SOARS WORKS MSR

SSA Form

Revision Action

Strengths

Areas for Improvement/Correction

SSA-827

Great use of your agency address as Collette’s mailing address.

Provide a phone number for the applicant. We recommend using your agency phone.

Include your agency name as part of a complete mailing address for the applicant.

SSA-1696

Good job on this SOAR Critical Component

Appointed Representative Rep ID: As of September 30, 2024, if you do not include your Rep ID at the top of the SSA-1696, SSA will not process the form. To obtain a Rep ID, you must register with SSA as a Representative using the SSA-1699: Representative Registration form. We recommend that all SOAR-trained case workers register ASAP to avoid SSA-1696 processing delays for the applicants they serve. Read more about Representative Registration.

Section 1 – Claimant’s Information: Include your agency name as part of a complete mailing address for the applicant.

Section 4 – Representative’s Information: Include your agency name as part of your complete mailing address.

SSA-16

Nice inclusion of “SOAR” and your contact information in Remarks.

3: You only need to answer this question if English is not the applicant’s preferred language.

5B: This would be skipped for Collette, since #5A was “Yes.”

8: SSA will need a date here to continue with the disability application. We recommend using Collette’s last date of work (12/21/2021). This date should match across all forms.

13: If Collette’s claim is approved, her children may be eligible for benefits based on her earnings record, so it’s important to include their full names.

14A: This is a tricky question and will be “Yes” because Collette paid into Social Security in all jobs she worked during this time. (So, while she wasn’t working consistently, in those jobs that she did work, she paid into Social Security).

17A: This would be $700 for Collette.

18A: This would be “Yes” for Collette. She is still unable to work due to her illnesses, injuries, or conditions.

Remarks: Since Collette is incarcerated at the time of application, she will be considered “at-risk” for (not “experiencing”) homelessness. Most of the other details here can be saved for the MSR.

SSA-8000

Great work on this lengthy form reporting Collette’s income, resources, and living situation.

A 2024 version of this form is available for future use at https://www.ssa.gov/forms/ssa-8000-bk.pdf.

1D: Since you have Collette’s parents’ names, include them here to help with identification, even though she is also applying for SSDI.

2: Include your agency name as part of a complete mailing address for the applicant.

3: We recommend not leaving this space blank or SSA may believe that Collette is living at the mailing address. Collette is incarcerated, so her current residence address will be the jail. For applicants experiencing homelessness, you could write “Homeless” here.

4: The applicant will want to either provide direct deposit information or enroll in Direct Express which allows them to receive their benefits using a debit card.

7B: We recommend using Collette’s last date of work (12/21/21). This date should match across all forms.

19: Collette is currently incarcerated, so you would choose “Institution.”

51: This would be skipped for Collette since she has not previously received SSI.

53H: This would be skipped since #53E was “No.”

58B: This would be skipped since#58A was “No.”

61: All parts of this question can be left blank for SOAR-assisted SSI applications, as they only apply to those who are “applying on behalf” of the applicant as a legal guardian. In the SOAR model, the case manager is assisting individuals with applications, but applicants are applying on their own behalf.

SSA-3368

Nice improvement!

6A: If the applicant does not remember their Job Title, you can use a generic term that describes the tasks performed. Type of Business can be a generic term (rather than employer name). Be sure to list the most recent job first and include any information you have gathered about pay – even if estimated.

7: Be sure to list all current medications.

Section 8: While you included all facility names, the information provided about each is either incorrect or incomplete. It is critical to provide complete and accurate information here to help ensure that DDS accesses all available medical records and prevent application processing delays.

Section 10 (#10A): This section is only for individuals who are already receiving SSI, so can be skipped for Collette.

Revision Action

Feedback

New feedback: You added some good details, but a majority of the feedback was not addressed.

· Please take the time to review the records provided in the course so that you can include accurate details and quotes in the MSR.

· Details must be placed in the appropriate sections. Do not simply copy/paste progress notes.

· Avoid extra verbiage – keep it succinct by sticking to the facts.

Feedback not addressed:

· This is a nice start! However, additional information is needed to illustrate a stronger link between Collette’s symptoms and her functioning.

