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The Ohio Benefit Bank TM OBB Access SSI/SSDI Guide February 2016 Version 1.3 The Ohio Benefit Bank (OBB TM ) Support Website: support.ohiobenefits.org
The Ohio Benefit BankTM
OBB Access SSI/SSDI Guide
February 2016Version 1.3
The Ohio Benefit Bank (OBBTM) Support Website:support.ohiobenefits.org
© 2016 by the Ohio Association of FoodbanksAll Rights Reserved
Page iv
ContentsQuick Reference ..................................................................................................... vi
Icons & What They Mean ..................................................................................... viii
Section One | Introduction to OBB Access SSI/SSDIOrganization Map ................................................................................................. 12
Supported Programs ............................................................................................ 13
The Help Desk ...................................................................................................... 14
Section Two | Basic Navigation Important Websites ............................................................................................. 17
Accessing the SSI/SSDI Counselor Support Website ........................................ 18
Accessing the SSA Website ................................................................................. 19
Accessing the TBB SSI/SSDI Website ................................................................. 19
Accessing the SSI/SSDI Training Website .......................................................... 20
Specialist Portal ................................................................................................... 20
Creating a Client ................................................................................................... 21
Client Portal .......................................................................................................... 22
Application Menu ................................................................................................. 23
Navigation Buttons ............................................................................................... 23
Dynamic Content .................................................................................................. 23
Required/Important Questions Indicator ........................................................... 23
Return to Page Reminder .................................................................................... 23
Help Content ......................................................................................................... 24
Reviewing and Editing Data ................................................................................. 24
Section Three | Detailed Navigation of TBB SSI/SSDIClient Background ................................................................................................ 27
Medical - General ................................................................................................. 29
Medical - Physical ................................................................................................. 30
Medical - Mental .................................................................................................. 31
Daily Living Activities ............................................................................................ 32
Forms and Medical Summary Report Guide ...................................................... 32
Forms for SSA ....................................................................................................... 32
Document Checklist ............................................................................................. 34
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Section Four | SSI/SSDI Application Process
Application Process - Overview............................................................................ 37
Step-by-Step Application Process ........................................................................ 38
Section Five | Forms AppendixSupported Applications and Forms..................................................................... 58
SSA-1696.............................................................................................................. 59
Consent to Use Information ................................................................................. 60
SSA-827 ................................................................................................................ 61
SSA-16 .................................................................................................................. 62
SSA-8000 ............................................................................................................. 63
Application Cover Sheet ....................................................................................... 64
SSA-795 ................................................................................................................ 65
SSA-3369 ............................................................................................................. 66
SSA-3373 .............................................................................................................. 67
Section Six | Case Management ToolsApplication Progress Page ................................................................................... 69
Memos .................................................................................................................. 70
Contacts .................................................................................................................71
Medical Records Request Letter Generator ........................................................71
Track Medical Records Requests ........................................................................ 72
Document Management ...................................................................................... 73
Uploading Documents ......................................................................................... 73
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Quick Reference
Important Contact InformationThe Benefit Bank® Help Desk
1.855.TBB.HELP (855.822.4357)
The Ohio Benefit Bank Staff
Ohio State Legal Services
1-866-529-6446
Important WebsitesCounselor Support Website
http://support.ohiobenefits.org
Training Website (see page 20)
training-ssi.thebenefitbank.org
Social Security Adminstration
www.ssa.gov
Job and Family Services Information Center
http://jfs.ohio.gov/ocomm_root/0001InfoCenter.stm
Locate your Community Action Agency
http://development.ohio.gov/community/ocs/locate.htm
Check the status of a HEAP application
http://development.ohio.gov/Community/ocs/energyhelp.htm
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Icons & What They MeanWith the hope of helping your training flow smoothly and to remind you of important concepts you will find three icons throughout this manual.
Specialist Tips
Tips and recommendations to help your SSI/SSDI session flow smoothly.
REM
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Remember
Important information to remember.
Practice with The Benefit Bank
Indicates that it’s time to turn to your computer and practice on The Benefit Bank (TBBTM) training website.
TBB PRACTICE
SPEC
IALIST TIP
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Section OneIntroduction to OBB Access SSI/SSDI
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OverviewThe Benefit Bank SSI/SSDI is an online service designed to help specialists better serve their adult clients as Authorized Representatives throughout the initial eligibility determination process for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). TBB SSI/SSDI assists people in case management roles by completing applications for benefits, collecting, storing, and submitting supporting evidence, providing step-by-step instructions, and reporting activities back to users.
ImplementationThe Ohio Benefit Bank Access SSI/SSDI is a partnership between the Ohio Association of Foodbanks, Solutions for Progress, the Social Security Administration (SSA), Disability Determination Services (DDS), and OBB sites that meet certain criteria. The Ohio Association of Foodbanks is the lead affiliate for TBB SSI/SSDI in Ohio and provides training and support to sites and specialists.
Key Features ▪ Tools for authorized representatives to upload,
store, and submit supporting evidence to agencies that determine eligibility.
▪ Specialists are permitted to work on client applications without the client being present.
▪ Tools for tracking applications and records requests, including an application progress page, task, and memo functions to help you organize work with each client.
SSI/SSDI Organization Agreement ReminderBefore you are permitted access to TBB SSI/SSDI, your organization must agree to the terms of the organization agreement. Below you will find a few important points included in the SSI/SSDI agreement.
1. The site agrees that only employees of the site will operate as SSI/SSDI specialists at the site and that only certified SSI/SSDI specialists will use TBB SSI/SSDI at the site.
2. The site agrees that paper records with client information retained at the site must be kept safe and secure.
3. The site agrees that SSI/SSDI specialists will act as Authorized Representatives for clients on their SSI/SSDI application. SSI/SSDI specialists will facilitate follow up as appropriate and agree to assist clients throughout the application process.* (See note below.)
4. The site agrees that paper records with client information retained at the site must be kept safe and secure. The site will adhere to the following protocols established to protect client confidentiality.
– The site agrees to maintain a functioning shredder at the site’s primary location, or contract with a shredding service.
– The site agrees that all permanent paper records such as copies of verifying documents for identification, income, assets, and expenses will be kept in secure files.
– The site agrees that they will have protocols in place for the deletion of a client’s scanned documents from their hardware. Staff will be aware and protocols will be enforced.
*SSI/SSDI Specialists will assist through the determination on the initial claim. Involvement
in Reconsideration or other appeals is at the discretion of the site.
