OMB control number
Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home
OMB 0960-0516 · SSA.
OMB 0960-0516
SSA collects this information to determine if institutionalized SSI recipients will only be in the institution or medical facility for three months maximum, and if they still need SSI payments. To do this, the recipient, the recipient’s representative payee, or if the recipient does not have a representative payee, someone on their behalf typically calls SSA to provide the statement of need, and a signed physician’s certification is sent via mail. In addition, SSA employees upon finding out about a recipient entering an institution can contact the recipient or recipient’s representative payee to obtain the statement of need and a physician's certification. SSA accepts a certification or copy of a certification signed by the recipient’s physician, attesting to the period of confinement. SSA accepts a signed statement or a verbal confirmation from the recipient, or from the representative payee, acting on behalf of the recipient, about the need to maintain a home. In addition, SSA created an official form, the SSA-186, Temporary Institutionalization Statement to Maintain Household and Physician Certification, that collects the signature of the SSI recipient, provides the statement of need, and the physician’s signature providing the physician’s certification with the time period of confinement. The form asks the same questions that are on the SSI Claims System screens. The respondents are medical providers, and SSI recipients or their representative payees.
The latest form for Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home expires 2026-08-31 and is listed under ICR 202105-0960-001.
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OMB Details
Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Statement from other Respondents
Federal Enterprise Architecture: Income Security - General Retirement and Disability
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form SSA-186 | Temporary Institutionalization Statement to Maintain Household and Physician Certification | Fillable Printable | Form |
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