CalWORKs SSI Advocacy Documentation

The CEW must document in CalWIN Journal Detail page window that a CalWORKs SSI Advocacy referral was made and the date additional documents were faxed under separate cover to the CalWORKs SW. Case Comments must also include the additional forms that were mailed to the client. If the SW contacts the CEW for additional information, the CEW must also document in case comments the additional information provided.

CEW Referral to CalWORKs SSI Advocacy

At this time, referrals to the CalWORKs SW for SSI Advocacy are only initiated from the CEW or by management exception via the CEW. The referral process is as follows:

A. The CEW:

• Downloads and mails to the client the “Appointment of SSI Representative” form, SSA-1096-U6. https://www.ssa.gov/online/ssa-1696.pdf
• If not in IDM, mails the client the “Physical Capacities” (CW 61A) and/or “Mental Capacities” (CW 61B) forms.
• Initiates referral to CalWORKs SSI Advocacy by following CA 85, “Referral to CalWORKs Social Worker” and selects CalWORKs SSI Advocacy from the Need drop-down in CalSAWS.
• Under separate cover faxes to SSI Advocacy fax number, (408) 286-7935, “Authorization to Release Medical Information" (CW 61) and if available, includes the following:
• “Physical Capacities (CW 61A) and/or “Mental Capacities (CW 61B).
• Any other available medical documents.

Note: When the CW 61A/CW 61B are returned, the CEW initiates an additional fax to CalWORKs SSI Advocacy.

B. The Designated CalWORKs SW:

• Receives referral from CEW.
• Assigns CalWORKs SSI advocacy case to a CalWORKs SW when email referral is received.

Note: The case is assigned to the CalWORKs SW once the email referral comes in. The SW follows-up with the CEW and/or the client to obtain additional medical reports.

CalWORKs Social Worker (SW) SSI Advocacy Steps

The CalWORKs SW follows the steps below for the various stages of the SSI process with the SSA. The various forms are online at the SSA website.

1. During the Referral Stage:
   1. Under separate cover receives and reviews “Physical Capacities” (CW 61A)/”Mental Capacities” (CW 61B) and/or medical reports.
2. During the Pre-Application Stage:
   1. Reviews CalSAWS case and medical records in Imaging to assist in obtaining general client medical related history.
   2. Identifies verification/documentation that is on file and/or needed in order to proceed with the Application/Assessment Stage.
   3. Contacts the client by phone to advise of potential SSI eligibility.
   4. Obtains CW 61 or other appropriate medical release forms.
   5. Sets up face-to-face appointment.
   6. Downloads from SSA website the Medical and Job Worksheet, and includes with the appointment letter. The letter is to include any documentation that is still needed by the client. https://www.socialsecurity.gov/disability/SSA-3381.pdf.
   7. Follows-up with telephone reminders to ensure client shows up for appointment.
   8. Initiates collateral contacts to obtain additional client information/ medical documentation.

Note: Collateral contacts may occur throughout the Pre-application & Application/Assessment Stages.

3. During the Application/Assessment Stage:
   1. Conducts face-to-face interview and reviews SSI process with the client.
   2. Gathers additional client information (this is ongoing throughout the entire application process).
   3. From the SSA website, completes the online application and the following forms for the client:
      1. Online Disability Benefits Application: https://secure.ssa.gov/iCLM/dib.
      2. “Appointment of SSI Representative” (SSA-1696-U4), https://www.socialsecurity.gov/online/ssa-1696.pdf.
      3. “Authorization to Disclose Information to the Social Security Administration” (SSA-827), https://www.ssa.gov/online/ssa-827.pdf.
      4. “Disability Report” (SSA 3368), https://www.ssa.gov/online/ssa-3368.pdf.
   4. Sends the application packet forms to the Social Security Office identified on the application.

Note: The Social Security application may be assigned to an analyst at the Fresno or Oakland DDS.

• Receives bar code from assigned SSA Analyst and submits additional supporting documentation (this is ongoing until all necessary documents are with DDS).
• SSA regional office analyst reviews packet and requests medical records.
• Follows-up with Social Security Office as appropriate.
• Intervenes/assists Social Security in obtaining medical records and/or other documentation.

Note: SSA may require client to undergo a consultative exam through their appointed medical doctor. The time frame for a decision is approximately 6months.

4. During the Appeal (Reconsideration) Stage:
   1. Schedules and conducts a face-to-face interview to re-assess the client.
   2. Requests an appeal within 60 days when the Social Security Application is denied. Generally, three elements need to be present:
      1. Still disabled.
      2. Still unable to work.
      3. Condition is getting worse, and/or new conditions exist. Check the box “Case Review” as this is the only option on a new claim.
   3. From SSA website, downloads and completes the following two forms: “Request for Reconsideration” (SSA-561-U2) https://www.ssa.gov/online/ssa-561.pdf and “Disability Report Appeal” (SSA 3441-BK) https://www.ssa.gov/online/ssa-3441.pdf.

Note: If the 60-day deadline is missed for filing for a reconsideration hearing, a 'good cause' letter can be submitted to SSA to extend appeal filing time beyond the 60 day time limit. There needs to be a legitimate reason for being late such as but not limited to, illness, claimant did not understand the requirement to file timely, or client’s condition prevented filing, etc.

5. During the Administrative Law Judge (ALJ Hearing) Stage:
   1. When the request for appeal is denied, refers client to list of attorneys to handle the appeal. It is very important to explain to the client the advantages of engaging an attorney at this juncture.
   2. Informs the client of the five step in the Appeals process:
      1. Level I: Reconsideration (application to decision approximately 180 days).
      2. Level II: Administrative Law Judge Hearing (time frame 6 to 9 months).
      3. Level III: Appeals Council Review (time frame up to years).
      4. Level IV: Federal Court Review (time frame up to 3 years).
      5. Level V: United States District Court (time frame up to 3 years)
   3. When attorney is selected, informs client to inform attorney to retain CalWORKs SW as secondary representative.

Note: If the client does not want to use an attorney, the SW can act as a support person only (not as a representative) and assist the client in obtaining records, new evidence and attending the ALJ hearing with the client. The SW can also assist with filing additional appeals.

Best Practices

The following best practices are to be adhered:

• For non-responsive clients, at a minimum, three telephone contacts must be made. A letter must be mailed advising client their SSI referral will be closed if they fail to respond.
• The CalWORKs SW validates most recent telephone numbers and addresses by reviewing case records, such as CalWORKs Semi-Annual Report (SAR 7), Case Comments, and contacting the EW and/or the EC for most recent information, as needed.
• For non-English speaking clients, arranges for translation services to assist during the meetings.
• When changing or ending Appointment of Representation status of the client, both the client and SSA will need to be notified.
• The CalWORKs SSI Advocacy Case must be kept open during the application/appeals process until the case is approved or denied.
• CalWORKs SW reminds attorney to retain SW as secondary representative while the client is represented by his/her attorney to ensure that the outcome of the SSI Appeal is forwarded to the county.

Note: Standard introduction letter should be sent to client in appropriate language.