We consider the existence of subsidies and/or special conditions when we make a substantial gainful activity (SGA) decision. We use only earnings that represent the real value of the work you perform to decide if your work is at the SGA level.

A “subsidy” is support provided by your employer that may result in you receiving more pay than the actual value of the services you perform. A subsidy may exist when you work under any of the following conditions:

• You receive extra assistance or employer accommodation to complete job duties (i.e., job coach, extra help, or supervision, etc.).
• You are assigned fewer or easier duties than typically required by the job description.
• You have a special relationship to the employer (i.e., friend, relative, long-term employee, etc.,).
• You take additional breaks or time off as an accommodation.
• You have other employer accommodations.

A special condition is support and on-the-job assistance provided by your employer, or someone other than your employer, for example, a vocational rehabilitation agency. Because of this support, you may receive more pay than the actual value of the services you perform.

Do subsidies or special conditions affect my SSI payments?

No, we do not consider subsidies or special conditions when we figure your SSI payment amount. We do, however, consider subsidies and special conditions when we determine your initial eligibility to SSI benefits.

A UWA (Unsuccessful Work Attempt) is when you try to work but have to stop or reduce your work to below the substantial gainful activity (SGA) level within six months because of your disability or because you lose the extra help you need to do your job.

What is the benefit of a UWA if you receive SSDI?

When we make an SGA decision to determine if your disability continues or ceases because of your work, we do not count your earnings during a UWA.

Can a UWA occur during the Trial Work Period (TWP)?

No. We do not consider a UWA during the TWP or after we decide that your disability has ceased.

Does a UWA affect your monthly SSI payment?

For SSI, we only consider a UWA as part of our SGA decision when you file an initial claim. After that, we do not consider a UWA when calculating your SSI payment.

How can IRWE help you?

We deduct the cost of certain impairment-related items and services that you need to work from your gross earnings when we decide if your work is substantial gainful activity (SGA). It does not matter if you also use these items and services for non-work activities.

When will we deduct your IRWE?

We deduct IRWE for SGA purposes when you meet all the requirements below:

• The item(s) or service(s) enables you to work.
• You need the item(s) or service(s) because of a physical or mental impairment.
• You pay for the item(s) or service(s) and are not reimbursed by another source such as Medicare, Medicaid, a private insurance carrier, or Employment Network (EN).
• The cost is “reasonable,” that is, it represents the standard charge for the item or service in your community.

How do we use IRWE to figure your Supplemental Security Income (SSI) monthly payments?

If you receive SSI benefits, we will exclude IRWE from your earned income when we figure your monthly payment amount. This applies if you meet the requirements above, you paid the expense in a month that you received earned income, and you performed work while you used the IRWE.

Can IRWE be deducted during a non-work month?

Generally, you must be working in the month you pay for an IRWE. However, in certain situations, we can deduct IRWE amounts for expenses you pay before you start or after you stop work.

What types of expenses are deductible?

The following table outlines the types of expenses that are deductible as IRWE.

How can a PASS help you?

A PASS allows you to set aside other income besides your Supplemental Security Income (SSI) and resources for a specified period. This allows you to pursue a work goal that will reduce or eliminate the SSI or Social Security Disability Insurance (SSDI) benefits you currently receive. For example, if you receive SSDI, wages, or other income, you could set aside some of that money to pay expenses for education, vocational training, assistive technology used for employment–related purposes or starting a business. Expenses must be related to achieving your work goal.

We do not count the income that you set aside under your PASS when we figure your SSI payment amount. We do not count the resources that you set aside under your PASS when we determine your initial and continuing eligibility for SSI.

A PASS can help you establish or maintain SSI eligibility and may increase your SSI payment amount. For example, if you receive $1,000 per month in SSDI, you have too much income to be eligible for SSI. However, if you otherwise qualify for SSI and have a work goal, you could use some of your SSDI to pay for PASS expenses to help you reach your work goal. Because we would not count the portion of your SSDI you are using toward your PASS, this could reduce your countable income enough so you could be eligible for SSI.

