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Request for Certification of Employment document sample
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Ticket Training Tuesdays
The Ticket To Work
Employment Network (EN) Payment Overview
Jul-11
Agenda
Part I
• Payment Methods
• Process for Requesting EN Payment
Part II
• Milestone Exclusions
Part I
Employment Network (EN)
Payment Methods
How Do ENs Get Paid under
the Ticket Program ?
Two Payment Methods for ENs
• Milestone/Outcome
• Outcome
What’s the Difference?
Milestone / Outcome Method
• EN’s can receive payments for Ticket-Holder
work while they are still receiving benefits
(Milestones) AND after their benefits stop
(Outcomes).
Outcome Method
• EN’s receive payments only after the Ticket-
holder’s benefits have stopped.
How Much Can AN EN Receive ?
Maximum Ticket Value
SSDI SSI
Milestone / Outcome
• Phase 1 Milestones $ 5,100 $ 5,100
• Phase 2 Milestones $ 4,202 $ 3,960
• Outcomes $13,752 $13,200
Total $23,054 $22,260
• Outcome $25,596 $24,540
Which Payment System
Is Best for Me ?
Depends on EN Business Model.
• For beneficiaries with low probability of
sustained Substantial Gainful Activity (SGA)-
level earnings
>Milestone / Outcome Method
• For beneficiaries with a higher probability of
sustained SGA-level earnings
>Outcome Method
What If I Change My Mind ?
• EN’s can change their Payment Method
once each calendar year.
• Changes affect only new Ticket
assignments.
Phase 1 Milestones
• Consists of four possible Milestone
payments
• Earnings are based on Trial Work Levels
(TWL) of $720 and not SGA
• Milestones must be paid in sequence,
e.g. available Phase 1 Milestones before
Phase 2 Milestones even if work attained
for Phase 1 Milestones is over SGA
Phase 1 Milestones (continued)
• To qualify for Milestone 1, the beneficiary must have
achieved Trial Work Level earnings or achieved
earnings that have equaled TWL had it been a full
month
• If TWL has not been reached within the first month,
TWL earnings would have to be met one of the next 2
months to avoid overpayment.
• The second Milestone is attained once the
beneficiary has worked 3 months within a 6 month
period at Trial Work Level amounts
Phase 1 Milestones (continued)
• The third Milestone is attained once the
beneficiary has worked 6 months within a 12
month period at Trial Work Level amounts
• The fourth Milestone is attained once the
beneficiary has worked 9 months within a 18
month period at Trial Work Level amounts –
– Certification of Services Needed
• http://www.yourtickettowork.com/selftraining/Cert
Statement060109.doc
Phase 2 Milestones
• Begins once all eligible Phase 1 Milestones are paid
• Any month after all Phase 1 payments have been
made in which the beneficiary demonstrates SGA
and is receiving cash benefits
• There are 11 possible Phase 2 Milestones for Social
Security Disability Insurance (SSDI) and Concurrent
beneficiaries
• There are 18 possible Phase 2 Milestones for
Supplemental Security Income (SSI) beneficiaries
Outcome Payments
• Payments to an EN or State VR Agency (acting as an EN) when
the beneficiary has earnings equal to or greater than SGA and is
no longer receiving cash benefits.
• ENs and State VR Agencies (acting as ENs) servicing SSDI and
Concurrent beneficiaries may receive up to 36 Outcome
payments.
• ENs and State VR Agencies (acting as ENs) servicing SSI
beneficiaries may receive up to 60 Outcome payments.
• Outcome payments can be made to ENs or State VR Agencies
(acting as an EN) even if a cost reimbursement payment has been
made for a previous timeframe
Outcome Payment Method
• SSI: Up to 60 monthly payments of $409 =
$24,540
• SSDI: Up to 36 outcome payments of $711 =
$25,596
Requesting EN Payments
The Basics
Requesting EN
Payment
• Before you Submit
– http://www.yourtickettowork.com/payment_opt
ions
• When to Submit
– TWL or SGA
– http://www.yourtickettowork.com/training_2
• What to Submit
– http://www.yourtickettowork.com/selftraining/E
NPaymentRequestForm_01012010.doc
Payment Request Options
• Evidentiary Payment Request
– Monthly or quarterly submission of Evidentiary
Payment Request (EPR) including primary evidence of
earnings
• Certification Payment Request
– When primary evidence of earnings is not readily
available, the EN may submit a Certification Payment
Request (CPR) using secondary evidence of earnings
information and a signed repayment agreement
Evidentiary
Payment Request Process
EN’s should submit for payment once
the beneficiary has completed their
milestone, or anytime after that point,
submitted with primary evidence of a
Ticket-holder’s earnings along with the EN
Payment Request form.
