Wisconsin Supplemental Security Income
Publications and Forms for Supplemental Security Income (SSI) found on this
website:
Fact Sheets and Other Publications
Policy Handbooks
Forms, Worksheets, and Instructions - all PDF files
-
SSI-E Natural Residential Setting,
Application Checklist (PDF, 9 KB)
F-20812
-
Natural Residential Setting,
Worksheet (PDF, 9 KB) F-20817
-
Natural Residential Setting, Worksheet
for Community Support Program (PDF, 6 KB)
F-20817A
-
Certification
for SSI-E Exceptional Expense Supplement (PDF, 11 KB)
F-20818
-
Caretaker
Supplement Application (PDF, 19 KB)
F-22571
-
Caretaker
Supplement Instructions for Application (PDF,
25 KB)
F-22571A
-
Authorization
for Retroactive Caretaker Supplement (CTS) (PDF,
23 KB)
F-22564
-
Authorization
for Recoupment Caretaker Supplement (CTS) (PDF,
19 KB)
F-22565
Interim Assistance Reimbursement (IAR) Letter Formats
Copy and paste text from the browser versions into a word processing file or
print off and use the PDF versions of appropriate letters.
| INITIAL
PAYMENT |
Authorization for Reimbursement of Interim
Assistance -
Initial Payment
Use this language when emergency assistance is provided to individuals
whose initial application for SSI is pending. |
| IAR Letter Format A -
Browser |
IAR Letter Format A -
PDF
(PDF, 13 KB) |
|
|
|
INITIAL POST-ELIGIBILITY PAYMENT |
|
Authorization for Reimbursement of Interim Assistance -
Initial Post-Eligibility Payment
Use this language when emergency assistance is provided to individuals
whose eligibility for SSI was suspended by SSA and retroactive SSI
benefits are anticipated. |
| IAR Letter Format B -
Browser |
IAR Letter Format B -
PDF
(PDF, 12 KB) |
|
| INITIAL
PAYMENT OR INITIAL POST-ELIGIBILITY PAYMENT |
Authorization for Reimbursement of Interim
Assistance -
Initial Payment or Initial Post-Eligibility Payment
This format combines the language in Letter Formats A and B and may be
used by agencies that wish to limit the number of forms they have in use. |
|
IAR Letter Format C - Browser
|
IAR Letter Format C - PDF
(PDF 17 KB) |
Next page (SSI publications found on the Social Security Administration's (SSA)
website)
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Last Revised:
March 14, 2013
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