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SSI/SSDI Contact
Jessica WeitthoffOhio Benefit Bank Program Manager
Main point of contact for SSI/SSDI related questions and issues.
office: 614-221-4336 x282cell: 614-361-8102
email: [email protected]
Organization Map
The State of Ohio Solutions for Progress “The Benefit Bank”
Funding and SupportTBB Programming &
Maintenance, Help Desk
Lead Agencies
Ohio Association of FoodbanksLead Agency, Training, Grants, Coordination and Marketing
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Supported ProgramsSupplemental Security Income (SSI)Supplemental Security Income (SSI) was created by Title 16 of the Social Security Act. SSI is for low-income individuals. Individuals applying for disability benefits who have never worked, or whose work history has not earned them the credits needed to qualify for Social Security Disability Insurance (SSDI), can apply for disability benefits under the SSI program.
Social Security Disability Insurance (SSDI)SSDI, or Social Security Disability Insurance (otherwise known as SSD or Social Security Disability), was created by Title 2 of the Social Security Act. SSDI provides disability benefits to individuals who have earned enough work credits to qualify.
Ohio Common ApplicationSpecialists have the option of e-submitting or paper filing the Ohio Common Application, assisting clients with the following programs:
▪ Food Assistance (formerly Food Stamps)
▪ Medicaid for the Aged, Blind, and Disabled
▪ Medicare Premium Assistance Program
▪ Bureau for Children with Medical Handicaps
▪ Child and Family Health Services
▪ Ohio Works First (Cash Assistance)
▪ Women, Infants, and Children (WIC)
Home Energy Assistance Program (HEAP)The Home Energy Assistance Program (HEAP) offers a one-time payment on a household’s heating bill during the program season, September through May.
Healthcare Coverage ApplicationThe Healthcare Coverage Application can be used to apply for the following programs by mail:
▪ Healthy Start and Healthy Families (Medicaid)
▪ Medicaid for Adults
▪ Advanced Premium Tax Credit
▪ Marketplace Insurance Coverage
Disabilities and Medical Conditions: Program Screening ToolThe Disabilities and Medical Conditions Program Screening tool is similar to QuickCheck. The tool will allow specialists to assess clients’ eligibility for the following programs:
▪ Healthy U
▪ Bureau for Children with Medical Handicaps
▪ Vocational Rehabilitation Services
▪ Veterans Vocational Rehabilitation and Employment
▪ Medicaid Buy-In for Workers with Disabilities
▪ Disability Financial Assistance
▪ Veterans Pension and Disability Compensation
▪ Aged, Blind, or Disabled Medicaid
▪ Social Security Disability Income (SSDI)
▪ Supplemental Security Income (SSI)
Other ProgramsOther programs available within The Benefit Bank SSI/SSDI include:
▪ Ohio Child Care Benefits
▪ Healthy U and Other Programs
▪ Opportunities for Ohioans with Disabilities
▪ OH Prescription Assistance (Golden Buckeye)
▪ Ohio USDA Child Nutrition Program
▪ Ohio Fatherhood Programs
▪ Ohio Child Support Referral
▪ National Voter Registration
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The Help DeskSolutions for Progress provides a Help Desk that responds to phone and e-mail inquiries from specialists. The Help Desk is available for support as you assist clients.
Contact the Help Desk when:
▪ You forget your login name and password
▪ The Benefit Bank is not responsive or behaving as expected
▪ You need help with technical troubleshooting
▪ You get an error message
▪ You need help finding answers to client questions
When calling the Help Desk be sure to indicate that you are a SSI/SSDI specialist.
Before contacting the Help Desk, read the blue help links and search TBB for answers. TBB contains links to information that will answer many common questions.
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Contact the TBB Help Desk1.855.822.4357
1.855.TBB.HELP
(Response within two business days)
Help Desk HoursHours During Tax Season:
9 AM - 8 PM Monday-Friday
9 AM - 5 PM Saturday
Normal Hours:
9 AM - 5 PM Monday-Friday
Section TwoBasic Navigation Important Websites To ensure your SSI/SSDI client sessions run smoothly, you should have the following websites open in separate tabs:
Counselor Support Site support.ohiobenefits.org
Social Security www.ssa.gov/applyfordisability
SSI/SSDI Live Site ssi.thebenefitbank.org
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Accessing the SSI/SSDI Counselor Support Websitesupport.ohiobenefits.orgThis website provides access to training resources, a detailed step-by-step guide of the application process, documents, and other resources.
DocumentsAs an SSI/SSDI specialist you will visit the Counselor support site to access documents frequently throughout the application process. In most cases you will download the forms, fill-in information on your computer, print multiple copies, and obtain your client’s signature.
For example, under the Forms section you’ll find the three forms that need to be completed with each client before starting an application inside TBB. They are the SSA - 1696, the Consent to Use Information, and the SSA - 827.
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Accessing the SSA Websitewww.ssa.gov/applyfordisabilityAs a specialist you will be responsible for obtaining the Reentry number for your clients from the SSA website. This notifies the SSA office of the intent to file. Clients and specialists have 60 days from the date these numbers are generated to file a full application with the SSA.
Accessing the TBB SSI/SSDI Websitessi.thebenefitbank.orgAs a SSI/SSDI specialist you will use the TBB SSI/SSDI website (also called the live-site) to fill out the SSI/SSDI application and other necessary forms. TBB also provides:
▪ tools to upload, store, and submit supporting documents
▪ tools to track applications and records requests
▪ a memo function to allow you to record case notes
Note that this website URL is different than the web address you use to access the counselor-assisted version of TBB. Currently, TBB SSI/SSDI exists separately from the traditional version. This means that, after your training, you will be given a second login name for use on the TBB SSI/SSDI website.
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Accessing the SSI/SSDI Training WebsiteThe Benefit Bank training website acts as a mirror to the live site. You may practice using TBB on this site any time without worrying about submitting fake client information.
Never assist real clients using the training website and do not enter training clients into the live site. The training site is red, the live site is green.
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1. Go to:
training-ssi.thebenefitbank.org
2. Your training login name is ohiossi______
3. The password is always tbb12345
Search by complete or
partial entries
To view a complete list
of your clients, leave all fields blank and click
SearchCase status
must be recorded on
the Application Progress page to be included
in search results
Click here to create
new client
Specialist PortalUpon logging in, you will view the Specialist Portal. From here you can create a new client profile or manage existing clients.
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Creating a ClientThe client creation page captures basic information such as the client’s name, social security number, and address.
TBB PRACTICE
Create a Client Account - Austin Green
(Continue with address as entered)
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Client PortalUpon creating a client you will be brought to the client portal page. This page functions as a homepage for the client. It provides links to applications, tasks, memos, and other resources to assist you in securing benefits for your client.
Client name appears here
Case notes go here
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Application MenuThe application menu allows you to visualize completed portions of the applications and prepare for upcoming questions.
▪ Checkmarks indicate that a section is complete.
▪ Arrows appear alongside the next required section.
▪ Inactive links appear as gray text and indicate that a previous section must be completed prior to accessing the link.
Navigation ButtonsPrevious and Save and Continue buttons appear at the bottom of most pages. On longer pages, you may also find a Save button. This will allow you to save what you have entered without going on to the next page.
When working on long pages, an auto reminder pop-up will appear after twenty minutes which will force the specialist to save the page. This ensures that no work is lost while inputting data onto lengthy pages.
Dynamic ContentTBB makes liberal use of dynamic content. This technology allows relevant follow-up questions to appear on the same page as the original question where applicable.
Required/Important Questions IndicatorRed asterisks appear next to many questions throughout the program. In a few cases the asterisks indicate that a response is required, for example the client’s last name must be provided. The majority of questions with asterisks are not required. They are important and should be answered. However, if left unanswered, specialists will still be permitted to proceed to the next page.
TBB is designed in this way to afford specialists the greatest flexibility in tailoring their sessions to clients’ circumstances.
Return to Page ReminderThe return to page reminder appears at the bottom of most pages. When selected, it records the page and highlights it in the Review and Edit Menu as green text.
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Blue text indicates sections you’ve
visited
Toggle between views of the application
Green text indicates you visited and
requested to view later
Gray Text indicates pages you
have not yet visited
Red asterisk indicates sections you have visited
contain required/important questions
Help ContentGlossary Terms appear as blue hyperlinks.
Clarifying Questions are also blue hyperlinks preceded by a question mark icon.
Specialist Tips are presented as text in a blue box. Appearing only in the SSI/SSDI application, the tips address advocacy and case management issues that are pertinent to the application process.
Reviewing and Editing DataTo ensure that the application you ultimately submit is as accurate as possible, you are encouraged to review all the information you entered prior to submission. In reviewing the application, you may discover errors or unanswered questions. Even when a response is correct, you may find that it could be expanded or better illustrated with a different example.
Review and Edit Menu
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Section ThreeDetailed Navigation of TBB SSI/SSDI
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Client BackgroundIn this section, you will be asked to give as much information as possible about the client. Information about their household, work history, education, income, and expenses will help determine the client’s eligibility for benefits. There are several documents that are very useful in completing this section. Please note that the documents are not required, as some clients may not have them in their possession. However, it is recommended that you prepare your client before the first meeting so that they arrive ready with as much documentation as possible. At the end of each sub-section, you will find a list of acceptable documents that can be used to fill out that portion of the application. Some documents will be useful in more than one area, so make sure to use all of the resources available to you.
Household InformationHousehold Information is the starting point for all programs available via The Benefit Bank. The client will be asked about where they are currently living. If the client has other members in the household their information will be recorded as well. Members of the client’s household do not have to be related. If anyone in the household is disabled, blind, or visually impaired make sure to mark them as such.
Children/ GrandchildrenThe client will be asked for information about any children or grandchildren that do not live with them. While they may not currently live with the client, they are nonetheless considered in determining their eligibility for benefits.
Additional Relationship InformationIf the client lives with other people in the household, then this section will allow the client to establish the relationships between the other members of the household. This helps to determine if the members of the household are eligible for any additional benefits.
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ExpensesThe Ohio Department of Job and Family Services
(ODJFS) and the Social Security Administration (SSA) collect information regarding applicants’ financial obligations.
The Benefit Bank has sorted expenses into five categories:
▪ Qualified Medical Expenses
– Qualified medical expenses include any hospital bills, prescription bills, office visit bills and copayments, lab fees, and other related expenses that are recurring, currently being paid, or that have been paid off within the last three months.
▪ Child and Dependent Care Expenses
▪ Child Support or Alimony Expenses
▪ Blind/Disabled Work-Related Expenses
▪ Shelter Expenses
– Shelter expenses include rent or mortgage payments, homeowners insurance, phone bills, and utility bills.
IncomeOne of the key factors in assessing an individual’s eligibility for public benefits is income. When The Benefit Bank and the governing agency determines eligibility, some income may be partially or completely excluded in reaching the final benefit calculation. Still, clients are required to disclose all funds received by both themselves and members of their household at the time of application.
There are several categories of income:
▪ Work-Related Income
– Work wages, salary, tips, worker’s compensation, unemployment compensation, military pay, union pay, and federal work-study are all considered work related income. If the client was self-employed, they will be required to report their profits and losses.
▪ Government Income
– Social Security Retirement Benefits, Social Security Survivors Benefits, Veterans Benefits, Cash Assistance, Food Assistance, and Energy
To make sure that you are entering all pertinent information, it is recommended that you not just ask clients about the broad categories, but solicit a response for each subcategory.
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Assistance are all considered government income.
▪ Other Income
– Child Support, Grants, Scholarships, Fellowships, and Life Insurance payments are just a few of the many things that can be considered other income.
▪ In-kind Income
– In-kind income is food, shelter, or some item (not cash). In-kind income can be unearned or earned (e.g., chores around the house).
Asset InformationThe client is required to report any assets in their possession. Assets are broken up into the following categories:
▪ Liquid Assets
– Cash, savings and checking accounts, certificates of deposit, trusts, bonds, stocks, retirement accounts, and mortgage notes are all considered liquid assets.
▪ Property Assets
– Real estate, business assets, pre-paid burial spaces and funeral expenses, mobile homes, and other property are considered property assets.
▪ Vehicle Assets
– Vehicles are cars, trucks, ATVs/quads, motorcycles, boats, mopeds, RVs, and campers.
▪ Insurance Assets
– Health, car, life, homeowner’s, renter’s, flood and disaster insurance policies, HMO’s, and Medicare Supplement plans should be counted as insurance assets.
▪ Medicare/Medicaid
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EducationHere the client will state their educational history, including the date (to their best approximation) at which they completed their highest level of education. Participation in special education classes and work support programs are also addressed.
Work HistoryThe client will have to signify the date they were no longer able to perform Substantial Gainful Activity, the date they last worked, and their employment history for the last 15 years.
Substantial gainful activity means the performance of significant physical or mental activities in work for pay or profit, whether or not profit is realized.
