Appendix B: Personal Care Supplement Client Notice

The CAO must include one of the following explanations with specific regulations on the Notice to Applicant  and a copy of all notices must be sent to the local Area Agency on Aging (AAA).

55 Pa. Code §   299.22(c)

 

Individual Has Met the Requirements for the Domiciliary Care/Personal Care Supplement


We have certified that effective [month/year] you have met the requirements for the Domiciliary Care/Personal Care Supplement to the Federal Supplemental Security Income (SSI) Program. On [date] we sent the Social Security Administration (SSA) an authorization to use the Domiciliary Care/Personal Care Supplement to determine your SSI payment level. The SSA will determine your eligibility for SSI or your new benefit amount if you are now receiving SSI. The SSA will let you know of its decision, the effective date, and the payment amount.

If you wish to appeal our decision regarding this certification, please follow the instructions found in the Appeal and Fair Hearing section of this notice. Domiciliary Care/Personal Care Supplement

 

55 Pa Code § 299.21

55 Pa Code § 299.22 (d)

 

Individual Has Not Met the Requirements for the Domiciliary Care/Personal Care Supplement  

We have determined that you have not met the requirements for the Domiciliary Care/Personal Care Supplement to the Federal Supplemental Security Income (SSI) Program because ______ . If you wish to appeal our decision please follow the instructions   found in the Appeal and Fair Hearing section of this notice. Domiciliary Care/Personal Care Supplement

 

55 Pa Code § 299.21

55 Pa Code § 299.22 (d)

 

 

Advance notice must be given on the PS/FS 162A and accompanied by the  PS/FS 162F

for any eligibility changes.

Individual No Longer Meets the Requirements for the Domiciliary Care/Personal Care Supplement

 

It was determined that you no longer meet the criteria necessary to continue receiving the Domiciliary Care/Personal Care Supplement to the Federal Supplemental Security Income (SSI) Program. Termination notification will be sent the Social Security Administration.  if you wish to appeal our decision please follow the instructions found in the Appeal and Fair Hearing section of this notice.   

 

55 Pa Code § 299.21

55 Pa Code § 299.22 (d)

 

Updated May 7, 2015,   Replacing February 14, 2012