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Table of Contents
A.
Log in Information .......................................................................................................................... 6
1.
Claims Home ..................................................................................................................................... 6
2.
Claims Summary............................................................................................................................... 7
B.
General Identification .................................................................................................................... 8
1.
Person Information ........................................................................................................................... 8
a.
Identity Information editing .......................................................................................................... 9
b.
Citizenship Information editing ................................................................................................. 11
c.
Contact Information editing ....................................................................................................... 13
d.
Accommodation Information editing........................................................................................ 17
2.
Supplemental Security Income Application ............................................................................... 18
3.
Disability ........................................................................................................................................... 20
4.
Children in Deeming Unit .............................................................................................................. 23
5.
Multiple SSNs .................................................................................................................................. 25
6.
Alien Status ...................................................................................................................................... 27
7.
Residency and Presence in U.S. ................................................................................................. 28
8.
Payment Method ............................................................................................................................. 29
9.
Advanced Designation ................................................................................................................... 31
10.
Financial Institutions Permission ............................................................................................. 32
11.
Personal Information Authorization ......................................................................................... 33
12.
Wage Authorization .................................................................................................................... 35
13.
Felony Warrant............................................................................................................................ 39
14.
Child’s Parents ............................................................................................................................ 43
15.
Marriage ....................................................................................................................................... 44
16.
Holding Out .................................................................................................................................. 50
17.
Sponsor ........................................................................................................................................ 52
C.
Living Arrangements ................................................................................................................... 53
1.
Residence Address and Jurisdiction ........................................................................................... 53
2.
Institution Residence ...................................................................................................................... 56
3.
Non-Institutional Care .................................................................................................................... 57
4.
Household Composition ................................................................................................................ 58
5.
Home Ownership and Rental Liability......................................................................................... 60
6.
Household Expenses and Contributions .................................................................................... 61
2
7.
Household of Another .................................................................................................................... 62
8.
In-Kind Support and Maintenance ............................................................................................... 63
9.
California Optional Supplement ................................................................................................... 65
10.
Massachusetts Optional Supplement ..................................................................................... 66
11.
Michigan Optional Supplement ................................................................................................ 67
12.
New Jersey Optional Supplement ........................................................................................... 68
13.
New York Optional Supplement............................................................................................... 69
14.
Vermont Optional Supplement ................................................................................................. 70
15.
Optional State Supplement ....................................................................................................... 71
16.
Living Arrangement Change ..................................................................................................... 72
D.
Resources ....................................................................................................................................... 73
1.
Resource Selection ........................................................................................................................ 73
2.
Trust .................................................................................................................................................. 75
3.
Vehicle .............................................................................................................................................. 77
4.
Real Property ................................................................................................................................... 79
5.
Business Equipment....................................................................................................................... 82
6.
Achieving a Better Life Experience (ABLE) Account ............................................................... 83
7.
Financial Institution Account ......................................................................................................... 85
8.
Cash .................................................................................................................................................. 88
9.
Stock, Bond, or Mutual Fund ........................................................................................................ 90
10.
Promissory Note, Loan, or Property Agreement................................................................... 91
11.
Item Held for Potential Value or Investment .......................................................................... 93
12.
Life Insurance .............................................................................................................................. 94
13.
Burial Fund................................................................................................................................... 97
14.
Burial Space or Related Item ................................................................................................... 98
15.
Other Resource ......................................................................................................................... 100
16.
Property / Cash Given or Sold ............................................................................................... 101
E.
Income................................................................................................................................................ 103
1.
Income Selection .......................................................................................................................... 103
2.
Temporary Assistance for Needy Families .............................................................................. 106
3.
Refugee Cash Assistance ........................................................................................................... 108
4.
Bureau of Indian Affairs Assistance .......................................................................................... 110
5.
Disaster Assistance ...................................................................................................................... 112
3
6.
Adoption, Foster Care, or Kinship Guardianship Assistance ............................................... 115
7.
Other State, Local, or Tribal Assistance ................................................................................... 118
8.
Other Federal Income Based on Need ..................................................................................... 120
9.
Alimony or Spousal Support ....................................................................................................... 122
10.
Child Support ............................................................................................................................. 125
11.
Wages ......................................................................................................................................... 128
12.
Quarterly Wages Summary .................................................................................................... 130
13.
Self-Employment Income ........................................................................................................ 131
14.
Substantial Gainful Activity ..................................................................................................... 134
15.
Work Expenses ......................................................................................................................... 135
16.
Work Expenses Summary ...................................................................................................... 136
17.
Sick Pay (Earned)..................................................................................................................... 137
18.
Sick Pay (Unearned) ................................................................................................................ 139
19.
Workers’ Compensation .......................................................................................................... 141
20.
Unemployment Compensation ............................................................................................... 144
21.
Social Security Benefit ............................................................................................................. 146
22.
Black Lung Benefit.................................................................................................................... 147
23.
Office of Personnel Management Benefit ............................................................................ 148
24.
Railroad Board Benefits........................................................................................................... 150
25.
Veterans Affairs Payment ....................................................................................................... 152
26.
Pension, Annuity, Retirement, or Disability Payment ........................................................ 155
27.
Interest ........................................................................................................................................ 159
28.
Dividend...................................................................................................................................... 162
29.
Royalties or Honorarium (Unearned) .................................................................................... 165
30.
