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Childhood Disability:
Supplemental Security Income Program
A Guide for School Professionals
This information is for school professionals who may teach or provide therapy, counseling, and/or other services to children with disabilities. It outlines the kinds of evidence that the Social Security Administration (SSA) needs to determine disability for a child under the Supplemental Security Income (SSI) program.
The SSI program can provide valuable monthly cash payments to children who are disabled under SSA rules and whose families have little income or resources.
Determining whether a child is disabled under SSI
regulations is a collaborative effort among Federal and State officials.
We rely upon your professional expertise and judgment to help us. Your information is not the only information we consider when we determine if the child qualifies for SSI, but it is very important to us. We make our determination based on all of the medical, school, and other information that we get.
We greatly appreciate your time, assistance, and support.
Introduction
Under the Supplemental Security Income (SSI) program, Social Security can provide cash payments to children with disabilities. A child who is eligible for Federal SSI cash payments is also eligible, depending on the State, for State supplemental payments, Medicaid, Food Stamps, and other social services. This financial, medical, and rehabilitation support may enable a child to improve his or her level of functioning. When coupled with various work incentives provided by the disability program, this support can ultimately lead an older child to independence so that he or she can leave the disability rolls.
There are two sets of eligibility criteria for receiving SSI: (1) financial criteria based on the income and resources of the child and family; and (2) medical criteria about the child's impairment or combination of impairments. The local Social Security office decides if a child's income and resources are within the SSI limits. In making that decision, the Social Security office must consider the income and resources of parents who are living in the same household with the child. The Disability Determination Services (DDS), a State agency, obtains the necessary information and makes the medical determination in childhood disability claims for SSA, using SSA rules. A DDS team, consisting of a disability examiner and a medical or psychological consultant, makes the disability determination.
Income includes earnings, Social Security checks, pensions, and non-cash items such as food, clothing, or shelter. The amount of income a person has each month affects the amount of SSI payment he or she can receive.
Resources include things like bank accounts, stocks, bonds, and property. Certain things usually do not count as resources, such as personal belongings, the family home, and family car.
Social Security reviews every SSI case from time to time to make sure that people receiving cash payments are still disabled, and are receiving the correct amount. SSI recipients (or their payees) are required to report any changes in their situations, such as changes in income, resources, household composition, school attendance, marital status, and improvement in medical condition.
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Representative Payees
When a child is eligible for SSI, SSA usually makes the cash payments to a responsible person or organization, known as a representative payee. Typically, a parent or other relative with whom the child lives serves as payee. In some cases, though, a family member or other person cannot serve as payee, and SSA appoints a qualified organization to be payee for the child. Whether a person or an organization, the payee must use the SSI payment for the benefit of the child and ensure that his or her current needs are met.
The payee’s first priority, then, is to provide food, clothing, shelter, medical care, and personal comfort items for the child. Once these needs are met, the payee may spend funds on other items, such as life insurance, burial arrangements, renovations needed to make the child's home safer or more accessible, furnishings for the child's use, medical equipment, dental care, and school expenses.
The payee must save any funds not used for the child's current needs, and must account annually for how he or she used the SSI payments for the child.
If you believe a representative payee is misusing a child's SSI payments, you should call the local Social Security Office.
Definition of Disability for Children
Under the law, a child is considered disabled for SSI purposes if:
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he or she has a medically determinable
physical or mental impairment (or combination of impairments); and
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the impairment(s) results in marked and
severe functional limitations; and
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the impairment(s) has lasted (or is expected
to last) for at least one year or to result in death.
What is a medically determinable physical or mental
impairment?
To meet the statutory definition, a child's impairment(s) must result from anatomical, physiological, or psychological abnormalities that are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. The impairment(s) must be established by medical evidence consisting of symptoms, signs, and laboratory findings, not only by a statement of symptoms.
We need evidence from acceptable medical sources
to establish whether a child has a medically determinable impairment(s).
