Forms

Please fillout all three forms- Ticket Agreement (Individual Work Plan), Social Security Consent of Release, and a Social Security Earnings release. Each needs your hand written signature. Please either mail or fax them to us. These forms are in a Microsolf Word format, if you need another type of file let us know.

The Ticket can be used by anyone who is ready to start working or will be going to school. It will protect you from a medical reveiw as long as you have assigned your ticket and it is considered in use.

Here is what we find out when you send in your two Social Security forms. The first is a Social Security "Consent for Release of Information" which gives information about:

Which type of assistance you receive
When you became eligible
Amount you receive
Overpayment balances
Next scheduled Medical review and frequency (important for "Ticket to Work" users)
Medicare and Medicaid eligibility
Any reported work exclusions

The second form is the Social Security "Request for Social Security Earnings Information". Information from this report helps us to see where you may be at in your TWP, EPE and Extended Medicare. If you are receiving SSI, it will show us if you may be eligible for a retroactive check.

We need one of each of the above to be able to assist you.

Knowledge = Opportunity! If you don't know what you are currently eligible for, you can't make an informed decision. We are here to help explain the Social Security rules to you, so you know where the Opportunities and the Pitfalls are that may affect you. We are your advocate!

Things that may be obstacles that will make a PASS Plan not suitable for you: 1. Married and spouse is working. 2. high resources (over $3000 cash in banks, pension funds) 3. money comes in monthly checks (not lump sums) 4. You do not intend to earn enough when the PASS is completed to work your way off of cash benefits.

For us to help you apply for the Social Security PASS Plan, we also need you to find a part time job that earns you over $350 in a month. We want to see that you are committed before we will assist you in receiving additional funds through the PASS Plan. We hope you will continue to work, but it is not required by us.

If you wish to go to school and want the Ticket to Work medical protect, make sure you send us the Ticket agreement and both Social Security releases. You would then be protected from losing both your Check and your Medical coverage as long as you were taking 8 credit hours/semester and earning less than $980/month.

If you do not want to work and wish to do the PASS yourself, here is the link Social Scurities PASS Plan form.

If we help you, we will provide you with our form which helps explain what they are looking for in your answers and what will disqualify you. Once you turn your PASS in it is hard to come back and change answers even if you did not understand the question. We want you to have a choice.