Payment Request Form
http://www.yourtickettowork.com/selftraining/EN_Payment_Request_Form020108.doc
I. Employment Network Information
1. EN Organization Name:
2. EIN Number (Tax ID Number):
3. Is the financial institution and bank account information
provided to the Ticket to Work Operations Support Manager on the
Automated Clearinghouse Payment Enrollment Form (ACH Form)
current?
Yes ___ No ___ (if No, please contact MAXIMUS @ 1-866-949-
3687 before submitting this request)
Incorrect or outdated information may delay or prevent
payment issuance to your Employment Network.
Payment Request Form
II. Ticket-holder Information
4. Ticket-holder’s Name:
5. Ticket Number/Social Security Number:
6. Name of Ticket-holder’s Employer:
7. Employer’s Address (if available):
8. Payment Method for this Ticket Assignment
A. Outcome Payment Method
B. Milestone-Outcome Payment Method
Payment Request Form
III. Phase 1 Milestone 1 Earnings Info
Please choose one of the following options by placing an “X”
next to your selection:
___ A. The beneficiary achieved TWL earnings during the
calendar claim month.
___ B. The beneficiary achieved less than TWL, but he/she
will achieve TWL earnings within the next 2 months.
___ C. The beneficiary achieved less than TWL earnings
and is not expected to achieve TWL earnings with in the
next 2 months.
Payment Request Form
IV. Payment Request Details
9. Payment Request Type
_____ A. Evidentiary Payment Request –
(Complete Section IV)
_____ B. Certification Payment Request –
(Complete Sections V and VI)
10. Claim month (s) and year (s) for this
payment request:
Payment Request Form
V. Evidentiary Earnings Information
11. Type of earnings documentation submitted:
(these items must be included with this form)
___ Pay slips
___ Employer prepared and signed employee
earnings statement
___ Records from Third Party Source containing
monthly wage information
____The Work Number ____Other
Payment Request Form
VI. Certification Payment Request Details
12. Type of Certification Information (Choose one):
____ Recent contact with beneficiary/employer
(please circle “beneficiary” or “employer”)
____ Attached Earnings Inquiry Request (EIR)
response received from MAXIMUS
____ Attached information containing data from the
National Directory of New Hires (NDNH)
____ Attached Self Employment Income (SEI) Form
(if beneficiary is self-employed)
Payment Request Form
VI. Certification Payment Request Details
(cont.)
13. Recent Contact Details (complete only if you selected
“recent contact” on item 12):
Type of contact (phone call, email, etc):
________________________________
Date of contact: ______________________
Description of information you learned from contact
regarding level of earnings:
Payment Request Form
VII. Repayment Agreement
(signature required):
By signing below, you as the EN agree to repay any
payments received (or allow the amount to be deducted
from future payments) if it is determined at a later date
that you were not entitled to payment.
_____________________________________________
______________________
Signature Date
Payment Request Form
VIII. Contact Information for the Employment
Network Representative Submitting this
Request
Print Name: _______________________
Phone Number: ____________________
FAX: ____________________________
Email: ___________________________
Primary Evidence of Earnings
• Pay stubs
• Earnings statement prepared and signed by employer
• Records from third-party source that gives monthly
earnings breakdown (i.e. The Work Number)
NOTE: All payment requests for self-employed Ticket-holders
must be submitted as Certification Payment Requests
Self-Employment
• Quarterly Payment Request
– Self Employment Income (SEI) form
– Repayment Agreement
*Quarterly tax reporting forms with receipt of tax
payment (e.g. cancelled check)
• Annual Payment Request
– Annual Self Employment Income Request form
– Repayment Agreement
* Annual Tax Reporting Forms with receipt of tax
payment (e.g. cancelled check)
Certification Payment Request
Process
If primary evidence of earnings is not readily
available, an EN can make a Certification
Payment Request by selecting the CPR option
on the EN Payment Request Form and
including an accepted source of secondary
earnings information, such as an Earnings
Inquiry Request (EIR) response. These CPR
requests can now be made for both
Outcome and Milestone payment requests.
