TN 2 (07-13)
SI 00605.010 Completing Part 1 Basic Eligibility of the Application for Supplemental Security Income (SSA-8001-BK)
A. Procedure for completing Part 1
Follow the procedure in this section when completing Part 1 of the SSA-8001-BK.
B. Part 1 questions
1. Questions 1 through 4 Identifying Information
These questions are self-explanatory. If the claimant:
does not have a social security number (SSN),
does not remember it, or
is waiting for a replacement card,
see SI 00604.016B.3. for further instruction.
To verify identity, record the claimant's parents' names per SI 00601.062B.2. in “Remarks” or on Form SSA-5002 (Report of Contact). The client identification screen (ACID) records identifying information for applications taken in the Modernized Supplemental Security Income Claims System (MSSICS). For information on the ACID screen, see MSOM MSSICS 008.002.
2. Questions 5 through 8 Identifying information for others
Complete if the claimant has a spouse as defined by the marital relationship rules in SI 00501.150 through SI 00501.153. If married, enter the claimant's date of marriage.
Record information about children living in the household in “Remarks” when deeming applies and this information is relevant to eligibility (e.g., date of birth, student status and income). For information on spouse-to-spouse deeming, see SI 01320.400.
When filling out the form for a child living with one or both parents, enter the father's name on one line and the mother's name on the other line in question 5. Show the corresponding information in questions 6 through 8.
When other children living in the household is relevant to eligibility, record the date of birth, student status and income in “Remarks”. For parent-to-child deeming instructions, see SI 01320.500.
If you have not already entered the identifying information for a spouse or parent(s), enter sponsor or sponsor's spouse's name in question 5 when sponsor-to-alien deeming applies. Complete question 8 for the sponsor or sponsor's spouse. Cross out “Spouse/Parent(s)” and enter “Sponsor/Sponsor's Spouse,” as applicable.
Note in “Remarks” the sponsor's marital status and dependents, if any. For dependents, enter all information relevant to eligibility. Include name, relationship, and whether receiving or filing for supplemental security income (SSI).
If you already entered identifying information for a spouse or parent(s), enter the required sponsor information in “Remarks”.
For sponsor-to-alien deeming instructions, see SI 01320.900. For sponsor-to-alien deeming instructions, see SI 00502.200.
NOTE: The sponsor or sponsor's spouse does not have to complete questions 6 and 7.
d. Essential persons
Complete questions 5, 6, and 8 with information about essential person(s). Cross out “Spouse/Parent(s)” and enter “Essential Person.” For definition of essential person(s), see SI 00501.100. For instructions on essential person deeming, see SI 01320.800.
e. Disposing of protective writings
Naming another person on the application:
creates a protective writing for him or her.
However, unless the named person is a spouse or former spouse, he or she must be living with the claimant to establish a protective writing. For information on title XVI protective writing, see SI 00601.020. For closeout instructions on protective writing see, SI 00601.037. If the claimant is potentially entitled to title II benefits, see GN 00204.010 for instructions.
3. Question 9 Other names and Social Security Numbers
Record any other names (including maiden names and other married names) or Social Security Numbers (SSN) used. We need this information for Numident verification of the SSN. If the Numident indicates multiple SSNs, see RM 10220.400. The multiple names or SSN (AMUL) screen collects this information for applications taken in MSSICS. For instructions on the AMUL screen, see MSOM MSSICS 008.004.
4. Questions 10 and 11 Place of birth
Record the place of birth for claimant (and spouse, if filing). We collect this information on the claimant identification (ACID) screen for applications taken in MSSICS. For instruction on the ACID screen, see MSOM MSSICS 008.002
5. Question 12 Illnesses, injuries, conditions (blind or disabled)
a. When to Complete
Complete this question for every claimant.
b. How to complete when claimant alleges Illnesses, injuries, or conditions
This question is self-explanatory. Follow the “Go To” instructions within the question. The disability data screen (ADIB) collects this information for applications taken in MSSICS. For instruction on the ADIB screen, see MSOM MSSICS 008.010.
