example, an appendectomy), the hospital can claim federal Medicaid reimbursement for this
service. Also, if a person is in an institution temporarily pending "other arrangements appropriate
17

to his needs," services may remain Medicaid-reimbursable.60
FEDERAL RULES ON MEDICAID REINSTATEMENT
Prisoners can have their Medicaid suspended.
Upon release, federal policy requires that their benefits resume.
Many individuals will be incarcerated for so long that their Medicaid benefits will have been
suspended for longer than the state's customary period of time after which a redetermination of
eligibility is conducted (time varies by state). The state will reassess whether these prisoners
remain eligible for Medicaid. However, this assessment should be conducted prior to release
because, under federal policy, a state may not drop someone from Medicaid without
determining whether or not the person can qualify under any of the state's eligibility
categories.61
States are permitted to use simplified procedures for redetermining the eligibility of
individuals who have been incarcerated, according to federal HCFA officials.62 Regardless of
the simplified procedures used, unless a state has determined that an individual is no longer
eligible for Medicaid, states must ensure that incarcerated individuals are returned to the rolls
immediately upon release. Thus, allowing individuals to go directly to a Medicaid provider
and demonstrate his/her Medicaid eligibility.63

COVERAGE AFTER RELEASE
When Medicaid eligibility is linked to SSI, a person may have to jump through many
administrative hoops before Medicaid benefits resume, depending on state policy and
administrative procedures. For example, a former prisoner may have to visit the local SSA and
state Medicaid offices to confirm that he or she has been released and complete other
administrative paperwork. As a result, people on SSI may have no health care coverage during
the time between their release from jail/prison and reinstatement of their SSI payments (normally
at least one or two weeks).
One way services can be covered immediately after someone is released from jail/prison is for
the state to continue the person's Medicaid eligibility pending reinstatement on SSI, which will
in turn restore federal Medicaid eligibility. Once the individual's SSI is reinstated, the federal
government will provide retroactive reimbursement for Medicaid-covered services furnished for
up to three months after the person was released. This means that even though federal dollars
may not be available immediately for services provided after release to former prisoners whose
Medicaid eligibility is tied to SSI, nearly all of these individuals will eventually be covered.
Providers can be paid by the state and the state will eventually receive federal funds. The state
will remain fully liable only for services to the very few individuals who are not found reeligible for SSI and Medicaid.
18

MEDICARE
Medicare coverage is also suspended when someone is incarcerated. It will not resume until the
persons’s SSDI payments resume. For more information on Medicare, call 1-800-MEDICARE
(1-800-633-4227)

IV. INITIAL APPLICATION
64

A. OVERVIEW OF THE INITIAL APPLICATION PHASE

This application process can be rather long and involved, but this manual will work with you
through the process and try to assist you with the relevant issues that may arise.
The initial application stage for SSI/SSDI begins when you meet your client and help him or her
fill out the initial application forms. These forms should be submitted at the Local Social
Security District Office. To find out which office is closest to you, see page 38.
After the forms are received and reviewed by a claims representative at the District Office, the
file is sent to the Disability and Adult Programs Division (DAPD), for disability eligibility
evaluation.
At the DAPD the file is assigned to a disability analyst. This analyst's assignment is to gather
and evaluate information regarding the claimant's disability. The analyst should request medical
records from the sources listed by the claimant in the initial application forms.
You can obtain the name and phone number of the analyst assigned to your client's case by
calling Master Files at the DAPD.
As an advocate, you should request medical records from your client's medical sources. Often,
the analyst is not able to obtain complete records for the claimant, thus it is important for the
advocate to gather all of these records, and eventually send them to the analyst. See page 40 for
a sample letter to the “treating physician.”
It is a good idea to contact the analyst and introduce yourself. Tell the analyst that you are:
• working with the claimant
• will help gather medical records
• a contact person for the claimant
Basically, it is a good idea to let the analyst know that you are working on the case too, and try
to develop a good working relationship with him or her.
Often times, comprehensive medical documentation does not exist for your client. This is
particularly true for clients who are homeless. In these instances, analysts will purchase
consultative examinations (CEs) for claimants.
In many instances, especially in the case of psychological CE, you may want to avoid having
your client see these doctors. This is because these doctors often do not see clients for the
appropriate time required for such examinations. Many psychological CEs last between 10-15
minutes, and seem to invariably find that our clients are able to work.
The best source of information on your client is your client's treating doctor. If your client has
such a doctor, request a report from him or her. Send this doctor a report request letter, and a
1002 form. The 1002 form is what the DAPD gives to doctors to fill out, regarding the claimant's
disability. Send the doctor the appropriate form based on your client's disability.
If your client does not have a treating doctor, try to arrange for an evaluation through a volunteer
or county doctor.
20

If you are unable to obtain an evaluation this way, then you have no choice but to have your
client attend a CE. You should note that you, or your client, can object to a particular
consultative examiner.
If your client goes to a CE, make sure to monitor and document for how long the CE lasts, as
well as the quality of the CE.
If you think the CE was of low quality, was conducted cursorily, or have any other objections,
write to the Public Relations Specialist (PRS) at the appropriate DAPD Branch. Individual
complaints to the PRS are taken seriously and can lead to an investigation of these examiners. It
is imperative though, that this complaint be received soon after the CE takes place, while the file
is still at the DAPD.
You should also send a Third Party Questionnaire to someone who knows the claimant and
understands his or her disability, and the way it affects the person’s daily activities. If the
claimant has no friends or family who are willing or able to do this, you can fill out this
questionnaire or the Community Outreach Questionnaire. Make sure to comment on how the
claimant's activities of daily living are affected by his or her disabling condition.
Once you have gathered all available medical information, you are ready to write a persuasive
letter to your client's analyst, explaining why the client's disability meets the requirements of
permanent disability. You should consider using the five step evaluation process. Analysts use
this evaluation process to determine if claimants are disabled. See section D, Initial Application:
Persuasive Letter, on page 29 for an overview of the five step evaluation process.
If throughout the process you have any problems and are unable to resolve them with the analyst,
talk to the analyst's supervisor, the Team Manager. If you cannot work with the Team Manager,
talk to the Case Adjudications Bureau Chief- keep going up the ladder until your client's needs
are met.
Once your client's disability has been evaluated, the file is sent back to the District Office.
If your client was found disabled, the next step is to go to the District Office for a final meeting.
You should both receive a notice in the mail to do so.
If your client was found not disabled, s/he will receive a denial letter. You have sixty days to file
for a reconsideration.

B. INITIAL APPLICATION: FORMS65
When beginning the application process, it is important to fill out the following forms. All are
available from SSA.

