SSI: Forms and Publications
This page includes links to Supplemental Security Income (SSI) forms and publications. Selecting a link will take you to a page where you can choose to view a form or publication in your preferred language.
If you’d like a printed version of a form or publication, make sure it’s available in print first. To do so, select the link you want, then check the “Other Location” column. If it says “None,” it’s not available in print. If it is available, you’ll see a link to fill out a request form.
You can find federal SSI-related publications on the Social Security Administration Publications search page.
- Assessment Worksheet for Natural Residential Setting, F-20817
- Assessment Worksheet for Natural Residential Setting: For Individuals With Serious and Persistent Mental Illness and/or Alcohol and Other Drug Dependent Diagnoses, F-20817A
- Authorization for Recoupment Caretaker Supplement, F-22565
- Authorization for Retroactive Caretaker Supplement, F-22564
- Authorized representative
- Caretaker Supplement Application and Instructions, F-22571
- Certification for SSI-E Exceptional Expense Supplement, F-20818
- Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, F-02340
- Request for Fair Hearing form
- SSI-E Natural Residential Setting Application Checklist, F-20812
The following are interim assistance reimbursement letter templates that certifying agencies can use as models:
- Authorization for Reimbursement of Interim Assistance—Initial Payment (Word) (letter format A; use this when emergency assistance is provided to people whose initial application for SSI is pending)
- Authorization for Reimbursement of Interim Assistance—Initial Post-Eligibility Payment (Word) (letter format B; use this when emergency assistance is provided to individuals whose eligibility for SSI was suspended by the Social Security Administration and retroactive SSI benefits are expected)
- Authorization for Reimbursement of Interim Assistance—Initial Payment or Initial Post-Eligibility Payment (Word) (letter format C; this format combines the language in letter formats A and B and may be used for agencies that wish to limit the number of forms they have in use)