This sub-section will ask some additional questions about the client’s work history and that of a spouse or former spouse (if applicable). This helps to determine if any additional benefits are available.
Military HistoryIf the client has a military history, then they will be asked about the years they served, their rank, and how they were discharged. If a client’s spouse or former spouse has a military history, only the years served will be required.
Combined with the client’s education and work history, this information constitutes a critical element of the disability determination process. It helps to establish the type of work that an individual is qualified to do and provides a basis for evaluating how an individual’s impairments limit their ability to work.
Warrants and Police ContactAn individual’s contact with the justice system may impact their eligibility for benefits. If the client has any unsatisfied warrants, is currently on parole or probation, or if they have been previously arrested then this information will be recorded into the system.
Obtain a Work History ReportIf you are unsure about
the client’s work history, you can obtain a written report from the SSA that includes a detailed account of the client’s earnings and a benefits estimate at: www.ssa.gov/myaccount. This process may take several weeks and it might be better for the client if you fill out the application now as best you can.
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Application Preferences & Other BenefitsThis sub-section asks some additional questions about the client. They can request a password to use SSA’s web and phone service, request a representative payee, and indicate previous receipt of public benefits.
A representative payee is an individual or organization that receives Social Security and/or SSI payments for someone who cannot manage or direct the management of his/her money. Payees should use the funds for the current and foreseeable needs of the beneficiary and save any remaining funds for the beneficiary’s future use.
Non-medical Eligibility EstimateBefore any medical history is established, TBB SSI/SSDI will estimate if the client is eligible for one, both, or none of the programs. For a complete listing of all the acceptable documents that can be used for the Client Background section, please refer to the SSI/SSDI Document Checklist that has been included on page 32.
Medical - GeneralThis introductory section asks for some basic information regarding a client’s medical history. A more extensive medical history will be examined in other sections.
Basic Medical Background In the Basic Medical Background sub-section, the client will describe his/her own disability. List any of the illnesses, injuries, or conditions that limit the client’s ability to work. You should record what the client says here, regardless of whether it sounds realistic or accurate.
If the client uses any assistive devices make sure to take note of that in this section. The client will also be asked about their physical traits, including weight and height.
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Medical History DetailsThis sub-section allows the client to provide contact details for medical professionals and others familiar with their case. This is important because these contacts may be able to provide some additional information to support the client’s claim for benefits.
Detailed information about doctor’s appointments, hospitalizations, and emergency room visits can also be submitted here.
Note: As you gather medical records, you may find yourself visiting and updating this section multiple times.
Substance AbuseIf a client indicates that they currently or previously used drugs or alcohol, they will be presented with a new sub-section entitled Substance Use. Most questions are open-ended. In this sub-section, clients reflect on their feelings about usage, its impact on their lives, and previous attempts to quit.
Medical - PhysicalThe Medical - Physical section presents many
common illnesses, injuries, and conditions that are often considered disabling by
the Social Security Administration. While the online system has many options, please note that your client’s illness, injury, or condition may not be listed. In this case, you should make sure to write
that illness, injury, or condition in the Basic Medical Background sub-section of the Medical-General section.
Presumptive Disabilities and Compassionate AllowancesIt will be extremely helpful for you to have your client’s medical records available for reference when you are filling out this sub-section. If your client experiences pain or symptoms that have not been diagnosed by a doctor, you need to schedule a doctor’s appointment for your client as soon as possible.
If any of the conditions listed under Presumptive Disabilities and Compassionate Allowances are experienced by the client, this may lead to expedited processing of their application for SSI and/or SSDI. To search the page to see if any of your client’s ailments are listed, hit Control + F on the keyboard and a new search bar will appear. Most browsers will highlight the word on the screen and take you to its location.
It may be helpful for you to consult the SSA’s Blue Book, which provides a more comprehensive list of disabilities with additional details. Go to www. ssa.gov and search for Blue Book.
Capabilities and AilmentsThis sub-section will ask some additional questions about the client’s physical health, as shown in the photo on the next page.
Body Systems Affected - Part I and IIIn these two sub-sections, the client will identify the bodily systems affected by their condition.
If the client has any of the conditions listed in the Presumptive Disability or Compassionate Allowance sections on this page, enter this information in the Additional Comments or Remarks text boxes for the SSA-3368, the SSA-8000, and/or the SSA-16. These Remarks text boxes appear in the Forms for SSA section. In your remarks, list the condition and whether it may be classified as a Compassionate Allowance or a Presumptive Disability.
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Medical History Details
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▪ Cardiovascular System ▪ Digestive System ▪ Genitourinary System ▪ Hematological System ▪ Skin System ▪ Musculoskeletal System ▪ Endocrine System ▪ Respiratory System ▪ Nervous System ▪ Immune System
These systems are:
Capabilities and Ailments
The client will also be able to indicate if they suffer from any impairments that affect multiple body systems. In both sections the clients are asked to elaborate as much as possible in order to get a better understanding of their conditions and to help determine their eligibility for benefits. As with the Presumptive Disabilities and Compassionate Allowances sub-section, you may find it helpful to use the Ctrl+F feature on your keyboard to help you locate a client’s illness, injury, or condition.
Medical - MentalThe Medical-Mental section explores the client’s emotional and behavioral state. In order to gather the necessary information, the online service shifts audiences and poses questions directly to the specialist.
There are nine sub-sections to the Medical - Mental section:
▪ Affect and Mood - (Evaluation & Post-evaluation)
▪ Anxiety - (Evaluation & Post-evaluation)
▪ Mental Content - (Evaluation & Post-evaluation)
▪ Bodily Concerns - (Evaluation & Post-evaluation)
▪ Sensorium and Cognitive Functioning - (Evaluation & Post-evaluation)
▪ Appearance and Behavior - (Post-evaluation Only)
▪ Flow of Conversation and Thought - (Post-evaluation Only)
▪ Work-Related Functioning and Multiaxial Classification - (Post-evaluation Only)
▪ Rating Observations - (Post-evaluation Only)
Notice that the questions in this section are divided into two categories: Evaluation and Post-Evaluation.
Evaluation questions are those for which direct feedback from the client is required, such as those that ask about the client’s ability to perform specific tasks.
Post-Evaluation questions do not require the client’s presence. They are primarily observational, soliciting the specialist’s assessment of such characteristics as the client’s appearance, cognitive functioning, and interpersonal skills. You may want to skip the post-evaluation questions and return to them later, after the client interview has concluded. It is very important to be as descriptive as possible when giving examples of a client’s symptoms or conditions and when entering
information regarding severity and duration. The DDS will be seeking information on how serious a client’s condition is and how it affects his/her functioning. Avoid giving short answers, such as “very severe” or “not a problem.” If you are not qualified or comfortable answering these questions make a note in
Remarks section and secure any available records from mental health providers.
