SI 00870.025 Documenting And Reviewing A PASS PASS Expert
A. PROCEDURE GENERAL PASS REVIEW REQUIREMENTS
1. Discuss PASS with the Individual
Contact the individual as soon as possible after receiving the PASS, even
if you have not reviewed it. Give the individual an overview of the PASS
process. Make sure that the person understands how it works, what can be
expected of SSA, and what will be expected of him/her, particularly with
respect to adhering to the savings/spending schedule of the PASS and
reaching the plan's milestones. If the individual still wishes to pursue
the PASS, proceed with SI 00870.025A.2. If the individual no longer
wishes to pursue the PASS, document the file and see SI 00870.025A.7.
2. Review the PASS
Review the PASS as soon as possible. Remember that a delay can result in
loss of a job or training opportunity for the individual. Take a common
sense approach when evaluating a PASS. Make sure the necessary release
forms have been obtained per SI 00870.004B.2.c.
Determine whether all elements of a PASS are present and addressed per
SI00870.006. You may use available aides, such as the VR assessment
software and the internet, to help you with this evaluation. You may
allow a PASS in which you have confidence, despite all of the elements of
a PASS not being present or adequately addressed, provided that your
approval reflects the congressional intent for the PASS provision
mentioned in SI00870.001A. Be sure to document the PASS your rationale in
such instances.
3. Modify the PASS
If a modification is needed, follow the instructions in SI 00870.030. Be
sure to explain to the person why the PASS can't be approved as
submitted.
4. Determine the Starting Month
Determine the starting month per SI 00870.007.
5. Determine the Exclusion
Compute the income and/or resources exclusion as follows:
o Determine total estimated PASS expenditures.
o From this total, subtract the value of current resources to be used
for the PASS. The remainder is the amount that must be paid with
income that will be excluded under the PASS.
o Determine the income exclusion that is most advantageous to the
individual, considering countable income (including any known SSDI
COLA, interest on excluded resources, etc.), fluctuations in income
(seasonal or otherwise), and the schedule of planned expenditures.
NOTE: If SSDI benefits or RSI benefits based on a disability will be
excluded, you may need to estimate when they might cease due to a
finding of SGA. Check the TWP on the MBR. Also be sensitive to the
need to amend a PASS due to changes in expenditures or income
(including COLAs). (See SI 00870.050.)
o Determine the highest amount of excluded resources expected to
accumulate in any month prior to the first progress review. This is
the amount of resources to be excluded under the PASS until it is
amended, extended, reviewed, terminated, or completed.
6. Making Systems Input
a. PASS Approved
If the individual is receiving SSI, follow the instructions in SM01005.170, SM 01305.105 and <xr id=SM01301820>SM
01301.820</xr> and input in the EN field of
the SSR as type "D" income:
o the amount of income to be excluded (earned and/or unearned); or
o $.01 (1 cent) with a "C" frequency code when only resources are
being excluded.
If an SSI application is pending, advise the FO of the appropriate inputs
to make. See MSOM section 137 A for instructions on inputting PASS
information onto MSSICS.
b. PASS Not Approved
Input type "D" income of $.01 (1 cent) with an "N" frequency code for the
month the denial notice is dated.
7. Issuing Notices
a. Individual Receiving SSI
Send a manual notice of approval or disapproval per SI 00870.040. For
approvals, enclose a PASS Expenditure/Savings Record (see SI 00870.100
Exhibit 7) and an SSI Recordkeeper folder (see SI 00604.110 ff.), if
available.
b. SSI Application Pending
Provide the FO with language it should use when it sends the notice about
SSI benefits to the person. If the PASS is approved and the person will
receive SSI benefits, remind the FO to send the materials identified in
SI 00870.025A.7.a. to the person and to send a copy of the notice to you.
8. Scheduling Reviews
a. Progress Checks
Schedule a progress check within 30 60 days of approval, or the first
milestone, if earlier. A brief telephone call to see how things are going
can be sufficient. Set up a schedule of subsequent progress checks
between progress reviews based on the circumstances of each PASS.
