0105.025.00 INTERVIEW PROCESS

0105.025.15.45 Supplemental Aid to the Blind Explanation

IM-105 August 23, 2002

Give copies of the following leaflets to each applicant:

  1. Supplemental Aid to the Blind pamphlet, IM-4SAB
  2. Hearings Rights, IM-4 Hearings
  3. Medicaid and You pamphlet, IM-4 Medicaid
  4. Non-Emergency Medical Transportation
  5. HCY, if needed
  6. 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-36
  4. Insurance Form, IM-9
  5. Referral for Social Security Number, SSN-1 if necessary
  6. Visual Disability Report, IM-68
  7. Third Party Liability, TPL-1 if needed
  8. Statement of Sighted Spouse, IM-2B
  9. Request for Direct Deposit, IM-4DD if needed
  10. Request for Information, IM-31A if needed
  11. HIPP-1, if applicable

Explain the following eligibility requirements:

  1. receipt of other assistance,
  2. SSI application,
  3. Age,
  4. SSN,
  5. vision,
  6. citizenship,
  7. residence,
  8. institutional residence,
  9. support from parent or sighted spouse,
  10. soliciting alms,
  11. real or personal property,
  12. need,
  13. Prior Quarter Coverage