TN 2 (07-13)
SI 00605.005 Completing Preliminary Information on the Application for Supplemental Security Income (SSI) SSA-8001-BK
A. Procedure for completing the blocks
Complete the following blocks as indicated in the following subsections. This procedure provides instruction for completing the preliminary section of the SSA-8001-BK form.
B. Preliminary information blocks
1. TEL block
Mark the TEL block located in the application header if the application interview is by telephone.
2. Date stamp block
Write in or use a date stamp to show the month, day, and year we received the signed application in the date stamp block after the header.
3. Deferred development block
If you are deferring development, mark the deferred development block. For information on deferred development, see SI 00603.003.
4. Abbreviated Application Process (ABAP) block
If you are using the abbreviated application process, mark the ABAP block. For information on the ABAP, see SI 00602.001.
5. SNAP (Supplemental Nutrition Assistance Program)-SSA/APP or SNAP-referred block
Mark the appropriate box indicating whether you completed a SNAP application or you referred the claimant to the SNAP agency after completing Part 5-Supplemental Nutrition Assistance Program (SNAP). We use this information to bill the Food and Nutrition Service (FNS) for the number of SNAP applications we complete.
6. Filing date block
Mark the filing date. The filing date is the earliest date between the date we receive the application and the protective filing date. To determine the filing date, see GN 00204.007.
a. Receipt date block
If the receipt date is the same date as the filing date, mark the receipt block.
b. Protective filing date block
If there is a protective filing date, mark the protective filing block. For information on written protective filing, see SI 00601.020. For information protective filing by oral inquiries, see SI 00601.025.
NOTE: If we issued a closeout notice for the protective filing date, and the claimant submits an application form after the protective filing closeout period, then we cannot use the protective filing date as the filing date. However, if an open protective filing exists, use that date.
7. Preferred language block
If claimant’s preferred language is not English, indicate the language the claimant prefers to write and speak. Write the language preferences in the space provided. For a list of language preferences, see SM 01005.545.
NOTE: The client language (CLLG) screen collects this information for applications taken in MSSICS. For more information on the CLLG screen, see MSOM ICD 002.004.
8. Type of claim block
Mark the box that indicates the type of claim the claimant is filing. For instructions on how to complete this block, see SI 00604.010.