1. APPOINTMENT OF REPRESENTATIVE FORM
This form informs the SSA that you are officially working with the claimant as his or her legal
representative. This form should be submitted with the application forms. It is important to have
this form on file, as it should insure that all copies of notices are sent to both you and the
claimant.
21

2. DISABILITY REPORT
This form is the first chance for the claimant to explain his or her disability. This form is critical
to the client's application and should be filled out carefully.
Some particularly important questions for this form are:
What is your disabling condition? It is important to list all of your client's impairments in this
section, including all mental and physical impairments.
To help you uncover hidden mental disabilities, ask your client some questions:
•
Do you have trouble sleeping?
•
Do you have trouble concentrating?
•
Have you ever been hospitalized without your consent?
•
Have you ever had bad nerves? What was that like?
Information about your Medical Records.
Be sure to list the names, addresses, and phone numbers of the client's doctors and
hospitalizations. Analysts will only contact the sources listed in this section for medical
evidence, so it is crucial that this section be as complete as possible.
Information about your Activities
This section of the form provides an opportunity to describe the extent of your client's disability,
and how it affects daily functioning. It is important to emphasize the actual limitations faced by
the client.
Information about the work you did. Talk to your client carefully to understand exactly how
his or her ability to work changed as his or her condition became more and more disabling.
Remarks.
In this section, you may include clarifying comments about work history, failed work attempts,
or the fact that the client needed your help in filling out the form.
Only use this form if your client has a substantial work history in the previous 15 years.
When describing the kind of physical activity required at the previous job, always include the
most strenuous work done.
Include failed work attempts in this section.
3. RELEASE FORMS
It is important to send release forms to doctors or hospitals so that you may receive medical
evidence regarding your client. A release form is anything in which the applicant gives
permission for his/her medical records to be released to the advocate.
4. DAILY QUESTIONNAIRE FORM
This is the most common form that DAPD sends to clients.
Ask questions so you get as much detail as possible. Paint a picture for the analyst to show what
22

this client's life is like. Specific examples are best. For example: I cannot cook because I often
have so much trouble remembering things that I forget to turn the stove off; I never answer my
telephone because I am afraid of who will be on the line; I do not go shopping because I cannot
lift any heavy bags.
5. THIRD PARTY QUESTIONNAIRE FORM
This form should be filled out by the claimant's family or friends - someone who understands the
claimant's disability and how his or her condition affects daily living.
This questionnaire tries to assess the client's functional limitations.
Again, ask questions so you get as much detail as possible. Paint a picture for the analyst to show
what this client's life is like. Specific examples are best. For example: She does not have any
friends because she constantly gets into fights and alienates people; she does not sleep through
the nights because she is awakened by panic attacks; he cannot use public transportation because
he cannot be in enclosed spaces around so many people.
6. COMMUNITY OUTREACH FORM
You or someone at your agency can fill out this form. It is similar to a Third Party Questionnaire,
and asks you about your interactions with the claimant.
Include details. Paint a picture for the analyst to show what the client's life is like. Specific
examples are best, e.g. it took us several hours to fill out the Disability Report because she had so
much trouble focusing, and became so fixated on trying to remember details that she just could
not remember.

TIPS FOR FILLING OUT THIRD PARTY QUESTIONNAIRE AND
COMMUNITY OUTREACH FORMS
Following are some general tips for the letter writer supporting a claimant’s application for SSI
benefits. These tips are directed to the letter writer; the “claimant” is the person applying for
benefits.
What is Useful66
Do not feel that you have to write about every subject area described below. Write about what you
know. If the claimant is not having problems in certain areas (for example, mental or emotional
functioning) or you do not really know the claimant well enough to comment, do not discuss that
area. Keep your letter to the point - the longer and more difficult it is to read the less likely it will
get read. Along these lines, it's best if you can type the letter. If not, write in clear handwriting to
the best of your ability. Do not worry about spelling or grammar. Use your language, do not try to
use formal or legal language. Make sure you sign and date your letter.
1. Write the letter in your own words simply describing the claimant's life based on what you
personally observe, not on what others have told you.
2. Explain your relationship to the claimant, how long you've known him or her, and how
often you get to see or talk with him or her.
23

3. Important principles to follow: Tell the truth. Don't exaggerate, but don't minimize the
claimant's difficulties. Write from personal knowledge -- your own observations. Provide
relevant details and examples but don't ramble.
4. If you have known the claimant for a long time, describe how the claimant has changed
since becoming ill or disabled, describing his or her life both before and after the disability
began. In particular, give specific examples of activities or tasks the claimant used to do but
which he or she can no longer perform or can do only with assistance, breaks, etc.
5. Describe the limitations you have observed in the claimant's ability to engage in everyday
activities such as running errands, cleaning house, cooking, shopping, engaging in projects or
hobbies. Examples of limitations may be the need to take frequent breaks and rest; the onset
of pain or other symptoms that require stopping an activity; the inability to lift objects over a
certain weight, etc. Remember these are just examples - write about the limitations that you
have actually observed.
6. If the claimant has limited his or her activities significantly to avoid symptoms, describe
how limited the activities are and contrast this with how the claimant was before he or she
became ill.
7. If the claimant has a physical disability, describe difficulties you've observed with sitting,
standing, walking, lifting, bending, etc.
8. If you or someone else help the claimant, write about what help is needed, how often it is
needed and how long this kind of assistance has been necessary.
9. If the claimant has developed depression or has other mental or emotional difficulties (even
if they are the result of his or her physical symptoms) describe the difficulties you have
observed in his or her ability to understand, remember and carry out instructions, concentrate
and maintain attention, or to respond appropriately to others in a social or work setting. Give
specific examples that you have noticed.
10. If fatigue, sleeplessness, pain or depression is involved, you may have noticed difficulty
concentrating, loss of concentration or attention, forgetfulness, a quick temper, avoidance of
other people, crying spells, or poor stress tolerance. Describe what you have seen and describe
whether you have observed any "trigger" for these symptoms.
11. If the claimant has good days and bad days, describe what the claimant does on a good
day and what he or she does on a bad day. Indicate how often the claimant seems to have a
bad day versus the number of good days.
12. If you know that the claimant had a hard time trying to work, tell about these problems
and how the claimant tried to cope.
What is not Useful67
As long as you tell the truth, write from personal knowledge and don't exaggerate the claimant's
difficulty, there really is nothing you shouldn't say. But here are a few tips:
1. Unless you have a medical background or have some other reason to know about the claimant's
medical condition, don't write about medical issues, for example by giving a medical diagnosis or
stating that the claimant's symptom is caused by a particular medical condition. Leave this for the
24

doctors.
2. Don't try to play to sympathy. Disability is based on the claimant's inability to work, not on
whether the claimant is a nice person or needs money very badly, or has children he or she is
having trouble supporting, etc.
3. Don't write about the claimant's inability to get a job or that nobody would hire the claimant
with his medical history. The only thing that matters is the claimant's ability to perform a job.
4. Don't compare the claimant to others who seem less disabled but get disability benefits. Such
comparisons don't help and may even give the wrong impression.
5. Generally, don't state opinions. State facts based on your observations. Specifically, don't draw
conclusions that the claimant can't work or is disabled. The one exception may be if you are an
employer and in a position in which you can state that as an employer you would not hire the
claimant citing the specific reasons why. Ultimately, however, Social Security makes the decision
about disability, and it will disregard your opinions on the matter. Your personal observations are
much more important.
6. Don't argue the case.

