Social Security Disability Benefits Who Should Read This Information You should, if you want to know more about the various kinds of disability benefits available from Social Security. This booklet will tell you who is eligible, how to apply, and what you need to know once benefits start. We pay disability benefits under two programs: the Social Security disability insurance program and the Supplemental Security Income (SSI) program. The medical requirements for disability payments are the same under both programs and a person's disability is determined by the same process. While eligibility for Social Security disability is based on prior work under Social Security, SSI disability payments are made on the basis of financial need. And there are other differences in the eligibility rules for the two programs. This booklet deals primarily with the Social Security disability program. For information on SSI disability payments, ask at any Social Security office for the booklet, SSI (Publication No. 05-11000). Please Note: This booklet provides a general overview of the Social Security disability program. The information it contains is not intended to cover all provisions of the law. For specific information about your case, contact Social Security. Part 1--Introduction To Disability And Social Security What We Mean By Disability Who Can Get Social Security Disability Benefits? Disability Benefits For People With HIV Infection Disability Benefits For Children How Much Work You Need Part 2--Signing Up For Disability How To Apply How To Speed Up Your Claim Who Decides If You Are Disabled? How We Determine Disability Rules For Blind Persons If Your Claim Is Denied Part 3--When Your Claim Is Approved Your First Check How Much You Will Get From Social Security How Other Payments Affect Benefits Benefits May Be Taxed You Can Get Medicare If You're Disabled Reviewing Your Disability What Can Cause Benefits To Stop? Part 4--Going Back To Work Benefits While You Work For More Information Other Booklets Available Part 1--Introduction To Disability And Social Security Disability is something most people don't like to think about. But the chances of your becoming disabled are probably greater than you realize. In fact, studies show that one out of four young workers will become disabled some time during his or her lifetime. It's a fact that, while most people spend time working to succeed in their jobs and careers, few think about ensuring that they have a safety net to fall back on should the unthinkable happen. This is where Social Security comes in. We pay cash benefits to people who are unable to work for a year or more because of a disability. Benefits continue until a person is able to work again on a regular basis, and a number of work incentives are available to ease the transition back to work. What We Mean By Disability It's important that you understand how Social Security defines disability. That's because different programs have different bases for determining disability. Some programs may pay for partial disability or for short-term disability. Social Security does not. Disability under Social Security is based on your inability to work. You will be considered disabled if you are unable to do any kind of work for which you are suited and your disability is expected to last for at least a year or to result in death. Some consider this a strict definition of disability and it is. The program assumes that working families have access to other resources to provide support during periods of short-term disabilities, including workers compensation, insurance, savings, and investments. It is designed to provide a continuing income to you and your family when you are unable to do so. Benefits continue as long as you remain disabled. Who Can Get Social Security Disability Benefits? You can receive Social Security disability benefits at any age. If you are receiving disability benefits at age 65, they become retirement benefits, although the amount remains the same. Certain members of your family may also qualify for benefits on your record. They include: Your unmarried son or daughter, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under 18 or under 19 if in high school full time. Your unmarried son or daughter, 18 or older, if he or she has a disability that started before 22. (If a disabled child under 18 is receiving benefits as a dependent of a retired, deceased, or disabled worker, someone should contact Social Security to have his or her checks continued at 18 on the basis of disability.) Your spouse who is 62 or older, or any age if he or she is caring for a child of yours who is under 16 or disabled and also receiving checks. Certain family members may qualify for disability benefits if you should die. They include: Your disabled widow or widower 50 or older. The disability must have started before your death or within seven years after your death. (If your widow or widower caring for your children receives Social Security checks, she or he is eligible if she or he becomes disabled before those payments end or within seven years after they end.) Disability Benefits For People With HIV Infection People with HIV infection or AIDS may also qualify for disability benefits when they are no longer able to work. Some people with HIV infection that has not progressed to AIDS may be just as severely disabled as a person with AIDS and, therefore, just as likely to qualify for disability. For more information, ask for the booklet A Guide to Social Security And SSI Disability Benefits For People With HIV Infection (Publication No. 05-10020). Disability Benefits For Children In recent years, there has been a growing concern about whether parents are aware of the disability benefits that are available for their disabled children. More than 900,000 children under 18 who have disabilities currently receive such benefits; many suffer some form of mental retardation, others from various childhood conditions. SSI disability benefits are payable to people of any age with a disability, including children. For more information, ask Social Security for the booklets SSI (Publication No. 05-11000) and Benefits For Children With Disabilities (Publication No. 05-10026). Social Security dependents benefits are payable to children under 18 if a parent is receiving retirement or disability benefits or is deceased. These benefits may also be paid to children 18 or older who were disabled before age 22. Benefits will continue into their adult years as long as they remain disabled. How Much Work You Need To qualify for Social Security disability benefits, you must have worked long enough and recently enough under Social Security. You earn up to a maximum of four credits per year. The amount of earnings required for a credit increases each year as general wage levels rise. Family members who qualify for benefits on your work record do not need work credits. The number of work credits needed for disability benefits depends on your age when you become disabled. Generally you need 20 credits earned in the last 10 years ending with the year you become disabled. However, younger workers may also qualify with fewer credits: The rules are as follows: Before age 24--You may qualify if you have six credits earned in the three-year period ending when your disability starts. Age 24 to 31--You may qualify if you have credit for having worked half the time between 21 and the time you become disabled. For example, if you become disabled at age 27 you would need credit for three years of work (12 credits) out of the past six years (between age 21 and age 27). Age 31 or older--In general, you will need to have the number of work credits shown in the chart