CPR Earnings Information Sources
Recent Dated Contact – The EN has had recent contact
with either the beneficiary or the employer and
confirmed that the beneficiary has earnings that qualify
for Milestone or Outcome payment
Earnings Inquiry Response (EIR) – The EN has
received an EIR response from MAXIMUS that the
beneficiary has earnings over 3 times SGA for the
quarter in question
National Directory of New Hires (NDNH) – If the EN
has access to the NDNH they may submit a print-out
of the appropriate information
Self-Employment Income (SEI) Form – If the Ticket-
holder is self-employed, the SEI form must be
completed and signed by the Ticket-holder
Earnings Inquiry Request (EIR)
• Earnings information available prior to
submitting payment requests
• Receive written response indicating
whether beneficiary is over 3 x SGA for a
given calendar quarter
• Only last two years of earnings
information is available
Earnings Inquiry Request (EIR)
– How to Submit
• Directly through website with online
submission form –
www.yourtickettowork.com/earningsinquiry
• EIR Form – Will receive by email or
download from website
• Email or fax in form with accompanying
data sheet
EIR Website Screenshot
Earnings Inquiry Request (EIR)
– Restrictions
• Only written EIR requests will be accepted
• Email submission must be sent from
authorized person
• Earnings are generally available eight months
after the close of a quarter
• Not available for time periods before or after
Ticket assignment
• Earnings info generally not available for self-
employed or employees of the Federal
government
To Summarize
Option Evidentiary Payment Certification Payment
Request Request
(Outcome or Milestone) (Outcome or Milestone)
EN Submits EN Payment Request Form EN Payment Request Form (on
(on website) and primary website), secondary earnings
earnings evidence evidence, and a signed
repayment agreement
Evidence Required Primary earnings evidence Secondary earnings evidence
•EIR response
•Report of contact
•SEI Form
Request Submitted At any time after a closed earnings period
(monthly, quarterly, or longer)
Best Used When When primary evidence is When remote contact is
available due to regular, in- maintained, EIR response is
person contact with the Ticket- positive, or the Ticket-holder is
holder self-employed
Split Payment
• Beginning January 4th, MAXIMUS introduced a new split payment procedure.
• Form SSA-1401 will be mailed identifying the EN’s involved. At which time, the ENs
can work together to come to a decision for a percentage spilt of the payments.
• Or the ENs can choose to allow MAXIMUS and SSA to make the decision based on
each organization’s service records.
• If the ENs choose to come to their own decision, they must each sign the Split
Payment form and send it back to MAXIMUS indicating what the split will be. Or
each EN can sign a separate form and submit them, each indicating the percentage
split.
• The percentages have to match. If they do not match, MAXIMUS and SSA will make
the split determination based on service records.
• You can access the form on our website -
http://www.yourtickettowork.com/selftraining/SSAForm1401-SplitPayment121109.doc
SSI Telephone Wage Reporting
• Beneficiaries can now report monthly
wages with just a telephone call
• Beneficiaries must be on SSI or
concurrent benefits (SSI and SSDI)
• Callers must also have some prior
earnings on record
• Service not available for SSDI or for
beneficiaries who are self-employed
SSI Telephone Wage Reporting
• How to use this service:
– The wage earner calls 866-772-0953 and
provides their name and SSN
– Then the caller keys in the total gross
earnings for the previous month
• Key Points:
– Calls must be placed by the 6th of the month
following the earnings
– SSA recommends that clients consult with the
local SSA field office before using the service
SSI Telephone Wage Reporting
• Benefits of using the service:
– EN gets paid faster as SSA has verified
earnings in a more timely manner
– The beneficiary is saved a trip to the field
office each month to provide pay stubs
Auto-Pay
Auto-Pay
ENs will have the option of putting
individual Tickets under Auto-Pay. This
option will allow ENs to receive automatic
monthly Outcome Payments for any
Ticket-holder for which Outcomes 1-12
have already been paid.
Auto-Pay
Once a Ticket is enrolled in Auto-Pay, the EN does not
have to submit any further payment requests or
evidence.
• All Milestones and Outcomes 1-12 will be paid when
qualifying earnings are posted to SSA records (Auto-Pay
Phase 2 currently not in place).
• Outcomes 13 > will be paid monthly without waiting for
earnings verification (Auto-Pay Phase 1 currently in
place).
Checking Payment Status
• EN Payment Status Report (weekly)
To follow up on outstanding EN payment request:
If more than 30 days have passed since the payment request was
sent to SSA for payment consideration send an Email to your
Account Representative
Include:
– Beneficiary’s SSN only (not name)
– Specific payment request (for Milestones – the MS number; for
Outcome – the claim month and year)
– Date of request submitted to SSA, available from MAXIMUS
IPP-PAID system
• Developed by the U.S. Department of the Treasury's
Financial Management Service
• Provides participating Federal agencies (including
SSA) a method of making remittance information
available to their vendors through the Internet.