Experience shows that PASS participants frequently run into problems when
starting out. (See SI 00870.055.)
b. Progress Reviews
Schedule progress reviews (see SI 00870.055) on the basis of:
o the end of the time allowed for "VR evaluation;"
o critical milestones;
o 6 month intervals during which funds will be accumulated for PASS
expenses but not disbursed;
o when the individual files a self employment tax return;
o when achievement of the occupational goal is expected;
o any other factor you consider appropriate.
B. PROCEDURE SPECIAL CONSIDERATIONS
1. Prior PASS
Advise the person that a new PASS may not be considered until an
explanation is provided as to why he/she is not working in the
occupational goal of a previously completed PASS. Before a new PASS can
be allowed, the individual must provide evidence that he/she is unable to
work in the prior occupational goal. This might be evidence that his/her</phrase></f>
condition has worsened to the point that the prior goal is no longer
feasible, or that the person was unable to find employment. Allow a
reasonable period of time for the individual to provide such evidence.
If the individual cannot provide the evidence and the prior PASS was
allowed before 12/97, review the prior PASS. If the prior PASS is
unavailable or, upon review, the approval did not mandate any milestones
necessary for achieving the goal, and the individual wishes to pursue the
same work goal, you may approve a new PASS with the same goal.
2. Earnings Requirements
Determine whether the occupational goal satisfies the earnings
requirements in SI 00870.006A.5. If it does not, follow the instructions
in SI 00870.030 for modifying the PASS. If the individual won't modify
the plan, deny per SI 00870.025A.6.b. and SI 00870.025A.7.
3. Feasibility of Goal and Viability of Plan
a. Assuming Feasibility and Viability
Absent evidence to the contrary, assume that an occupational goal is
feasible and the plan for achieving it is viable per SI 00870.006A.3 and
SI 00870.006A.4. if the goal is "VR evaluation," or if the PASS was
prepared by any of the following:
o a State VR counselor;
o a public or private vocational counselor, case manager, social
worker, or other individual who is licensed or certified by: (1) a
government agency, (2) the Commission on Rehabilitation Counselor
Certification (CRCC), or (3) the Certification of Insurance
Rehabilitation Specialists Commission (CIRSC); or
o an individual acting on behalf of an agency that has been
certified by the above or accredited by an appropriate but
unrelated local or nationally recognized organization such as the
American Association for Counseling and Development or the
National Rehabilitation Association.
If in doubt, ask for evidence of the preparer's credentials or those of
the organization for which the preparer works and create a precedent
file.
b. Evidence to The Contrary
Do not apply the assumption in SI00870.025B.3.a. if there is evidence to
the contrary. Some examples of such evidence are:
o an obvious mistake or oversight on the part of the preparer that
could jeopardize successful completion of the PASS;
o a history of problems with PASSes developed by the preparer; and
o the individual would have insufficient income and/or resources to
pay for usual living and PASS expenses if PASS is approved.
c. Evaluating Feasibility of the Goal
If the assumption in SI 00870.025B.3.a. does not apply, consider the work
goal in terms of:
o the nature of the individual's impairment and the limitations
imposed by it, based on available evidence, including medical
evidence in the FO or the diagnostic code on the SSR or MBR;
o the individual's age (extreme youth or advanced age may contribute
to making some occupational goals unrealistic);
o the individual's strengths and abilities, based on available
indicators; and
o any observations made by the CR who conducted the initial PASS
interview.
If the person has had 2 or more unsuccessful PASSes, follow the
instructions in SI 00870.025B.3.e.
d. Evaluating Viability of the Plan
Do not routinely question the feasibility of a work goal or the viability
of a plan if the assumption in SI 00870.025B.3.a. does not apply.
Evaluate the viability of the plan based on consideration of the factors
in SI 00870.025B.3.c. and:
o the person's prior work history, education, and training;
o how milestones, and target dates for completing them, relate to
the occupational goal; and
o the individual's familiarity with the requirements and duties of
the occupational goal.