shown below. Unless you are blind, at least 20 of the credits must have been earned in the 10 years immediately before you became disabled. Born After 1929, Credits Become Disabled At Age You Need 31 through 42 20 44 22 46 24 48 26 50 28 52 30 54 32 56 34 58 36 60 38 62 or older 40 Part 2--Signing Up For Disability How To Apply You should apply at any Social Security office as soon as you become disabled. (You may file by phone, mail, or by visiting the nearest office.) However, Social Security disability benefits will not begin until the sixth full month of disability. This waiting period begins with the first full month after the date we decide your disability began. How To Speed Up Your Claim The claims process for disability benefits is generally longer than for other types of Social Security benefits from 60 to 90 days. It takes longer to obtain medical information and to assess the nature of the disability in terms of your ability to work. However, you can help shorten the process by bringing certain documents with you when you apply and helping us to get any other medical evidence you need to show you are disabled. These include: The Social Security number and proof of age for each person applying for payments. This includes your spouse and children, if they are applying for benefits. Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment. Names of all medications you are taking. Medical records from your doctors, therapists, hospitals, clinics, and caseworkers. Laboratory and test results. A summary of where you worked in the past 15 years and the kind of work you did. A copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year. Dates of prior marriages if your spouse is applying. Do not delay filing for benefits just because you do not have all of the information you need. The Social Security office will be glad to help you. Who Decides If You Are Disabled? After helping you complete your application, the Social Security office will review it to see if you are eligible to apply for disability benefits. These include such factors as whether you have worked long enough and recently enough to qualify for disability benefits, your age, and,if you are applying for benefits as a family member, your relationship to the worker. The office will then send your application to the Disability Determination Services (DDS) office in your state. There, a decision will be made as to whether you are disabled under the Social Security law. In the DDS office, a team consisting of a physician (or psychologist) and a disability evaluation specialist will consider all the facts in your case and decide if you are disabled. They will use the medical evidence from your doctors and from hospitals, clinics, or institutions where you have been treated. Again, the quicker we get the evidence, the faster your claim will be processed. This is why we suggest you bring any copies of your medical reports you have with you. You should also be sure to contact the doctors and treatment facilities to let them know we will be requesting medical evidence in your case. On the medical report forms, your doctors or other sources are asked for a medical history of your condition: what is wrong with you; when it began; how it limits your activities; what the medical tests have shown; and what treatment has been provided. They are also asked for information about your ability to do work-related activities, such as walking, sitting, lifting, and carrying. They are not asked to decide whether you are disabled. Additional medical information may be needed before the DDS team can decide your case. If it is not available from your current medical sources, you may be asked to take a special examination called a consultative examination. Your doctor or the medical facility where you have been treated is the preferred source to perform this examination. Social Security will pay for the examination or any other additional medical tests you may need, and for certain travel expenses related to it. Social Security's rules for determining disability differ from those in other government and private programs. However, a decision made by another agency and the medical reports it obtains may be considered in determining whether you are disabled under Social Security rules. Once a decision on your claim is reached, you will receive a written notice from the Social Security Administration. If your claim is approved, the notice will show the amount of your benefit and when payments start. If it is not approved, the notice will explain why. How We Determine Disability You should be familiar with the process we use to determine if you are disabled. It's a step-by-step process involving five questions. They are: 1. Are you working?If you are and your earnings average more than $500 a month, you generally cannot be considered disabled. 2. Is your condition severe ? Your impairments must interfere with basic work-related activities for your claim to be considered. 3. Is your condition found in the list of disabling impairments? We maintain a list of impairments for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step. 4. Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then we must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further. 5. Can you do any other type of work?If you cannot do the work you did in the last 15 years, we then look to see if you can do any other type of work. We consider your age, education, past work experience, and transferable skills, and we review the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied. Rules For Blind Persons You are considered blind under Social Security rules if your vision cannot be corrected to better than 20/200 in your better eye, or if your visual field is 20 degrees or less, even with a corrective lens. There are a number of special rules for persons who are blind. The rules recognize the severe impact of blindness on a person's ability to work. For example, the earnings limit for people who are blind is generally higher than the $500 limit that applies to non-blind disabled workers. This figure changes annually. For current figures and other information on special rules for persons who are blind, ask for the leaflet If You Are Blind...How We Can Help (Publication No. 05-10052). If Your Claim Is Denied If your claim is denied or you disagree with any other decision we make, you may appeal the decision. The Social Security office will help you complete the paperwork. There are four levels of appeal. If you disagree with the decision at one level, you may appeal to the next level. You have 60 days from the time you receive the decision to file an appeal to the next level. We assume that you receive the decision five days after the date on it, unless you can show us that you received it later. For more information about appeals, ask for the factsheet, The Appeals Process (Publication No. 05-10041). Part 3--When Your Claim Is Approved Your First Check Once a decision is made that you are disabled, you will receive your first Social Security disability check dating back to the sixth full month from the date we decide your disability began (but no more than one year of back benefits can be paid). You also will receive a booklet describing your responsibilities as a Social Security beneficiary: What You Need To Know When You Get Disability Benefits (Publication No. 05-10153). You should read this booklet carefully and keep it in a safe place with your other valuable papers in order to refer to it whenever questions arise. How Much You Will Get From Social Security The amount of your monthly disability benefits is based on your lifetime average earnings covered by Social Security. If you would like an