Rental or Lease Income .......................................................................................................... 167
F.
Benefit Leads ................................................................................................................................... 178
1.
Potential Eligibility for Other Benefits Selection ...................................................................... 178
2.
Supplemental Nutrition Assistance Program (SNAP) ............................................................ 179
3.
Health Expenses and Third Party Liability ............................................................................... 181
4.
Social Security Lead..................................................................................................................... 182
5.
Disability Entitlement .................................................................................................................... 183
6.
Child’s Entitlement from Parents ............................................................................................... 185
7.
Retirement Entitlement ................................................................................................................ 186
4
8.
Retirement and Disability Entitlement ....................................................................................... 187
9.
Spouse or Surviving Spouse Entitlement................................................................................. 188
10.
Military Service .......................................................................................................................... 189
11.
Railroad Employment............................................................................................................... 191
12.
Federal Employment ................................................................................................................ 193
13.
State or Local Government ..................................................................................................... 195
14.
Union Membership ................................................................................................................... 197
15.
Private Employment ................................................................................................................. 199
16.
Foreign Benefits ........................................................................................................................ 201
G.
Summary ....................................................................................................................................... 203
1.
Living Arrangements Summary .................................................................................................. 203
2.
Resources Summary.................................................................................................................... 204
3.
Income Summary .......................................................................................................................... 205
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A. Log in Information
1. Claims Home
This page is used to input a Social Security Number (SSN) to establish or review claim(s).
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2. Claims Summary
The Claim Summary page allows you to view, manage, and establish claims.
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B. General Identification
1. Person Information
Person Information captures and displays data related to an individual’s identity, contact
information, citizenship, military service, and special accommodation needs. The Person
Information page enables the user to view, and when applicable, update an individual’s
information. It also displays death information.
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a. Identity Information editing
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Dropdown list:
Birth Date Proof Type
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b. Citizenship Information editing
Modal window:
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Dropdown list:
U.S. Citizenship Proof
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c. Contact Information editing
Modal Window:
Add New Address
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Edit T16 Mailing
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Dropdown list:
Spoken Language Preference
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Written Language Preference
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d. Accommodation Information editing
Dropdown list:
Impairment Type
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2. Supplemental Security Income Application
This page collects the type of application being processed, and the date the claim was
established. Additionally, it collects information about the non-claimant applicant.
Dropdown list:
Application Type
Applicant Type
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More Info link:
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3. Disability
This page documents the allegation of disability or blindness, the onset date alleged by the
individual, the SSA employee’s decision regarding the disposition of the medical portion of
the file, and the date the field office sent the file for a medical decision.
Once in the path, this page remains in the path and the user cannot remove the page.
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Dropdown list:
Reason not referred
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More Info link:
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4. Children in Deeming Unit
This page collects the number of ineligible children (including children eligible on their own
records) who live with or have lived with the claimant since the date indicated.
More Info link:
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Dropdown list:
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5. Multiple SSNs
This page collects additional social security numbers that have either been used by or
issued to the claimant, claimant spouse, living with parent, deemor children, sponsor,
sponsor spouse and/or co-sponsor spouse.
Dropdown list:
Type
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More Info link:
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6. Alien Status
The purpose of this requirement is to determine each month if N13 (Not a citizen or lawfully
admitted alien) applies. When N13 does not apply for the month, the person is considered
qualified for SSI based on Alien Status. Note: All other factors of SSI eligibility must still be
met.
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7. Residency and Presence in U.S.
More info link:
Residency and Presence in U.S. (Initial Claim)
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8. Payment Method
The Payment Method page collects the claimant and eligible spouse’s payment choice.
Dropdown list:
Payment method type
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“Payment method type” is Direct Deposit
Dropdown list:
Account type
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9. Advanced Designation
SSI Advance Designation is a mini-path function in the SSI Claims system. Advance
Designation is automatically placed in the SSI Claims path for the person on the claim when
a new claim is established for the person on the claim. When accessing Advance
Designation, the user is presented with the Advance Designation of Representative Payee
application in establish, update or query mode.
The Advance Designation of Representative Payee application collects advance designation
data for the applicants and beneficiaries who do not have a representative payee. If the
time comes that they need a representative payee, individuals can be advance designated
in priority order. The Advance Designation of Representative Payee application also allows
applicants and beneficiaries who have a representative payee to update the phone number
of any existing advance designations that are currently present in the application.
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10.
Financial Institutions Permission
The Financial Institutions Permission page documents whether the claimant, eligible
spouse, and deemors give permission to contact Financial Institutions.
Modal Window:
Add New Permission
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11.
Personal Information Authorization
This page documents whether the claimant, eligible spouse, and members of the deeming
unit give authorization for third parties to disclose their personal information to SSA.
More Info link:
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Modal Window:
“Person available to provide response” is Yes
Dropdown list:
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12.
Wage Authorization
SSI Wage Authorization is a mini-path function in SSI Claims system. Upon accessing the
page, the user is presented with a data collection screen. The SSI Wage Authorization page
interfaces with the Programmatic Wage Authorization application, which houses
authorization responses and presents the appropriate response collection elements and
information depending on the authorization response status and claim status of both Title 16
and Title 2. This function collects and/or displays information regarding authorization for
SSA to obtain wage and employment information from third party providers for the claimant,
eligible spouse, ineligible spouse, eligible child, ineligible child, parent, sponsor, sponsor
spouse, and sponsor cosponsor.