Answer all questions in the third person. For example, “The
client (or he/she) has an unfounded fear of spiders, heights, and the government.”
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Daily Living ActivitiesNote: Be detailed and thorough in this section. DDS uses this information to determine the extent of functional limitations related to disabling conditions.
This section focuses on the client’s day-to-day experiences, and helps to paint a picture of the impact an individual’s disability has on routine activities. The questions asked within Daily Living Activities section are broken down into the following categories:
Routine and Care (Evaluation & Post-evaluation)
▪ How does the client spend their days and evenings?
▪ Do they take care of any other people?
▪ Do they have any pets or other animals?
Sleep
▪ Where does the client sleep at night?
▪ Do the illnesses, injuries, or conditions affect their sleep?
Personal Care
▪ Do they need any special reminders to take care of personal needs/grooming?
▪ Do they need help or reminders taking medicine?
Meals / Eating
▪ Does the client eat regularly?
▪ Do they need help getting meals?
Chores and Shopping
▪ Does the client drive or use public transportation?
▪ Can they handle their own money and accounts?
Hobbies and Social Interactions
▪ Can the client watch TV, read a book, or sit through a movie?
▪ Do they spend time with other people (in person, on the phone, on the computer, etc.)?
Activities Affected
▪ How mobile is the client?
▪ Can they concentrate on completing a task?
▪ Can they follow instructions?
RemarksThe following forms include a Remarks section allowing specialists to include pertinent information regarding a client’s case not otherwise captured on the application:
▪ Application for Supplemental Security Income (SSA-8000)
▪ Application for Disability Insurance Benefits (SSA-16)
▪ Disability Report - Adult (SSA-3368)
▪ Work History Report (SSA-3369)
▪ Function Report - Adult (SSA-3373)
If a client has more than one contact, has additional medical records, or if there is any information that could not be fit into the forms then it should be added here. As you add information, make sure you are adding them to the correct form.
Forms and Medical Summary Report GuideForms for SSAExplaining Limits on Ability to WorkThe first page of this section focuses on the question, “What are the illnesses, injuries, or conditions that limit your ability to work?” It is a critical question in the SSI/SSDI application process and specialists must take care in providing a response.
To help, TBB provides a “Client-Supplied Answer” and a “TBB-Supplied Answer.” The Client- Supplied Answer is a direct quote from the client. TBB-Supplied Answer is a distillation of data relevant to the question collected by TBB. Using both of the answers specialists should craft a response that clearly communicates their understanding of the client’s case.
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Once you have finished adding remarks, you will be presented with the completed forms. One copy of the SSA-16 and/or SSA-8000, SSA-3368, and SSA-3369 will be generated for each client.
Depending on the circumstances of your client’s case, SSA-3373, SSA-4814, and SSA-795 may also be generated.
▪ Function Report – Adult (SSA-3373)
▪ Medical report on Adult with Allegation of HIV Infection (SSA-4814)
▪ Statement of Claimant or Other Person (SSA-795)
Everyone is expected to submit the SSA-1696 and SSA-827, the second and fourth step listed on the Application Progress Page. Specialists will have to determine whether or not to submit a SSA-827 and/or SSA-561 for their client.
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Household Information □ Photo ID □ Certificate of Birth □ U.S. Passport □ Certificate of Naturalization □ Marriage Certificate
Proof of living arrangement: □ Copy of lease □ Rental loan agreement □ Property agreement □ Deeds or other proof of land ownership □ Proof (statement) of in-kind support or maintenance
Expenses □ Copies of medical expense bills □ Copy of lease or rental agreement □ Copy of mortgage statement
Income □ W-2 □ SSA-7011 □ SSA--1002 □ Tax Records and Receipts (for proof of self-
employment)
Asset Information □ Bank account statements □ Copies of Certificates of Deposit □ Copies of stocks or mutual fund certificates □ Copies of burial contracts □ Copies of life insurance policies □ Vehicle titles, bill of sale, or current registration (if
claim of vehicle is not accepted by SSA)
Education □ School Records □ Official statement from school showing enrollment
Work HistoryOne of the following:
□ W-2 □ SSA-7011 □ SSA-1002 □ Any statement signed by employer □ SSA-4500-U6 (signed by authorized state or local
official)OR, if one of the above cannot be found, two or more of the following (check which ones):
□ Pay envelopes □ Vouchers □ Union records □ Income tax returns □ Records of state unemployment compensation
agencies □ Personal records
Military History □ Proof of military pay wages □ Any official military service documents
Document ChecklistTo assist you in completing applications, the documents listed below are grouped by the sections and sub-sections in TBB.
Section FourSSI/SSDI Application Process
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Application Process - Overview
1. Complete Important Forms
2. Establish a Protective Filing Date
3. Complete Applications
4. Submit Application and Follow-up
Complete form SSA-1696
Complete Consent to Use Information
form
Complete form SSA-827
Obtain a reentry number from the
SSA website
Create a new client in TBB and record
the number in client memos
Complete and submit applications
for other income support programs
Complete the Ohio SSI/SSDI application
Print applications, review information,
obtain client signatures
Use the template submission email (from the support site) to submit for
data entry
Maintain communication
with SSA, Disability Determination
Services (DDS), and your client
Submit signed applications
and forms with Application Cover Sheet to the local
SSA office
Note: Do not try to do this in a single appointment. Most applications require between two and four appointments, depending on individual circumstances.
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Step-by-Step Application ProcessComplete form SSA-1696A. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click the Documents tab
D. Download form SSA-1696
E. Complete the form with you client. Print, sign, and date the form in all the spaces marked for Claimant and Representative
F. Put one copy in your submission folder and file the other 3 copies in your client’s records
PRACTICE
Meet Dallas GrayFill out SSA - 1696 for Dallas Gray
Use the information below to complete this step for Dallas Gray.
1. In the Name (Claimant) (Print or Type) field type Dallas Gray.
2. In the Social Security Number field type Dallas’ social: 888-77-6666.
3. In the Address field enter Dallas’ address: 400 Warren St., Apt B, Columbus, Ohio, 43215.
4. Enter Dallas’ phone number: 614-555-1234.
Before printing the form ask your trainer to check your work.