For a self employment goal evaluating the viability of the plan includes
evaluating the business plan. See SI 00870.026 for more information about
business plans and examples of knowledgeable third parties that might
help you evaluate the business plan.
e. Feasibility or Viability is Questionable
If you doubt the feasibility of the occupational goal or the viability of
a plan, or the individual has had 2 or more unsuccessful PASSes, proceed
as follows:
o Discuss your concerns with the individual and/or the preparer, if
the individual has given permission to contact the third party. If
you continue to believe that the PASS should not be approved as it
is at present, discuss possible modifications.
o If the individual is unwilling to modify the PASS, ask his/her
permission to have a knowledgeable third party evaluate the PASS.
o With the individual's permission, contact a rehabilitation agency,
preferably one that has worked with the individual in the past, or
another knowledgeable source (e.g., a therapist or the
individual's physician) to evaluate the PASS. Provide the third
party with all pertinent information including your concerns.
NOTE: Any cost for this "second opinion" can be included as a PASS
expense if the PASS is approved. If the individual will not agree to
either a third party evaluation or necessary modifications, explain why
the PASS application cannot be allowed before issuing a denial notice.
4. Timetable
Make sure that the plan specifies when:
o all PASS activities began or will begin;
o each milestone that marks progress toward the goal is to begin and be
completed;
o the goods and services will be obtained; and
o the individual expects to begin working in the goal.
If no disbursements will be made within the first 6 months and the reason
is not obvious, obtain an explanation for the delay. If warranted, ask
the individual to submit any readily available documentation that
supports the explanation.
Decide whether the timetable is acceptable. If the timetable is not
acceptable, follow the instructions in SI 00870.030 for modifying a PASS.
EXAMPLE: Acceptable Timetable
FACTS: John Myers is a 16 year old 11th grader who receives SSI. His only
source of income is the income deemed from his parents. John wants to
become a computer programmer and plans to take a 2 year programming
course at a community college after high school. His career counselor
submits a letter indicating that he can handle a college curriculum.
CONCLUSION: You help John set up a PASS under which he can save money for
his college tuition and the purchase of a computer after his graduation
from high school. Under the PASS, John's parents will set aside money in
a separate bank account to save for John's college expenses. The amount
set aside will be deducted from John's deemed income.
When deeming stops, John's parents intend to give the money directly to
him and have him put it in the separate account. John expects to begin
using the funds for his college expenses beginning with his first
semester.
Because John may change his college plans, this PASS should be monitored
closely. A progress review (with an accounting) should be conducted every
6 months until disbursements begin.
5. Expenses
a. General
Make sure the PASS contains the following:
o a list and, if necessary, description of the items and services to
be purchased (broad categories or groupings as listed in g. below
are sufficient unless you question the expense);
o an estimate of the cost for each article on the list (if the
estimate seems unreasonable, obtain verification per d. below);
o an explanation of why each article is needed to achieve the
occupational goal (unless the reason is obvious);
o an indication that SSI and the individual's other income and
resources will cover both the individual's PASS expenses; and
o living expenses (documenting living expenses on an SSA 632, or
SSA 8006 F4 or SSA 8011 F3 per SI 00835.600 or SI 00835.625,
respectively, may be helpful).
NOTE: Because forms SSA 8006 F4 and SSA 8011 F3 reflect a limited
definition of shelter under the in kind support and maintenance rules,
the individual's ordinary living expenses may include expenses not listed
on these forms.
b. Business Start up Costs
Treat all expenses, including ongoing costs, to be incurred during the
first 18 months, or longer if warranted, of a PASS that involves starting
a business as excludable start up costs if the expenses meet the
necessary and reasonable criteria. You may approve expenses the person
incurs after the start up period if the individual would not otherwise
have sufficient remaining income and resources to cover living expenses,
medical expenses, and work expenses as described in SI 00870.006A.1
EXAMPLE: In 8/2000 a State VR counselor contacts a PASS expert about
setting up a PASS for Joan King. Joan is a blind SSI recipient who has a
private insurance benefit of $425 a month and plans to open a candy shop
in 12/2000.