The SSI Wage Authorization function is automatically placed in the SSI Claims system path
when required by current Policy in Initial Claims, Preeffectuation Review Contact page, and
Redetermination events. It is also available to the user in other SSI Claims system events
upon request. SSI Wage Authorization allows the user to review and update Programmatic
Wage Authorization status without having to exit the SSI Claims system application.
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More Info link:
Current Authorization Details
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“Person available to provide response in person, over the phone, or through a signed paper form” is Yes
More Info link:
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Dropdown list:
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13.
Felony Warrant
These pages document the claimant’s or eligible spouse’s status as a Fugitive Felon or
Parole Probation Violator.
This DFR documents two (2) separate pages:
•
Felony Warrants
•
Parole or Probation Violation Warrants
As a result of the Martinez Court Settlement, SSA will only suspend on the following felony
arrest warrants:
•
Flight to avoid prosecution or confinement – Offense Code 4902
•
Flight – escape – Offense Code 4999
As a result of the Clark Court order, SSA can no longer make initial determination to
suspend or deny payments based on a Parole or Probation violations. Historical information
will be displayed, but new claims will not include PPV questions.
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“Accused or convicted of a felony or an attempt to commit a felony” is Yes
Dropdown list:
State or Country
State
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Federal Jurisdiction or Country
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Modal Window:
Add Warrant
Dropdown list:
Good Cause
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14.
Child’s Parents
This page documents the SSNs of parents living with a child claimant who is under age 18
prior to the effective filing date. It also documents SSNs of non-deemor parents for a
claimant who alleges becoming disabled prior to age 22. It also adds a lead on the Child’s
Entitlement from Parents page for deemor and non deemor parents.
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15.
Marriage
The Marriage page captures and displays data related to marriages, which are active or
terminated for all the people on the Person Claim Summary page. It establishes marital
relationships and also collects the information about a separated/former spouse of the
claimant. The information collected on the Marriage page is shared data among all claims
where that person’s SSN is active. The Marriage Information section of the Marriage page
enables the user to view, and when applicable, update an individual’s information. This
information is collected in Person Information (PI).
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Add Marriage
Dropdown list:
Suffix
State/Territory
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More Info link:
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Dropdown list:
Marriage Type or Non-Marital Legal Relationship Information
Special Relationships
Reason Marriage Ended
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SSI Marriages - Marriage Summary
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16.
Holding Out
This page collects the information about the possible holding out relationship(s) of the
person. It also collects the decision about a holding out relationship. The information
collected on the Holding Out page is shared data among all claims where that person’s SSN
is active.
Develop possible holding out relationship(s) as of, or any time since xx/xx/xxxx is Yes
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Modal Window:
Develop Holding Out Relationship
More Info link:
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17.
Sponsor
This page collects preliminary information about the claimant's individual sponsors and their
spouses. This information is used to determine the sponsors, co-sponsor spouses, and
sponsor's spouses that exist on the claimant’s record.
Modal Window:
Add Sponsor
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C. Living Arrangements
1. Residence Address and Jurisdiction
The Residence Address and Jurisdiction page collects the claimant’s physical residence
address and jurisdictional address when it is different from the physical residence address.
In addition, it is used to record additional residence related data to determine the claimant’s
federal living arrangement. It is the first living arrangement data collection page in the SSI
application for deferred, full, and abbreviated claims.
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Dropdown list:
Country
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State/Territory
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2. Institution Residence
The purpose is to record residence data collected when the claimant is residing in an
institution.
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3. Non-Institutional Care
This page collects living arrangement information when the claimant lives in a noninstitutional care situation. Non-Institutional Care is when the claimant is placed by a public
or private agency under a specific program of protective placement such as foster or family
care. This information is necessary to document the living arrangement determination.
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4. Household Composition
The Household Composition page exists to collect household composition information
necessary for decisions relating to the federal living arrangement determination, in-kind
support and maintenance from within the household and deeming.
Modal Window:
Add Other Household Members
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5. Home Ownership and Rental Liability
The Home Ownership and Rental Liability page collects data regarding home ownership or
rental liability in household situations. It collects the mortgage or rental payment amount and
frequency of mortgage or rental payment, whether anyone in the household is a child or
parent of the landlord, current market value of the home and landlord information. This
information is used in conjunction with other living arrangement screens to determine
eligibility and/or payment amount.
Dropdown list:
Ownership or Rental liability
Payment Frequency
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6. Household Expenses and Contributions
This page documents:
•
Whether the claimant lives in an all public assistance household, or a public assistance
household subject to the payment cap.
•
Whether the claimant lives in the household of another, and whether a bona fide loan
agreement exists between the claimant and another household member to cover the
claimant's share of the household expenses.
•
The claim representative’s decision as to whether unstated income or the probability of inside
in-kind support and maintenance (ISM) is an issue in special situations.
•
When the claimant owns or rents, this page also collects information about household
expenses and contributions needed to derive the amount of in-kind support and maintenance
and cash received by the claimant or eligible couple from within the household, as well as the
monthly loan amount when there is a loan agreement that does not meet the "assume to
cover pro rata share" requirement.