1
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Complete Consent to Use Information FormA. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click the Documents tab
D. Download Consent to Use Information form
E. Complete, print two copies, sign, and date the form
F. Put one copy in your submission folder and file the other copy in your client’s records
PRACTICE
Fill out Consent to Use Information
Complete the Consent to Use Information form for Dallas Gray. Before printing the forms ask your trainer to check your work.
2
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Complete form SSA-827A. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click the Documents tab
D. Download form SSA-827
E. Complete, print two copies, sign, and date the form
F. Put one copy in your submission folder and file the other copy in your client’s records
PRACTICE
Fill out SSA-827
Use the information below to complete this step for Dallas Gray.
1. Type Dallas Gray into the NAME field.
2. Type his social: 888-77-6666, then his birthday: 02-03-1983.
3. Enter today’s date.
4. In the Address field enter Dallas’ address: 400 Warren St., Apt B, Columbus, Ohio, 43215.
5. Enter his phone number: 614-555-1234.
6. Enter your phone number.
Before printing the form ask your trainer to check your work.
3
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Obtain a Reentry NumberA. Go to the United States Social Security Administration website -
www.ssa.gov/applyfordisability
B. Click Apply for Disability at the bottom of the page
C. Click Start a New Application
D. Choose, “I am helping someone who is not with me”
E. Continue filling applicable fields until a Reentry Number is generated
F. Write this number down and immediately proceed to step 5
4
PRACTICE
Obtain a Reentry Number
Watch as your trainer demonstrates this step.
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Create Client and Add MemosA. Log into TBB SSI/SSDI - ssi.thebenefitbank.org
B. Click Create New Client
C. Complete applicable fields
D. Click Create Client
E. Go to TBB SSI/SSDI - ssi.thebenefitbank.org
F. Open the Client Portal Page for the client you are serving
G. Type the Reentry Number into the Add Memo box
H. Click Create Memo Item
5
PRACTICE
Create Client and Add Memos
Use the information below to complete this step for Dallas Gray.
1. Use the screen shot to the right to fill out the first section of information.
2. Dallas’ address is: 400 Warren Street, Apt. B, Columbus, Ohio, 43125 in Franklin County.
3. His phone number is 614-555-1234.
4. His email address is [email protected]
5. Continue with the address you entered
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Household Information1. After entering the household information section, turn electronic submission ON by switching the ESUB button
to YES
2. No, there are no other people to include in the household
3. Dallas is single
4. He is a US citizen
5. Dallas is disabled but not blind
6. He is not a current member of the military or veteran
7. He is not a surviving spouse or dependent child of a veteran
8. Dallas does not have a separate mailing address
Submit Applications for Other Income Support ProgramsA. Go to TBB SSI/SSDI - ssi.thebenefitbank.org
B. Open the Client Portal Page for the client you are serving
C. Click Ohio Common Application for Benefits or Ohio HEAP Application to apply for these programs
D. If completing the Ohio Common Application for Benefits turn electronic submission ON by switching the ESUB button to YES
6
PRACTICE
Complete Applications for other Programs
Use the information below to complete the Ohio Application for Benefits for Dallas Gray. From the client portal click Ohio Common Application for Benefits
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Complete the Ohio SSI/SSDI ApplicationIMPORTANT: This section may take several appointments to complete, so plan accordingly.A. From the client portal page of TBB SSI/SSDI - ssi.thebenefitbank.org - click Ohio SSI/SSDI
Application
B. Complete the following sections: Client Background, Medical-General, Medical-Physical, Medical-Mental, Daily Living Activities.
7
PRACTICE
Start SSI/SSDI Application
Complete Basic Medical Background and explore this section using your own made up information.
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Print applications, Review Information, Obtain SignaturesA. In the Forms for SSA section of the application, carefully read and follow on screen
instructions to enter impairments that limit your client’s ability to work and final remarks
B. Press Save & Continue
C. Enter final remarks when applicable
D. Press Save & Continue
E. Open and review each application
F. Print two copies of the SSA-16 and SSA-8000
G. Print one copy of the other TBB generated forms including SSA-3369, 3368, 3373 and any other forms
H. Client signs and dates one copy of the SSA-16 and SSA-8000
I. Specialist puts signed SSA-16 and SSA-8000 in the submission file and all unsigned forms are filed in the client’s records
8
Retrieve copies of the forms for Dallas Gray, sign, and deposit them properly in the folders provided by your trainer. P
RACTICE
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Use the template submission email (from the support site) to submit for data entryA. Find the client ID number:
– From the Specialist Portal search for the client using the Find a Client tool
– Highlight the client ID and click Ctrl + C to copy the number
– Click the client name to open client account
– In Add Memo box, click Ctrl + V to paste client ID
– Click Create Memo Item
B. Use the template to send an email to [email protected] and [email protected]
– Go to the OBB Access SSI/SSDI support site, http://ssi.ohiobenefits.org
– Click documents
– Click template submission email
– Complete each field
C. You will receive a data entry receipt when your client’s application has been completed (generally within one business day), but you may proceed immediately to step 10
9
PRACTICE
Find Client ID and Send Email
1. Find the client ID to Dallas’ account.
2. Send an “email” by filling in the information below.
To:From:Subject:
Message:Your name:Your client’s ID Number (not SSA reentry number):Is this your first application you are submitting within the last 6 months? (yes/no):
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Submit Applications and Forms to local SSA field officeA. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click the Documents tab
D. Download Application Cover Sheet
E. Retrieve forms SSA-1696 and SSA-827 from the hard-copy client file (completed earlier in the process)
F. Retrieve signed SSA-16 and SSA-8000
G. Check the box next to each form number on the Application Cover Sheet as the packet is assembled
H. In the Submission Date box put today’s date
I. Type Reentry Number in the box provided (stored as a memo on the Client Portal Page, see step 5)
J. Complete the form with your client’s name and your contact information
K. Mail or hand-deliver the completed application packet to the client’s local SSA field office
10
PRACTICE
Submit the Applications
Complete the Application Cover Sheet for Dallas Gray and compile all documents required for the local SSA field office and bring the completed packet to your trainer.
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Maintain communication with SSA, DDS, and your clientYour responsibilities as Authorized Representative may include:
▪ Helping your client stay informed throughout the process
▪ Gathering medical evidence
▪ Gathering supporting evidence from non-medical sources
▪ Submitting verifications to SSA
▪ Submitting verifications to DDS
▪ Helping clients keep scheduled appointments
▪ Providing other assistance as necessary
Ask Questions!The OBB Access SSI/SSDI team is available to support you. Please be in touch if you have any questions or concerns: [email protected] ?
