The Supplemental Security Income (SSI) Cut-off Survey

Name of person completing survey:

Organization:

Address:

E-mail:

Telephone number: 

Date: 

1. Please indicate if you have refugee clients who have lost SSI benefits WHO are (CHECK ALL THAT APPLY):

   65 or older
   Male
   Female
   Psychiatrically Disabled
   Physically Disabled
   

2. What hardships have your clients who have lost their SSI benefits faced?

   Loss of housing
   Limited funds for food
   Loss of medical care
   Other:

3. How have your clients who have lost SSI supported themselves?

   Through financial support form their families
   Through state or local government income assistance
   Through support of community organizations
   They have not been able to find the support they need
   Other:

4. Why are these individuals not U.S. citizens?

   English language difficulties have prevented them from passing citizenship tests
   They appear to be disabled, but they have not had the medical and other services they need to obtain disability waivers for the citizenship test.
   Obtaining citizenship is too expensive for them.
   They are unaware of their true status as citizens or non-citizens.
   Other:
5. Do you have any stories to share about clients who have lost their SSI benefits? If so, please tell them to us: