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Social Security Overview. December 2003. Terminology. Social Security Benefits Title II Supplemental Security Benefits Title 16 SSI. Social Security Benefits Quarters of Coverage. Quarter of coverage in 2003= $890 2004 = $900 Fully insured -- 40 quarters

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Social Security Overview


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    Presentation Transcript
    1. Social Security Overview December 2003

    2. Terminology • Social Security Benefits • Title II • Supplemental Security Benefits • Title 16 • SSI

    3. Social Security BenefitsQuarters of Coverage • Quarter of coverage in 2003= $890 • 2004 = $900 • Fully insured -- 40 quarters • Or one quarter for each year after age 21 • Currently insured: 6 quarters within a 13 quarter period ending with the quarter you: a) die or b) become entitled to disability or old age insurance benefits.

    4. Retirement • Must be Fully Insured • Early Retirement • Age 62 • 2004- apx. 20% reduction • Born 1960 or later – 30% reduction • Regular Retirement • 2004 – Age 65 and 4 months • Maximum benefits $1,825 • Born 1960 or later – age 67

    5. Dependent Benefits • Children • Insured entitled to old age or disability benefits or deceased • Natural, adopted child, stepchild or grandchild/step grandchild (parents must be deceased or disabled at time insured became eligible for benefits or died) • Under 18 or • In secondary school under 19 or • Disabled before age 22

    6. Benefits for Spouses • Spouses • Insured entitled to old age or disability benefits • Valid marriage and • married at least one 1 year or • child in common • Age 62 or older or • Caring for child of wage earner who is under age 16 or disabled • Divorce Spouses may qualify

    7. Widow(er)s • Insured was fully insured • Valid marriage and • Marriage lasted 9 months (some exceptions) or • Natural or adoptive parents of a child • and age 60 or • age 50 and disabled • disability must have began within 7 years of the wage earner's death • Unmarried or remarried after age 60 or age 50 if entitled as a disabled widow(er)

    8. Benefits for Widowed Parents • Insured was fully or currently insured at time of death • Widow or widower and marriage lasted at least 9 months and • Unmarried • Caring for child of the insured who is under age 16 or disabled

    9. Surviving Parents of Wage Earner • Insured was fully insured and is deceased • 62 years old • Not married since insured person died • Must have been dependent on insured for at least half of your support

    10. Disabled • Fully insured • Disabled within last date of insurance -- 20 quarters in a 40 quarter period and disabled within that period unless: • Under age 31 when become disabled or • Previously disabled under age 31 or • Statutorily blind and fully insured

    11. SSI • Age • 65 and • Meet the citizenship criteria • Disabled

    12. Appeals Process • Initial • Reconsideration • Hearing • Appeals Council • Federal Court

    13. Appeal Deadlines • 60 days unless good cause shown • SS presumes receipt 5 days from date of mailing • 10 day rule for continuing benefits • Applies for both reconsideration and hearing request • Reopening • 12 months of the initial decision for any reason • Good Cause • 2 years SSI • 4 years SS

    14. Adult Disability Definition • The inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which: • has lasted or can be expected to last for a continuous period of not less than 12 months • or can be expected to result in death.

    15. Adult Sequential Evaluation NO Yes No No

    16. Resources Used by SSA in Disability Determinations • Listings • Grid • Bureau of Disability Determinations Services – BDDS • Medical Experts • Vocational Experts

    17. Rules • Statute • 42 U.S.C. §§ 401 etseq., 1381 etseq. • Regulations • 20 C.F.R. §§404 etseq., 416 etseq. • Rulings • POMS • HALLEX

    18. Definition of Disabilityfor Children • A physical or mental condition (or a combination of conditions) that results in marked and severe functional limitations and: • The condition must last or be expected to last at least 12 months or • be expected to result in the child's death.

