Application

Revised on October 1, 2024

1. The initial SSI application packet includes the following:
   
   1. SSA Cover Letter;
   2. Interim Assistance Reimbursement Authorization (DSHS form 18-235) (signed original);
   3. SSI Application (SSA-8001) (Title 16 application);
   4. SSDI Internet iClaim/i3368 (Title 2 application);
   5. Work History Report (SSA-3369);
   6. Function Report (SSA-3373);
   7. Authorization to Disclose Information to SSA (SSA-827) (signed original, copy, or electronic signature);
   8. Personal Observation Statement;
   9. Consent for Release of Information (SSA-3288) (signed original or copy); and
   10. A return envelope.
2. Refer to SSI Forms for a description of documents used.
3. Refer to the SSI Facilitation - Introduction section for filing timelines under Worker Responsibilities Step 5.
4. Mail the completed SSI application packet to the local SSA District Office (SSADO) within five calendar days of the client's signature date.
5. Verify that the SSADO has received the application packet.