estimate of your disability benefit, all you have to do is call or visit Social Security and ask for it. We'll send you a form you can use to get a Personal Earnings and Benefit Estimate Statement. How Other Payments Affect Benefits Eligibility for other government benefits can affect the amount of your Social Security disability benefits. Other Disability Benefits Social Security benefits may be affected if you are also eligible for workers' compensation (including black lung) or for disability benefits from certain federal, state, local government, Civil Service, or military disability programs. Total combined payments to you and your family from Social Security and any of these other programs generally cannot exceed 80 percent of your average current earnings before becoming disabled. (Note that for income tax purposes, your unreduced benefit is counted.) Government Pension Offset If you are a disabled widow or widower or the spouse of a disabled worker, a government pension offset may reduce your Social Security payment. The offset applies if you become eligible for a federal, state, or local government pension based on your own work not covered by Social Security. The amount of your Social Security spouse's benefit may be reduced by two-thirds of the amount of your government pension. There are some exceptions when the offset would not apply. For more information, call or visit Social Security to ask for a free copy of the factsheet Government Pension Offset (Publication No. 05-10007). Pension From Work Not Covered By Social Security If you become disabled and entitled to a Social Security disability benefit and you also receive a monthly pension based on work not covered by Social Security, your disability payment will be smaller than normal. That's because we use a different formula to figure the Social Security benefit of people who get other public pensions. For more information, call or visit Social Security to ask for a free copy of the factsheet A Pension From Work Not Covered By Social Security (Publication No.05-10045). Benefits May Be Taxed Some people have to pay federal income taxes on their Social Security benefits. This usually happens only if your total income is high. At the end of the year, you will receive a Social Security Benefit Statement (Form SSA-1099) showing the amount of benefits you received. The statement is to be used for completing your federal income tax return if any of your benefits are subject to tax. You may use the Internal Revenue Service Publication 915 for additional information on the tax. You Can Get Medicare If You're Disabled You will be automatically enrolled in Medicare after you have been getting disability benefits for two years. Medicare has two parts hospital insurance and medical insurance. Hospital insurance helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this coverage, so it's premium free if you're eligible. The other part of Medicare, medical insurance, helps pay doctors' bills and other services. You pay a monthly premium for this coverage if you want it. Most people have both parts of Medicare. Help For Low-Income Medicare Beneficiaries If you get Medicare and have low income and few resources, your state may pay your Medicare premiums and, in some cases, other out-of-pocket Medicare expenses such as deductibles and coinsurance. Only your state can decide if you qualify. To find out if you do, contact your state or local welfare office or Medicaid agency. For more general information about the program, contact Social Security and ask for the leaflet Medicare Savings For Qualified Beneficiaries (HCFA Publication No. 02184). Reviewing Your Disability Your benefits will continue as long as you are disabled. However, your case will be reviewed periodically to see if you are still disabled. The frequency of the reviews depends on the expectation of recovery. If medical improvement is expected, your case will normally be reviewed within six to 18 months. If medical improvement is possible, your case will normally be reviewed no sooner than three years. If medical improvement is not expected, your case may be reviewed no sooner than seven years. What Can Cause Benefits To Stop? There are two things that can cause us to decide that you are no longer disabled and to stop your benefits. Your benefits will stop if you work at a level we consider substantial. Usually, average earnings of $500 or more a month are considered substantial. Your disability benefits would also stop if we decide that your medical condition has improved to the point that you are no longer disabled. You must promptly report any improvement in your condition, your return to work, and certain other events as long as you are receiving benefits. These responsibilities are explained in the booklet you will receive when benefits start. Part 4--Going Back To Work Benefits While You Work If you're like most people, you would rather work than try to live on disability benefits. There are a number of special rules that provide cash benefits and Medicare while you attempt to work. We call these rules work incentives. You should be familiar with these disability work incentives so you can use them to your advantage. If you are receiving Social Security disability benefits, the following work incentives apply: Trial Work Period--For nine months (not necessarily consecutive), you may earn as much as you can without affecting your benefits. (The nine months of work must fall within a five-year period before your trial work period can end.) A trial work month is any month in which you earn more than $200. After your trial work period ends, your work is evaluated to see if it is substantial. If your earnings do not average more than $500 a month, benefits will generally continue. If earnings do average more than $500 a month, benefits will continue for a three-month grace period before they stop. Extended Period of Eligibility--For 36 months after a successful trial work period, if you are still disabled, you will be eligible to receive a monthly benefit without a new application for any month your earnings drop below $500. Deductions for Impairment-Related Expenses--Work expenses related to your disability will be discounted in figuring whether your earnings constitute substantial work. Medicare Continuation--Your Medicare coverage will continue for 39 months beyond the trial work period. If your Medicare coverage stops because of your work, you may purchase it for a monthly premium. Different rules apply to SSI recipients who work. For more information about Social Security and SSI work incentives, ask for a copy of the booklet Working While Disabled ... How We Can Help (Publication No. 05-10095). For More Information You can get more information 24 hours a day by calling Social Security's toll-free number: 1-800-772-1213. You can speak to a service representative between the hours of 7 a.m. and 7 p.m. on business days. Pre-recorded information and services also are available during and after normal business hours. If you want to speak to a representative, it's best to call later in the week and later in the month. When you call, have your Social Security number handy. Hearing-impaired callers using TTY equipment can reach Social Security between 7 a.m. and 7 p.m. weekdays by calling 1-800-325-0778. The Social Security Administration treats all calls confidentially--whether they're made to our toll-free numbers or to one of our local offices. We also want to ensure that you receive accurate and courteous service. That is why we have a second Social Security representative monitor some incoming and outgoing telephone calls. Other Booklets Available Social Security has a number of publications