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7. Household of Another
This page collects the data to determine if the claimant pays his or her pro rata share of the
household expenses when the claimant is not the householder (owner/renter). It also
collects the information needed to determine if the claimant receives in-kind support and
maintenance from the household.
Eat all meals out
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8. In-Kind Support and Maintenance
This page collects the data to determine if outside In-Kind Support and Maintenance applies for full
applications. It collects information about all types of ISM other than inside ISM; i.e., collects information on
ISM to one, institutional ISM, and outside ISM.
More Info link:
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Modal Window:
Add ISM
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9. California Optional Supplement
The California Optional Supplement page collects the claimant’s responses to questions
required of all SSI applicants in the state of California. It also records the Claim
Representative’s determination of the appropriate State Supplementation code.
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10.
Massachusetts Optional Supplement
The Massachusetts Optional Supplement page documents the claimant’s household
expenses in claims with living arrangement periods prior to 04/2012. The documentation of
the claimant’s household expenses on this page was necessary to determine if the claimant
meets the 2/3 of household expense requirement. It also records the Claim Representative’s
determination of the appropriate State Supplementation code.
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11.
Michigan Optional Supplement
The Michigan Optional Supplement page documents the claimant’s eligibility for Michigan
Optional Supplement payments. It records the Claim Representative’s determination of the
appropriate State Supplementation code.
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12.
New Jersey Optional Supplement
The New Jersey Optional Supplement page documents the claimant’s eligibility for New
Jersey Optional Supplement payments. It records the Claim Representative’s determination
of the appropriate State Supplementation code.
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13.
New York Optional Supplement
The New York Optional Supplement page documents the claimant’s eligibility for New York
Optional Supplement payments.
More Info link
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14.
Vermont Optional Supplement
The Vermont Optional Supplement page documents the claimant’s eligibility for Vermont
Optional Supplement payments. It records the determination of the appropriate State
Supplementation code.
More Info link
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15.
Optional State Supplement
The Optional State Supplement page is used to collect the identifying information that
documents the claimant's eligibility for optional state supplementary payments.
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16.
Living Arrangement Change
The Living Arrangement Change page exists to record the claimant’s allegation about
whether or not the living arrangement information already collected has changed. It also
indicates whether a living arrangement change is expected.
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D. Resources
1. Resource Selection
The Resource Selection page collects and displays information about the resources owned
by the claimant or deemor (claimant, claimant spouse, ineligible spouse, parent, sponsor,
sponsor spouse, and co-sponsor spouse associated with the claim). This page collects the
claimant’s or deemor’s allegation of ownership for each resource type and is used to trigger
the first source of a resource type into the SSI Claim path. When a source of a particular
resource type already exists in the SSI Claim path, this page displays information about the
existing sources. This page provides an option for the user to add another source of an
existing resource type. During preeffectuation reviews or redeterminations, the page
provides a way for the user to indicate which of the existing resources will be presented as
he walks the path.
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2. Trust
The Trust page collects information about trusts for Supplemental Security Income (SSI)
claimants and deemors. The page collects information about any trusts (excluding burial
trusts) which the claimant or deemors own or whose name appears on the title. It also
records assets contained within the trust and a description of those assets. The value
section of the page records the combined value of the assets contained within the trust
including the total loan amounts against those assets. This information is used, in
conjunction with other resource pages, to determine the claimant's countable resources.
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Dropdown list:
Funding type
Revocability
Trustee type
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3. Vehicle
The Vehicle page collects information about any vehicles (e.g., cars, trucks, boats,
motorcycles, etc.) which the claimant or deemor’s own or whose name appears on the title.
It also records a description of the vehicle, the market value, the amount owed on a loan for
which this vehicle is security and the use of the vehicle. This information is used, in
conjunction with other resource pages, to determine the claimant's countable resources.
NOTE:
Due to a regulations change effective March 9, 2005, two USE fields (04/01/2005
OR LATER and BEFORE 04/01/2005) were added to accommodate the proper
documentation of the use of the vehicle during each of those time-periods.
Dropdown list:
Type
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Use before 04/01/2005
Use 04/01/2005 or later
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4. Real Property
The Real Property page is used to collect the identifying information for any real property
that is owned by the claimant, eligible spouse and/or deemors. In addition to the identifying
information, this data group collects the value of the resource. For example: land, houses,
buildings, and property in foreign countries.
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Dropdown list:
Country – United States or U.S. Territory (Default)
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State/Territory
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5. Business Equipment
The Business Equipment page is used to collect business equipment information, values
and whether or not the equipment is co-owned for resources. This information is used in
conjunction with other resource pages to determine the claimant’s countable resources.
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6. Achieving a Better Life Experience (ABLE) Account
The Achieving a Better Life Experience (ABLE) Account page (hereafter referred to as the
ABLE page) exists in the SSI Claims System for all claimants and deemors when an
Achieving a Better Life Experience (ABLE) account has been reported to the Field Office.
Upon receipt of a state agency report, SSA’s systems employ a series of rules to match and
update each account received to an existing ABLE account.
More Info:
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Dropdown list:
Program state
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7. Financial Institution Account
The Financial Institution Accounts pages exists in SSI Claims Systems, which records
information about the financial institution accounts of Supplemental Security Income (SSI)
claimants and deemors. The information collected includes: the type of financial institution
account, the account number, the name and address of the financial institution, the value of
the account for particular periods, and whether the account is co-owned, earns interest
and/or is set aside for burial.
