The SSA-8202-F4-INST is a 4-page form folded to 3-3/4" 8-1/2". There are four versions
of the form:
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SSA-8202-F4-INST and SSA-8202-F4-SP-INST are the English and Spanish versions of the forms for use by all States except California.
These versions include a food stamp message.
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SSA-8202-F4-INST-NFS and SSA-8202-F4- INST-SP-NFS are the English and Spanish versions of the forms for use by California only. These
versions do not include a food stamp message.
All versions of the form include information about:
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How to complete the SSA-8202-BK;
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Timeframe for responding and the consequences of not responding;
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Recipient reporting responsibilities;
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Food stamps (in all States but California);
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Medicaid transfer of assets;
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Paperwork Reduction Act of 1995; and
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