Understanding Supplemental Security Income
If You Are Disabled or Blind2011 Edition

See the definition of disability for a child under age 18 in the section, WHAT DOES "DISABLED" MEAN FOR A CHILD?

See also the definition of disability for anyone age 18 or older in the section, WHAT DOES "DISABLED" MEAN FOR AN ADULT?

See the definition of blindness for an adult or child in the section, WHAT IS "BLINDNESS" FOR AN ADULT OR CHILD?

  WHAT  HAPPENS  WHEN  I  APPLY?  

When you file an application for SSI benefits based on disability or blindness, we will first decide whether you meet the income and resource criteria and other eligibility requirements. If you do, we will ask you for the:

	dates, places, and types of work you have done in the 15 years before you became unable to work because of your illnesses, injuries, or conditions, including your daily duties for the type of work you did and why your employment ended;
	information about your physical or mental impairment(s) ;
	names, addresses, and telephone numbers of doctors, hospitals and any other medical sources you have seen;
	dates of treatment and the kinds of treatment you have received from your doctors, hospitals and other medical sources;
	names of each prescription and non–prescription medicine that you take and the doctor who prescribed it;
	the kinds of medical tests you have had, when and where they were done, and who sent you for them; and
	for a disabled child, the name, address, and telephone number of the child's school and teacher and a third party to assist with the claim.

IT IS VERY IMPORTANT TO GIVE US COMPLETE INFORMATION.

As part of the disability or blindness determination, the Social Security personnel also look at any work you are doing. Generally, if you are working and earning more than $1,000 per month (effective January 2011), we will not find you disabled. We call this substantial gainful activity. This does not apply if you are blind.

The local Social Security office personnel do not make the disability determination. The local Social Security office sends the claim to a State agency that we call the Disability Determination Services (DDS). The DDS decides whether or not you are disabled according to the SSA definition of disability.

We, or the DDS, may ask you to fill out forms about your disability or blindness. If you need help, a Social Security or DDS employee will help you. If we mail the forms to you, you can also ask someone to help you.

  OBTAINING  EVIDENCE  ABOUT  YOUR  

IMPAIRMENT(S)

AND  FUNCTIONING  

The DDS does not examine you and they usually do not meet with you. They may contact you for additional information. While they will not base their decision solely on your statements about yourself (for example, the fact that you are enrolled in special education classes), that kind of information is very important and useful.

If the DDS cannot get enough information from your doctors and other people to decide if you are disabled, they will arrange and pay for an examination or testing by a qualified medical professional (who may be your own physician, psychologist, optometrist, or speech/language pathologist or other health care provider).

Please see the SSI Spotlight on Payment for Travel to Medical Exams and Tests .

The term substantial gainful activity describes a level of work activity that is both substantial and gainful. Substantial work activity involves performance of significant physical or mental duties, or a combination of both, which are productive in nature. For activity to be substantial it need not necessarily be performed on a full-time basis; work activity performed on a part-time basis may also be substantial. Generally, earnings averaging over $1,000 a month (for the years 2010 or 2011) demonstrate SGA.

Gainful activity is work performed for pay or profit; or work of a nature generally performed for pay or profit, whether or not a profit is realized.

For SSI purposes, the substantial gainful activity provision does not apply to blind individuals.

  HOW  LONG  DOES  THE  DECISION  TAKE?  

The decision usually takes about three to four months from the date of application.

If you have a compassionate allowance condition, your case may be fast-tracked and decided sooner. The compassionate allowance initiative is for applicants whose medical conditions are so severe that their conditions obviously meet Social Security’s disability standards. You must submit medical information that confirms your diagnosis. For more information about compassionate allowances, visit our website at: http://www.ssa.gov/compassionateallowances/

Sometimes, we can make a "presumptive" disability or blindness determination and start paying you while the DDS makes its decision. See expedited payments.

After helping you complete your application, the Social Security office will review it to see if you meet the basic non-medical requirements for disability or blindness benefits. The Social Security office will send your application to the DDS office in your State. The DDS will decide whether you are disabled or blind under the Social Security law.

The DDS looks at the information you have given us. They also review your medical records, information about how you are functioning, and, if applicable, your work history, and then decide if you are disabled or blind for SSI purposes.

If they cannot make a determination based on the information they have, the DDS will schedule a special medical examination or test for you and will pay for this examination or test. They may pay for your travel expenses to this examination or test. It is important that you go to the special medical examination or test if one is scheduled. If you do not keep the appointment, the DDS could deny your claim.

For more information about paying your travel costs to attend a medical exam, see the SSI Spotlight on Payment for Travel to Medical Exams or Tests.

In deciding if you are disabled, the DDS team uses a process called the sequential evaluation process.

  WHAT  IS  THE  SEQUENTIAL  EVALUATION  PROCESS?  

If you appear to meet all the non–medical eligibility requirements (income, resources, residency, citizenship, etc.), we use a step–by–step process to determine if you are disabled. These steps are called the sequential evaluation process. The following sections describe how we use the sequential evaluation for adults and children.