C. INITIAL APPLICATION: MEDICAL RECORDS
1. TREATING DOCTOR’S REPORT REQUEST LETTER
You will need to write a letter to the claimant’s treating doctor.
See page 40 for a sample letter to a treating doctor. Be sure to include the appropriate 1002 form.
Along with the letter, and the form, send the doctor a copy of the Guidelines for Information in
Doctor's report.
Often times it is necessary to call the doctor after the letter is sent out. This doctor's report is
extremely vital to your client's application, so it is important to make this follow-up call.

2. QUESTIONNAIRES FOR DOCTORS (1002 FORMS)
The best source of information on the applicant is the applicant’s treating doctor.
If the applicant has such a doctor, request a report from him or her. Send the doctor a report
request letter, and a 1002 form. The 1002 form is what the DAPD gives to doctors to fill out
regarding the applicant’s disability. Send the doctor the appropriate form based on your client’s
disability.
1002 Forms are available from SSA.
25

There are 13 separate 1002 Forms, each one addressing a different class of disability. They are:
• Muscoloskeletal System
• Special Senses and Speech
• Respiratory System
• Cardiovascular System
• Digestive System
• Gentio-Urinary System
• Hemic and Lymphatic System
• Skin
• Endocrine System and Obesity
• Neurological
• Mental Disorders
• Neoplastic Diseases, Malignant
• Immune System
If you are not sure which one to send, consult the doctor.
3. THE LISTINGS OF IMPAIRMENTS
The Listings of Impairments describes, for each major body system, impairments that are
considered severe enough to prevent a person from doing any gainful activity. The Listings
provide the definitions and perimeters of each impairment. Most of the listed impairments are
permanent or expected to result in death, or a specific statement of duration is made. For all
others, the evidence must show that the impairment has lasted or is expected to last for a
continuous period of at least 12 months. The criteria in the Listings of Impairments are
applicable to evaluation of claims for disability benefits or payments under both SSDI and SSI.68
The criteria in the Listings of Impairments apply only to Step Three of the multi-step sequential
evaluation process (see following section). At that step, the presence of an impairment that meets
the criteria in the Listing of Impairments (or that is of equal severity) is usually sufficient to
establish that an individual who is not working is disabled. However, the absence of a listinglevel impairment does not mean the individual is not disabled. Rather, it merely requires SSA to
move on to the next step of the process.69
In its entirety, the Listings of Impairments is nearly 200 pages long. Its length prohibits us from
including it in this manual. The Listings of Impairments is available online at ssa.gov
The Listings of Impairments is also published in SSA’s Publication Disability Evaluation Under
Social Security. Its publication number is 64-039. This publication is updated every two years.
If you do not have access to the Internet, you may be able to borrow an attorney or advocate’s old
copy. Another option is to contact an attorney or advocate and ask them to photocopy or print the
sections applicable to your situation. See pages 45-48 for a list of attorneys and advocacy
agencies who do SSI work.
26

When arguing your case, either in the written or oral form, it is important to frame the disability
according to the Listings as much as possible. See the sample Persuasive Letter on page 41 for an
example this.

D. INITIAL APPLICATION: PERSUASIVE LETTER
1. OVERVIEW OF WRITING A PERSUASIVE LETTER70
Before writing a persuasive letter to the analyst, you should consider how the medical evidence
points to a finding of disabled.
Consider the five-step sequential evaluation process.
Briefly, the sequential evaluation process is the method used by analysts to determine claimants
are disabled.
Step 1: clients who are homeless or at risk of homelessness, have no trouble meeting this step.
They are not earning substantial gainful activity (SGA). For SSI applicants the SGA limit is $500
per month. For SSDI applicants there is no resource limit. Proceed to step 2.
Step 2: This step asks if the claimant has a severe impairment. The use of 'severe' in this instance
is an overstatement. Any physical or mental impairment (other than a cold or a scar) should
qualify. You can go to step 3.
Step 3: Does the claimant meet or equal the Listings? Here is your client's best opportunity for a
quick and favorable decision. Take a look at the Listings. If the medical evidence demonstrates
that the claimant's disability fulfills the criteria for any one of the Listings, he or she can be found
disabled at the third step of the sequential evaluation process.
If the claimant does not meet or equal the listings, go to step 4.
Step 4: Can the claimant perform past relevant work? This work is the occupation which the
claimant has performed for the longest amount of time. Can he or she perform the physical
activities required for that kind of job (reaching, sitting, bending, standing, lifting, etc.); can he or
she focus and concentrate, follow directions, complete tasks in a timely way, as required by such
a job? If not, go to step 5.
Step 5: This step asks if there is any job existing in significant numbers in the national economy
which the claimant can perform. This step is analyzed based upon the claimant's Residual
Functional Capacity (RFC). The RFC mostly concerns itself with the exertional capabilities of the
claimant to do sedentary, light, medium, heavy, or very heavy work. This step also considers the
claimant's non-exertional limitations (mental RFC), as well as factors such as age, education,
work experience and skills. Take a look at the Grids, this can help you make a fifth step analysis.
27