11
Step-by-Step Application Process
1Complete form SSA-1696A. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click Documents
D. Download form SSA-1696
E. Complete the form with you client. Print, sign, and date the form in all the spaces marked for Claimant and Representative
F. Give one copy to your client and file the other 3 copies in a hard-copy client file for later use
2Complete Consent to Use Information FormA. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click Documents
D. Download Consent to Use Information form
E. Complete, print two copies, sign, and date the form
F. Give one copy to your client and file the other copy in a hard-copy client file
3Complete form SSA-827A. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click Documents
D. Download form SSA-827
E. Complete, print two copies, sign, and date the form
F. Give one copy to your client and file the other copy in a hard-copy client file
Complete Important Forms
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4Obtain a Reentry NumberA. Go to the United States Social Security Administration website -
www.ssa.gov/applyfordisability
B. Click Apply for Disability at the bottom of the page
C. Click Start a New Application
D. Choose, “I am helping someone who is not with me”
E. Continue filling applicable fields until a Reentry Number is generated
F. Write this number down and immediately proceed to step 5
5Create Client and Add MemosA. Log into TBB SSI/SSDI - ssi.thebenefitbank.org
B. Click Create New Client
C. Complete applicable fields
D. Click Create Client
E. Go to TBB SSI/SSDI - ssi.thebenefitbank.org
F. Type the Reentry Number into the Add Memo box
G. Click Create Memo Item
Establish a Protective Filing Date
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6Submit Applications for Other Income Support ProgramsA. Go to TBB SSI/SSDI - ssi.thebenefitbank.org
B. Open the Client Portal Page for the client you are serving
C. Click Ohio Common Application for Benefits or Ohio HEAP Application to apply for these programs
D. If completing the Ohio Common Application for Benefits turn electronic submission ON by switching the ESUB button to YES
7Complete the Ohio SSI/SSDI ApplicationIMPORTANT: This section may take several appointments to complete, so plan accordingly.A. From the client portal page of TBB SSI/SSDI - ssi.thebenefitbank.org - click Ohio SSI/SSDI
Application
B. Complete the following sections: Client Background, Medical-General, Medical-Physical, Medical-Mental, Daily Living Activities.
8Print applications, Review Information, Obtain SignaturesA. In the Forms for SSA section of the application, carefully read and follow on screen
instructions to enter impairments that limit your client’s ability to work and final remarks
B. Press Save & Continue
C. Enter final remarks when applicable
D. Press Save & Continue
E. Open and review each application
F. Print two copies of the SSA-16 and SSA-8000
G. Print one copy of the other TBB generated forms including SSA-3369, 3368, 3373 and any other forms
H. Client signs and dates one copy of the SSA-16 and SSA-8000
I. Specialist files signed SSA-16, SSA-8000 and client leaves with all unsigned forms
Complete Applications
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Submit Application and Follow-up
9Use the template submission email (from the support site) to submit for data entryA. Find the client ID number:
– From the Specialist Portal search for the client using the Find a Client tool
– Highlight the client ID and click Ctrl + C to copy the number
– Click the client name to open client account
– In Add Memo box, click Ctrl + V to paste client ID
– Click Create Memo Item
B. Use the template to send an email to [email protected] and
– Go to the OBB Access SSI/SSDI support site, http://ssi.ohiobenefits.org
– Click documents
– Click template submission email
– Complete each field
C. You will receive a data entry receipt when your client’s application has been completed (generally within one business day), but you may proceed immediately to step 10
10Submit Applications and Forms to local SSA field officeA. Go to the counselor support website - support.ohiobenefits.org
B. Click Access SSI/SSDI
C. Click Documents
D. Download Application Cover Sheet
E. Retrieve forms SSA-1696 and SSA-827 from the hard-copy client file (completed earlier in the process)
F. Retrieve signed SSA-16 and SSA-8000
G. Check the box next to each form number on the Application Cover Sheet as the packet is assembled
H. In the Submission Date box put today’s date
I. Type the Reentry Number in the box provided (stored as a memo on the Client Portal Page, see step 5)
J. Complete the form with your client’s name and your contact information
K. Mail or hand-deliver the completed application packet to the appropriate local SSA field office
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11Maintain communication with SSA, DDS, and your clientYour responsibilities as Authorized Representative may include:
▪ Helping your client stay informed throughout the process
▪ Gathering medical evidence
▪ Gathering supporting evidence from non-medical sources
▪ Submitting verifications to SSA
▪ Submitting verifications to DDS
▪ Helping clients keep scheduled appointments
▪ Providing other assistance as necessary
Ask Questions!The OBB Access SSI/SSDI team is available to support you. Please be in touch if you have any questions or concerns: [email protected]?
Section FiveForms Appendix
On the next few pages you will find filled-out copies of important forms.
More information on each form, including where they can be found and their purpose, is available on the next page.
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Supported Applications and FormsForms Generated by TBBForm Name PurposeSSA-16 - Application for Disability Insurance Benefits The initial application to apply for Social Security Disability Insurance
(SSDI) benefits.SSA-795 - Statement of Claimant or Other Person Available for any additional information or comments about a client that
does not fit on another form.SSA-3368 - Disability Report – Adult This form contains the client’s medical history, as well as the effects of
their condition.SSA-3369 - Work History Report Lists the client’s work history from the 15 years prior to when their
disabling condition began.
SSA-3373 - Function Report -- Adult Examines how the client’s illnesses, injuries, or conditions limit their functioning.
SSA-4814 - Medical report on Adult with Allegation of HIV Infection
Collects information regarding severity of the infection; client may be determined as presumptive disability.
SSA-8000 - Application for Supplemental Security Income
This form is the initial application to apply for Supplemental Security Income (SSI) benefits.
JFS 07200 - Request for Cash, Food Stamp, and Medical Assistance
This form will allow the client to apply for other benefits, like Food Assistance, if applicable.
JFS 07216 - Combined Programs Application for Healthy Families, Healthy Start, WIC, BCMH, and CFHS
Allows the client to apply for WIC, Healthy Start, and other similar programs, if applicable.
JFS 07103 - Application for Help with Medicare Expenses
This application assists the client in finding additional resources to help pay Medicare expenses.
Ohio Department of Mental Health (ODMH) Mental Status Questionnaire
This questionnaire will examine how the client’s disability affects their mental abilities.
Daily Activities Questionnaire This questionnaire will examine how the client’s disability affects their ability to perform daily tasks.
