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 of Medicaid Eligibility for Disabled Adult Child—PA 1783

Updated May 14, 2024, Replacing February 14, 2012