SI 00604.000 Completion of Form SSA-8000-BK, Application for Supplemental Security Income

Subchapter Table of Contents
Section Latest
Transmittal
SI 00604.001Application For Supplemental Security Income, Form SSA-8000-BKTN 4 04-07
SI 00604.002Form SSA-8000-BK (Application for Supplemental Security Income (SSI): ExhibitTN 5 03-12
SI 00604.003Preliminary Discussion Before Completing the SSA-8000-BKTN 4 04-07
SI 00604.005Telephone (TEL) Block on Form SSA-8000-BK (Application for Supplementary Security Income (SSI))TN 6 05-12
SI 00604.006Food Stamp-Social Security Administration/Application and Food Stamp (FS-SSA/APP and FS)-Referred BlocksTN 5 03-12
SI 00604.007Unmarked Portion of Upper Right Corner of Page 1TN 4 04-07
SI 00604.008Filing Date BlockTN 4 04-07
SI 00604.009Preferred Language BlockTN 4 04-07
SI 00604.010Procedure for Type of Claim SectionTN 5 03-12
SI 00604.015Completing Part I (Basic Eligibility) of the SSA-8000-BK: GeneralTN 5 03-12
SI 00604.016Name, Sex, Birthdate, and SSN - Question 1(a)TN 4 04-07
SI 00604.017Other Names and SSNs and Identifying Information - Question 1(b) - (d)TN 4 04-07
SI 00604.018Marital Status: Question 5TN 5 03-12
SI 00604.019Prior Marriage(s): Question 6TN 5 03-12
SI 00604.020Illnesses, Injuries, or Conditions (Blind or Disabled): Question 7TN 5 03-12
SI 00604.022Birthplace and U.S. Citizenship: Questions 8 Through 10TN 5 03-12
SI 00604.023Aliens Status: Question 11TN 5 03-12
SI 00604.024Alien Lawfully Admitted For Permanent Residence: Question 12TN 5 03-12
SI 00604.025Qualified Alien Status Based on Battery or Extreme Cruelty While in the U.S.: Question 13TN 5 03-12
SI 00604.028Qualified Alien Status Based on Active Military Duty: Question 14TN 5 03-12
SI 00604.030U.S. Residency: Question 15TN 5 03-12
SI 00604.031Presence in the U.S.: Question 16TN 5 03-12
SI 00604.035Alien Allocation: Question 17TN 5 03-12
SI 00604.038Fugitive Felons: Question 18TN 5 03-12
SI 00604.045Completing Part II (Living Arrangements) of the SSA-8000-BK: GeneralTN 5 03-12
SI 00604.046Where You Live: Question 20TN 5 03-12
SI 00604.047Institution: Question 21TN 5 03-12
SI 00604.048Institution Residence Information: Question 22TN 5 03-12
SI 00604.049Noninstitutional Care: Questions 23 and 24TN 5 03-12
SI 00604.050Household Arrangements: Question 25TN 5 03-12
SI 00604.051Living Alone or Only With Spouse: Question 26TN 5 03-12
SI 00604.052Household Composition: Question 27(a)TN 5 03-12
SI 00604.053Children in Household Receiving Income: Question 27(b) and (c)TN 5 03-12
SI 00604.054Rent-Free Shelter: Question 28TN 5 03-12
SI 00604.055Home Ownership: Question 29TN 5 03-12
SI 00604.056Rental Liability: Question 30TN 5 03-12
SI 00604.057Landlord/Tenant Relationship: Question 31TN 5 03-12
SI 00604.058Inside In-Kind Support and Maintenance (ISM) and Cash from Within Household: Question 32TN 5 03-12
SI 00604.059Separate Consumption and Separate Purchase of Food: Question 33TN 5 03-12
SI 00604.060Contributions to Household Expenses: Question 34TN 5 03-12
SI 00604.061Loan to Repay Share of Household Expenses: Question 35TN 5 03-12
SI 00604.062Earmarked Sharing: Question 36TN 5 03-12
SI 00604.063Household Operating Expenses: Question 37TN 5 03-12
SI 00604.064In-Kind Support and Maintenance (ISM) and Cash From Outside Of The Household: Question 38TN 5 03-12
SI 00604.065Changes In Living Arrangements: Question 39TN 5 03-12
SI 00604.070Completing Part III of the SSA-8000-BK (Resources) - GeneralTN 4 04-07
SI 00604.071Vehicles: Question 40TN 5 03-12
SI 00604.072Life Insurance: Question 41TN 5 03-12
SI 00604.073Life Estates, Unprobated Estates, and Other Items: Question 42TN 5 03-12
SI 00604.074Liquid Resources: Questions 43 and 44TN 5 03-12
SI 00604.075Other Property: Question 45TN 5 03-12
SI 00604.077Changes in Resources Since the Filing Date: Question 46TN 5 03-12
SI 00604.078Transfer of Resources: Question 47TN 5 03-12
SI 00604.079Burial Funds: Question 48TN 5 03-12
SI 00604.080Burial Space: Question 49TN 5 03-12
SI 00604.085Completing Part IV (Income) of the SSA-8000-BK: GeneralTN 5 03-12
SI 00604.086Income: Question 50TN 5 03-12
SI 00604.087Overpayment Collection From Other Benefits: Question 51TN 5 03-12
SI 00604.088In-Kind Support and Maintenance (ISM) to One Person or Other In-Kind Income: Question 52TN 5 03-12
SI 00604.089Wages: Question 53TN 5 03-12
SI 00604.090Self-Employment: Question 54TN 5 03-12
SI 00604.091Blind Work Expenses (BWE) and Impairment-Related Work Expenses (IRWE): Question 55TN 5 03-12
SI 00604.092Court Ordered Support: Question 56TN 5 03-12
SI 00604.093School Attendance: Question 57TN 5 03-12
SI 00604.095Completing Part V of the SSA-8000-BK (Potential Eligibility for Food Stamps/Medical Assistance/ Other Benefits) - GeneralTN 4 04-07
SI 00604.096Supplemental Nutrition Assistance Program (SNAP) (Formerly Known as Food Stamps): Question 58TN 5 03-12
SI 00604.097Medical Assistance: Question 59TN 5 03-12
SI 00604.098Leads For Other Benefits: Question 60TN 5 03-12
SI 00604.100Completing Part VI (Miscellaneous) of the SSA-8000-BK: Question 61TN 5 03-12
SI 00604.105Completing Part VII of the SSA-8000-BK (Remarks)TN 4 04-07
SI 00604.108Important Information: Item 62TN 5 03-12
SI 00604.109Signatures: GeneralTN 5 03-12
SI 00604.111Signature: Item 63 and 65TN 5 03-12
SI 00604.113Mailing Address: Question 2TN 5 03-12
SI 00604.114Claimant's Residence Address: Question 3TN 5 03-12
SI 00604.116Direct Deposit Information: Question 4TN 5 03-12
SI 00604.118Blind or Visually Impaired Notice Options: Question 64TN 5 03-12
SI 00604.119Witnesses - Question 65TN 4 04-07
SI 00604.120Completing the "Receipt For Claim" and "Changes To Report" Tear-Off PageTN 4 04-07
SI 00604.130Filing For Medicaid Based on SSITN 4 04-07

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500604000
SI 00604.000 - Completion of Form SSA-8000-BK, Application for Supplemental Security Income - Table of Contents - 05/15/2012
Batch run: 10/19/2017
Rev:05/15/2012