AvailabilityLink: http://www.ssa.gov/online/ssa-3288.pdf Show
InstructionsUpdated: 4/2002 Note: Instructions for Medicaid Eligibility and Texas Works are listed separately below. MEDICAID ELIGIBILITY INSTRUCTIONSINTRODUCTIONOn August 22, 1996, Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, was enacted. Under this new law only certain excepted classes of qualified aliens are eligible for supplemental security income (SSI) and food stamps. This exception involves aliens who are lawfully admitted to the United States for permanent residence under the Immigration and Nationality Act and who have worked or can be credited with 40 qualifying quarters (QQ). Under certain conditions, the QQs of parents or spouses can be added to the alien's record to achieve the needed 40 QQs. The Social Security Administration (SSA) is the primary source for information on QQs and provides this information via the Wire Third Party Query (WTPY) automated system, only after a Consent for Release of Information (SSA-3288) is completed and signed. PURPOSEAfter determining which Social Security numbers are needed to request QQs histories on, the Consent for Release of Information forms (SSA-3288) must be obtained. Federal regulations mandate that a Consent for Release of Information (SSA-3288) must be completed and signed, before requesting the 40 qualifying quarters of coverage information for the applicant/recipient, the parent(s) and/or spouse. A Consent for Release of Information (SSA-3288) must be signed by each individual whose work history will be used to establish the 40 quarters of coverage information. However, a consent form is not needed when requesting information on a deceased individual's Social Security Number. Important: If someone refuses to cooperate and will not complete the consent form, do not request the 40 QQs information. SSA cannot and will not provide the information. A signed SSA-3288 must be obtained and is necessary because these records are protected by the Privacy Act. PROCEDUREForm RetentionDo not send the completed SSA-3288 to SSA. The forms must be retained in the case folder. SSA will request to see these forms as part of their annual security audit of the Texas Department of Human Services or if a question is raised. How to Complete the SSA-3288This consent form (SSA-3288) must be completed and signed only by:
Note: Do not use the SSA-3288 to request information about earnings or employment history. DETAILED INSTRUCTIONSComplete the shaded items only:
TEXAS WORKS INSTRUCTIONSPURPOSETo obtain an individual's consent for DHS to submit a request to SSA for verification of 40 quarters of earnings. PROCEDUREWhen to PrepareWorker must complete the form for each person for whom verification of 40 quarters if being requested. Form RetentionRetain the original signed form in the case folder until no longer needed. DETAILED INSTRUCTIONSEnter the name, date of birth, and Social Security number of the person for whom 40 quarter information is requested. Exception: No signature is required if the spouse or parent is deceased. Workers must ensure that a signature is obtained for each person for whom a consent form is completed. Since 2012, individuals filing for Social Security disability benefits on their own behalf have had alternative ways to sign and submit their Authorization to Disclose Information to the Social Security Administration (Form
SSA-827). Adults filing online now can use a click-and-sign process, while those filing by telephone or in person can use our attestation process to sign and submit their SSA-827. Beginning August 2013, the attestation process used for adult telephone and in person claims is also
available for some disability claims filed for children. Children filing a claim on their own behalf or individuals with legal authority to act on behalf of a child can use our attestation process to sign and submit the SSA-827 when filing by telephone or in person. This does not apply to children age 12 or old who are still considered a minor under state law. How do these processes work? As part of the disability application process, claimants have the option to
sign the SSA-827 using click-and-sign (adult internet claims only), or using our attestation process (adult and some child telephone and in person claims). In both the click-and-sign and attestation processes, once the form is signed, it is transmitted and saved directly to Social Security's systems. This transmission eliminates the need for applicants to print, sign, and mail (or deliver) a paper copy of the form to a Social Security office. Our application process includes
steps to verify the identity of the signer, and we continue to protect the information and records we receive. When filing online, applicants can print a copy of the signed SSA-827 for their records. For those filing by telephone or in a Social Security office, we will provide a copy of the
signed SSA-827. What are the benefits of these processes? By offering applicants new options to sign and submit the SSA-827, we improve our process and provide better service to our customers. Social Security estimates that, on average, this reduces disability application processing time by nine days on cases filed online or by telephone, resulting in applicants receiving much needed medical insurance coverage and cash benefits sooner. Applicants filing over the internet also benefit from a streamlined process that allows for the online submission of all parts of their disability application. I am applying for disability benefits. How does this affect me? If you are an adult applying for disability benefits on your own behalf, once you have read the SSA-827 and intend to authorize disclosure to Social Security, you will have the opportunity to sign the form more efficiently as part of your disability application, whether you are applying over the telephone, in person, or online. If you are filing for childhood disability benefits by telephone or in person, you may now have the opportunity to sign the SSA-827 more efficiently as part of the disability application process. By signing the SSA-827 using one of our new processes, you will not have to print, sign, and mail (or deliver) a paper copy of the form to a Social Security office. This means that we can begin processing the disability claim sooner. I provide Social Security with patient or student records. How does this affect me? You will continue to receive a signed SSA-827 with each of Social Security’s requests for records. There is no change to the current HIPAA-compliant SSA-827 form
you are already accepting. In the completed signature block, you may see an indication that the applicant signed using our new processes. You may see the name of the Social Security employee in the witness block if your patient applied for disability benefits by telephone or in a Social Security office. The only new thing is the method used to sign the form. I am filing a disability appeal. How does this affect me? If you are an adult filing a disability appeal on your own behalf, once you have read the SSA-827 and intend to authorize disclosure to Social Security, you will have the opportunity to sign the form more efficiently as part of your disability appeal, whether you are filing over the telephone, in person, or online. If you are filing an appeal in connection with a claim for childhood disability benefits, you may now have the opportunity to sign the SSA-827 more efficiently whether you are filing over the telephone or in person. By signing the SSA-827 using one of our new processes, you will not have to print, sign, and mail (or deliver) a paper copy of the form to a Social Security office. This means that we can begin processing your disability appeal sooner. Frequently Asked Questions regarding the Signature Processes Organizations that are helping us spread the word about our new signature processes Department of Defense (DoD): Reliance on a Signature on Form SSA-827 when Disclosing Protected Health Information to the Social Security Administration Professional Association of Healthcare Office Managers (PAHCOM): March/April 2012 PAHCOM Journal article For more information about these changes, contact your local Professional Relations OfficerWhy am I getting a letter from the Social Security Administration?Whenever we send you a notice, it is because there is something you should know or do about your claim, benefit status or benefit amount. We send you a notice before we make a change to your benefit amount or eligibility. We will send a notice whenever we must tell you about activity on your case.
How do I request a document from Social Security?Please call us at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday between 8 a.m. and 5:30 p.m. or contact your local Social Security office.
What is a CBSV form?CBSV is typically used by companies that provide banking and mortgage services, process credit checks, provide background checks, satisfy licensing requirements, etc. With the consent of the SSN holder, CBSV can verify if the SSN holder's name, date of birth, and SSN match SSA's records.
What can you do if someone accesses your Social Security?If you know your Social Security information has been compromised, you can request to Block Electronic Access. This is done by calling our National 800 number (Toll Free 1-800-772-1213 or at our TTY number at 1-800-325-0778).
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Authorization for the social security administration to release information
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