    19. Children’s Sequential Evaluation

    20. Functional Equivalence - Six Domains • Acquiring and using information • Attending and completing tasks • Interacting and relating with others • Moving about and manipulating objects • Caring for yourself • Health and physical well-being

    21. Functional Equivalence • Need one extreme limitation or • Two marked limitations • Can also be functional equivalent if no listing exists for condition or combination of impairments “equals” a listing

    22. Medical Improvement • All cases are given a diary date • Sequential evaluation different • Appeal within 10 days to preserve benefits

    23. Drug and Alcohol Cases • Basis for the disability must be independent of drug or alcohol condition • Payee will be appointed • Can require treatment

    24. Amount of Benefits - 2004 • SSI- • $564 individual • $846 disabled couple • Couple includes “holding yourself out as married” • Paid on the first of the month • Title 2 • Maximum $1825 • Usually at least $20 more than SSI if disabled or aged • Medicare deduction – $66.60 • Don’t forget IDHS programs to pay premium • Payments dates vary

    25. Reduction/Nonpayment of Benefits -SSI • Income • Unearned income disregard ($20) • Child support disregard (1/3 of support) • Earned income disregard ($65, and ½ of balance.) • Inkind Income • Deeming • Asset limitation • $2000 individual • $3000 eligible couple • Residents in public institutions • Failure to comply with drug or alcohol treatment • Fleeing felons

    26. Reduction/Nonpayment of Benefits – Social Security • No asset limitation • Earned income • Does not affect Retirement benefits if 65 or older • Disability benefits • Trial work period- any 9 months where you earn $580. Extended period of eligibility- 36 months, no payment if earn more than $810 • Receipt of Other Title 2 benefits -reduced $ for $ • Workers’ compensation • Aliens who leave the country for more than 6 months • Failure to comply with drug or alcohol treatment • Nonpayment while serving time for a felony

    27. Payment of Benefits • Lump Sums • Transitional Assistance and P3 offset- both SSI and SS disability • SSI only • Reduction for receipt of TANF • Restricted account for children’s lump sum

    28. Overpayments • Reconsideration • 60 day time limit • Appeals within 30 days stays action until reconsideration issued. • Appeals after 30 days stops action until reconsideration issued. • Amount Recouped • SSI – 10% • SS- No limit, but can be negotiated

    29. Waivers • No time limit • All recouped money returned if successful • Must establish not at fault and • Defeat the purposes of the SSI program to collect the overpayment or • presumed for an individual receiving SSI • Against equity and good conscience or • Impede efficient or effective administration of program

    30. Ticket to Work • Voluntary program to assist Title II disability and SSI disability recipients • Using a ticket will not result in a continuing disability review (“CDR”) • No CDR for working after 24 months on benefits • Expedited Reinstatement for Individuals whose benefits stop due to working • Expanded medical coverage

    31. Immigrant Restrictions -Qualified Immigrants • Legal Permanent Residents • Refugees, Asylees, Cuban/Haitian entrants, Amerasians, victims of trafficking, and those whose deportation is being withheld. • Lawfully present active duty members of the U.S. Armed Forces and their spouses and dependent children. • Lawfully present veterans with an honorable discharge and their spouses and dependent children.

    32. Qualified Immigrants Who Arrived on or Before 8/22/96 • Eligible for SSI • Eligible for SS

    33. Immigrants Who Arrive After 8/22/1996 • SSI - Distinction between LPRs and other Qualified Immigrants • SS - Qualified Immigrants Eligible

    34. LPR’s Who Arrive After 8/22/96 • Bar on SSI • Only eligible if can be credited with 40 quarters (after a 5 year wait) • Credits can be from worker, spouse, or parents while they were children • No quarters counted after 12/31/96 if individual received “federal means tested public benefit” during the quarter • Includes TANF, Medicaid, KidCare, Food Stamps

    35. Resources • Social Security Website • http://www.socialsecurity.gov/ • Includes Handbook, POMS, Rulings, HALLEX, CFR • Dictionary of Occupational Titles (DOT) • Diagnostic and Statistical Manual IV-TR • Social Security Claims and Procedures - McCormick • Medical Proof of Social Security - Hirshman • Video tape library