that contain information about other Social Security programs. Contact Social Security to get a free copy of any of these publications. They include: Understanding The Benefits (Publication No.05-10024) A comprehensive explanation of all the Social Security programs. Retirement (Publication No. 05-10035)--Explains Social Security retirement benefits. Survivors (Publication No. 05-10084)--Explains Social Security survivors benefits. Medicare (Publication No. 05-10043)--Explains Medicare hospital insurance and medical insurance. SSI (Publication No. 05-11000)--Explains this program, which provides a basic income to people who are 65 or older, disabled, or blind and have limited income and resources. Benefits For Children With Disabilities (Publication No. 05-10026)--Explains benefits available to children with disabilities. Working While Disabled . . . How We Can Help (Publication No. 05-10095) Explains work incentives for Social Security and SSI beneficiaries. If You Are Blind . . . How We Can Help (Publication No. 05-10052)--Explains benefits available to persons who are blind. Most of these publications are also available in Spanish. Social Security information is also available to users of the Internet. Type http://www.ssa.gov to access Social Security information on the Internet. Social Security Administration SSA Publication No. 05-10029 May 1996 ICN 456000 ---------- What You Need To Know When You Get Disability Benefits Social Security Administration SSA Publication No. 05-10153 June 1996 (February 1996 edition may be used) Who Should Read This Booklet? You should, now that you're receiving Social Security disability benefits. You might think that because the disability application process is over and your benefits are about to start, you no longer have to worry about Social Security. But what happens if your check doesn't arrive on time? Or what happens to your check if you're away from home for awhile? And what should you do if your condition improves? Or what if you want to go back to work but are afraid of losing your benefits? Knowing the answers to these and other questions now will save you a great deal of time, inconvenience, and maybe some money, later. That's why you should read this booklet now, then put it aside for reference later. For easy reference, this booklet is divided into four parts: -- Your Disability Benefits -- Reporting Changes That Can Affect Your Benefits -- Reviewing Your Disability Case -- Helping You Return To Work If you also receive Supplemental Security Income (SSI) checks, there are some additional rules for that program. Ask Social Security for a copy of the booklet "What You Need To Know When You Get SSI" (Publication No. 05-11011). __________________________________ Social Security's Toll-Free Number 1-800-772-1213 Internet: http://www.ssa.gov __________________________________ What's Inside Part 1: Your Disability Benefits Your Benefit Amount When To Expect Your Check The Best Way To Receive Your Check If You Choose To Get A Check By Mail Returning Checks Not Due Paying Taxes On Your Benefits How Long Payments Continue A Word About Medicare Benefits For Children If A Social Security Employee Visits You Free Social Security Services A Message About Food Stamps Your Personal Information Is Safe With Social Security Part 2: Reporting Changes That Can Affect Your Benefits If You Change Your Address If Your Condition Changes If You Go To Work If You Go Outside The United States If You Receive Other Disability Benefits If You Get A Pension From Work Not Covered By Social Security If You Are A Spouse Or Surviving Spouse Who Receives A Government Pension If You Get Married If A Person Is Not Able To Manage His Or Her Own Funds If A Beneficiary Is Convicted Of A Criminal Offense If A Beneficiary Dies How To Report A Change Part 3: Reviewing Your Disability Case Frequency Of Reviews What Happens During A Review Special Appeal Rights Part 4: Helping You Return To Work Understanding "Substantial" Work Nine-Month Trial Work Period 36-Month Extended Period Of Eligibility Medicare Continues Help With Work Expenses Vocational Rehabilitation If You Become Disabled Again Special Rules For Blind Persons Who Work For More Information Other Booklets Available Part 1--Your Disability Benefits Your Benefit Amount Your Certificate of Award explains how much your disability benefit will be and when payments start. It also shows when you can expect your condition to be reviewed to see if there has been any improvement. If family members are eligible, they will receive a separate notice and a booklet about things they need to know. If you are getting disability benefits on your own record, or if you are a widow or widower getting benefits on a spouse's record, your payments cannot begin before the SIXTH FULL month of disability. If the sixth month is past, your first payment may include some back benefits. Your Social Security benefit may be reduced if you are eligible for workers' compensation, other public disability payments, or a pension from a job where you did NOT have to pay Social Security taxes. (See "If Your Receive Other Disability Benefits", "If You Get A Pension From Work Not Covered By Social Security", and "If You Are A Spouse Or Surviving Spouse Who Recieves A Government Pension" for more information.) You can expect your payment amount to go up in future years. Whenever the cost of living goes up in a year, benefits will be increased by that amount the following January. If there is an increase, you will get a notice telling you about it. You do not have to apply for this increase; it comes automatically. When To Expect Your Check Your check should arrive on the third day of every month. If the third falls on a Saturday, Sunday, or legal holiday, you will receive your check on the last banking day before then. The check you receive is the benefit for the previous month. For example, the check you receive dated July 3 is for June. Your benefit can either come to you in the mail or be deposited directly into your bank account. The Best Way To Receive Your Check Social Security encourages people to have their checks sent directly to their bank or other financial institution because it's safer and more convenient. You won't have to stand in line waiting to cash your check, you needn't be concerned about mailbox theft or losing your check. And if you're away from home, your check will be deposited for your immediate use. Most beneficiaries now use this service. You can change to direct deposit by calling the customer service representative where you bank, or call Social Security's toll free number, 1-800-772-1213, between 7 a.m. and 7 p.m. Have your Social Security number and a personal check or bank statement handy. If you already have direct deposit and decide to change your account or financial institution, don't close your old account until direct deposit to your new account has started. It usually takes one or two months to process the change from one bank or account to another. If you have questions about direct deposit, ask your financial institution or any Social Security office. If You Choose To Get A Check By Mail The post office generally delivers your check on time every month, but if your check is delayed, wait at least three days before reporting the missing check to Social Security. The most common reason checks are late is because a change of address was not reported. If your check is lost or stolen after you receive it, contact Social Security immediately. Your check can be replaced, but it takes time. To be safe, you should cash or deposit your check as soon as possible after you receive it. You shouldn't sign the check until you are at the place where you will