Colorado IM-14 Authorization for SSI Reimbursement: Signing and Filing

The Colorado IM-14 form is a one-page authorization — officially titled “Authorization for Reimbursement of Interim Assistance Initial Claims Payment or Posteligibility Case Payment” — that you sign when applying for Aid to the Needy Disabled–State Only (AND-SO) cash assistance. By signing it, you give the Social Security Administration permission to send part of any retroactive SSI payment you later receive directly to Colorado, repaying the state for the cash benefits it gave you while your SSI claim was pending.¹ Signing is a condition of eligibility, so you cannot receive AND-SO without it.²

Who Has to Sign It

Anyone applying for AND-SO through a Colorado county department of human services signs the IM-14 as part of eligibility.² AND-SO provides monthly cash benefits to low-income Colorado residents with a disability that prevents them from working, and it is designed as a bridge while you pursue federal SSI.³ The same requirement applies to applicants for the Aid to the Blind (AB) program.

The arrangement is simple in concept: Colorado pays you now, and if the SSA later approves your SSI claim, the retroactive federal payment reimburses the state for what it already gave you.

Where to Get the Form

Your county caseworker will hand you the IM-14 during your AND-SO application appointment. You don’t need to hunt it down on your own. If you want to see it in advance, a fillable PDF is posted on the Colorado Department of Human Services training portal.¹ To locate your county office, the department maintains a directory at cdhs.colorado.gov/contact-your-county.⁴

How to Fill Out the IM-14

The form has only a handful of fields, but two of them trip people up. You will provide:

Your full legal name, matching the name on your SSI application.
Your county case number. Your caseworker can give you this if you don’t have it.
Your current mailing address, including city, town, and zip code. This is where the state will mail written notices about the reimbursement once SSI is approved.
One checkbox — either “Initial Claim Only” or “Posteligibility Case Payment Only.” Check “Initial Claim” if you are applying for SSI for the first time. Check “Posteligibility” if your SSI was previously suspended or terminated and you are seeking reinstatement.
Your signature and date on one line, and a state representative’s signature and date on a separate line.¹

Two mistakes make the form invalid. The first is checking both the Initial Claim and Posteligibility blocks. If both are marked, you and the state representative will need to sign a fresh copy with only one selected.¹ The second is forgetting the state representative signature. Your signature alone is not enough. Plan to complete the form in person at your county office, or confirm with your caseworker how to handle the second signature if an in-person visit isn’t possible.

The 60-Day SSI Filing Deadline

If you checked the Initial Claim block, you have 60 days from the date the state receives your signed IM-14 to file your SSI application with the Social Security Administration.¹ Missing that window can jeopardize your AND-SO eligibility, so file for SSI as soon as possible after signing.

If You’re Checking the Posteligibility Box

For reinstatement cases, the reimbursement period starts on the date your reinstatement becomes effective and runs through the month your recurring SSI payments resume. The authorization stays active for 12 months from the date the SSA receives it, or until the end of the period in which you can request administrative or judicial review of the suspension or termination, whichever is longer.⁵

Where the Form Goes After You Sign

You submit the completed IM-14 to your local county department of human services, the same office handling your AND-SO case. The county transmits the authorization electronically to the SSA.²

Keep a copy for yourself. If a dispute later arises about the reimbursement amount, your copy proves you authorized a specific type of recovery (initial claim or posteligibility) on a specific date. If you hand-deliver the form, ask for a date-stamped receipt. If you mail it, use certified mail so you have a tracking record.

What Your Signature Actually Sets in Motion

Once the SSA approves your SSI claim, the reimbursement happens mostly behind the scenes. The SSA calculates the retroactive SSI payment covering the months from when you became eligible through the month your regular payments begin. Instead of sending the full amount to you, the SSA withholds enough to cover what Colorado paid you in interim assistance and sends that portion directly to the state.⁶ The state applies that money to reimburse the AND-SO program.²

If the retroactive SSI payment is larger than what the state paid you, and it often is, the state must pay you the excess within 10 working days of receiving the federal reimbursement. The state must also send you a written notice explaining how much the SSA repaid, how much excess is owed to you, and your right to a hearing if you disagree.⁷

This is a one-time event. It does not change your ongoing monthly SSI payments once the retroactive balance is settled.

If SSI Is Denied, or If the Check Reaches You First

The IM-14 only authorizes reimbursement from an actual SSI payment. If the SSA denies your claim, there is no retroactive payment for the state to intercept, and the federal reimbursement mechanism does not activate.⁶

Different situation if the retroactive SSI check arrives at your address before the state can intercept it. The county department is authorized to establish a recovery from you directly, through installments or a lump sum.² If that happens, contact your caseworker immediately to arrange repayment and avoid an overpayment dispute.

Disputing the Numbers

You have two separate avenues for challenging a reimbursement figure, and they do not overlap.

If you believe the state mishandled the reimbursement, for example by keeping more than it should have or sending you too small an excess payment, you are entitled to a state hearing in Colorado. Federal regulations require this as a condition of the state’s interim assistance agreement with the SSA.⁶ The written notice the state sends you after the reimbursement must inform you of this right.⁷

If you believe the SSA itself calculated the wrong total to withhold, that appeal goes directly to the SSA, following the standard SSI appeals process.⁶ You start with a written request for reconsideration within 60 days of receiving the SSA’s notice. The SSA assumes you received the notice five days after the date printed on it, so count your 60 days from that point.⁸

You cannot get a federal hearing to challenge what the state did with the money, and you cannot get a state hearing to challenge the SSA’s math. Pick the right venue for the error you’re disputing.

1
Colorado Department of Human Services. Authorization for Reimbursement of Interim Assistance Initial Claims Payment or Posteligibility Case Payment
2
Colorado Secretary of State. Code of Colorado Regulations – Interim Assistance Reimbursement
3
Colorado Department of Human Services. Adult Financial Programs
4
Colorado Department of Human Services. Contact Your County Human Services Department
5
Social Security Administration. Interim Assistance Reimbursement Internet Handbook
6
eCFR. 20 CFR Part 416 Subpart S – Interim Assistance Provisions
7
Social Security Administration. 20 CFR 416.1910 – Requirements for Interim Assistance Agreement
8
Social Security Administration. Understanding Supplemental Security Income Appeals Process