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Dropdown list:
Account type
Modal Window:
Search Financial Institutions
Select from Favorites
86
More Info link:
Consider Early-Deposited Benefits (EDB) Exclusion
87
8. Cash
The Cash page exists in the SSI Claims system application to record information about cash
in the possession of Supplemental Security Income (SSI) claimant or deemor. The
information collected includes: periods of possession, amounts, exclusion reason(s), and if it
is set aside for burial. This information is used, in conjunction with other resource pages, to
determine the claimant’s countable resources.
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More Info link:
Consider Early-Deposited Benefits (EDB) Exclusion
89
9. Stock, Bond, or Mutual Fund
The Stock, Bond, or Mutual Bond page collects information about a stock, bond, or mutual
fund of a Supplemental Security Income (SSI) claimant or deemor. The information
collected includes the type of stock, bond or mutual fund, description, the issuance date for
a bond, whether it earns interest or dividends, the value for particular periods, whether it is
co-owned, and/or whether the stock, bond, or mutual fund is set aside for burial. This
information is used, in conjunction with other resource pages, to determine the claimant’s
countable resources.
Dropdown list:
Type
90
10.
Promissory Note, Loan, or Property Agreement
The Promissory Note, Loan or Property Agreement page exists in the SSI Claims System
application, which allows the user to collect information about any promissory note, loan or
property agreement which a claimant or deemor owns, or whose name appears on the title.
It also records information about the borrower, the date and amount of the original loan,
current market value, the outstanding principal balance, and the plan for repayment. This
information is used in conjunction with other resource pages, to determine the claimant’s
countable resources.
Dropdown list:
Type
91
Address – Country
92
11.
Item Held for Potential Value or Investment
The Item Held for Potential Value or Investment page is used to collect items of value such
as collectibles, race or breeding horses, jewelry not worn or held for family significance, etc.
These items can be owned by the claimant, eligible spouse and/or deemors. This
information is used in conjunction with other resource pages to determine the claimant’s
countable resources.
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12.
Life Insurance
The Life Insurance page exists in the SSI Claims system , which records information about
the life insurance policies of Supplemental Security Income (SSI) claimants and deemors.
The information collected includes: the type of policy, name of insured, face value, cash
surrender value, loan amount, excluded amounts, insurance company name and address, if
the policy pays dividends, whether the policy is co-owned, and/or is set aside for burial. This
information is used in conjunction with other resource pages, to determine the claimant’s
countable resources.
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Dropdown list:
Name of insured
Address - Country
95
State/Territory
96
13.
Burial Fund
The Burial Fund page exists in the SSI Claims System, and allows the user to collect
information about burial contracts and trusts that the claimant owns. It also records who the
contract or trust is for, the date it was set aside, the original amount set aside, whether it is
co-owned, revocable, irrevocable or partially irrevocable, earns interest, as well as the
purchase price or market value. This information is used in conjunction with other resource
pages to determine the claimant’s countable resources.
Dropdown list:
97
14.
Burial Space or Related Item
The Burial Space or Related Item page is used to collect information about the location and
value of burial spaces and related items (cemetery lots, crypts, caskets, vaults, urns, and
mausoleums, other repositories for burial, headstones or markers) which the claimant owns
or whose name appears on the title. This information is used, in conjunction with other
resource pages, to determine the claimant’s countable resources.
Dropdown list:
Type
98
Relationship of person for whom held
99
15.
Other Resource
The Other Resource page collects information about other resources, which are not listed
separately on the Resources Selection menu for a Supplemental Security Income (SSI)
claimant or deemor. The information collected includes the type of resource, a description,
its value for particular periods, and whether or not the resource is co-owned and/or is set
aside for burial. This information is used, in conjunction with other resource screens, to
determine the claimant’s countable resources.
Dropdown list:
Type
100
16.
Property / Cash Given or Sold
The Property / Cash Given or Sold page is used to collect whether the claimant or claimant's
eligible spouse disposed of any resources in the 36 months prior to the effective filing month
or in the post-entitlement period of review. This data group serves two purposes. The first
purpose is to collect information regarding the validity of an alleged transfer of resource
ownership for SSI resource determinations. The second purpose of this data group is to
collect information about resources that have been given away or sold at less than fair
market value for State Medicaid agency notification.
101
Dropdown list:
Receiver’s address – Country
Receiver relationship
Method of transfer
102
E. Income
1. Income Selection
The Income Selection page collects and displays information about the type of income being
received by the claimant or deemor. The Income types that are selected trigger the source
of income type into the SSI Claim path. When a source of a particular income type already
exists in the SSI Claim path, this page displays information about the existing sources.
This page also provides an option for the user to add another source of an existing income
type.
103
104
105
2. Temporary Assistance for Needy Families
This page collects and/or displays information regarding Temporary Assistance for Needy
Families being alleged or received and the amount.
106
Dropdown list:
State/Territory
107
3. Refugee Cash Assistance
This page collects and/or displays information regarding the type of refugee cash assistance
being alleged or received and the amount.
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
108
State/Territory
109
4. Bureau of Indian Affairs Assistance
This page collects and/or displays information regarding the Bureau of Indian Affairs
Assistance being alleged or received and the amount.
