Get Maximus Ssi Form

Filling out the Maximus SSI Form is an essential step for families seeking to apply for Supplemental Security Income benefits for children in custody with severe disabilities. This guide will provide clear and supportive instructions to help you complete the form successfully.

Follow the steps to fill out the Maximus SSI Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Enter the child's name, date of birth, and Social Security number in the respective fields.
3. Fill in the details of the foster care parents or facility, including the telephone number, street address, city, state, and zip code.
4. Provide the date of placement for the child in DHS or JCS custody.
5. Indicate whether there is a court order placing the child in custody by selecting 'Yes' or 'No'.
6. Answer whether the child has a diagnosed mental or physical impairment by selecting 'Yes' or 'No'. If the answer is 'No' to either question, do not proceed with the referral.
7. Review and select any indicators that apply to the child's eligibility for the SSI program from the listed options.
8. Indicate if the child is receiving any benefits based on a deceased, disabled, or retired parent's account by selecting 'Yes' or 'No'.
9. Fill in the referral information, including your name, telephone number, county, and designation as DHS or JCS.
10. Enter the date and email address to send the referral to MAXIMUS.
11. Once all fields are completed, make sure to save any changes, download, print, or share the form as needed.

Complete the Maximus SSI Form online today to ensure timely processing of your application for benefits.