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ISSUE DATE: 09/2017

No provisions.


Follow GA for non-SSI interim assistance.

If the client becomes retroactively eligible for SSI, review the case for retroactive MSA eligibility. Consider the following:

Only months that GA has been reimbursed through the DHS/SSI interim assistance reimbursement (IAR) process (or months for which the county received reimbursement directly from the client) are eligible for MSA.

Refer to the DHS Financial Operations MAXIS CASE/NOTE for which months have been reimbursed (see GA above).

Issue retroactive MSA payment(s) based on the client’s current MSA basic needs grant. Do not include special need items.

A GA reimbursement may remain due from the client for a specific month. This typically happens when counties are unable to close GA in time to prevent an additional GA payment after SSI begins. If this occurs, budget the full SSI benefit rate, without any disregard, plus the GA for that month against the appropriate MSA standard. The difference would be either the amount of GA the client continues to owe or the amount of MSA to be issued to the client.


GRH payment months are not eligible for retroactive MSA.


Require clients to complete an interim assistance agreement (IAA) if their basis of eligibility is:

Permanent illness.


Temporary illness.


Placement in a facility.




Developmental disability/mental illness.


RSDI/SSI application/appeal pending.


Advanced age.


Learning disabled.


Any time they apply for other benefits or whenever you expect their benefits to be reinstated after a period of suspension.

Clients who are potentially eligible for Supplemental Security Income (SSI) must complete the SSI Interim Assistance Authorization (DHS-1795) (PDF).

Clients who are potentially eligible for other benefits such as RSDI, Workers’ Compensation, Veterans benefits, or private insurance (such as short or long-term disability; or auto, business or home liability insurance) must complete the Interim Assistance Agreement (Non-SSI) (DHS-1795A) (PDF).

Clients who are potentially eligible for both SSI and other benefits must sign both a DHS-1795 and a DHS-1795A.

Allow 30 days for clients to sign IAAs. Benefits may be approved before a client returns signed IAAs or applies for Social Security benefits. A person may receive an extension to the 30-day requirement to apply for other benefits if they have good cause to not apply. See 0012.12 (Applying for Other Benefits).

If, after 30 days, the client does not sign the forms(s), close benefits with a 10-day notice. Clients who refuse to sign the DHS-1795 or DHS 1795A are ineligible for GA.

Clients must sign a DHS-1795 and/or DHS-1795A at initial application or whenever changes in their circumstances indicate potential eligibility for other benefits. IAAs remain valid until one of the following occur:

Social Security Administration (SSA) approves the SSI and/or RSDI application.

SSA denies an application and client does not appeal the decision within 60 days.

Client does not apply for other benefits, SSI and/or RSDI within 1 year of signing the form(s).

Client and agency agree in writing to end IAA authorization(s).

IAA forms are invalid if signed more than 30 days before a Combined Application Form (CAF) or Change Report Form is received. Enter a case note and file IAAs. Inform the client that they have 30 days to complete and return new IAA forms. For more information on coding STAT/PBEN see TEMP Manual TE02.12.14 (Interim Assistance Reimbursement Interface).

The agreement allows the state, county, and tribal agencies to seek repayment of benefits issued while an application for other benefits is pending and then approved. Unless prohibited by federal or state law, seek repayment when clients receive retroactive payments from other programs. The amount of the repayment cannot exceed the amount of benefits issued.

People who sign the DHS-1795 for SSI agree to let the Social Security Administration (SSA) reimburse the state for GA and/or GRH received during the period of retroactive SSI eligibility. DHS will mail a notice and explanation to clients and will notify counties via MAXIS CASE/NOTE when clients become eligible for SSI and the state has been reimbursed. Refer any remaining questions regarding SSI interim assistance reimbursements to DHS Financial Operations at 651-431-2427 or 1-888-702-9975.

Notify the DHS Benefit Recovery Section (BRS) of clients who sign a DHS-1795A for Workers' Compensation. BRS will seek recovery of benefits paid during the period covered by the workers' Compensation claim.

For benefits that clients may receive directly, request repayment directly from the client. If the client does not voluntarily repay the benefits issued, begin action to recover it. See 0025 (Benefit Adjustments and Recovery).

When the client’s only source of income is RSDI and the client has no other resources, the county must ask the client to voluntarily repay the interim assistance he/she received. If the client refuses to voluntarily repay the interim assistance, the county may initiate a civil action to recover the interim assistance. The DHS-1795A includes a statement informing clients that RSDI payments, both retroactive and current, cannot be garnished, attached, executed upon, or levied upon. The form also explains that, although clients cannot be forced to use their RSDI benefits to repay the interim assistance they received, they can voluntarily use their RSDI benefits to repay their state debt.

Immediately determine MSA eligibility of any client SSA finds eligible for SSI. See MSA provisions.


Follow GA, with the following EXCEPTION:

If the client becomes retroactively eligible for SSI, review the case for retroactive GRH eligibility. Consider the following:

Do not recalculate the client's GRH budget for months that GRH has been reimbursed through the DHS/SSI Interim Assistance Reimbursement (IAR) process or months for which the county received reimbursement directly from the client.

If GRH was not reimbursed through the DHS/SSI Interim Assistance Reimbursement (IAR) process or voluntarily repaid by the client, the GRH budget must be recalculated for the months in which the client received SSI.

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