Acceptable medical sources are:
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licensed physicians (medical or osteopathic);
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licensed or certified psychologists (includes
school psychologists, for purposes of establishing mental retardation/learning
disorder/borderline intellectual functioning);
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licensed optometrists (for the measurement
of visual fields or acuity);
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licensed podiatrists (for purposes of
establishing impairments of the foot, or foot and ankle, depending on
the State);
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qualified speech-language pathologists
(for purposes of establishing speech or language impairments ); and
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other individuals authorized to send us
copies or summaries of the medical records from a hospital, clinic, or
other health care facility.
Once we have established the existence of an impairment(s), we may also use evidence from other medical and non-medical sources to show the severity of the impairment(s) and how it affects the child's functioning. Other medical sources not listed above include, for example, physicians’ assistants, nurse practitioners, audiologists, and licensed clinical social workers. Non-medical sources include, for example, schools, public and private social welfare agencies, parents, guardians and other care givers. Educators and other school professionals (counselors, nurses, early intervention team members), in particular, can provide the specific, reliable information we need about how the child has functioned in school over the last 12 months. This information gives us an insight into the child's day-to-day functioning, which is very important in determining childhood disability.
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Role of the School Professional
School records and appropriate educational personnel are two of the best
sources of evidence about how a school-age child is functioning.
DDSs ask school administrators to ensure that appropriate points of contact with schools and with school personnel are set up year round. This is vitally important to ensure timely disability determinations for children throughout the year, especially during the summer.
In general, we ask schools to provide the following:
- Copies of a child's school records, including records of:
- - Academic performance, psychological evaluation,
attendance and behavior;
- - Standardized and other specialized testing;
- School-based therapeutic interventions (e.g.,
speech and language therapy) and the use of other special
services, including placement in special education classes or other specially
adapted settings;
- Individualized education programs (IEP); and
- Other periodic assessments of the child; e.g.,
comprehensive triennial assessments.
- Assessments by teachers and other qualified
personnel about the child's activities and functioning; that is:
- what the child can and cannot do, or is limited
in doing. We use a federally approved form, the Teacher Questionnaire (SSA-5665), to request information from teachers.
Description of Other Information We Need from
Teachers and
Other Educational Personnel
To fully document a child’s case, we need information from sources who know the child well and are familiar with how the child functions from day-to-day in all settings ,at school, at home, or in the community. The information you provide about a child's day-to-day functioning in school will help us to determine the effects of a physical or mental impairment(s) on the child’s ability to function in age-appropriate activities compared to that of other children the same age who do not have impairments. We need this information from you even if the child has been (or was) in your class for only a short time. Your information is not the only information we will consider when we determine whether the child qualifies for SSI, but it is very important to us.
SSA considers all of the mental and physical limitations
resulting from a child's impairment(s). We address those limitations in
terms of the following broad domains of functioning:
Acquiring and Using Information
We consider how well a child:
Learning and thinking begin at birth. A child learns
as he/she explores the world through sight, sound, taste, touch, and smell.
As a child plays, he/she acquires concepts and learns that people, things,
and activities have names. This lets the child understand symbols, which
prepares him/her to use language for learning. Using the concepts and
symbols acquired through play and learning experiences, a child should
be able to learn to read, write, do arithmetic, and understand and use
new information.
Thinking is the application or use of information
a child has learned. It involves being able to perceive relationships,
reason, and make logical choices. People think in different ways. When
a child thinks in pictures, he/she may solve a problem by watching and
imitating what another person does. When a child thinks in words, he/she
may solve a problem by using language to talk his/her way through it.
A child must also be able to use language to think about the world and
to understand others and express him or herself; e.g., to follow directions,
ask for information, or explain something.
Attending and Completing Tasks
We consider how well a child:
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is able to focus and maintain attention, and
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begins, carries through, and finishes activities, including the
pace at which the child performs activities and the ease with which the
child changes them.