To open the shop, Joan will need: $15,000 worth of stock and counter
supplies; $350 for the first year's liability, fire, and theft insurance;
$150 for utilities hook up; $250 for the first month's rent; and a
security deposit of $500. Thereafter, costs will be an estimated $1,000 a
month for stock, $350 a year for insurance, $250 a month for rent, and
$125 for utilities.
The counselor says that VR will provide the initial stock and counter
supplies, and that the PASS will be to help with the other items.
You advise Joan that she can set aside funds under her PASS to cover, at a
minimum, the first 18 months of the business' operation, 12/2000
5/2002, that are not otherwise paid by VR. Her start up costs include:
o the $350 for the first year's insurance plus any additional
insurance premiums for coverage due through 5/2002;
o the $750 for the security deposit and rent due through 5/2002
($250 a month);
o the $150 for utilities hook up plus the cost for utilities through
5/2002; and
o re stocking of inventory at $1,000 a month through 5/2002.
You advise Joan that you will exclude $405 of her insurance benefit,
since $20 would be otherwise excluded, and any earnings from the store
she chooses to set aside for her PASS until either:
o she has paid for all of the start up costs; or
o beginning 6/2002 or later, she earns a sufficient income from the
store to cover her living, medical, and work expenses (see SI00870.006A.1).
c. Relation of Expenses to Occupational Goal
Determine whether each of the planned expenditures is needed to achieve
the goal. Allow only those, or that part of the cost of the expense, that
did not exist before the individual began actively pursuing the goal
(which may have been before the individual submitted the PASS itself).
See SI 00870.006B.11. for when it may be appropriate to defer the
decision on a particular expense.
If you doubt the need for a particular expense, contact any provider or
agency involved for an explanation. If no provider or agency is involved,
obtain an explanation and any available related documentation from the
individual.
d. Reasonable Cost
Determine whether a less expensive alternative would meet the
individual's needs. If not, check the precedent file for the cost of
similar items. If the cost is excessive by comparison, or you can find no
similar item, determine the item's current market value (CMV) per SI01110.400.
Fees for services must be based on actual time spent providing the
services. If the PASS indicates that necessary services were provided
before the PASS was submitted, document the file with the individual's
signed statement (e.g., on an SSA 795 or on the SSA 545 BK) confirming
that the services were provided. If the individual has already paid for
these services, obtain proof of payment.
For items rented or leased by the hour, day, etc., allow only charges for
units of time related to the PASS unless:
o the charge reflects a minimum rental period; or
o a longer rental period is more economical or practical than
frequent shorter periods.
EXAMPLE: An individual who runs a cleaning service uses a floor buffer
two days a month. The daily rental rate is $40, which equates to $960 a
year. The individual could buy the buffer for $600. You may allow the
cost of buying the buffer. If the individual cannot afford to buy it, or
wishes to rent until he/she is better established, you may allow the
expense for renting it.
e. PASS Preparation Fees
In conjunction with d. above, document the file as to whether the fee (or
some portion of it) for preparing a PASS is reasonable. In assessing the
reasonableness of the fee, consider the overall involvement the preparer
had in the development of the PASS, such as aptitude testing, counseling,
and any other pertinent services.
If the preparer has filed an SSA 1696 U4 to serve as the individual's
representative, be sure that no part of the preparation fee is for
services performed as the representative. Payments to a representative
involve a specific SSA billing process (see GN 03920.001 ff.).
If a PASS must be modified, do not allow charges for preparing the
modification. Do not allow fees for monitoring the person's progress
towards an approved work goal.
EXAMPLE: A PASS includes a $1,000 expense for a local private VR agency's
assistance with the PASS. The PASS expert contacts the agency to
determine whether the expense is reasonable.
The PASS expert learns that the agency has been certified by the State,
worked closely with the individual in developing the PASS, and conducted
an assessment of the individual's interests and abilities to help
identify an appropriate occupational goal. The agency also plans to
monitor the PASS to ensure that the individual complies with all
requirements.
The agency estimates that a counselor spent 12 hours assessing the
individual's vocational abilities and an additional 8 hours developing
the PASS. It values this assistance at $35 per hour, for a total of $700.
