SOCIAL SECURITY — PUBLIC ASSISTANCEAGENCY INFORMATION REQUEST

FORM SSA-1610-U2
Instructions

SOCIAL SECURITY — PUBLIC ASSISTANCE
AGENCY INFORMATION REQUEST

12-1999

PURPOSE

To provide a uniform method of exchanging information between public assistance and Social Security offices in situations that cannot be resolved by contacting the beneficiary or going through the BENDEX or State Data Exchange (SDX) systems.
To request or confirm specific information.
To report a change in public assistance status that may affect Special Age 72 Social Security benefit (Prouty).
To provide the Social Security Administration (SSA) with specific information about a claimant's status.

PROCEDURE

When to Prepare

In these instructions, Form SSA-1610-U2 is referred to as Form 1610.

The worker uses Form 1610 only when a client cannot supply the needed information or when the worker is unable to obtain satisfactory information through SDX or the BENDEX system. Texas Department of Human Services (DHS) requests the information from SSA only to determine the eligibility of an applicant or client. The worker must not disclose the information to any other organization or individual, except according to SSA instructions and regulations or DHS policy.

Workers use Form 1610 to:

Serve as informational leads to SSA if the worker thinks the client is eligible.
Verify Retirement, Survivors, and Disability Insurance (RSDI) benefit status if this information is not available from the applicant, BENDEX, or SDX.
Verify SSN or SSCN.
Notify SSA that an applicant/client has been certified or denied public assistance, and to notify SSA if Prouty benefits should be terminated or reinstated.
Verify information if SDX or BENDEX information is different from what the client provided.

Special Procedures for Using Form 1610

1. Verify that the client is eligible for services in Title XX — When Social Security benefit information is not available in TANF records, SDX records, or documents the applicant has, the worker submits Form 1610 to the SSA office. On the form, the worker writes the statement: "Title XX eligibility. All other sources have been checked." Only staff can contact SSA. Contracted providers do not use Form 1610.

2. Obtain information for Medicaid (Title XIX)

If RSDI (Title II) benefit information is not available from any other source, the worker submits Form 1610 for initial MAO applicants. This includes MAO applicants for three months prior eligibility. On the form, the worker writes the following statement: "Initial Title XIX-MAO. All other sources have been checked."
If the worker has problems with applied income, he verifies Title II benefits from other sources. If the worker cannot verify benefits from other sources, he submits Form 1610 to the SSA office. On the form, the worker writes: "Vendor Payment - Applied Income. All other sources have been checked."

3. Secure information in the Food Stamp program — The worker sends Form 1610 to SSA for verification of Social Security benefits only if the information is not available from other sources. On the form, the worker writes: "Food Stamp Eligibility. All other sources have been checked."

4. Secure information in the TANF program

Initial eligibility. When information needed to verify benefits is not available from other sources, the worker submits Form 1610. On the form, the worker writes: "TANF Initial Eligibility. All other sources have been checked."
TANF client with initial entitlement to Title II benefits. When information needed to verify benefits is not available from other sources, the worker submits Form 1610. On the form, the worker writes: "TANF Client with Initial RSDI Entitlement. All other sources have been checked."

Number of Copies

The worker completes an original and one copy.

Transmittal

The worker sends the original to the local SSA office. The worker keeps the pink copy in the case record.

SSA staff check information DHS provides in Items 1 and 3 against his records. SSA staff complete or correct missing items and incorrect information. If there is any reason to question which record is correct, SSA staff resolve the problem so that SSA and DHS records are consistent.

SSA staff complete Form 1610 providing the information requested. The original form is returned to DHS. The worker files it in the case record and destroys the carbon copy.

Note: Workers must provide as much information as possible when initiating the form.

DETAILED INSTRUCTIONS

For use of Form 1610, detailed instructions are printed on the pink copy. Follow these instructions when the form is submitted or received from SSA.

Note: To request verification of RSDI benefits or SSCNs for applicants, the worker must write the appropriate message in 4.a. (See When to Prepare.) The worker checks "No" in the box to the right in Item 4.a.

If the worker checks "Yes" in Item 4.a., he must explain why verification is needed in addition to that available from SDX, BENDEX, or Buy-in.

FORM SSA-1610-U2Instructions