Appendix C: SSI Form Letters and Notices

Pickle Amendment Form Letter—PA 1779

Notice of Special SSI Recipient Status—PA 1780

Sample Letter to the Social Security Administration—PA 1781

Notice Of Medicaid Eligibility for SSI Recipient—PA 162M.1

Notice to Disabled Children under the BBA of 1997—PA 1782

Notice of Medicaid Eligibility for Disabled Adult Child—PA 1783

Updated February 14, 2012, Replacing December 17, 2008