Dropdown list:
Type
110
State/Territory
111
5. Disaster Assistance
This page collects and/or displays information regarding the type of Disaster Assistance
being alleged or received and the amount.
112
Dropdown list:
Type
State/Territory
113
Country – United States or U.S. Territory (Default)
114
6. Adoption, Foster Care, or Kinship Guardianship Assistance
This page collects and/or displays information regarding adoption, foster care, or kinship
guardianship assistance being alleged or received, and the amount.
115
Dropdown list:
Income and Funding Type
Country – United States or U.S. Territory (Default)
116
State/Territory
117
7. Other State, Local, or Tribal Assistance
This page collects and/or displays information regarding the type of other state, local, or
tribal assistance being alleged or received and the amount.
118
Dropdown list:
Type
State/Territory
119
8. Other Federal Income Based on Need
This page collects and/or displays information regarding the type of Federal Income based
on need being alleged or received, and the amount.
120
Dropdown list:
Type
State/Territory
121
9. Alimony or Spousal Support
This page collects and or displays information regarding Alimony or Spousal Support being
alleged or received and the amount.
122
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
123
State/Territory
124
10.
Child Support
This page collects and/or displays information regarding Child Support being alleged or
received and the amount of income being garnished for Child Support for the period.
125
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
126
State/Territory
127
11.
Wages
This page collects and/or displays information regarding the verification of wages the person
receives, the date the person receives the wages, and the amount of the wages along with
any deductions. This page is updated by the user and other external applications (e.g. SSI
Telephone Wage Reporting and SSI Monthly Wage Verification).
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Dropdown list:
Country – United States or U.S. Territory (Default)
State/Territory
129
12.
Quarterly Wages Summary
This page displays information about wages in a quarterly format.
The employee compares this wage information with information on the alert produced by the
State Wage Record Match. The alert is disposed of or developed based on the result of the
employee comparison.
130
13.
Self-Employment Income
This page collects and/or displays information regarding self-employment income.
131
Dropdown list:
Country – United States or U.S. Territory (Default)
State/Territory
132
IRS Tax Year Type
Profit or Loss
133
14.
Substantial Gainful Activity
The Substantial Gainful Activity (SGA) page collects information regarding the Claim
Specialist’s determination of the claimant's involvement in SGA.
134
15.
Work Expenses
This page collects and/or displays information regarding work expenses incurred by
claimants that have alleged disability or blindness on the Disability page. The system places
this page in the path when an individual has alleged disability or blindness or low vision, and
has reported Wages or Self-Employment income.
135
16.
Work Expenses Summary
The Work Expenses Summary page displays information regarding blind or impairment
related work expenses reported on the claim. Reported expenses are grouped by period. A
period is a month or series of months with the same expenses in the same amounts.
Periods are first displayed in collapsed format, and can be expanded to present each
expense and the associated monthly expense amount.
136
17.
Sick Pay (Earned)
This page collects and/or displays information regarding earned sick pay being alleged or
received and the amount.
137
Dropdown list:
Country – United States or U.S. Territory (Default)
State/Territory
138
18.
Sick Pay (Unearned)
This page collects and/or displays information regarding unearned sick pay being alleged or
received and the amount.
139
Dropdown list:
Country – United States or U.S. Territory (Default)
State/Territory
140
19.
Workers’ Compensation
This page collects and displays information about Workers’ Compensation benefits being
alleged or received.
141
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
142
State/Territory
143
20.
Unemployment Compensation
This page collects and/or displays information regarding the type of unemployment being
alleged or received and the amount.
144
Dropdown list:
Country – United States or U.S. Territory (Default)
State/Territory
145
21.
Social Security Benefit
This page collects and/or displays information regarding the type of Social Security being
alleged or received and the amount. It is updated by the user, iClaim and the Master
Beneficiary Record (MBR) interface with SSI systems.
146
22.
Black Lung Benefit
This page collects and/or displays information regarding the type of Black Lung Benefit
being alleged or received and the amount.
Dropdown list:
Type
147
23.
Office of Personnel Management Benefit
This page collects and/or displays information regarding Office of Personnel Management
Benefit being alleged or received and the amount. OPM makes U.S. Civil Service and
Federal Employee Retirement System (FERS) payments for disability, retirement, or death.
When this information is updated to the SSR via the OPM interface, the system will also
update the data on the Centrally Stored Information (CSI). Open a standalone post
entitlement event via MSSICS to send the updated data to the SSR. Cost of living
allocations (COLAs) are only updated for those individuals on the SSR.
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Modal Window:
Get ID
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24.
Railroad Board Benefits
This page collects and/or displays information regarding the type of Railroad Board Benefit
being alleged or received, and the amount.
Dropdown list:
Type
150
Modal Window:
Get ID
151
25.
Veterans Affairs Payment
This page collects and/or displays information regarding the type of Veterans Affairs
Payments income being alleged or received, and the amount.
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Dropdown list:
Type
Modal Window:
Get ID
153
Get ID – Dropdown list:
VA Payee
VA beneficiary receiving portion of augmented benefits
154
26.
Pension, Annuity, Retirement, or Disability Payment
This page collects and/or displays information regarding the type of pension, annuity,
retirement, disability payment, or similar income being alleged or received and the amount.