Write a persuasive letter to the analyst based on your analysis of the sequential evaluation
process.
Advocate for your client. This letter should point to the medical records and questionnaires to
underline how the existing evidence directs a finding of disabled.
See Page 41 for a sample persuasive letter.
2. SAMPLE QUESTIONS TO ASK THE APPLICANT71
These are questions you can ask the applicant to help you paint a better picture of his or her
disability for SSA.
I. About the Disability (These questions are aimed at assessing the severity of the client’s
impairment. The sample questions here are ones you might ask a client who suffers from
anxiety/panic attacks. You would want to tailor these questions to your client’s specific
disability.)
A. What prevents you from being able to work?
B. Do you have anxiety/panic attacks? How often do they occur?
1. Can you give me an example of how anxiety/panic attacks prevent you from
being able to work?
2. What happens to you during an anxiety attack? What are the
emotional/physical manifestations?
3. How long have you had this condition?
4. What would happen to you when you were a child?
5. When was the last time you experienced an anxiety attack? What happened to
you on this occasion? What triggered the anxiety attack?
6. Can you give me another example of one?
7. Have you ever tried to overcome an anxiety attack?
8. How do you cope with these attacks? What do you do when you have a panic
attack?
II. Medical Treatment
A. Are you currently on medication?
B. What does your doctor say about your condition?
C. How often do you see your doctor?
D. How long have you been seeing him/her?
III. Activities (These questions are aimed at assessing how the client’s condition effects his/her
ability to function and engage in simple daily activities. Some relevant questions may also appear
on the Activities of Daily Living questionnaire, so you may want to review this questionnaire
with your client before the hearing.)
A. What do you do on a typical day?
1. What was your day like yesterday?
2. How did your day start?
3. What did you do in the morning?
4. How did you spend your afternoon?
28

5. Do you drive?
6. Do you take public transportation? Why/why not?
B. How do you obtain food/nutrition?
1. Do you go shopping?
2. How often?
3. What do you get?
4. Do find the task easy or difficult? Why?
C. Describe your sleeping habits
1. Do you sleep well or poorly?
2. What disrupts your sleeping? (nightmares, racing thoughts)
3. How often does this occur?
4. What do you do when you find yourself sleeping poorly?
D. How do you live?
1. Do you keep your place clean? Why or why not?
2. Do you maintain your hygiene? Why or why not?
3. Do you go out every day? Why or why not?
IV. Socializing (These questions assess the impact of the client’s disability on his/her ability to
function and interact with others.)
A. Do you have friends? Why? Why not?
B. How often do you see them?
C. Describe your friends.
D. What do you do when you get together with them?
E. What about intimate relationships?
F. Do you have family/friends in the area?
G. How often do you see them? Why?
H. Do you ever have difficulties with people? (For example, some people have
difficulties with others on the street, at the gas station, at the store.)
I. What are your hobbies/favorite activities?
V. Past Work History (These questions will reveal the client’s past work history and the impact
of the client’s disability on his/her ability to work and be in a work environment; may also reveal
how the disability has prevented from engaging in work on a regular basis.)
A. Can you describe the jobs you have performed in the past 15 years? (Starting with the
most recent)
B. What were your job responsibilities?
C. How were you doing on the job? (Were you performing well? If not, why? What parts
of the job were difficult?)
D. How long did you work there?
E. Why did you leave?
VI. Ability to Work
A. Do you think that if you tried, you could go tow work on a regular basis? Why or
why not?
B. What do you think would happen if you went back to work tomorrow?
29

C. Do you think you could perform any of your past jobs? Why or why not?
D. Would you like to work if you could? (Only ask this if your client would like to work
and would be sincere)
VII. Other questions to consider when disability is based on a mental impairment. (These
questions are intended to assess the severity of the client’s disability and to reveal how the
disability limits the client’s ability to concentrate, remember/carry out tasks/ instructions, be
punctual at work, interact well with co-workers, supervisors and the public)
A. How is your appetite?
B. Do you eat regularly?
C. How is your energy level?
D. Do you have any trouble remembering things? Examples of being forgetful? (Forgot
why you went to the store, where you live, why you got on the bus, where you
were going)
E. How is your ability to focus your attention, to concentrate?
F. Sometimes when people are depressed, as you have described yourself, they hear or
see things.
1. Do you ever hear or see things? How often?
2. Have you ever acted on these things?
G. You described yourself as an angry person.
1. Do you ever think about t lashing out at others? How often?
2. What do you think about? Describe your thoughts.
H. Do you feel that you can trust people?
1. Ever feel suspicious of people? How often?
2. Feel that people are following you, talking about you, thinking about hurting
you, out to get you? How often?
3. Have you ever acted based on these thoughts?
I. Do you have trouble sleeping
J. Do you have nightmares?
K. Do you experience flashbacks?
L. What do you do when you have nightmares/flashbacks?

V. RECONSIDERATION
OVERVIEW OF RECONSIDERATION STAGE
If SSA denies an initial claim, the next step is to file a Request for Reconsideration. A Request for
Reconsideration must be filed within 60 days of the date of the denial letter, plus five days for
mailing, giving the claimant a total of 65 days to file. If the Request for Reconsideration is not
filed within the 65 days allotted, Social Security will usually dismiss the claim unless good cause
has been established for the late filing. Once a claim is dismissed, a claimant must start the
process again with a new application, which causes delays and usually decreases the amount of
retroactive benefits payable to the claimant if benefits are eventually granted.
At the reconsideration level, it is the advocate’s job to make sure the paperwork for the initial
Request for Reconsideration is completed accurately and submitted on time and to work with the
decision maker at SSA to make sure the records are complete and that the file is processed
without unnecessary delays.
.
You will use many of the same forms at the reconsideration stage as you did at the initial
application stage. Be sure to include any additional evidence of the applicant’s disability that
you have gathered since the initial application.
Statistically, about 20% of the time a claimant wins at reconsideration. If your client was found
not disabled, s/he will receive a letter of denial of benefits. You and your client then have sixty
days to file for an Administrative Law Judge Hearing.

VI. ADMINISTRATIVE LAW JUDGE HEARING72
If your client’s claim is denied at reconsideration, s/he will receive a notice in the mail.
At this time, you should assist your client in determining whether s/he should appeal the denial
and request a hearing before an Administrative Law Judge (ALJ).
The hearing request must be made 60 days from the date of notice. To request a hearing, you
should fill out two forms:
1. Request for Hearing by ALJ
2. Claimant’s Statement When Request for Hearing is Filed and the issue is Disability
Once the hearing request is made, the file is sent from the Local District Office to the Social
Security Office of Hearings and Appeals. There the case will be assigned to an ALJ.
Your client will be notified of the time and place of the hearing at least 20 days before the hearing
date.
The hearing date may not be set for 6-10 months, from the date of request. Sometimes, it takes
over a year for the hearing to be scheduled.
Usually, the ALJ will be the first decision maker to see the claimant face to face.
The hearings are fairly informal. The only people likely to be there are the judge, a secretary
operating a tape recorder, the claimant, the claimant’s attorney, and anyone else the claimant has
brought with him or her. In some cases, the ALJ has a medical doctor or vocational expert
present to testify at the hearing. There is no jury nor are there any spectators at the hearing.
There is no attorney at the hearing representing Social Security trying to get the judge to deny the
disability claim.
Statistically, over half of the claimants who have a Social Security disability hearing win.
We recommend that you refer your client to an SSI Attorney, who specializes in this kind of
work.
See pages 45-48 for a list of attorneys and agencies that might be able to help.