Attention involves regulating levels of alertness
and initiating and maintaining concentration. It involves the ability
to filter out distractions and to remain focused on an activity or task
at a consistent level of performance. This means focusing long enough
to initiate and complete an activity or task and changing focus once it
is completed. It also means that if a child loses or changes focus in
the middle of a task, he/she is able to return to it without other people
having to remind him/her frequently to finish it.
Adequate attention is needed to maintain physical
and mental effort and concentration on an activity or task. Adequate attention
permits a child to think and reflect before starting or deciding to stop
an activity. In other words, the child is able to look ahead and predict
the outcome of his/her actions before acting. Focusing attention allows
a child to attempt tasks at an appropriate pace. It also helps determine
the time needed to finish a task within an appropriate timeframe.
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Interacting and Relating with Others
We consider how well a child:
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initiates and sustains emotional connections with others,
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develops and uses the language of his/her community,
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cooperates with others,
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complies with rules
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responds to criticism, and
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respects and takes care of the possessions of others.
Interacting means initiating and responding to
exchanges with other people, for practical or social purposes. A child
interacts with others by using facial expressions, gestures, actions,
or words. A child may interact with another person only once, as when
asking a stranger for directions, or many times, as when describing his/her
day at school to parents. A child may interact with people one-at-a-time,
as when listening to another student in the hallway at school, or in groups,
as when playing with others.
Relating to other people means forming intimate
relationships with family members and with friends the same age, and sustaining
them over time. A child may relate to individuals, siblings, parents or
a best friend, or to groups, such as other children in childcare, friends
in school, teammates in sports activities, or people in the neighborhood.
Interacting and relating requires a child to respond
appropriately to a variety of emotional and behavioral cues. A child must
be able to speak intelligibly and fluently so that others can understand;
participate in verbal turntaking and nonverbal exchanges; consider others'
feelings and points of view; follow social rules for interaction and conversation;
and respond to others appropriately and meaningfully.
A child's activities at home or school or in the
community may involve playing, learning, and working cooperatively with
other children, one-at-a-time or in groups; joining voluntarily in activities
with the other children in school or community; and responding to persons
in authority (e.g., parents, teacher, bus driver, coach, employer).
Moving About and Manipulating Objects
We consider how well a child:
These are called gross and fine motor skills.
Moving one's body involves several different kinds
of actions:
Rolling one's body; rising or pulling oneself from a sitting to a standing
position; pushing oneself up; raising one's head, arms, legs, and twisting
one's hands and feet; balancing one's weight on one's legs and feet; shifting
weight while sitting or standing; transferring from one surface to another;
lowering oneself to or toward the floor as when bending, kneeling, stooping,
or crouching; moving oneself forward and backward in space as when crawling,
walking, running, and negotiating different terrain (e.g., curbs, steps,
hills).
Moving and manipulating things involves several
different kinds of actions:
Engaging one's upper and lower body to push, pull, lift, or carry objects
from one place to another; controlling shoulders, arms, and hands to hold
or transfer objects; coordinating eyes and hands to manipulate small objects
or parts of objects.
These actions require varying degrees of strength,
coordination, dexterity, pace, and physical ability to persist at the
task. They also require a sense of where one's body is and how it moves
in space; the integration of sensory input with motor output; and the
capacity to plan, remember, and execute controlled motor movements.
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Caring For Yourself
We consider how well a child:
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maintains a healthy emotional and physical state, including how
well the child gets his/her physical and emotional wants and needs met
in appropriate ways;
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copes with stress and changes in the environment; and
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takes care of his/her own health, possessions, and living area.
Caring for and regulating oneself effectively,
with the degree of independence appropriate to a child's age, depends
upon the ability to respond to changes in emotions and daily demands of
the environment. Caring for oneself is characterized by a sense of personal
autonomy, or independence and mastery, or competence. The effort to become
independent and competent should be observable at birth and should continue
throughout childhood. Emotional well-being requires a basic understanding
of the body, including its normal functioning, and physical and emotional
needs.