· The MSR is a critical component of the SOAR process. It should contain detailed observations and specific examples of Collette’s symptoms and functioning. Direct quotes from the applicant, collateral sources, and the medical records are powerful to include and more concise than paraphrasing.

· There were important details provided in the Practice Case materials that were not included here. Be sure that you have reviewed all the progress notes, videos, and medical records on the Class 1-4 Practice Case pages. I also recommend revisiting Class 5 of the SOAR Online Course.

· Remove the template title.

MSR Section

Feedback

Introduction

New feedback:

· Good addition of her height/weight along with descriptions of her appearance and mannerisms when experiencing symptoms of depression vs. mania.

· However, this should be an overview that “paints a picture” of Collette. You cannot simply copy/paste your progress notes. It is not just about putting the information on paper – this must be easy for DDS to read and follow.

· Many details here are unnecessary to include (i.e., details about each conversation) or would be better suited to other sections.

· The Introduction heading should not have been removed

Feedback not addressed: Be sure to include all the applicant’s physical and mental health diagnoses, so DDS will know which conditions to consider while reading the MSR.

Personal History

New feedback: Good addition of details about her past and the abuse/trauma she has endured. Nice job including details about her son, why he was removed from her care, and the depression she experienced at that time.

· Again, do not copy/paste your progress notes . Provide an easy-to-follow, chronological account of her upbringing/young adulthood. While there are good details here, it is difficult to follow.

Feedback not addressed:

· This section matches the wording of an MSR that is posted on the “Course Hero” website and has been submitted by other trainees. Be sure to submit original work.

· State only the facts. There is a lot of extra verbiage, opinion, and information that doesn’t reflect what you have learned about Collette.

· What does her sister say about the abuse Collette has experienced throughout her life?

· Are there any links between the trauma she has experienced and her current functioning – only include information for which you have evidence!

· Why isn’t her daughter living with her? What is her current relationship with her children?

· Include information about her prior and current living situations and any periods of homelessness.

Educational History

Well done!

Legal History

New feedback: Good job adding her incarceration and expected release date along with other reasons she has been arrested.

· No need to provide a list of dates.

· Only include information for which you have evidence. “Her mental illness had her taking something that did not belong to her but in her mind, she actually thought it was hers” is not an accurate statement about Collette.

Feedback not addressed:

· It is important to connect any of the applicant’s legal history with their mental health symptom symptoms. Were any of Collette’s interactions with police a result of symptoms of her illness?

MSR Section

Feedback

Employment

New feedback: Great job including details about her work history!

· Nice start including information from Collette about her work experiences (feeling yelled at when corrected, working too slow, etc.).

Feedback not addressed:

· DDS will be determining whether she can work to levels of SGA, and the MSR is the only place they will learn why her previous attempts have been unsuccessful.

· While you are correct that Collette has been unable to maintain employment, it is critical to provide specific examples of how this is related to her symptoms and functioning. Include details and quotes from Collette and her former employers that demonstrate how her symptoms impaired her ability to work.

Military (if applicable)

N/A

MSR Section

Feedback

Physical Health Diagnoses & Symptoms

Good job noting her diabetes and high blood pressure.

Physical Health Treatment

New feedback: Nice job noting that she is inconsistent with medications/prescribed diet.

Feedback not addressed:

· Are there any treatment records you can reference (date/location) as sources for the information provided?

· When and where did she receive treatment? What medications was she prescribed?

Mental Health Diagnoses & Symptoms

Great inclusion of her mental health diagnoses.

Mental Health Treatment

· New Feedback: Avoid lists of dates as this does not speak to the applicant’s functioning.

· Feedback not addressed:

· This should be one of the most robust sections of the MSR that provides an overview of all the mental health treatment the applicant has received and highlights information from the records that helps meet the medical criteria for disability.

· Briefly summarize the treatment Collette has received at each provider (e.g., Any County Jail and County General Hospital). Note that substance use treatment at County Probation Alternatives can be summarized here or in the Substance Use History section. Her evaluation by Dr. Banes at XYZ CMHC should be highlighted as her current mental status exam.

