Social Security_Disability Insurance

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Program Accomplishments

In fiscal year 2004, an average of 7,696,000 disabled workers and their dependents received monthly cash benefits. It is estimated that for fiscal year 2005, an average of 8,005,000 disabled workers and their dependents will receive monthly cash benefits. During fiscal year 2006, the average number receiving benefits is expected to increase to 8,302,000.

Uses and Use Restrictions

Monthly cash benefits are paid to entitled disabled persons and to entitled auxiliary beneficiaries throughout the period of disability generally after a 5-month waiting period.

Costs of vocational rehabilitation also are paid for certain beneficiaries.

There are no restrictions on the use of benefits received by beneficiaries, although the right to future benefits is not transferable or assignable.

In general, State agencies make initial disability determinations for the Federal Government.

The Federal Government gives the States funds, in advance or by way of reimbursement, for necessary costs in making disability determinations under 20 CFR 404 Subparts P and Q.

Necessary costs are direct as well as indirect costs as defined in 41 CFR 1-15, subpart 1-15.7 of the Federal Procurement Regulations System for costs incurred before April 1, 1984; and 48 CFR 31, Subpart 31.6 of the Federal Acquisition Regulations System and Federal Management Circular A-74-4, as amended, or superseded for costs incurred after March 31, 1984.

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Eligibility Requirements

Applicant Eligibility

A disabled worker is entitled to Social Security disability benefits if he or she has worked for a sufficient period of time under Social Security to be insured, has not attained "full-benefit retirement age" (66 years old for workers age 62 in 2005), has filed an application, and is under a disability as defined in the Social Security law.

The law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

The insured status requirements depend upon the age of the applicant and the date he or she became disabled.

Coverage credits under the social security systems of certain foreign countries with which the U.S.

has reciprocal agreements may be taken into account to meet the requirements.

Certain family members of disabled workers are also entitled to benefits: (1) Unmarried children under age 18, or under age 19 for full-time students in elementary or secondary school; (2) unmarried adult offspring at any age if continuously disabled since before age 22; (3) wife or husband at any age if child in his or her care is receiving benefits on worker's Social Security record and is under age 16 or disabled; (4) spouse age 62 or over; and (5) divorced wives or husbands age 62 or over who were married to the worker for at least 10 years.

(Benefits are also payable to auxiliaries, including certain disabled widow(er)s, disabled surviving divorced spouses, children under age 19 who are full-time students in an elementary or secondary school, and disabled children of the worker, after the worker dies.

See 96.004 "Social Security-Survivors' Insurance".) For workers who are first entitled after 1985 for both (a) a pension based on non-covered employment; and (b) Social Security disability (or retirement) benefits, a less generous benefit formula applies.

In addition, Social Security disability benefits are reduced (offset) by the amount that the sum of all disability benefits payable under Social Security and certain Federal, State, or local public disability and workers' compensation laws or plans exceeds the higher of 80 percent of the worker's average current earnings or the total Social Security benefit that would otherwise be payable on the disabled worker's record.

The Social Security benefit for a spouse of a disabled worker is subject to a pension offset if the spouse receives a governmental pension based on his or her own work in non-covered employment.

However, the offset does not apply if: (i) the person received or became eligible to receive the pension before December 1, 1982, and can meet requirements for Social Security auxiliaries' benefit as they existed in January 1977; or (ii) if the person received, or was eligible to receive, the pension before July 1, 1983, and the person was dependent on his or her spouse for at least one-half support at the time the spouse died, became disabled or became entitled to Social Security benefits.

The amount of the public pension used for purposes of the offset against Social Security spouse's benefits is equal to two-thirds of the public pension.

The Social Security benefit for the spouse of a disabled worker is also offset dollar for dollar by the amount of any Social Security benefit the spouse receives based on his or her own work.

All benefits to spouses and children of disabled workers are subject to an earnings test unless those beneficiaries are full-benefit retirement age or older.

Beginning with the year 2000, the retirement earnings test was eliminated beginning with the month in which the beneficiary reaches full-benefit retirement age (FRA).

A person at and above FRA will not have Social Security benefits reduced because of earnings.