VII. APPEALS COUNCIL73
If the Administrative Law Judge denies the case at the hearing level, the next and final step of the
administrative process is to file a Request for Review with the Appeals Council. The Request for
Review must be filed within 65 days of the date of the Hearing Decision. At the Appeals Council
level, the attorney will write a brief setting forth the legal reasons why the Judge's decision was
incorrect and should be overturned.
The Appeals Council is currently taking two years to make a decision. In the meantime, a
claimant should generally file a new application with Social Security to attempt to get the benefits
granted while the case is pending at the Appeals Council. Filing a new application will not affect
the pending claim.
The Appeals Council can do one of three things when they make their decision:
1. They can decide that the Administrative Law Judge was wrong and grant benefits
themselves. (This rarely happens); or,
2. They can send the case back to the Administrative Law Judge for another hearing; or,
3. They can deny the claim.

VIII. FEDERAL DISTRICT COURT74
Once a claimant has gone through the whole administrative process with Social Security and has
received a denial at the Appeals Council, the next step is judicial review by the federal district
court. The claimant must file a complaint in the federal court within 65 days of the date of the
Appeals Council denial. The claimant's attorney and the United States Attorney (representing
Social Security) both file briefs, and the Judge makes his or her decision based on the briefs. The
briefs contain a summary of all of the evidence and detailed legal arguments in which each side
states its position. Occasionally, there will be an oral argument in federal court if the Judge finds
it necessary.
The federal court will do one of three things when making its decision:
1. The court can grant the case outright;
2. It can remand the case to Social Security for another hearing; or,
3. It can deny the case.
If the district court denies the case, it can be appealed to the United States Court of Appeals,
which will go through a process similar to that at the district court level.

IX. LOCATING YOUR LOCAL SSA OFFICE
SSA offices are located in every county in California. To find out which one is closest to you,
simply call Social Security’s toll free number 1-800-772-1213. You can call for an appointment
or to speak to a service representative between the hours of 7 a.m. and 7 p.m. on business days.
The lines are busiest early in the week and early in the month so it is best to call at other times.
Whenever you call, have your Social Security number handy.
If you are using a touch tone phone, recorded information and services are available 24 hours a
day, including weekends and holidays.
People who are deaf or hard of hearing may call your toll-free TTY number, 1-800-325-0778,
between 7 a.m. and 7 p.m. on business days.
If you do not have access to a phone, you can write to the SSA headquarters office and they will
be able to direct you to the appropriate local office. The address for SSA headquarters is:
Social Security Administration
Office of Public Inquiries
Windsor Park Building
6401 Security Blvd.
Baltimore, Md. 21235
If you have access to the Internet, you definitely should check out the Social Security
Administration website at http://www.ssa.gov. The site has a wealth of information, including
several handbooks that you can download and print.
If you do not have access to the Internet, write the SSA office you are nearest to or the SSA
headquarters and request the following handbooks:
•
•
•
•
•
•

Social Security Disability Benefits (SSA Publication No. 05-10029)
The Appeals Process (SSA Publication No 05-10041)
Your Right to Representation (SSA Publication No. 05-10075)
A Guide to SSI For Groups And Organizations SSA Publication No. 05-11015)
SSI for Noncitizens (SSA Publication No. 05-11051)
SSI In California (SSA Publication No. 05-11125)

X. WHAT YOU’RE ELIGIBLE FOR IN SSI BENEFITS
INDIVIDUALS

AGED

DISABLED

Independent Living

$750.00

$812.00

Non-Medical Board
and Care

918.00

Independent Living,
No Cooking
Facilities

829.00

Household of
Another

574.00

COUPLES AGED
OR DISABLED
Independent Living

1332.00

Non Medical Board
and Care

1836.00

Independent Living,
No Cooking
Facilities

1490.00

Household of
Another

1091.00

BLIND
Independent Living

1,544.00

Household of
Another

1,304.00

BLIND PERSON
WITH AGED OR
DISABLED
SPOUSE
Independent Living

1,465.00

Household of
Another

1,223.00

BLIND

650.00

XI. SAMPLE LETTERS

A. SAMPLE LETTER TO A TREATING DOCTOR
Date
Doctor’s Name
Address
Re:
SSN:
Dear Dr. L:
Hello, I am an advocate working with Mr. G on his claim for federal disability benefits. One of
the most important aspects of his claim is documentation of Mr. G’s disabilities. Enclosed is an
authorized representative form. As his treating doctor, you are probably most familiar with Mr.
G’s mental health status.
It would be fantastic if you could fill out the enclosed mental status evaluation form. This is the
same form used by the Social Security Administration. I have also enclosed some guidelines that
can help you understand exactly what information they are looking for in assessing Mr. G’s
disability. It is important to comment specifically on his activities of daily living and how long
his disability is expected to last.
Please return the form to me as soon as possible. If you have any questions, please do not hesitate
to contact me at 555-5555. My address is 555 5th Street; my fax number is 333-3333. Thank you
in advance for your help.
Sincerely,

Your name

B. SAMPLE PERSUASIVE LETTER75
July 31st, 2002
Ms. Betty Waters
Department of Social Services
Disability and Adult Programs Division
P.O. Box 24225
Oakland, CA 94623
Re:
Mr. Joe X application
SSN: 123-45-6789
Dear Ms. Waters:
Mr. Joe X is a 55 year old male with multiple disabilities who is currently incarcerated at
San Quentin. He will be released on September 30, 2002 and will be returning to the Oakland
area. He was born in Kentucky but has lived in various places around the United States. He has
apparently had two psychiatric hospitalizations a long time ago. He has some memory of work
history at record stores and in radio stations, but does not know when he last worked or where.
He believes it has been more than ten years since he was able to work.
Mr. X has had two extensive psychological evaluations by Deborah Grover, Ph.D., one of
which is on file and the other is submitted with this letter. He has also had a mental status exam
by Adrienne R. Fox, a psychiatrist. Mr. X has had a physical evaluation by Walter Q. Andrews,
M.D. and a spine evaluation aided by CT scans and X-rays by Dr. Ira Black. The results of all
three of their evaluations should be in Mr. X’s file
Mr. X suffers from back and knee pain, acute paranoia, depression, anxiety and mild
mental retardation, probably due to organic damage. He should be found disabled at the third step
of the sequential evaluation pursuant to Listings of Impairments section 12.05 C. And 12.08
I. REVIEW OF THE RECORD
a. Psychological Impairments
On her first examination, Dr. Grover, the consulting psychologist, diagnosed Mr. X as
follows: Personality Disorder, NOS, with Hostile and Paranoid Features. She also found a Pain
Disorder Associated with Both Psychological Factors and a General Medical Condition, Chronic
(10/24/96 Evaluation, p.5) COGNISTAT results indicated severe to moderate impairments of Mr.
X’s short term memory skills (Ibid. P. 4)
On her second, even more extensive evaluation, Dr. Grover found further evidence of
significant cognitive deficits: On the Weschler Adult Intelligence Scale-Revised (WAIS-R), Mr.
X scored a 65 on his Performance IQ, showed significant deficits in his ability to organize
38