· For each treatment visit summarized, include facility name, date and context of treatment (i.e., why she was seen), diagnoses received, doctors who provided treatment, and medications administered/prescribed. Also include quotes from the records that document symptoms or functional impairments and clearly illustrate how her symptoms correspond with the Bipolar Disorder listing in the SSA Blue Book .

MSR Section

Feedback

Substance Use History

Great quote from Collette!

New feedback: Good mention of County Probation Alternatives. When did she receive treatment there?

Feedback not addressed:

· What were her dates of onset? Why did she first start drinking?

· Are there additional reasons she has given for why she drinks?

Materiality

Feedback not addressed:

· Nice job touching on substance use materiality by noting that she experiences symptoms while not actively using. To strengthen this, provide specific examples.

· Details from County Probation treatment records, particularly documentation of drug-free toxicology screens, along with symptoms exhibited, would be strong evidence to include.

· Did she continue to experience severe mental health symptoms while incarcerated and not actively using? Can you provide a few examples from the Any County Jail records?

MSR Section

Feedback

Overall Functional Information Feedback

New feedback: Rather than add details to an introductory paragraph, place examples in the appropriate areas.

Feedback not addressed:

· The functional information section is one of the most important of the MSR as it addresses 50% of the disability criteria.

· Include at least 1-2 good paragraphs/6-8 sentences for each of the four areas of functioning. Use specific examples and quotes to illustrate a strong link between her symptoms and functional impairments.

· It may be helpful to re-read Class 5 of the SOAR Online Course to familiarize yourself with the areas of functioning and see examples of how to document functional limitations.

Understand, Remember, or Apply Information

Feedback not addressed:

· The wording here is vague and most doesn’t apply to this area of functioning.

· Does Collette struggle to recall details about her own past (i.e., prior earnings or why she is incarcerated)?

· Does Collette ever have difficulty remembering appointments or prior conversations/interactions? (What does the CPS worker say about this? Do you have observations?)

· Provide specific examples of her trouble remembering or following instructions at work.

Interact with Others

Nice inclusion of her isolation. How is this related to her symptoms?

New feedback: Good job adding details from Collette about not being liked as well as her preference for being alone – use her exact words and quotation marks.

· Relay only the facts as you have learned them. What evidence do you have that she has struggles to interact with others “due to her issues with consistency, realism, and concentration”?

· Being easily sidetracked would fit better in Concentrate, Persist, or Maintain Pace.

Feedback not addressed:

· Are there any quotes from Collette about forming friendships or relationships?

· How does she function in groups at Probation Alternatives? What does she say about participating?

· How did she behave during visits with her daughter?

· How does she interact with supervisors?

· How does she interact with you (her SOAR case worker) during meetings?

Concentrate, Persist, or Maintain Pace

New feedback: Good inclusion of her completing tasks at work ether too slowly or quickly (but incorrectly).

· Needing instructions repeated and difficulty following instructions belongs in Understand, Remember, or Apply Information. Becoming upset when corrected fits better in Interact with others.

Feedback not addressed:

· Describe examples of Collette’s slow vs. rapid/tangential movements and speech.

· Is she easily distracted or need redirection in conversation?

· Does she need extra breaks at work?

Adapt or Manage Oneself

New feedback: Good addition of her lack of experience paying bills/maintaining a household – what does her sister say about her ability to do these things? Great example of her inability to ride the bus – use direct quotes from Collette!

Feedback not addressed:

· Erratic/rapid speech; inability to remain engaged in lengthy conversations would fit better in Concentrate, Persist, or Maintain Pace.

· Provide specific examples of how Collette’s symptoms interfere with her ability to manage her daily needs such as bathing, sleeping, or eating.

· Is she able to do laundry, shop at the store, cook meals?

· Is she able to manage the treatment she has been provided for her mental health diagnoses/symptoms?

· When she was asked to do new tasks at work, how did she respond?

MSR Section

Feedback

MSR Summary

Nice job re-stating her mental health diagnoses.

New feedback: Good addition of her physical health conditions along with noting some of her functional impairments. Focus on those that have impacted her ability to work.

Signatures and Contact Information

Feedback not addressed: Include contact information for the applicant’s Acceptable Medical Source (AMS). It is also helpful to obtain their co-signature. (For Collette, this could be Dr. Banes).