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:
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)
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
The worker completes an original and one copy.
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.
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.