• Match recently deposited EN payments to your
records prior to receiving statements from the Social
Security Administration.
• Free of charge to registered vendors with Internet
access, and is free of charge to participating Federal
agencies.
• Visit the web site at https://www.ipp.gov/
Part II
Milestone Exclusions
Important Reminders
• Achievement of Milestones must occur
after Ticket assignment and before
start of the outcome payment period.
• Actual EN payments may be different
for each beneficiary.
Phase 1 Exclusions
Partnership Plus Exclusion
• If the beneficiary chooses services from a
State VR Agency that has selected cost
reimbursement and the beneficiary is
working when the State VR Agency
closes the case, then Phase 1 Milestone
payments are not payable to an EN or
other State VR Agency (acting as an EN)
under the same ticket
Phase 1 Milestone Exclusions
(continued)
Recent Work Rule
• Work at or above Trial Work level ($720 in
2010) within 18 months “prior to Ticket
assignment” can impact EN’s access to
Phase 1 Milestones
> Patterned after criteria used for Phase 1
Milestone payments
> Beneficiary CD mailed to ENs includes
recent work history
> Rule does not apply to Tickets assigned prior
to July 21, 2008
Recent Work Rule
Apply each rule independently to
determine which Milestones are
available
• Milestone 1 not available if earnings = TWL in
month prior to Ticket assignment
• Milestone 2 not available if earnings = TWL in 3
of 6 months prior to Ticket assignment
• Milestone 3 not available if earnings = TWL in 6
of 12 months prior to Ticket assignment
• Milestone 4 not available if earnings at TWL in 9
of 18 months prior to Ticket assignment
18 Month Prior Earnings Tool
http://www.yourtickettowork.com/selftraining/IWP_Look-Back_Tool_041309.xls
For More Information
Where to Go for More Information
• For more information on the Ticket to
Work Program:
> Visit the MAXIMUS web site at:
www.yourtickettowork.com
or call: 1-866-949-3687
> Visit SSA’s Work Site at:
www.socialsecurity.gov/work
EN/VR Account Managers by State 2/1/2010 703-236-extension
State Account Manager Phone Extension
Alabama Patrick McClure 6711
Alaska Darnell Clay 6703
Arizona Charles Powell 6663
Arkansas Patrick McClure 6711
California Aaron Aybar 3402
Colorado Charles Powell 6663
Connecticut Barbara Allen-Thomas 6634
Delaware Keitra Hill 6700
District of Columbia Rebecca Fay 6641
Florida Anita Bediako 6624
Georgia Patrick McClure 6711
Hawaii Aaron Aybar 3402
Idaho Darnell Clay 6703
Illinois Akila Early 6722
Indiana Dionne Doby 6720
Iowa Sheila Etherly 6713
Kansas Sheila Etherly 6713
Kentucky Rebecca Fay 6641
Louisiana Patrick McClure 6711
Maine Barbara Allen-Thomas 6634
Maryland Keitra Hill 6700
Massachusetts Barbara Allen-Thomas 6634
Michigan Dionne Doby 6720
Minnesota Sheila Etherly 6713
Mississippi Patrick McClure 6711
Missouri Adrian Catwell 6615
Montana Charles Powell 6663
Nebraska Charles Powell 6663
Nevada Darnell Clay 6703
New Hampshire Barbara Allen-Thomas 6634
New Jersey Keitra Hill 6700
New Mexico Charles Powell 6663
New York LaNelle Barber 6656
North Carolina Rebecca Yohannes 6669
North Dakota Charles Powell 3403
Northern Marianas Ilds Aaron Aybar 3402
Ohio Barry Carlson 3403
Oklahoma Sheila Etherly 6713
Oregon Darnell Clay 6703
Pennsylvania Keitra Hill 6700
Puerto Rico Aaron Aybar 3402
Rhode Island Barbara Allen-Thomas 6634
South Carolina Rebecca Yohannes 6669
South Dakota Charles Powell 6663
Tennessee Rebecca Fay 6641
Texas Shifferaw Gessesee 6617
Utah Charles Powell 6663
Vermont Barbara Allen-Thomas 6634
Virgin Islands LaNelle Barber 6656
Virginia Rebecca Fay 6641
Washington Darnell Clay 6703
West Virginia Rebecca Yohannes 6669
Wisconsin Adrian Catwell 6615
Wyoming Charles Powell 6663
Questions?
MAXIMUS Ticket to Work
1-866-949-3687 Toll Free
1-866-833-2967 TDD
www.yourtickettowork.com
ENOperations@yourtickettowork.com