cash it. If you sign it ahead of time and lose it, the person who finds it could cash it. A government check must be cashed within 12 months after the date of the check, or it will be void. Returning Checks Not Due If you receive a check you know is not due, (for example, you are working and your condition has improved) you should take it to any Social Security office. Or return it to the U.S. Treasury Department, Division of Disbursement, at the address on the check envelope. Enclose a note telling why you are sending the check back. If you have direct deposit, you should refund any payments you receive that you know are not due. Paying Taxes On Your Benefits Some people who get Social Security have to pay taxes on their benefits. You will be affected only if you have substantial income in addition to your Social Security benefits. -- If you file a federal tax return as an "individual," and your combined income* is between $25,000 and $34,000, you may have to pay taxes on 50 percent of your Social Security benefits. If your combined income is above $34,000, 85 percent of your Social Security benefits is subject to income tax. -- If you file a joint return, you may have to pay taxes on 50 percent of your benefits if you and your spouse have a combined income* that is between $32,000 and $44,000. If your combined income* is more than $44,000, 85 percent of your Social Security benefits is subject to income tax. -- If you are a member of a couple and file a separate return, you probably will pay taxes on your benefits. * On the 1040 tax return, your "combined income" is the sum of your adjusted gross income plus nontaxable interest plus one-half of your Social Security benefits. How Long Payments Continue Your disability benefits generally will continue for as long as your impairment has not medically improved and you cannot work. They will not necessarily continue indefinitely. Because of advances in medical science and rehabilitation techniques, an increasing number of people with disabilities recover from serious accidents and illnesses. Also, many individuals, through determination and effort, overcome serious conditions and return to work in spite of them. As explained in "Part 3--Reviewing Your Disability Case", your case will be reviewed periodically to make sure you're still disabled. In addition, you are responsible for promptly reporting if your medical condition improves, if you believe that you can work, or when you actually do return to work. (See "If Your Condition Changes" and "If You Go To Work" for more information.) Your benefits may be affected if you marry (unless you are getting disability benefits on your own record), if you receive certain other types of disability checks, or if you go to certain countries. Make sure you read and understand the information on what to report in Part 2--Reporting Changes That Can Affect Your Benefits. In this way, you can avoid having to pay back some benefits later. If you are still getting disability benefits when you turn 65, your benefits will be automatically changed to retirement benefits, generally in the same amount. You will then receive a new booklet explaining your rights and responsibilities as a retired person. If you are a disabled widow or widower, your benefits will be changed to regular widow or widower benefits (at the same rate) at 60, and you will receive a new instruction booklet that explains the rights and responsibilities for people who get survivors benefits. A Word About Medicare After you receive disability benefits for 24 months, you will be eligible for Medicare. You will get information about Medicare several months before your coverage starts. (If you have chronic kidney disease requiring regular dialysis or a transplant, you may qualify for Medicare almost immediately.) Help For Low-Income Medicare Beneficiaries If you get Medicare and have low income and few resources, your state may pay your Medicare premiums and, in some cases, other "out-of-pocket" Medicare expenses such as deductibles and coinsurance. Only your state can decide if you qualify. To find out if you do, contact your state or local welfare office or Medicaid agency. For more general information about the program, contact Social Security and ask for a copy of the publication "Medicare Savings For Qualified Beneficiaries" (HCFA Publication No. 02184). Benefits For Children If a child is getting checks on your account, there are important things you should know about his or her benefits. When A Child Reaches 18 A child's benefits stop with the month before the child reaches 18, unless the child is either disabled or is a full-time elementary or secondary school student and remains unmarried. About five months before the child's 18th birthday, the person receiving the child's benefits will get a form explaining how benefits can continue. A child whose benefits stopped at 18 can have them started again if he or she becomes disabled before reaching 22 or becomes a full-time elementary or secondary school student before reaching 19. If A Child Is Disabled A child can continue to receive benefits after age 18 if he or she has a disability. The child also may qualify for SSI disability benefits. Call us for more information. If A Child At 18 Is A Student A child can receive benefits until age 19 if he or she continues to be a full-time elementary or secondary school student and remains unmarried. When a student's 19th birthday occurs during a school term, benefits can be continued up to two months to allow completion of the term. Social Security should be notified immediately if the student drops out of school, changes from full-time to part-time attendance, is expelled or suspended, or changes schools. We should also be told if the student is paid by his or her employer for attending school. We send each student a form at the start and end of the school year. It is important that the form be filled out and returned to us. Benefits could be stopped if the form is not sent back. A student can keep receiving benefits during a vacation period of four months or less if he or she plans to go back to school full time at the end of the vacation. A student who stops attending school generally can receive benefits again if he or she returns to school full time before age 19. The student needs to contact Social Security to reapply for benefits. Having A Child After Benefits Start If you become the parent of a child after you begin receiving Social Security benefits and the child is in your care, be sure to notify us so that the child can also receive benefits. If A Social Security Employee Visits You If anyone comes to your home to talk about Social Security or SSI, ask for his or her identification. Anyone who is from Social Security will be glad to show you proper identification. If you have any doubts about the person, you can call us to ask if someone was sent to see you. And REMEMBER: Social Security employees will NEVER ask you for money to have something done. It's their job to help you. Free Social Security Services You never have to pay for information or service at Social Security. Some businesses advertise that they can provide name changes, Social Security cards, or earnings statements for a fee. All these services are provided free by Social Security. So don't pay for something that's free. Call us first. Social Security is the best place to get information about Social Security. A Message About Food Stamps You can get a food stamp application and information at any Social Security office. Or call our toll-free number 1-800-772-1213. Ask for the leaflet "Food Stamps and Other Nutrition Programs" (Publication No. 05-10100) or the factsheet "Food Stamp Facts" (Publication