information, had extremely impaired scores on the Trail-Making Test, and evidenced marked and
severe impairments in his memory skills across the board. (1/7/97 Eval, pp.2 and 3). The
incomplete results of the MMPI-II showed strong evidence of paranoia. (14 of 16 questions
endorsed in Persecutory Ideas. Ibid. P.3)
Dr. Fox also found a Cognitive Disorder NOS in his evaluation in addition to a Mental
Disorder Due to multiple medical problems. (10/4/96 Eval, p. 4) Dr. Andrews write up of his
physical exam of Mr. X is notable primarily for his assessment that Mr. X had significant
psychiatric disorders. He found Mr .X had psychiatric disturbances of thought and mood, and
would consider a diagnosis of major depression with paranoid features. (11/16/96 Eval., p. 7)
b. Physical Impairments
Mr. X has a history of back and knee pain. While Mr. X did not allow Dr. Andrews to
perform a thorough physical exam, Dr. Andrews did note evidence of decreased range of motion
flexion in the neck. (11/16/96 Eval., p.6)
Dr. Ira Black was able to obtain both a CT scan and x-rays of Mr. X back. He found a
herniated disc at L4-5 with arthritic changes and neurological deficits. (12/17/96 Eval., p.1) Dr.
Black found that Mr. X’s inability to sit, bend or work was consistent with our medical findings.
And that such limitations would be expected given Mr. X’s diagnosis. (Ibid. P. 2).
Mr. X has also attempted to get evaluations of his knees. Due to a lack of insurance and
his refusal to be seen at San Francisco General Hospital or by a medical examiner chosen by
DAPD, we were unable to get an evaluation. Mr. X’s paranoia and personality disorder also
prevented him from cooperating with a pulmonary test scheduled through DAPD, though he did
show up for the appointment. He has had recent treatment for pneumonia in the emergency room
at St. Mary Hospital. (Record should be in his file)
II. DETERMINATION OF DISABILITY
Mr. X should be found disabled based on Listings of Impairments section 12.05 C. On
Mental Retardation. Section 12.05 C requires a valid verbal, performance or full scale IQ of 60
through 70 and a physical or other mental impairment imposing additional and significant workrelated limitations of function.
In Mr. X’s case, in addition to his Performance IQ score of 65, he has both a physical and
mental impairment, which imposes additional and significant work-related limitations. The
additional mental impairment is, in fact, so sever as to qualify him independently at the Listing
level under Listings of Impairments section 12.08.
Dr. Grover administered the WAIS-R and accepts Mr. X’s scores as valid. Mr X’s
Performance IQ score of 65 is consistent with Dr. Grover’s finding that he is completely unable to
organize the information from the world around him. Mr. X’s IQ scores in the Vocabulary and
Information subjects were average and above-average, which Dr. Grover accepts as evidence that
Mr. X’s level of functioning was at least average and would explain why Mr. X is able to appear
39

intelligent and is often able to adequately express himself verbally (1/7/97 Eval. P. 3)
Mr. X’s physical impairments impose additional and significant work-related limitations
of function. He suffers from significant back pain due to a herniated disk and arthritic changes.
This prevents Mr. X from being able to sit, being able to walk more than a few blocks and being
able to work. He uses a cane and always stands for his interviews. (See evaluations of Dr. Fox,
at p.2, Dr .Andrews at p. 6; Dr. Grover p. 2 and 6)
Mr. X also has a mental impairment that imposes additional and significant work-related
limitations. His personality disorder is, in fact, so severe that it qualifies as another Listings level
impairment under section 12.08. A Listings level impairment is me under section 12.08 when a
requirement in both 12.08(a) and 12.08 (b) are met.
Mr. X easily meets Listings (A) 2. And (B) 1 and 2. He has pathologically inappropriate
suspiciousness and hostility. Virtually every medical professional (and social service provider)
who has come in contact with Mr. X has noted his extreme suspiciousness and paranoia. He was
so suspicious and hostile to Dr. Andrews that in the initial examination hew was unwilling to
have Dr. Andrews touch him or undergo any physical examination. (11/15/96 Eval., p. 2) On the
second appointment, he refused to undress and would only allow the doctor to measure the girth
of his calves. (Ibid. P. 6). Dr. Andrews found the patient was hostile and paranoid. He displayed
evidence of paranoid thought processes and impoverished thought content. (Ibid. P. 6)
Dr. Grover found Mr. X extreme suspiciousness and hostility his most striking
psychological trait. In her initial meeting with him, he refused to remove an oversized poncho
that covered him, and would not remove his dark glasses. She reported, the most striking
presentation regarding this client was his pervasive paranoid and hostile stance with the examiner
from the minute he entered the room. (10/24/96 Eval, p. 2). In the family and social history, Mr.
X refused to answer in any detail and stated that any of the other questions regarding family and
social history were of a personal nature and of no use to this examiner n the evaluation. (Ibid. P.
3)
Even in the second and third meetings with Dr. Grover, in which Dr. Grover noted Mr. X
to be cooperative, Mr X evidenced agitation, frustration and irritation at what was being asked of
him on a regular basis. The client did evidence multiple instances of extreme paranoid ideation
and persecutory delusions which guided much of his behavior. (1/7/97 Eval., p.2).
In order to meet Listing 12.08, the pathologically inappropriate suspiciousness or hostility
must also result in at least two of the listings under 12.08 (B). Mr X >s paranoia has resulted in
both B. 1. Marked restriction in activities of daily living, and B.2 Marked difficulties in
maintaining social functioning, as well as B. 3. Deficiencies of concentration, persistence or pace
resulting in frequent failure to complete tasks in a timely manner.
Mr. X’s restrictions in activities of daily living have been noted throughout the record. He
is unable to shop, cook, or clean for himself. (Daily Activities Questionnaire, Dr. Fox’s report, p.
3, Dr. Andrews report, p.4) He has been dependant on the social welfare system for shelter and
40

