How to Fill Out and Submit the SSP 14: Interim Assistance Reimbursement

The SSP 14 form in California is a one-page authorization you sign so that the Social Security Administration can send your first retroactive SSI/SSP payment to your county instead of to you, repaying the county for the General Assistance or General Relief it gave you while your SSI claim was pending.¹ Federal law at 42 U.S.C. § 1383(g) authorizes this arrangement, and any California county participating in the Interim Assistance Reimbursement program must have a signed SSP 14 on file for each recipient.²

You can get a blank form from the California Department of Social Services website or from your county social services office.³

What to Enter on the Form

Every field matters because SSA uses the form to route your back-payment. Fill in:

Your full legal name as it appears on your SSI application and Social Security records.
Your nine-digit Social Security number. A mismatch with SSA records blocks processing.
Your current mailing address, city, and zip code.
The California county paying you General Assistance or General Relief.
The IA agency: the specific county welfare or social services department providing the interim assistance.
The GR code identifying your General Relief case. Ask your caseworker; it is not something you look up.
The claim type checkbox. Check exactly one. Checking both boxes invalidates the entire form.¹
Your signature and date. If you sign with a mark instead of a written signature, two witnesses must also sign and give their addresses.

A county representative signs as well. One conflict rule to know: if the same county agency is both your legal guardian or representative payee and the agency seeking reimbursement, a representative of that agency cannot sign the form on your behalf. SSA will reject the authorization.⁴

Initial Claim or Posteligibility

The two checkboxes cover different time periods, and picking the wrong one derails the reimbursement.

Check “Initial Claim Only” if you filed a new SSI application and are waiting on a decision. Reimbursement then covers the period from the first month you become eligible for SSI/SSP through the month your regular monthly payments begin.¹

Check “Posteligibility Case Only” if your SSI benefits were previously terminated or suspended and you are seeking reinstatement. Reimbursement then covers the gap from the effective date of reinstatement through the first month your regular SSI/SSP payments resume.¹

One form handles one situation. If both apply to you, sign two separate SSP 14s, each with a single box checked.

Submitting the Form to SSA

The county, not you, transmits the completed SSP 14 to the Social Security Administration by mail, fax, or SSA’s electronic system. The authorization must reach SSA within 30 calendar days of the date you signed it. A late-arriving form is treated as not effective and gets sent back to the county.⁴ Missing that window can cost the county its right to reimbursement, so confirm with your caseworker that the form has actually been sent.

Once SSA accepts the authorization, it registers in the payment system. If your SSI claim is later approved, SSA knows to route the retroactive lump sum to the county.

What Happens After Your SSI Is Approved

When SSA approves your claim, it calculates the retroactive benefits owed from your eligibility date through the start of regular monthly payments. That lump sum goes to the county because of the SSP 14 on file.

The county then looks at how much General Assistance or General Relief it actually provided during the covered period and subtracts that from the SSA payment. If the back-payment is larger than the interim assistance you received, you get the difference. The county must pay you that balance within ten working days of receiving the funds from SSA.²³

If the interim assistance the county paid you exceeds the retroactive SSI payment, the county absorbs the shortfall. It cannot bill you for the difference. Reimbursement is capped at what SSA sends.

The SSP 18 Notice and How to Dispute the Numbers

With any remaining balance, the county sends you an SSP 18, a Notice of Action and Right to Request a State Hearing on Interim Assistance. It shows the math: what SSA paid, what the county claimed, and what is left for you.⁵

Two different numbers, two different appeals:

If you think SSA miscalculated your retroactive SSI/SSP, file for reconsideration with your local Social Security office. You have 60 days from the date you receive SSA’s notice, and SSA assumes you received it five days after the date printed on it.⁶
If you think the county overbilled, request a state hearing through the California Department of Social Services.⁵

SSA cannot review the county’s interim assistance figure, and a state hearing cannot change SSA’s benefit calculation. Identify which number is wrong before you file.

How Long the Authorization Lasts

The baseline life of an SSP 14 is 12 months, measured from the date SSA receives the authorization from the county, not the date you signed.¹ If your SSI claim is still undecided at the 12-month mark, the authorization expires and you and the county sign a new one.³

An extension applies if you filed your SSI application on or before the date SSA received the authorization, or if you file within the 12-month window. In that case the authorization stays in effect past 12 months until:

SSA makes the first payment of retroactive SSI benefits on your claim, or
SSA issues a final determination and you do not request further review in time, or
You and the state mutually agree to terminate the authorization.⁷

The same extension rules apply to posteligibility cases.

Ending the Authorization Early

Terminating the SSP 14 before your SSI claim is resolved takes mutual agreement between you and the state. Neither side can end it alone.⁷ As a practical matter, if you ask to terminate, the county will almost certainly stop your interim assistance, since the SSP 14 is the legal basis for expecting repayment.

Ending the authorization does not cancel your SSI application or affect eligibility. It only changes where the retroactive payment goes. The tradeoff: you lose county cash assistance now in exchange for receiving your full SSI back-payment later, if your claim is approved.

If You Also Have a Social Security Disability Claim

If you are approved for both retroactive SSI and retroactive Social Security disability benefits (Title II) covering the same period, SSA applies a windfall offset to the combined payment. The offset applies to all retroactive months, including the portion used to reimburse the county.⁸ That reduces the retroactive SSI total, which reduces both the county’s reimbursement and whatever balance you receive. If you have a concurrent Title II claim, ask your caseworker or representative to walk you through the offset before you count on a specific back-payment figure.

1
California Department of Social Services. California SSP 14 – Authorization for Reimbursement of Interim Assistance
2
Office of the Law Revision Counsel. 42 USC 1383 – Procedure for Payment of Benefits
3
California Department of Social Services. Interim Assistance Reimbursement
4
Social Security Administration. Requirements for Valid IAR Authorizations
5
California Department of Social Services. SSP 18 – Notice of Action and Right to Request a State Hearing on Interim Assistance
6
Social Security Administration. Understanding Supplemental Security Income Appeals Process
7
Social Security Administration. Effective Life of an IAR Authorization
8
Social Security Administration. Introduction to Title II/Title XVI Windfall Offset