6. Question 13 Citizen and alien status
a. Claimant and spouse (if filing) are United States citizens by birth
Do not complete question 13 through 16. Go directly to question 17.
b. Claimant or spouse (if filing) are NOT United States citizens by birth
Complete this question for the claimant and claimant's spouse (if filing). Follow the “Go To” instructions depending on the allegation. The citizenship (ACIT) screen collects citizenship status for applications taken in MSSICS. For instruction on the ACIT screen, see MSOM MSSICS 008.012.
c. 13(a) Naturalized citizen
Complete question 13(a) and follow the “Go To” instructions within the question.
d. 13(b) and 13(c) American Indian born outside of the United States
Check the appropriate box, complete (c) and follow the “Go To” instructions within the question. If the alien alleges being an American Indian born in Canada, verify the status per SI 00502.105B.1. If the alien alleges being a member of a federally recognized Indian tribe, verify status per SI 00502.105B.2.
e. 13(d) Qualified alien current immigration status
In general, to get SSI, an alien must be in a qualified alien category and meet an exception condition that permits eligibility for qualified aliens. For alien eligibility, see SI 00502.100. Consider time-limited eligibility based on prior alien status if the claimant has been in lawful permanent resident (LPR) status less than 7 years and does not meet the other alien eligibility requirements in SI 00502.100A.3.a. For Department of Homeland Security (DHS) documents that are evidence of qualified alien status, refer to SI 00502.130. For information on verifying DHS documents, see SI 00502.115.
The alien data (AALN) screen collects alien status for applications taken in MSSICS. For instruction on the AALN screen, see MSOM MSSICS 008.016.
7. Question 14 Lawful Permanent Resident (LPR)
For the policy for sponsor-to-alien deeming, see SI 00502.200 through SI 00502.280. To determine if the claimant is a qualified alien based on LPR status with 40 qualifying quarters of earnings, see SI 00502.135B.2. Remember to obtain the information in question 5 for ineligible, separated, and deceased spouses.
8. Question 15 Qualified alien based on battery or extreme cruelty
A claimant meets qualified alien status based on battery or extreme cruelty if he or she meets the requirements in SI 00502.100A.2.b.
9. Question 16 Qualified alien based on active duty in the armed forces
To develop qualified alien based on active duty in the armed forces, see SI 00502.1400.
10. Question 17 Residency
Complete this question for all claimants. The information documents U.S. residency, a factor of eligibility for SSI. For developing U.S. residency, see GN 00303.740. The residency presence (ARES) screen (described in MSOM MSSICS 008.013) collects claimant residency information for applications filed in MSSICS.
11. Question 18 Presence in the U.S.
Complete this question for all claimants. This information helps to determine whether a claimant meets the “presence in the U.S.” provision of the Act. To determine the claimant’s presence in the U.S., see SI 00501.410. The ARES screen collects the claimant's U.S. presence for applications taken in MSSICS. For instruction on the ARES screen, see MSOM MSSICS 008.013.
12. Question 19 Mailing Address
Complete per SI 00604.114 (identical to question 2 on the SSA-8000-BK (Application for SSI)). Enter the mailing address of the claimant who signs block 36. The mailing or payment address (ADDR) screen records the mailing address for applications taken in MSSICS. For instructions for the ADDR screen, see MSOM MSSICS 008.005.
13. Question 20 Special notice options (SNO) for blind or visually impaired claimants
Complete if the claimant alleges blindness or a visual impairment. Enter the claimant's preferred notice option. We collect this notice selection on the ADDR screen when the claimant (and eligible spouse) alleges blindness. For instruction on the ADDR screen, see MSOM MSSICS 008.005.
14. Questions 21 and 22 Fugitive felons and parole and probation violators
Complete these questions for all claimants over age 13. For ineligibility criteria under Section 202 of P.L. 104.193 see SI 00530.001 through SI 00530.430.
The Law Enforcement (ALEF), Felony Warrant (AWRF), and Parole and Probation Violation Warrant (AWRP) screens collect the claimant's status as a fugitive felon and parole and probation violator. For information on these screens, see MSOM MSSICS 008.022 through 008.024.