SEQUENTIAL EVALUATION FOR ADULTS AGE 18 OR OLDER

STEP 1:  ARE YOU WORKING?

If you are working and doing substantial gainful activity (SGA), we cannot consider you disabled, and the process ends here. We make this decision in your local Social Security office.

We decide if your work is "substantial" (significant) and "gainful" (for pay). We generally consider earnings over $1,000 per month (effective January 2011) to be SGA.

STEP 2:  DO YOU HAVE A SEVERE IMPAIRMENT?

Examples of basic work activities are:

	physical functions such as standing, walking, sitting, lifting; pushing, pulling, reaching, carrying, or handling;
	seeing, hearing, speaking;
	understanding and carrying out and remembering simple instructions;
	use of judgment;
	responding appropriately to supervision, co–workers and usual work situations; and
	dealing with changes.

If your impairment (s) is not severe, we will find that you are not disabled. If your impairment (s) is severe, we will go to the next step.

STEP 3:  DO YOU HAVE AN IMPAIRMENT THAT MEETS OR MEDICALLY EQUALS A SOCIAL SECURITY "LISTING ?"

If your impairment(s) is severe, we decide if it meets or medically equals a listed impairment(s) in our Listings of Impairments (the Listings).  We decide if your impairment(s) “meets” one of the Listings by comparing it to the specific requirements in the Listings.  (It is not enough just to have a diagnosis named in the Listings).  If your impairment(s) meets or medically equals the requirements of a listing and meets the duration requirement, we will find you disabled and the process ends here.

If your impairment(s) is severe, but does not meet or medically equal a listing , we can still find you disabled at a later step in the process.  We decide what you are physically and mentally able to do, despite the limitations resulting from your impairments.  We call this decision a "Residual Functional Capacity" (RFC) assessment.

STEP 4:  ARE YOU ABLE TO DO YOUR PAST WORK?

STEP 5:  CAN YOU DO ANY OTHER KIND OF WORK?

At step five, we consider your RFC limitations, your vocational outlook, and work available in the national economy. Generally, your ability to adjust to doing other work is better if you are younger, have more education, or have learned transferrable skills in previous work. We look at the limitations described in your RFC assessment, your age, education, and past work experience to decide if you could adjust to other work. If you can adjust to other work, you will be found not disabled. If you cannot adjust to other work, we will find you disabled.

SEQUENTIAL EVALUATION FOR INDIVIDUALS UNDER AGE 18

STEP 1:  IS THE CHILD WORKING?

If a child is working and doing SGA, we cannot consider the child disabled, and the sequential evaluation process ends here.  We make the SGA decision in your local Social Security office.  We define SGA for children in the same way that we define it for adults.  See, WHAT IS SUBSTANTIAL GAINFUL ACTIVITY.

STEP 2:  DOES THE CHILD HAVE A SEVERE IMPAIRMENT?

STEP 3:  DOES THE CHILD'S IMPAIRMENT MEET OR MEDICALLY EQUAL A LISTINGS?

If the child has a severe impairment(s), we then decide if it meets or medically equals a Listing .  The Listings cover the major body systems and include descriptions of common physical and mental impairments (such as cerebral palsy, mental retardation, and asthma) along with specific medical severity criteria. 

A child is disabled if he or she has an impairment, or combination of impairments, that:

“meets” (meets the medical criteria of) one of the impairments in the Listings; or "medically equals" (is equal to the medical criteria of) one of the listings; or "functionally equals" the Listings.

We decide if a child's impairment(s) "meets" one of the Listings by comparing it to the specific requirements in the Listings. (It is not enough just to have a diagnosis named in the Listings). If a child's impairment(s) meets or medically equals the requirement of a listing and meets the duration requirement, the DDS will find the child disabled and the process ends here.

If a child's impairment(s) is severe but does not meet or medically equal a listing, we then decide whether the impairment(s) "functionally equals" the Listings. This means that the DDS assesses the effects of the impairment(s) on the child's ability to function at home, at school, and in the community.

We will consider questions such as:

	What activities is the child able or not able to perform?
	Which activities are limited in comparison with those of same–age children?
	What type and amount of help does the child need to complete age–appropriate activities?

Once we have a clear picture of the child's activities (what he or she can and cannot do) we decided how much the child is limited in each of six domains. The domains are broad areas of functioning intended to capture all of what a child can or cannot do. They are:

	acquiring and using information;
	attending and completing tasks;
	interacting and relating with others;
	moving about and manipulating objects;
	caring for himself orherself; and
	health and physical well-being.

If a child's impairment or combination of impairments results in "marked" limitations in 2 of these domains of functioning, or an "extreme" limitation in one domain, then his or her impairment(s) functionally equals the Listings.

We define "marked" and "extreme" limitations in several ways in our rules. The most general definition of a "marked" limitation in a domain is when a child's impairment(s) interferes seriously with the child's ability to independently initiate, sustain, or complete activities. An "extreme" limitation in a domain is when a child's impairment(s) interferes very seriously with these abilities.