TN 9 (07-00)

A. Policy for pass referrals

SSA will make referrals to appropriate public or private agencies if an individual needs assistance in developing a plan. Although all SSA staff is responsible for assisting the public, the PASS expert is principally responsible for helping individuals interested in PASS.

B. Procedure -- develop lists of agencies

1. General Information About PASS Referrals

The PASS expert should work with FO staff, the Public Affairs Specialist(PAS), the Work Incentive Liaison(WIL), or the Area Work Incentive Cordinator(AWIC) to develop and maintain (with the regional office assistance, as needed) a current list of public and private agencies and organizations in the general area that assist individuals in developing a PASS. List as many groups as possible to ensure that the individual has more than one option. See SI 00870.003B.1, existing advocacy lists, and the Combined Federal Campaign (CFC) publications for the types and names of possible agencies.

2. Content of PASS Referral List

Make sure that the PASS referral list contains:

• the name and address of the agency/organization;

• the name and telephone number of an agency contact person;

• the geographic area the agency services, if applicable;

• whether the agency/organization only serves people with certain disabilities, if known; and

• any information as to whether the agency is likely to charge for services, including PASS development charges.

3. Disclaimer for PASS Referral List

If the list is to be provided to potential PASS candidates, make sure it contains a disclaimer to the effect that:

• SSA does not endorse any of the listed agencies;

• the list is compiled for the convenience of the public;

• an individual is not restricted to the agencies on the list; and

• the individual is solely liable for any contract signed with the agency.

The disclaimer may read as follows: "For your convenience, we have listed below some agencies and organizations that may help you if you want to work. You are welcome to contact any of them. You may also contact agencies and organizations not on the list. We provide this list for your convenience, but we do not endorse anyone on it. If you sign a contract with an agency, you alone are liable."

C. Procedure -- referral

1. Selecting an Agency

a. Prior Contact With Agency

If the individual has had prior contact with a particular agency, refer the individual to that agency, unless he/she prefers a different agency. If so, follow SI 00870.005C.1.b.

b. No Prior Contact With Agency

If the individual has had no contact with any agency or does not wish to re-contact a particular agency:

• provide the individual with a copy of the list of agencies which will help develop a PASS;

• ask the individual to select an agency from the list or one of the individual's own choosing; and

• advise the individual that the referral does not constitute SSA's endorsement of the agency or its services and that fulfilling any contractual obligations will be the person's, not SSA's, responsibility.

2. Referral

Refer the individual to the agency using Form SSA-1407-U4 located at

DI 13501.035 Exhibit 1. Add pertinent information to the remarks section of this form, as necessary.

If the agency is other than a State VR agency, attach a copy of the signed release form (SSA-3288) as explained in SI 00870.004B.2.c.

NOTE: Use of Form SSA-1696-U4 requires the agency to include the person as the representative in every SSA-related matter, not just PASS. (See GN 03910.001 ff. for more information about representatives.)