No. 05-10101). Your Personal Information Is Safe With Social Security Social Security keeps personal information on millions of people. That information--such as your Social Security number, earnings record, age, and address--is confidential. Generally, we will discuss this information only with you. We need your permission if you want someone else to help with your Social Security business. If you ask a friend or family member to call Social Security, you need to be with them when they call so we will know that you want them to help. The Social Security representative will ask your permission to discuss your Social Security business with that person. If you send a friend or family member to our local office to conduct your Social Security business, send your written consent with them. Only with your written permission can Social Security discuss your personal information with them and provide the answers to your questions. In the case of a minor child, the natural parent or legal guardian can act on the child's behalf in taking care of the child's Social Security business. We urge you to be careful with your Social Security number and to protect its confidentiality whenever possible. Although we can't prevent others from asking for your Social Security number, you should know that your Social Security records are kept private. There are times when the law requires Social Security to give information to other government agencies to conduct other government health or welfare programs--such as Aid to Families with Dependent Children, Medicaid, and food stamps. Programs receiving information from Social Security are prohibited from sharing that information. Part 2--Reporting Changes That Can Affect Your Benefits You should promptly report any changes that may affect your disability benefits. Family members receiving benefits also should report events that might affect their checks. The events that must be reported are explained on the next few pages. If You Change Your Address You must notify the post office and Social Security immediately if you change your mailing address. In fact, failure to report a change of address is the leading cause of checks not arriving on time. Your report should include your claim number, your old address, and the new address, including ZIP Code. Give the names of all family members who should receive benefits or information at the new address. You should report a new address even if you have direct deposit because important letters from Social Security are sent to your mailing address, even though your benefits go directly to a bank. Your benefits could be stopped temporarily if Social Security cannot locate you because you have not reported a change of address. If Your Condition Changes You must notify us if there is any change for the better in your condition. Failure to do so could mean you'll get payments you aren't dueþmoney that will have to be repaid. Your case will be reviewed periodically to determine if you're still disabled. (See Part 3--Reviewing Your Disability Case for more information.) If You Go To Work You should tell us if you take a job or become self-employed NO MATTER HOW LITTLE YOU EARN. If you are still disabled, you will be eligible for a trial work period and can continue receiving benefits for up to nine months (see Part 4--Helping You Return To Work). Also, notify us if you have any special work expenses resulting from your disability (such as specialized equipment, a wheelchair, or even some prescription drugs), or if there is any change in the amount of the expenses. If You Go Outside The United States If you are a citizen of the United States, your Social Security payments generally can continue for as long as you are outside the United States and meet all requirements. (The Social Security office has a list of 60 other countries whose citizens also can get Social Security checks if they leave the United States.) However, you must notify Social Security when you plan to leave the U.S. for 30 days or more so that any letters can be sent to the right address. Notifying us also will enable you to learn about any special rules that apply to those receiving benefits outside the U.S. And remember to let Social Security know when you return to the U.S. If you are a citizen of a country not approved for us to send checks, your benefits will be suspended after you have been outside the U.S. for six months, unless you meet specific conditions. And, if you go to a country where U.S. Treasury Department regulations prohibit sending checks, your benefits will stop immediately. For more information, ask any Social Security office for the booklet "Your Social Security Payments While You Are Outside The United States" (Publication No. 05-10137). If You Receive Other Disability Benefits If you are disabled, and under 65, Social Security benefits for you and your family may be reduced if you are also eligible for workers' compensation (including black lung payments) or for disability benefits from certain federal, state, or local government programs. Tell us if you: -- Apply for another type of disability benefit; or -- Begin receiving another disability benefit or a lump-sum settlement; or -- Already receive another disability benefit and the amount changes or your payment stops. If You Get A Pension From Work Not Covered By Social Security If your disability began after 1985, tell us if you start receiving a pension (for which you were first eligible after 1985) from a job where you did NOT pay Social Security taxes. For more information, ask at any Social Security office for the factsheet "A Pension From Work Not Covered By Social Security" (Publication No. 05-10045). If You Are A Spouse Or Surviving Spouse Who Receives A Government Pension If you are a disabled widow or widower or the spouse of someone getting disability benefits, your Social Security payments may be reduced if you worked for a federal, state, or local government agency where you did not pay Social Security taxes and you receive a pension from that agency. Notify Social Security if you begin to receive such a pension or if the amount of the pension changes. Ask for the factsheet "Government Pension Offset" (Publication No. 05-10007) for more information. If You Get Married Here's how marriage may affect your disability benefits and when you must report. -- If you are getting disability benefits on your own record- -Your payments will continue and you don't need to report the marriage. But, report any change of name so it will appear on your future checks. -- If you are a disabled widow or widower--Payments will continue, but remember to report the name change. If your current spouse dies, you may be eligible for higher benefits on his/her work record. -- If you are an adult who was disabled before age 22 and you are getting benefits on the Social Security record of a parent or grandparent--You should report your marriage. Payments generally will end unless you marry a person receiving certain types of Social Security benefits. If your benefits stop because of marriage, they cannot be started again unless the marriage is declared void. -- Benefits for the child of someone getting disability benefits always end if the child marries. This must be reported right away. If A Person Is Not Able To Manage His Or Her Own Funds If a person receiving benefits becomes unable to manage his or her funds, someone should let Social Security know. Social Security will arrange for an organization or person called a "representative payee" to receive and use the benefits for that person. The payee is responsible for: -- Properly using the benefits on behalf of the beneficiary, -- Reporting any events that may