155
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
156
State/Territory
157
Modal Window:
Get ID
Branch of Service
Beneficiary Type
158
27.
Interest
This page collects and/or displays information regarding the type of interest being alleged or
received and the amount.
159
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
160
State/Territory
161
28.
Dividend
This page collects and/or displays information regarding the type of Dividend being alleged
or received and the amount.
162
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
163
State/Territory
164
29.
Royalties or Honorarium (Unearned)
This page collects and/or displays information about the type of royalties and/or honorarium
(unearned) being alleged or received and the amount. It is counted as unearned income. If
the royalties or honoraria (unearned) are determined to be earned, then enter as wages on
the Wages page.
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Dropdown list:
Country – United States or U.S. Territory (Default)
State/Territory
166
30.
Rental or Lease Income
This page collects and/or displays information regarding the type of Rental or Lease Income
being alleged or received and the amount.
167
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
State/Territory
168
31.
Other Income
This page collects and/or displays information regarding the type of “other income” being
alleged or received and the amount. “Other Income” is any type of income that cannot be
collected on any of the other income pages.
169
Dropdown list:
Type
Country – United States or U.S. Territory (Default)
170
State/Territory
171
32.
Blind Countable Income
This page collects and/or displays information regarding the type of Blind Countable Income
being alleged or received, and the amount.
172
33.
Plan to Achieve Self-Support
This page collects and/or displays information regarding a Plan for Achieving Self-Support
(PASS). The PASS is a disabled or blind person’s work goal to achieve self-support. Approved
expense items used for a PASS program are deducted from earned income.
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34.
School Data
This page collects information regarding school attendance and student status for individuals
(both eligible and ineligible) who are under age 22 and attending school regularly. This
information is used to determine whether a student qualifies for the Student Earned Income
Exclusion. This information is also used to determine if a child who is a student, between 18 and
22, not married, not eligible for SSI and living in the household of the claimant, is an ineligible
child for inclusion in the deeming process.
174
Screenshot – Collect School Data - Yes
175
Dropdown list:
Country – United States or U.S. Territory (Default)
State/Territory
176
35.
Child Support Enforcement Data
Child Support Enforcement is a mini-path function in SSI Claims system. Upon accessing the
Child Support Enforcement function, the user is directed to query page containing data from the
Office of Child Support Enforcement (OCSE). The ICSE function links to the OCSE Query
pages, which house data from the National Directory of New Hires (NDNH). OCSE controls and
maintains the data in NDNH.
The Child Support Enforcement function is automatically placed in the SSI Claims system path
when required by current Policy in Initial Claims events and is available to the user in other SSI
Claims system events upon request. The Child Support Enforcement page allows the user to
retrieve and view New Hire, Wage, and Unemployment data directly from NDNH without having
to exit the SSI Claims system.
Dropdown list:
Jump to report section
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F. Benefit Leads
1. Potential Eligibility for Other Benefits Selection
This page collects the claimant and claimant spouse’s allegation regarding their prior
involvement with military service, work for railroad, federal, state, or local government, work
under a union or private pension plan, and potential eligibility under a foreign government's
social security system or pension plan. It also collects the claimant and claimant spouse’s
allegations as to their spouse, former spouse, or parent's prior involvement with military
service, work for railroad, federal, state, or local government, work under a union or private
pension plan and potential eligibility under a foreign government's social security system or
pension plan. It also inquires about their eligibility for Supplemental Nutrition Assistance
Program (SNAP), Medicaid, health expenses and third party liability coverage.
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2. Supplemental Nutrition Assistance Program (SNAP)
The Supplemental Nutrition Assistance Program (SNAP) page exists in the Supplemental
Security Income (SSI) application, and allows the user to collect data used to determine
whether or not:
•
•
•
A claimant wants to file for SNAP
SSA can take the claimant’s SNAP application
A claimant wants to file their SNAP application at the SSA Field Office
SNAP data is collected for the eligible individual. SNAP eligibility is determined based on the
household as the entity and not an individual, so this page only appears once, even if a
couple is filing.
When a claimant does not wish to file for assistance at the SSA office, an explanation is
recorded for policy documentation, and does not appear on their application.
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More Info link:
180
3. Health Expenses and Third Party Liability
The Health Expenses and Third Party Liability page allows the user to collect data pertaining
to:
•
•
•
A client’s eligibility for Medicaid coverage
A client’s third party insurance coverage and who is the owner of the policy.
Information pertaining to an insurance claim or legal action that the claimant may have
filed or has pending
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4. Social Security Lead
The Social Security Lead page collects information about the claimant or his/her spouse’s,
former spouse’s or parent’s social security coverage. The information collected on this page
is used to decide if the user should refer the claimant to file and pursue Title II benefits.
This screen is a read-only screen.
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5. Disability Entitlement
The Disability Entitlement page exists in the SSI Claims System to explore potential
entitlement to Disability benefits for the claimant and claimant spouse. The information
collected on this page is used to determine what, if any, action needs to be taken in order to
ensure that the claimant has pursued potential entitlement to these benefits.
Dropdown list:
Reason not entitled
183
184
6. Child’s Entitlement from Parents
The Child’s Entitlement from Parents page exists in SSI Claims system to explore the
claimant’s potential entitlement to auxiliary or survivor benefits from the claimant’s parents.