food. (10/24/96 Eval. P. 6)
Mr. X pathological suspiciousness and hostility has its greatest consequences in his
difficulty in maintaining social functioning. Mr. X has no reported contact with friends or family.
(10/24/96 Eval., p. 3, 11/15/96 Eval. P. 4,) and, in fact stays away from other people on the street
and in shelters. (Dr. Fox Eval. P.3) He has the ability to anger, alienate or irritate virtually
everyone with whom he comes in contact. Dr. Groer reported in her first exam, he had alienated
and/or irritated most of the staff of the Triage Unit by the time he had completed our intake exam
(10/24/96 Eval., p. 6) This attorney can also report that Mr. X has angered and alienated most of
the staff in the office. (One should also note that both offices, the Triage Unit and the Homeless
Advocacy Project, have great experience and tolerance in working with mental disabilities and
personality disorders. That Mr. X stands out is testament to the severity of his personality
disorder.)
Mr. X’s personality disorder, perhaps accompanied by organic damage, also have resulted
in significant deficiencies in concentration and memory. Dr. Grover’s administration of the
Weschler Memory Scale-Revised showed marked and sever impairments on his memory skills
across the board. The Attention/Concentration score left him in the less than .05 percentile.
These test scores are supported by this attorney’s own experience with Mr. X Mr. X needed all
appointments written down for him, and even then he was frequently confused about meeting
times, as he would lose the pieces of pater.
III. CONCLUSION
Mr. X should be found disabled at the third step of the sequential evaluation process
pursuant to Listings of Impairments section12.05 C and section 12.08. He has multiple
disabilities, both physical and mental, and is incapable of maintaining any form of substantial,
gainful employment.
Thank you both for your attention to this case, and for your patience in waiting for the
available medical reports. If I can be of any further assistance, please do not hesitate to contact
me, (555) 555-5555
Sincerely,
Joe Doe
Legal Advocate

XII. SSI/SSDI ATTORNEYS/AGENCIES
Below you will find attorneys and agencies who do SSI/SSDI advocacy. These parties may or
may not be able to assist individual claimants. Often, they will only be able to provide you with
general advice or referrals. This list is for informational purposes only - it is not an endorsement
of any attorney or agency. Please note that this list is not exhaustive.
IN CALIFORNIA
Alameda County

(916) 551-2133

Bay Area Legal Aid
405 14th Street 11th floor
Oakland, California 94612
1-800-551-5554
http://www.baylegal.org

Fresno County
Central California Legal Services
2014 Tulare, Suite 600
Fresno, California 93721
(559) 570-1200
http://www.centralcallegal.org

Homeless Action Center
2500 Martin Luther King Jr. Way
Berkeley, California 94704
(510) 540-0878
http://www.homelessactioncenter.org

Kings County
Central California Legal Services
208 West Main Street, Suite U-1
Visalia, California 93291
1-800-350-654
1-800-417-3296
http://www.centralcallegal.org

Contra Costa County
Bay Area Legal Aid
1017 Macdonald Avenue
Richmond, California 94801
1-800-551-5554
http://www.baylegal.org

Lassen County
Senior Advocacy Center
1647 Hartnell Avenue Suite 6
Redding, CA -96002-2268
(530) 223-0999
http://www.shastanet.org/slc/sls.html

The Hawkins Center
101 Broadway
Richmond, California 94804
(510) 232-6611
http://www.hawkinscenter.org

Los Angeles County
El Dorado County
Bet Tzedek Legal Services
145 S. Fairfax Avenue Suite 200
Los Angeles, California 90036
(323) 939-0506
http://www.bettzedek.org
Bay Area Legal Aid
4340 Redwood Highway Suite A-5

Volunteer Legal Service Program of
Northern California
517 12th Street
Sacramento, California 95814
Marin County
42

San Rafael, California 94903
1-800-551-5554
http://www.baylegal.org

Riverside County
Law Offices Of David Shore
1310 Union Plaza Court
Oceanside, California 92054
(760) 966-9180

Law Offices of Peter Young
271 Miller Avenue
Mill Valley, California 94941
(425) 388-2400

Sacramento County
Law Offices of Olson, Hagel, Waters and
Fishburn
555 Capitol Mall Suite 1425
Sacramento, California 95814
(916) 442-2952

Mariposa County
Central California Legal Services
357 West Main Street, Suite 201
Merced, California 95340
(209) 723-5466
http://www.centralcallegal.org

Volunteer Legal Service Program of
Northern California
517 12th Street
Sacramento, California 95814
(916) 551-2133
http://www.sacbar.org/vlsphomepage.html

Merced County
Central California Legal Services
357 West Main Street, Suite 201
Merced, California 95340
(209) 723-5466
http://www.centralcallegal.org

San Diego County
Law Offices Of David Shore
1310 Union Plaza Court
Oceanside, California 92054
(760) 966-9180

Modoc County
Senior Advocacy Center
1647 Hartnell Avenue Suite 6
Redding, CA -96002-2268
(530) 223-0999
http://www.shastanet.org/slc/sls.html

Law Offices of John Byran Martin
4025 Camino Del Rio South Suite 300
San Diego California 92108
1-800-568-4529

Placer County
San Francisco County
Volunteer Legal Service Program of
Northern California
517 12th Street
Sacramento, California 95814
(916) 551-2133
http://www.sacbar.org/vlpshomepage.html

Bay Area Legal Aid
50 Fell Street
San Francisco California 94102
1-800-551-5554
http://www.baylegal.org
(415) 397-7262

Benefits Rights Project
225 Bush Street, Suite 757
San Francisco, California 94101

General Assistance Advocacy Project
43

Redding, CA -96002-2268
(530) 223-0999
http://www.shastanet.org/slc/sls.html

276 Golden Gate Avenue
San Francisco, California 94102
(415) 928-8191
http://www.gaap.org

Siskiyou County
Law Offices of Peter Young
271 Miller Avenue
Mill Valley, California 94941
(425) 388-2400

Senior Advocacy Center
1647 Hartnell Avenue Suite 6
Redding, CA -96002-2268
(530) 223-0999
http://www.shastanet.org/slc/sls.html

Legal Services for Prisoners With Children
1540 Market Street #490
San Francisco, California 94102
http://www.prisonerswithchildren.org

Solano County
Legal Services of Northern California
Solano County Offices
1810 Capital Street
Vallejo, California 94590
(707) 643-0054
http://www.sacbar.org/vlsphomepage.html

San Mateo County
Bay Area Legal Aid
2287 El Camino Real
San Mateo California 94403
1-800-551-5554
http://www.baylegal.org

Sonoma County
Law Office of Peter Young
271 Miller Avenue
Mill Valley, California 94941
(425) 388-2400

Santa Clara County
Bay Area Legal Aid
2 West Santa Clara Street 8th Floor
San Jose, California 95113
1-800-551-5554
http://www.baylegal.org

