FAQ

You can obtain valuable insight into the reason an applicant was previously denied by reviewing the applicant’s electronic folder, or at minimum, obtaining the “Disability Determination Explanation” or denial notice. Most likely, you will have easy access to the denial notice from the applicant or, if you are the authorized representative, SSA should have mailed a copy to you. You can also request reason for denial by contacting your local SSA office. Learn more at Reviewing Denial Notices.

The date the applicant became disabled is not necessarily the date that he/she was first diagnosed. SSA is looking for the date on which they were unable to work at a substantial gainful level due to their illnessess/conditions.  You should enter the date that they were no longer able to work (or last worked at an SGA level). 

We recommend creating a case-file folder for each applicant, specifically for SSA and SOAR paperwork. It is helpful if this folder has separate sections to organize your material. While you are gathering information for the application, you can store your interview notes, signed agency releases of information used to gather medical records, and any medical records or collateral information you have gathered. You can also store any completed SSA forms or worksheets in this folder. As you gather medical records, it is helpful to read through them and fill out the paper SSA-3368 Adult Disability Report as a worksheet with the key information from the records.

It may also be helpful to write a short summary of the medical records from each treatment provider as you gather them and include this in the folder. This will save time when you start to write your Medical Summary Report (MSR), as you can utilize the information from the summaries rather than re-reading the medical records. Additionally, your interview notes from the folder will be beneficial to use as a basis for your MSR.

When you are ready to submit the SSI/SSDI application, the folder will contain all the information you need to complete the disability application. Once you’ve submitted the application, place copies of the online application receipt, paper forms submitted to the SSA office (SSA-1696 and SSA-8000), and a copy of your MSR in the folder. Finally, once you receive the decision letter from SSA, include this in the folder for your records and store the information according to your agency guidelines.

Great questions! For the MSR, there currently isn’t a way to submit that online unless you are registered with DDS to use Electronic Records Express. Through that system, you can submit medical records and additional documentation by uploading it to the ERE system. I recommend reaching out to your DDS Professional Relations Officer, or your local SOAR contact, for details on how to register. Alternatively, DDS can generate a bar-coded cover sheet which you can use to fax the MSR and records to DDS. By using this process, the documentation will be added directly to the applicant’s file.

Applications can still use the SOAR process if applicants need to go to the SSA office for an interview. Many SSA offices waive the need for this interview if the SOAR representative fills out the disability application online and the SSI application (SSA-8000) on paper and delivers it to the SSA office. However, some SSA offices still require the applicant to attend an interview to verify the information in the SSI application. I recommend completing the online portion of the disability application at least 1-2 days before this interview, so that SSA has critical information about the case on file before the interview. You’ll then be able to provide supporting documentation on the application after the case reaches DDS.

For the application forms, use this link for working on real applications. Some of the training forms have certain parts that are fillable/not-fillable, but the link above will guide you to where the forms can be found on SSA’s website. Remember that the SSA-16 and SSA-3368 can be used as worksheets, as those will be filled out and turned in online.

Homeless/Transient (Living Arrangement): A transient is an individual with no permanent living arrangement, i.e., no fixed place of residence. A transient is neither a member of a household nor a resident of an institution. 

Examples:

• a homeless individual (i.e., someone who sleeps in doorways, overnight shelters, parks, bus stations, etc.); or
• a person who stays with a succession of friends or relatives and has no permanent living arrangement on the first moment of the month.

(Source: https://secure.ssa.gov/apps10/poms.nsf/lnx/0500835060)

When reporting data in our SOAR national outcomes, we calculate days to decision from the time the application is turned in to SSA until DDS makes a decision on the application.  The receipt from the Online Disability Benefit Application will show the date the application was received by SSA and the date on the notification letter from SSA can be used as the date of decision.

The SSA program which concerns “work credits” is Disability Insurance Benefits (DIB or Title II).  To be eligible, an applicant (who is the wage earner) needs “insured” status which depends on the quarters of coverage that have been acquired as a result of gainful, “covered“ employment [FICA taxes].  A “quarter of coverage” is based on 1 of 4 calendar year quarters, i.e. the 3-month time period that ends on March 31, June 30, September 30, or December 31. 

A wage earner must have sufficient quarters of coverage to be “fully insured,” and therefore, entitled to DIB.  The maximum quarters of coverage needed is 40, but 6 quarters of coverage are required at a minimum. In addition to being fully insured, the wage earner must also be “currently insured.” This is the part of your question about “expiring credits.” For the period of 40 quarters immediately preceding disability, the wage earner must have a least 20 quarters of coverage in that 40 quarter period. This is the “20/40 rule.” 

In other words, the wage earner must have worked steadily and fairly recently until disability. Insured status will lapse if she or he stops working, or becomes disabled, and fails to earn quarters of coverage for 20 quarters (about 5 years).  So, if the wage earner did not work steadily during the 40 quarter periods, the insured status lapses sooner than 5 years. The wage earner must be fully insured at the time of becoming eligible in the first full month of becoming disabled. Lapse in insured status means that the wage earner is not eligible for disability insurance benefits. 

The date that the insured status lapsed becomes critical for establishing that disability began before that lapsed date in order to be eligible for DIB. The SSA field office can compute the wage earner’s date last insured, also known as “DLI”. Note: quarters of coverage are computed differently for younger wage earners.  Read more at https://www.ssa.gov/oact/progdata/insured.html

HIPAA requires medical providers to release the patient's records within 30 days after the request is received (https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/ind…). Some states have laws that require the release of medical records in fewer than 30 days.

If an applicant's initial application has been denied, they have 60 days from the date on the denial letter to appeal the denial. If they want to submit a new initial application, they have to wait 60 days from the date on the denial letter before submitting a new initial application.

DDS does not have a set time limit to make a determination. However, on average, SOAR-assisted applications get a decision in under four months. If you are concerned about a specific case, I would regularly follow up with the DDS examiner assigned to the case. Make sure to ask how you can assist with gathering any additional information needed to make a decision.