In addition, other agencies may not count income that has been excluded under a PASS when determinng eligibility for housing assistance or the Supplemental Nutrition Assistance Program (food stamps).

If you receive SSI or could qualify for SSI after setting aside income or resources to pursue a work goal, you could benefit from a PASS.

Your PASS must include all the following:

• Be designed especially for you.
• Be in writing. We prefer that you use our form, the SSA-545-BK. You can get copies of the PASS form, SSA-545-BK, from our website at www.ssa.gov/online/ssa-545.html, calling our toll free number 1-800-772-1213, visiting your local office, or from any PASS Expert. If you need in-person help, you must make an appointment to visit a local office.
• Have a specific work goal that you can perform.
• Have a specific timeframe for reaching your goal.
• Show what income you receive (other than your SSI payments) and resources you have that you will use to reach your goal.
• Show how you will use your income and resources to reach your work goal.
• Show how the money you set aside will be kept separate from other funds.
• Be approved by us.
• Be reviewed periodically by us to assure your plan is helping you make progress towards your work goal.

Anyone may help you with your PASS. For example, vocational counselors, social workers, benefit specialists or employers can help you. We will evaluate the plan and decide if it is acceptable. We can also help you put your plans in writing.

We have specially trained employees (PASS Specialists) that work with the PASS program. When you submit a written PASS proposal to a PASS Specialist, they will review it to:

• Make sure the work goal is reasonable.
• Make sure that you need the items and services listed on the PASS application to reach the work goal.
• Make sure the expenses are reasonably priced.
• Work with you to make any needed changes.

Where can you get more information about a PASS?

You can get a PASS Specialist’s telephone number by visiting our website at: www.ssa.gov/disabilityresearch/wi/passcadre.htm or calling our toll-free number 1-800-772-1213 between 8 a.m. and 7 p.m. Monday through Friday.

You can ask for a pamphlet entitled Working While Disabled — How We Can Help (SSA Publication No. 05-10095). It is also available online at www.ssa.gov/pubs/EN-05-10095.pdf. You can also get a copy from your local office or by calling our toll-free number 1-800-772-1213 between 8 a.m. and 7 p.m. Monday through Friday.

A Sample PASS (SSI ONLY)

Example 1 – Wages Being Excluded under an approved PASS

• Billy wants to go to school to become a social worker.
• Billy works part time and earns $665 per month.
• We figure out Billy's countable income using the earned income formula (refer to the Earned Income Exclusion section).
  $665 - $20 = $645 - $65 = $580.
  $580 / 2= $290 in countable income.
• Billy's earned income reduces his SSI benefit of $967 by $290 per month to $677.
• He agrees to spend the $290 in countable income on his education and we approve a PASS.
• We set aside this income, and his SSI increases by $290 per month for the PASS timeframe. Billy receives $967 in SSI benefits and has $290 to use for approved PASS expenses.

A Sample PASS (SSDI ONLY)

Example 2 – SSDI Being Excluded under an approved PASS

• Maria wants to go to school and become a paralegal.
• She receives $1,000 in SSDI benefits:
• The goal for Maria’s employment is to generate enough income to eliminate SSDI. (Have expected earnings over the SGA limit).
• Maria determines she needs $980 per month for tuition, books, and school supplies. We can exclude up to $980 per month in SSDI income. This represents the full amount of Maria’s SSDI payment after deduction of the SSI general exclusion.  This will make Maria eligible for the full SSI payment.
• Maria must use the SSI payment for living expenses and use the PASS funds for approved plan expenses.

How do I qualify for continued payment under Section 301?