Sonoma County Legal Aid
37 Old Courthouse Square Suite 100
Santa Rosa, California 95404
(707) 542-1290

Mental Health Advocacy Project
111 W. St. John Street, Suite 315
San Jose, California 95113
(408) 294-9730

Toulumne County
Central California Legal Services
357 West Main Street, Suite 201
Merced, California 95340
(209) 723-5466
http://www.centralcallegal.org

Shasta County
Senior Advocacy Center
1647 Hartnell Avenue Suite 6
Trinity County

Redding, CA -96002-2268
(530) 223-0999
http://www.shastanet.org/slc/sls.html

Senior Advocacy Center
1647 Hartnell Avenue Suite 6
44

Visalia County
Central California Legal Services
208 West Main Street, Suite U-1
Visalia, California 93291
1-800-350-3654
1-800-417-3296
http://www.centralcallegal.org
Yolo County
Volunteer Legal Service Program of
Northern California
517 12th Street
Sacramento, California 95814
(916) 551-2133
http://www.sacbar.org/vlsphomepage.html

NATIONAL ORGANIZATIONS
Bazelon Center for Mental Health Law
1101 15th Street, N.W. Suite 1212
Washington, D.C. 20005
(202) 467-5730
http://www.bazelon.org
National Organization for Social Security
Claimant’s Representatives
6 Prospect Street
Midland, N.J. 07432
1-800-431-2804
http://www.nosscr.org

ENDNOTES
1. Bazelon Center for Mental Health Law, Finding the Key: An Explanation of Federal
Medicaid and Disability Program Rules. Available online at
http://www.bazelon.org/findingthekey.html
2. SSA Pub. No. 05-11125,, SSI In California, (May 2002) Available online at
http://www.ssa.gov/pubs11125.html
3. Id..
4. SSA Pub. No., 64-039, Disability Evaluation Under Social Security, (January 2001)
5. Charles T. Hall, Esq., Disability Benefits: Frequently Asked Questions, National Organization
for Social Security Claimant’s Representatives. Available online at
http://www.nosscr.org/hallfaq.html
6. Id.
7. See Note 5 See also SSA Pub No 64-039, Disability Evaluation Under Social Security,
(January 2001)
8. Id.
9. Id.
10. Id.
11. See Note 5. See also SSA Pub. No. 05-10041, The Appeals Process (April, 1999) p.1
12. See Note 5.
13. See Note 5.
14. See Note 5
15. See Note 5
16. Id.
17. Id.
18. SSA Pub. No 64-309, Disability Evaluation Under Social Security, (January 2001) p. 2
19. Id.
46

20. See Note 5. See also SSA Pub. No. 05-11041, The Appeals Process (April, 1999) p. 1-2
21. Id.
22. See Note 5.
23. See Note 5.
24. See Note 5.
25. See Note 5. See also SSA Pub. No. 05-11015, A Guide to SSI For Groups And
Organizations, (June 2002) p. 20-22
26. See Note 5
27. See Note 5
28. See Note 5. See also SSA Pub. No. 05-11000, Supplemental Security Income, (March,
2001)
29. Id.
30. See Note 5. See also SSA Pub. No. 05-10084, Survivors Benefits, (March, 2001), available
online at http://www.ssa.gov/pubs/10084.html
31. See Note 5.
32. See Note 5
33. See Note 5
34. See Note 5
35. See Note 5
36. See Note 5
37. See Note 5
38. SSA Pub. No. 05-11000, Supplemental Security Income, (March, 2001)
39. See Note 5. See also SSA Pub. No. 05-11015, A Guide To SSI For Groups and
Organizations, (February 2001) p. 10-12
40. See Note 5. See also SSA Pub. No. 05-11015, A Guide to SSI For Groups And
Organizations, (June 2002) p. 4

41. Id.
42. SSA Pub. No. 05-11051, Supplemental Security Income for Noncitizens, (June, 2002) p. 1-3.
Available online at http://www.ssa.gov/pubs/11051.html
43. Id.
44. Id.
44. SSA Pub. No. 05-11125, SSI In California, (May, 2002) Available online at
http://www.ssa.gov/pubs11125.html
46. 20 C.F.R. 416.1321(b)
47. 20 C.F.R. 416.221
48. 20 C.F.R. 416.421
49. 20 C.F.R. 416.1335
50. 42 U.S.C. 402(x)(1)(A)(i) as amended by Public Law 106-170
51. 42 U.S.C. 402(x)(1)(A)(ii) as amended by Public Law 106-170
52. The old rules will continue to apply to individuals whose jail or prison confinement began
before April 1, 2000. Although it is not described here, the Bazelon Center has a memorandum
that lays out those rules. If you would like a copy, send a request with a stamped self addressed
envelope to: Bazelon Center Publications Desk, 1101 15th Street N.W. Suite 212, Washington
D.C. 20005
53. 20 C.F.R. 404.468(a)
54. 20 C.F.R. 416.211
55. 42 U.S.C. 1382 (e)(1)(I) as amended by Public Law 104-93; 42 U.S.C. 402(x) as amended
by Public Law 106-170
56. 42 U.S.C. 1383(m)
57. 42 U.S.C. 1396(d)(a)(27(A)
58. Social Security Act Section 1905(a)(A)
59. 42 C.F.R. 435.916
60. 42 C.F.R. 435.1009(b)

61. 42 C.F.R. 435.916
62. Letter from HHS Secretary Donna Shalala to Congressman Charles Rangel, April 6, 2000
63. Letter from Sue Kelley, Associate Regional Administration, Divison of Medicaid and State
Operations, HCFA Region II, to New York Medicaid Director, September 14, 2000.
64. The description of the “Overview of the Initial Application” was originally published on the
website of the Bay Area Homeless Alliance, available at http://www.baha.org/ssi/init.shtml For
more information, see SSA Pub. No. 05-11000, Supplemental Security, (March 2001)
65. Id.
66. “What is Useful” was originally published by the Hawkins Center of Law and Services for
the Disabled, Tips for a Letter from a Family or Friends Supporting a Claim of Disability,
available online at http://www.hawkinscenter.org/publications/tips.htm
67. Id.
68. SSA Publication No. 64-039, Disability Evaluation Under Social Security (January 2001)
p.19-20
69. Id.
70. See Note 59.
71. See Note 59.
72. See Note 59.
73. The description of the “Appeals Council” was taken from the website of the law firm Olson,
Hagel, Waters, and Fishburn. It can be found at
http://www.olsonhagel.com/ss_process.html#appeals
74. Id.
75. The sample persuasive letter was originally found on the website of the Bay Area Homeless
Alliance, located at http://www.baha.org/ssi/docs/30perlet.txt