To meet these needs successfully, a child must
employ effective coping strategies, appropriate to his/her age, to identify
and regulate feelings, thoughts, urges, and intentions. Such strategies
are based on taking responsibility for getting needs met in an appropriate
and satisfactory manner. This includes establishing and maintaining adequate
self-control when regulating responses to changes in moods and environment,
and developing appropriate means to delay gratification.
Caring for and regulating oneself means becoming
increasingly independent in making and following one's own decisions.
This entails relying on one's abilities and skills and displaying consistent
judgment about the consequences of caring for oneself. As a child matures,
using and testing his/her own judgment helps develop confidence in independence
and competence.
Health and Physical Well-being
We consider the cumulative physical effects of:
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physical or mental impairments, and
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their associated treatments or therapies on a
child's functioning.
A physical or mental disorder may have physical
effects that vary in kind and intensity, and may make it difficult for
a child to perform activities independently or effectively. A child may
experience problems such as generalized weakness, dizziness, shortness
of breath, reduced stamina, fatigue, psychomotor retardation, allergic
reactions, recurrent infection, poor growth, bladder or bowel incontinence,
or local or generalized pain. A child may have difficulty with senses,
including reduced hearing or visual acuity.
In addition, the medications a child takes (e.g.,
for asthma, depression) or the treatment a child receives (e.g., chemotherapy,
multiple surgeries) may have physical effects that also limit performance
of activities.
A child's illness may be chronic with stable symptoms,
or episodic with periods of worsening and improvement. We will consider
how a child functions during periods of worsening and how often and for
how long these periods occur. A child may be medically fragile and need
intensive medical care to maintain his/her level of health and physical
well-being. In any case, as a result of the illness itself, the medications
or treatment a child receives, or both, he or she may experience physical
effects that interfere with functioning in any or all activities.
All requests for this information will be accompanied
by a release-of-information form signed by a parent or guardian (and/or
by the child, if appropriate).
When you provide information, you should describe
the child's activities, limitations and behaviors as specifically as possible.
For example, "shouts at and shoves other children when teased about
impairment 1-2 times per week" provides clearer and more useful information
than "gets in fights frequently."
How We Use This Information
We consider all of the relevant information in the child's case record and will not consider any single piece of evidence in isolation. We consider the information provided by teachers, counselors, parents, caregivers, and others, along with the medical evidence, to complete a picture of the child's functioning compared to that of other children of the same age who do not have impairments. To make a timely and accurate disability determination in the case of each child who applies for SSI based on disability, we depend upon all of the information you provide us and are grateful for your cooperation.
Need More Information?
You can find additional information about the Social Security disability process and the medical criteria that we use to determine disability in children in our publication, Disability Evaluation Under Social Security, Publication Number 64-039, commonly referred to as the "Blue Book." You may obtain a copy of this publication, free-of-charge; send your request by mail, fax, or phone to:
Office
of Supply and Warehouse Management
239 Supply Building
6301 Security Blvd.
Baltimore, Maryland 21235
Phone: (410) 965-2039
Fax: (410) 965-2037
Email: oplm.oswmrptorders@ssa.gov
Internet: www.socialsecurity.gov (select publications link)
Internal Components:
The Office of Supply & Warehouse Management (OSWM) has introduced
a new ordering warehouse system that has proved to be very reliable and
provides excellent customer service. Your staff and Public Affairs Specialist
(PAS) should request public information materials directly into Supply's
web-based on-line ordering system--the Warehouse Management Control
System
(WMCS).
You may order each publication by using the Inventory Control Number.
You may also go directly to the Medical
Listings ("Blue Book") on-line.
A complete list of available publications
are also on SSA's website.
You may contact the Professional Relations Branch
at the Social Security Administration's Headquarters. The address is:
Social Security Administration
Office of Disability Programs
Professional Relations Branch
4670 Annex Building
6401 Security Boulevard
Baltimore, Maryland 21235
Publication No. 64-049
ICN 436935
December 2001
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