If we find that you no longer have a disability due to medical improvement, or if you are age 18 and we find that your eligibility ends because you do not meet the adult requirements for disability, your benefit payments usually stop. However, if you are participating in an appropriate program of vocational rehabilitation (VR) or similar services, your benefits may continue until your participation in the program ends. To qualify for continued payments under Section 301, you must meet all the requirements below:

• You must be participating in an appropriate program of the VR or similar services that began before your disability ends under our rules.
• We must review your program and decide that your continued participation in the program will increase the likelihood of your permanent removal from the disability benefit rolls.
  

What is an appropriate program of VR or similar services?

Here are some examples of appropriate programs:

• An individualized education program (IEP) for an individual age 18 through 21.
• An individual work plan (IWP) with an employment network (EN) under the Ticket to Work program.
• A Vocational Rehabilitation (VR) Agency using an individualized plan for employment (IPE).
• A program of VR services, employment services, or other support services carried out under a similar, individualized written plan with either an agency of the federal government, American Job Center, or another provider of service approved by us.
• A Plan to Achieve Self-Support (PASS).

How long may my benefits continue?

Under Section 301, your benefits may continue until:

• You complete your program.
• Your participation in the program stops.
• We decide that your continued participation in the program will not increase the likelihood of your permanent removal from the disability benefit rolls.

EXR serves as a safety net for individuals who successfully return to work and, as a result, lose their entitlement to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits and payments. If your benefits ended because of your work and earnings, and you stop working within 5 years of when your benefits ended, you may be able to have your benefits restarted immediately by requesting EXR.

How does EXR help you?

If you have stopped receiving benefits due to your work, we may be able to restart them. The EXR provision allows you to receive up to 6 months of temporary cash benefits while we conduct a medical review to decide if we can reinstate your benefits. You may also be eligible for Medicare and/or Medicaid during this provisional benefit period.

Who can we reinstate?

You are eligible to request EXR if you meet all the following requirements:

• Your previous entitlement to SSDI benefits is terminated due to performance of substantial gainful activity (SGA); or your previous SSI disability or blindness eligibility terminated because of excess earned income or a combination of earned and unearned income.
• You are unable or become unable to perform SGA in the month you apply for EXR.
• You are unable to work at the SGA level due to your medical condition.
• Your current medical impairment(s) is the same as, or related to, your original disabling impairment(s).
• You request EXR within 5 years from the month your benefits stopped.

What happens after my request for reinstatement is approved?

The month we reinstate your disability payments begins your initial reinstatement period (IRP). The IRP can last for 24 months (not necessarily consecutive) and ends when you have received 24 months of payable benefits. If you receive SSDI benefits, we can pay you for any month during the IRP that your earnings are not substantial gainful activity (SGA). If you receive SSI benefits, the normal income counting rules apply.

When is the IRP completed?

The IRP is completed when you have received a total of 24-months (not necessarily consecutive) of payable benefits.

What happens after completion of the IRP?

If you receive SSDI benefits, you are entitled to:

• A new 9-month trial work period.
• A new 36-month extended period of eligibility.
• A new 60-month period to file an EXR request if your reinstated benefits are stopped due to SGA.
• A new period of extended Medicare coverage.
  

"Unincurred Business Expenses" are contributions made by others to your self-employment business effort. For example, if the state vocational rehabilitation agency gives you a computer for your business, or a friend works for your business as unpaid help, these are "unincurred business expenses".

We generally follow the Internal Revenue Service (IRS) rules to figure your net earnings from self-employment. The IRS only allows you to deduct expenses you actually paid or incurred debt. When we make a SGA decision, we also deduct unincurred business expenses from your net earnings because we want an accurate measure of the value of your work.

What qualifies as an unincurred business expense?

For an item or service to qualify as an unincurred business expense, it must be an item or service that the IRS would allow as a legitimate business expense if you had paid for it.

Do unincurred business expenses affect your Supplemental Security Income (SSI) payments?

No. We do not deduct unincurred business expenses from earnings when we figure your SSI payment amount. However, unincurred business expenses may be deducted for SGA determinations in SSI initial applications.