0105.025.15.50 Blind Pension Program Explanation

IM-105 August 23, 2002

Give copies of the following leaflets to each applicant:

  1. Blind Pension pamphlet, IM-4 Blind Pension
  2. Hearings pamphlet, IM-4 Hearings
  3. Medicaid and You pamphlet, IM-4 Medicaid
  4. Health Insurance Premium Payment (HIPP) Program

Complete the following forms, at a minimum:

  1. Application and Eligibility Statement, IM-1MA
  2. Identification Data, IM-35
  3. Age Verification Form, IM-11
  4. Insurance Form, IM-9
  5. Referral for Social Security Number, if necessary,  SSN-1
  6. Visual Disability Report, IM-68
  7. Third Party Liability, if needed, TPL-1
  8. Householder's Certificate, IM-2A
  9. Statement of Sighted Parent or Spouse, IM-2B
  10. Request for Direct Deposit, if needed, IM-20
  11. Request for Information, IM-31A
  12. HIPP-1, if applicable

Explain the following eligibility requirements:

  1. receipt of or ineligibility for other assistance,
  2. total property,
  3. property transfer,
  4. residence,
  5. institutional residence,
  6. age,
  7. vision,
  8. correctional treatment or operation,
  9. character,
  10. support from sighted spouse, and
  11. soliciting alms.
  12. must have been rejected for SAB within the past 90 days on a factor other than vision or age
  13. Prior Quarter Coverage