In the calendar year in whichabeneficiaryreachesFRA,benefitsarereduced$1forevery$3ofearnings above the limit allowed by law, $31,800 in 2005, but this reduction is applied only to months prior to attainment of FRA.

For years before the year the beneficiary attains FRA, the reduction in benefits is $1 for every $2 of earnings over the annual exempt amount.

Further, no benefit can be paid to an alien in the United States unless he or she is lawfully present in the United States.

In addition, an alien cannot qualify for benefits if he or she never had a work-authorized Social Security Number (SSN) (effective for benefit applications based on SSNs issued after 2003).

Beneficiary Eligibility

Qualified disabled workers under full retirement age (FRA). Under the definition of disability in the Social Security Law, disability benefits are provided to a person who is unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment that has lasted or is expected to last at least 12 months, or to result in death. Disabled widow(er)s' benefits are covered under survivors insurance. Felony-related impairments and confinement-related impairments cannot be considered in determining whether an individual is under a disability if the individual has been convicted of a felony which was committed after October 19, 1980. Effective for claims finally adjudicated on or after March 29, 1996, (or for claims approved before then, with benefits payable beginning January 1, 1997) eligibility can no longer be based on drug addiction or alcoholism.

Credentials/Documentation

Proof of disability and possibly proof of age. If applying for benefits for family members, additional proofs of age, relationship to disabled worker, or full-time school attendance may be required.

Aplication and Award Process

Preapplication Coordination

None.

This program is excluded from coverage under E.O.

12372.

Application Procedures

Telephone toll free at 1 (800) 772-1213 or telephone or visit the local Social Security Office.

Award Procedures

After review of the application is completed, the applicant (or representative payee) will be notified by mail.

Deadlines

An individual should apply for disability benefits when he or she believes the entitlement requirements may be met. Retroactivity of benefit payments is limited to 1 year before filing.

Authorization

Social Security Act of 1935, Title II, as amended; Public Laws 96-265; 97-123, and 97-35. 42 U.S.C. 401; 42 U.S.C. 402; 42 U.S.C. 416; 42 U.S.C. 420-425.

Range of Approval/Disapproval Time

Not applicable.

Appeals

Telephone or visit any Social Security Office. The appeal process ranges from a reconsideration through hearings and appeals levels to a review by the Federal courts.

Renewals

Not applicable.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula or matching requirements.

Length and Time Phasing of Assistance

Not applicable.

Post Assistance Requirements

Reports

Any change in address or other requirement (such as improvement of disabling condition or work activity) must be reported to the local Social Security Office when it occurs.

Audits

Continuing Disability Reviews: Persons are contacted periodically to see if they continue to qualify for benefits.

Records

Not applicable.

Financial Information

Account Identification

20-8007-0-7-651.

Obigations

(Benefit Payments) FY 07 $96,988,000,000; FY 08 est $102,854,000,000; and FY 09 est not reported. (Note: These figures represent benefits actually paid, or expected to be paid.)

Range and Average of Financial Assistance

Monthly cash benefits for a worker disabled in 2005 range up to a maximum of $2,099 based on the level of the worker's earnings and the age at which a worker becomes disabled. The corresponding maximum for such a worker with a family is $3,148.60 As of December 31, 2004, the average benefit paid to a disabled worker alone was $880 and the average amount payable to a disabled worker with eligible dependents was $1,496. This takes into account stipulations set forth in Public Law 96-265 and Public Law 97-35. Under Public Law 97-123, the minimum amount is no longer applicable for workers who either become disabled or first met the insured status requirements after December 1981, and a lesser amount can be paid, depending on the worker's average earnings.

Regulations, Guidelines, and Literature

Code of Federal Regulations, Title 20, Parts 401, 402, 404, 422, 423, 429, 430, and 498. "Disability" and other publications are available from any Social Security Office without charge. The Social Security internet address is www.ssa.gov and it includes copies of all disability-related laws, regulations, rulings, and free publications, as well as other information about the disability insurance programs.

Information Contacts

Regional or Local Office

Consult Appendix IV of the Catalog.

Headquarters Office

Office of Public Inquiries, Room 4100, Annex, Social Security Administration, Baltimore, MD 21235. Telephone: (410) 965-2736. Use the same number for FTS.

Criteria for Selecting Proposals

Not applicable.