affect payments, -- Completing a Representative Payee Report when asked to do so by Social Security. If you have a representative payee and are also addicted to drugs or alcohol, you may be referred to the State Substance Abuse agency for treatment. Please Note: If a person has "power of attorney" for someone, that does not automatically qualify him or her to be the representative payee. For more information, ask Social Security for A Guide For Representative Payees (Publication No. 05-10076). If A Beneficiary Is Convicted Of A Criminal Offense If someone getting Social Security benefits is convicted of a criminal offense, Social Security should be notified immediately. Benefits generally are not paid for months a person is imprisoned for a criminal conviction, but any family members who are eligible may continue to receive benefits. Benefits also are not paid to individuals confined in an institution by court order who, in connection with a criminal offense: -- have been found guilty but insane, -- have been found not guilty by reason of insanity or similar factors (such as mental disease, mental defect, or mental incompetence), or -- are incompetent to stand trial. If A Beneficiary Dies When a beneficiary dies, no payment is due for the month of death. For example, if the person dies in June, even if it was on the last day, the check dated July 3 (which is the June check) should be returned. However, if the check is issued jointly to a husband and wife, the survivor should get in touch with any Social Security office about cashing the check. If the beneficiary was using direct deposit, the bank also should be notified of the death so it can return any payments received after death. When a person getting disability benefits dies, payments to his or her family will be changed to survivors benefits. If the worker received benefits on behalf of children, a new representative payee must be appointed. A death certificate or other proof of death is needed. How To Report A Change You can report a change simply by calling Social Security at 1-800-772-1213. You can also visit any office or mail in the reporting form given to you when you applied for benefits. If you send a report by mail, be sure to include: -- Your name, and if different, the name and Social Security claim number of the person on whose account you get benefits; -- Name of person(s) about whom the report is made; -- Your Social Security claim number; -- What new information is being reported; -- Date of the change; and -- Your signature, address, phone number, and date. If you need help in completing a report, the people at any Social Security office will be glad to help you. Or, you can call our tollþfree number--1-800-772-1213--24 hours a day. Be sure to have your Social Security number handy. If you are getting benefits on somebody else's record (a spouse, for example), we need his or her Social Security number, too. Part 3--Reviewing Your Disability Case Under Social Security law, all disability cases must be reviewed from time to time. This is to make sure that people receiving benefits continue to be disabled and meet all other requirements. Your benefits generally will continue unless there is strong proof that your condition has medically improved and there is evidence that you are able to return to work. Frequency Of Reviews How often your case is reviewed depends on the severity of your condition and the likelihood of improvement. The frequency can range from six months to seven years. Your Certificate of Award shows you when you can expect your first review. Here are general guidelines for reviews: -- Improvement expected--If medical improvement can be predicted when benefits start, your first review should be six to 18 months later. -- Improvement possible--If medical improvement is possible but cannot be predicted, your case will be reviewed about every three years. -- Improvement not expected--If medical improvement is not likely, your case will be reviewed only about once every five to seven years. What Happens During A Review After you get a letter announcing the review, someone from your Social Security office will contact you to explain the review process and your appeal rights. You will be asked to provide information about any medical treatment you've received and any work you might have done. Then your file will be sent to the state agency that makes disability decisions for Social Security. An evaluation team that includes a disability examiner and a doctor will carefully review your file and request your medical reports. If reports are not complete or current enough, you may be asked to have a special examination or test that the government will pay for. Once a decision is reached, we will send you a letter explaining it. If we decide you are still disabled, your benefits will continue. If we decide you are no longer disabled, you can file an appeal (see section below). If you don't, your benefits will stop three months after we said your disability ended. Special Appeal Rights If you don't agree with a decision we make, you can appeal it. You have 60 days to file a written appeal with any Social Security office. Generally, there are four levels to the appeals process. They are: -- Reconsideration--Your claim is reviewed by someone who did not take part in the first decision. -- Hearing Before an Administrative Law Judge--You can appear before a judge to present your case. -- Review by Appeals Council--If the Appeals Council decides your case should be reviewed, it will either decide your case or return it to the administrative law judge for further review. -- Federal District Court--If the Appeals Council decides not to review your case or if you disagree with its decision, you may file a lawsuit in a federal district court. If you disagree with the decision at one level, you have 60 days to appeal to the next level until you are satisfied with the decision or have completed the last level of appeal. You have two special appeal rights when a decision is made that you are no longer disabled. They are: -- Disability Hearing--This is part of the reconsideration process. You can meet face-to-face with the person who is reconsidering your case to explain why you feel you are still disabled. You can submit new evidence or information and can bring someone who knows about your disability. This special hearing does not replace your right to also have a formal hearing before an administrative law judge (the second appeal step) if your reconsideration is denied. -- Continuation of Benefits--While you are appealing your case, you can have your disability benefits and Medicare coverage (if you have it) continue until an administrative law judge makes his or her decision. However, you must request the continuation of your benefits during the first 10 days of the 60 days mentioned earlier. If your appeal is not successful, you may have to repay the benefits. Part 4--Helping You Return To Work Even after you start receiving disability benefits, you may want to try working again. To help you, there are many "work incentives"--rules that are designed to ease the transition back to work. These rules continue cash payments and Medicare while you work, help with the extra work expenses associated with working with a disability, and help with rehabilitation and training that may lead to a new line of work. A brief description of these rules follows. For detailed "work incentive" information, ask Social Security for the booklet "Working While Disabled...How We Can Help" (Publication No. 05-10095). Understanding "Substantial" Work To understand how work affects your disability benefits, you need to understand how Social Security measures your