The rest of the fee is for the planned monitoring services.
You determine that $420 (12 hrs. @ $35/hr.) is reasonable for a
vocational assessment by a State certified private VR agency. You also
determine that $280 (8 hrs. @ $35/hr.) is a reasonable fee for preparing
the PASS itself. However, you inform the VR agency and the individual
that fees for monitoring a PASS are not allowable expenses, and that the
PASS will have to be modified to remove the $300 portion of the overall
fee that is for monitoring.
f. Items of Unusual Value
Per SI 00870.025B.5.a, if the PASS calls for the purchase of an item of
unusual value, such as a vehicle or a computer, the individual must
explain why the item is necessary in order to reach the goal. The
individual also must justify the cost of the item if it does not appear
to be reasonable. If the PASS does not contain this information, ask for
it. If necessary, explain that the expense cannot be allowed without this
information.
Determine whether the item is necessary, and whether the cost is
reasonable. (See SI 00870.006B.2. and SI 00870.006B.3. for the criteria
to use in making this determination.) If you need assistance in
evaluating the individual's explanation of why the item is necessary, or
justification of the cost (see SI 00870.025B.5.a.), consult an objective,
knowledgeable third party (a professional in the field of vocational
rehabilitation and employment, someone in computer sales, RO systems
staff, etc.).
If the individual cannot justify the need for the item, or can justify
the need but not the stated cost, but the PASS can still be allowed,
advise the individual that the PASS can be amended to include the item
(or revised cost for the item) at such time as satisfactory justification
is provided.
When considering whether to defer your decision on an expense pending
completion of a particular milestone, take into account any effect that
deferral would have on other types of assistance being received, such as
Food Stamps. Discuss your reasoning with the individual and explain why
deferral may be in his/her best interest. Consider a short term rental or
lease as an appropriate alternative until the individual reaches one or
more milestones under the PASS.
g. Examples of Allowable Expenses
The following list, which is not all inclusive, contains examples of
items and services for which expenses can be allowed under a PASS,
provided that they satisfy the criteria in SI 00870.006B:
o attendant care
o basic living skills training (see SI 00870.006A.8)
o child care
o dues and subscription costs for publications for academic or
professional purposes
o equipment, supplies, operating capital, and inventory required to
establish and carry on a trade or business (see SI 00870.026)
o equipment and tools, including safety equipment, whether specific
to the individual's condition or designed for use by a
non disabled person
o finance and service charges connected with obtaining any of the
above, including finance and service charges related to a bank
account that is set up solely for the purpose of keeping PASS
funds separate and identifiable
o food and shelter while temporarily absent from one's permanent
residence to attend educational, training, employment, trade, or
business activities, if there is also a cost associated with
maintaining the permanent residence
o job coaching/counseling services
o job search or relocation expenses
o meals consumed during work hours (including job training and
school)
o modifications to buildings, vehicles, etc., for operational or
access purposes for persons with disabilities
o PASS preparation fees
o taxes and government imposed user fees (e.g., permits and
licenses) connected with obtaining any item on this list, except
that income taxes or government imposed penalties or fines are not
allowable
o transportation hire of private or commercial carriers, or hire
of person to drive the individual's vehicle
o transportation lease, rental, or purchase of a vehicle, plus
associated costs for fuel, insurance, maintenance, registration,
taxes, etc. (see SI 00870.006B.7. and SI 00870.006B.8.)
o transportation public transportation and common carriers
o tuition, books, supplies, and all fees and costs imposed by or in
connection with an educational or occupational training facility,
including fees for tutoring, testing, counseling, etc.
o uniforms, specialized clothing, safety equipment, and appropriate
attire (e.g., suits, dresses) needed for job interviews or to
begin working in an office or professional setting
C. PROCEDURE MAINTAIN PASS LIBRARY
Notwithstanding paper retention instructions, maintain a library of
approved and disapproved PASS cases. Use the material in this library for
reviews of PASS changes, progress checks and reviews, expense
evaluations, and as models for new plans.
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