Federal Supplemental Security Income (SSI)-related publications, as well as Social Security publications, are also available.
Click the number (e.g., F-22571) of a form or publication to go to a page where you will be able to choose a language in which to view that form or publication.
Note: Some materials are available as paper versions and can be ordered by completing an online request form. Before requesting a paper version of a form or publication, review the appropriate forms or publications list to ensure it is available as a paper version. If the entry in the column "Other Location" reads "None," paper versions are not available. All other entry types will provide ordering instructions.
Forms
- 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
- Caretaker Supplement Application and Instructions, F-22571
- Certification for SSI-E Exceptional Expense Supplement, F-20818
- Request for Fair Hearing form
- SSI-E Natural Residential Setting Application Checklist, F-20812
Handbooks
Letter Formats
The following are interim assistance reimbursement letter formats. Copy and paste the text from the browser versions into a word processing file or print and use the PDF versions.
- Authorization for Reimbursement of Interim Assistance—Initial Payment (letter format A; use this when emergency assistance is provided to people whose initial application for SSI is pending) (BROWSER or PDF)
- Authorization for Reimbursement of Interim Assistance—Initial Post-Eligibility Payment (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) (BROWSER or PDF)
- Authorization for Reimbursement of Interim Assistance—Initial Payment or Initial Post-Eligibility Payment (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) (BROWSER or PDF)