work. Disability benefits can be paid only if you are unable to do any "substantial" work. The amount of your earnings is the key to determining whether your work is substantial. In general, if your wages average MORE THAN $500 A MONTH (after allowable deductions), you are performing substantial work. If your average monthly earnings are BETWEEN $300 AND $500 A MONTH, your work could be considered substantial if the amount and quality of your work are about the same as that done by workers in your area who are not disabled. In making this decision, we consider the time, energy, skill, and responsibility involved in your work. Earnings of LESS THAN $300 A MONTH are not considered substantial. (See "Special Rules For Blind People Who Work" for special rules for blind people who work.) If your earnings are "subsidized"--that is, if your employer says you are paid more than the reasonable value of your work--the subsidy part of your pay is not counted as earnings in deciding whether you are performing substantial work. IF YOU ARE SELF-EMPLOYED, your business income alone may not be the best measure of whether you are doing substantial work. Business income may depend on many other factors, such as the economic situation and services of other people. In such cases, more consideration is given to the AMOUNT OF TIME you spend in your business than the amount of your income. Following are the rules that may help you return to work. Nine-Month Trial Work Period You can continue to receive benefits for up to nine months while you try to work. The months need not be in a row, but they must take place within a 60-month period. Generally speaking, a "trial work" month is any month in which you earn over $200 in gross wages (regardless of amount of time worked) or spend 40 hours in your own business (regardless of amount of earnings). You will receive your full benefits during this period. At the end of nine months of trial work, we decide if you are able to do "substantial" work. If you can, your benefits will stop after a three-month adjustment period. If you are not able to work, your payments will continue. Remember, your trial work period will continue only if you are still disabled. If you recover during a trial work period, your benefits will stop after a three-month adjustment period. 36-Month Extended Period Of Eligibility If your benefits stop because you have returned to work even though you are still medically disabled, you receive special "benefit protection" for the next 36 months. During that time, you can receive a benefit for any month your earnings fall below $500. You do not have to file a new application, but you do have to notify Social Security. If you are unable to continue working, your benefits continue indefinitely so long as you remain disabled. Medicare Continues If you are working even though you are still disabled, your Medicare coverage may continue for at least 39 months after the trial work period. After that, you may purchase the coverage with a monthly premium. Help With Work Expenses If you need certain equipment or services to help you work, the money you pay for them can be deducted from your earnings in deciding whether you are doing "substantial" work. It does not matter if you also need the items or services for daily living (such as a wheelchair). The cost of medical equipment, certain attendant care services, prostheses, and similar items and services is generally deductible. The cost of drugs or medical services is deductible only if required because of your condition. Vocational Rehabilitation When you applied for disability benefits, information about you and your impairment may have been sent to the state vocational rehabilitation agency. If they offer you services and you refuse them without good reason, your monthly benefits may be withheld. If you have not heard from them and are interested in receiving rehabilitation services, you should give them a call. Your disability benefits will continue while you receive rehabilitation services. Under a special rule, benefits can continue even if you medically recover while participating in an approved vocational rehabilitation or training program. For more information, ask Social Security for the booklet "How Social Security Can Help With Vocational Rehabilitation" (Publication No. 05-10050). If You Become Disabled Again If you become disabled a second time within five years after your benefits were stopped, your cash payments can begin again with the first full month you are disabled. Another "waiting period" is not required (as it was the first time you applied for Social Security disability benefits). However, you must file a new application. There is also no waiting period if you are a disabled widow or widower or a person disabled before 22 who becomes disabled again within seven years after benefits ended. If you had Medicare coverage, that will also resume without the 24-month waiting period (see "A Word About Medicare.") Special Rules For Blind Persons Who Work If you receive disability benefits because of blindness, there are two special rules that may help you when you work: -- Average monthly earnings of $960 or less in 1996 are not considered substantial work. This monthly amount will increase in future years. ('Understanding "Substantial" Work' explains how "substantial work" affects your disability check). -- If you are 55 to 65, monthly benefits will continue if you cannot do the regular (or similar) work you did before turning 55 or becoming blind, whichever is later. For more information, ask Social Security for a copy of the booklet "How Social Security And SSI Can Help If You Are Blind" (Publication No. 05þ10052). For More Information You can get more information by calling Social Security's toll-free number: 1-800-772-1213. You can call for an appointment or to speak to a service representative between the hours of 7 a.m. and 7 p.m. on business days. Our lines are busiest early in the week and early in the month, so if your business can wait, it's best to call at other times. Whenever you call, have your Social Security number handy. If you have a touch-tone phone, recorded information and services are available 24 hours a day, including weekends and holidays. People who are deaf or hard of hearing may call our toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days. The Social Security Administration treats all call confidentially--whether they're made to our toll-free numbers or to one of our local offices. We also want to ensure that you receive accurate and courteous service. That's why we have a second Social Security representative monitor some incoming and outgoing telephone calls. Other Booklets Available Social Security has a number of publications that contain information about other Social Security programs. Contact Social Security to get a free copy of any of these publications--all of which are also available in Spanish. They include: -- "Social Security--Understanding The Benefits" (Publication No. 05-10024)--A comprehensive explanation of all the Social Security programs. -- "Retirement Benefits" (Publication No. 05-10035)--Explains Social Security retirement benefits. -- "Survivors Benefits" (Publication No. 05-10084)--Explains Social Security survivors benefits. -- "Medicare" (Publication No. 05-10043)--Explains Medicare hospital insurance and medical insurance. -- "SSI Benefits" (Publication No. 05-11000)--Explains the SSI program, which provides a basic income to people who are 65 or older, disabled, or blind and have limited income and resources. -- "Working While Disabled...How We Can Help" (Publication No. 05-10095)--Explains the work incentives available to people with disabilities who work