Forms to be Filled out by ManuallySSA-546 - Workers' Compensation/Public Disability Benefit Questionnaire
This questionnaire will examine the client’s history of Workers’ Compensation and other disability benefits. Other benefits may impact SSI or SSDI benefits.
SSA-561 - Request for Reconsideration Allows the client to request an appeal if they are denied benefits for medical reasons. Needs to be turned in with form SSA-3441.
SSA-827 - Authorization to Disclose Information to the SSA
This form confirms that the client allows their information, including protected health information, to be sent to the Social Security Administration.
SSA-1696 - Appointment of Representative This form confirms that the client allows you to act as their representative to apply for benefits through the SSA.
SSA-3441 - Disability Report -- Appeal Allows the client to request an appeal if they are denied benefits for medical reasons.
JFS 06723 - Authorized Representative This form confirms that the client allows you to act as a client’s representative to apply for benefits through JFS.
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SSA-1696
Page 60
Consent to Use Information
Page 60 Page 61
SSA-827
Page 62
SSA-16
Page 62 Page 63
SSA-8000
Page 64
Application Cover Sheet
Page 64 Page 65
SSA-795
Page 66
SSA-3369
Page 66 Page 67
SSA-3373
Section SixCase Management Tools
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Application Progress PageThe application progress page is an interactive outline of the steps involved in seeking SSI and SSDI benefits. This tool allows you to keep track of where you are. Used consistently, the page ensures that you are managing each case in an orderly and timely fashion.
The information you enter on this page also populates activity reports, which collect data about the progress and outcomes of SSI and SSDI applications.
A red box indicates the current task needs to be
completed
Mark step as complete by clicking save
Often a completed step will generate a task to remind
specialists of the next action they must take
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MemosItems that do not require action, but are nonetheless important are recorded as memos. There are two categories of memos: client and specialist memos.
Client MemosAs you build your case load, you will make direct observations of clients, analyze information you’ve received, and discuss aspects of a case with third parties. Client memos offer you the space to record events such as:
▪ Client missed doctor’s appointment
▪ Client was banned from a shelter for misconduct
Specialist MemosSpecialist memos are not related to any particular client. Here you would enter general notes pertinent to your work, for example:
▪ Instructions for using the scanner provided by your organization’s IT department
▪ Password hint for ERE account.
Under the My Memos tab, memos can be viewed and can also be added. Note: memos cannot be edited or deleted.
Add text here or click Create Memo at the top of
client portal.
Create a specialist memo by clicking Create Memo from the specialist portal page
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ContactsTBB allows you to store two kinds of contacts: client and specialist. Selecting Show Contacts from the toolbar on the client portal page will bring you to a list of the client’s contacts. To view specialist contacts, you must be logged into TBB as a specialist, but not yet within a client’s case. Access your specialist contact list by selecting My Contacts from the toolbar on the specialist portal.
Medical Records Request Letter GeneratorThe letter generator merges relevant client information which you have entered in TBB application modules with a letter template. You are able to specify the type of letter you want to send, the sources of records, and the treating source and treatment date(s) for the record request.
The letter generator is available through the client portal page. First, click Ohio SSI/SSDI Application, then scroll to the bottom of the client application roadmap. The last section is the letter generator.
Letter Generator SelectorOnce you have clicked on the letter generator in your roadmap, you are taken to an introduction screen. Click Save and Continue to go to the Letter Generator Selector. Then, select Medical Records Request.
From this screen you have the option to choose the source of medical records (Provider or Non-provider), provider name, and treatment date and add comments.
A medical provider is anyone who is licensed to treat illnesses that are within the scope of their license, e.g., a doctor, psychiatrist, medical specialist. A non-medical provider is a professional organization or person that is aware of a client’s medical situation and can provide information based on current or past experiences with the client, e.g., social service agency, insurance company that has paid disability benefits, attorney, or prison.
If you have entered all the information needed, a print letter screen will appear next. You now have a link to your completed letter and the letter will also
Contact type for specialist contacts differ from clients
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Track Medical Records RequestsThis tool provides a place for specialists to track the status of a medical records request they have made for a client’s case.
The Track Medical Record Requests Tool will track medical records requests initiated using the Letter Generator. Once a Specialist enters data in response to these questions and then proceeds to generate a Medical Records Request Letter, the content of that request is transferred to this tool. This tool is linked with the Letter Generator and medical content cannot be tracked using this feature unless a letter has already been generated.
The Track Medical Record Requests Tool may be accessed from two locations. From the Specialist Portal, the Track Medical Record Requests Tool is available from the Specialist Portal Toolbar by clicking My Record Tracker. Specialists may also access the Track Medical Record Requests tool from the Client Portal Toolbar.
The Track Medical Record Requests Tool is set up as a series of tables. Specialists may update requests when status conditions are met, the client’s entry will move from one table to another. These tables provide a space to view and record aspects of a client’s case that require action. Some status components are not viewable until after a status field has been updated. Moreover, additional fields will be presented depending on what request table the Specialist is working within.
The four tables within the Track Medical Record Requests Tool are:
▪ Requests To Be Made
▪ Requests Outstanding
▪ Requests Received
▪ Requests Archived
appear in your Track Medical Records Request Tool.
The letter will include content from the following sections: client background, household information, medical - general, and medical history details.
Click here to update the status of a request
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Document ManagementBlank FormsBlank versions of all the forms that are needed to apply for Medicaid and SSI/SSDI are accessible from the Specialist Portal page. They are organized according to whether they are SSA, Medicaid, or Ohio Agency Forms. Most forms will be auto-generated by TBB; however, the following forms must be printed and completed by hand:
▪ SSA-561 Request for Reconsideration
▪ SSA-827 Authorization to Disclose Information the SSA
▪ SSA-1696 Appointment of Representative
▪ Screening Criteria for ODMH Expedited SSI and Medicaid Project
To access blank forms open a client account, click Document Management located in the top tabs, then click Print Blank Forms.
Uploading DocumentsThe Document Management Page provides a platform for specialists to organize and store and submit client documents.
Follow these steps to upload a document:
1. Select “Upload a Document” from the document management page.
2. Enter a name for the document.
3. Select a document type from the drop-down menu.
4. Find the document on the computer using the browse menu.
5. Enter notes into the note field if desired.
6. Click “Upload.”
Uploaded documents appear on the Document Management page.
The types of documents that are accepted are limited to documents that are 50MB or less. Attempts to upload larger, or other types, of documents will result in an error message.
Click the blue links to view and print
Asterisks appear next to forms that must be
completed by hand