All previous MSSICS screens of Child’s Entitlement from Father and Child’s Entitlement
from Mother will be converted to Child’s Entitlement from Parents.
Dropdown list:
185
7. Retirement Entitlement
The Retirement Entitlement page exists in the Supplemental Security Income (SSI)
application to explore potential entitlement to Retirement benefits for the claimant and
claimant spouse. The information collected on this page is used to determine what, if any,
action needs to be taken in order to ensure that the claimant has pursued potential
entitlement to these benefits.
Dropdown list:
186
8. Retirement and Disability Entitlement
The Retirement and Disability Entitlement page exists in the SSI Claims System to explore
potential entitlement to Retirement and Disability benefits for the claimant and claimant
spouse. The information collected on this page is used to determine what, if any, action
needs to be taken in order to ensure that the claimant and claimant spouse has pursued
potential entitlement to these benefits. When a new event occurs (initial claim or
redetermination) the user will be presented with Retirement entitlement and/or Disability
entitlement pages in the path.
Dropdown list:
187
9. Spouse or Surviving Spouse Entitlement
The Spouse or Surviving Spouse Entitlement page exists in the SSI Claims System to
explore potential entitlement to spouse, widow, or widower’s benefits. The information
collected on this page is used to determine what, if any, action needs to be taken in order to
ensure that the claimant has pursued potential entitlement to these benefits. The
information displayed on this page is derived from the data added to the claims file through
the Marriage Information section of the Marriage page when certain criteria is met.
Dropdown list:
188
10.
Military Service
The Military Service page exists in the SSI Claims System to collect data on the military
service of the claimant, spouse, former spouse or parent. The information is used to
determine the claimant’s potential eligibility for a military pension or Veterans Affairs (VA)
benefits by generating a referral letter directing the claimant to pursue such potential
entitlements.
189
Dropdown list:
Relationship
Claim status for military service benefits
Lead status
Diary Type
190
11.
Railroad Employment
The Railroad Employment page exists in the SSI Claims system to explore potential
entitlement to Railroad benefits for the claimant and claimant spouse. The information
collected on this page is used to determine what, if any, action needs to be taken in order to
ensure that the claimant has pursued potential entitlement to these benefits.
191
Dropdown list
Relationship
Claim status for military service benefits
Lead status
192
12.
Federal Employment
The Federal Employment page exists in the SSI Claims System to collect data about the
claimant's or someone else's (i.e., spouse, former spouse or parent's) work for the federal
government. The information is used to assess the claimant's potential eligibility for other
benefits by generating a referral letter directing the claimant to pursue potential entitlement
to federal employment benefits.
193
Dropdown list
Relationship
Claim status for military service benefits
Lead status
194
13.
State or Local Government
The State or Local Employment page exists in the SSI Claims System to explore potential
entitlement to State or Local benefits for the claimant and claimant spouse. The information
collected on this page is used to determine what, if any, action needs to be taken in order to
ensure that the claimant has pursued potential entitlement to these benefits.
195
Dropdown list
Relationship
Claim status for state or local government benefits
Lead status
196
14.
Union Membership
The Union Membership page exists in the SSI Claims System to explore potential
entitlement to Union Membership benefits for the claimant and claimant spouse. The
information collected on this page is used to determine what, if any, action needs to be
taken in order to ensure that the claimant has pursued potential entitlement to these
benefits.
197
Dropdown list
Relationship
Claim status for union benefits
Lead status
198
15.
Private Employment
The Private Employment page exists in the SSI Claims System to collect data about the
work history of the claimant, spouse, former spouse or parent. The information is used to
determine eligibility for a pension plan from private employment by generating a referral
letter directing the claimant to pursue potential entitlements.
Dropdown list
199
Relationship
Claim status for private employment benefits
Lead status
200
16.
Foreign Benefits
The Foreign Employment page exists in the SSI Claims system. This page collects data
about the claimant’s or someone else’s (i.e., spouse, former spouse or parent’s) work under
a foreign government social security or pension plan. This information is used to assess the
claimant’s potential eligibility for other benefits by generating a referral letter directing the
claimant to pursue potential entitlement to foreign employment benefits.
Dropdown list
201
Relationship
Claim status for foreign benefits
Lead status
202
G. Summary
1. Living Arrangements Summary
Living Arrangements Summary is an optional page that provides a summary of the Living
Arrangements data that have been collected in the detailed Living Arrangements pages for a
Supplemental Security Income claimant and claimant spouse, if applicable.
All fields on the Living Arrangements Summary page are display only.
203
2. Resources Summary
Resources Summary is an optional page that provides a condensed display of the resource
data that has been collected in the detailed resource data groups for a Supplemental
Security Income (SSI) claimant or deemor. In addition, the person’s countable resources
are totaled in Resources Summary to aid Claims Representative's in their review of the
claim or in performing manual resource deeming computations. Resources Summary is
entirely propagated or derived and no data can be changed on this data group.
All fields on the Resources Summary page are display only.
204
3. Income Summary
Income Summary (ISUM) is an optional, display-only page. It displays limited information
about a person’s countable income for the past 26 months, the current month, and the future
14 months. The information displayed is from the person’s detailed income records.
All fields on the Income Summary page are display only.
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| File Type | application/pdf |
| Author | Madison, Robin C. |
| File Modified | 2021-11-30 |
| File Created | 2021-11-30 |