TN 2 (07-13)

SI 00605.020 Completing Part 3 Resources of the Application for Supplemental Security Income SSA-8001-BK

A. Procedure for deferred development explanation

Provide the claimant with the following explanations for deferred development claims only. For instructions relating to abbreviated application process (ABAP), see SI 00602.001.

1. Financial accounts

Explain the following before you complete this section.

  • The claimant must report all accounts that show the name of the claimant, spouse, or parent(s) in any capacity, regardless of any special purpose for which the claimant established the account or whose money it is. This includes joint bank accounts. For information on the treatment of joint accounts, see SI 01140.205.

  • We may contact banks and savings institutions.

2. Effect of resource transfer at less than fair market value (FMV)

Public Law (P.L.) 100-169 (Foster Care Independence Act of 1999) requires us to determine if a claimant is ineligible for SSI due to transfer of resources for less than fair market value. Section 1917 (c ) and (d) of the Social Security Act require us to obtain transfer of resource and trust information needed for State Medicaid eligibility determinations. Therefore, we should explain that:

  • resource transfers at less than fair market value may have an effect on both SSI and Medicaid eligibility for a period of time. For more information on transfer of resources, see SI 01150.110. and

  • we may share any information we obtain with state agencies for Medicaid eligibility purposes.

NOTE: For a list of trusts that these laws affect, see SI 01120.201 and SI 01730.048.

B. Procedure for documenting resources

1. Annotating value

Annotate the value of resources as of the first moment of the reference date month. Note any changes since that date in the “Remarks” Section.

2. Consider exclusions

Consider whether we may exclude some of the resources named when determining countable resources such as:

3. Conditional benefits

Explain conditional benefits to a claimant whose benefits we would deny solely due to excess non-liquid resources if his or her liquid resources do not exceed three times the Federal Benefit Rate (FBR). Secure information for all resources so that you can determine whether we can pay conditional benefits. For more information on conditional benefits, see SI 01150.200 through SI 01150.210.

C. Procedure for completing questions

1. Question 26 Resources

a. General

Mark either the “Yes” or “No” column for each item listed (a through g). Check if co-owned with others and explain in the “Remarks” section. Complete the appropriate “Dollar Value” column for “Yes” answers.

The resource screens for applications taken in MSSICS are located in MSOM MSSICS 012 and MSSICS 013. The resource menu (RMEN) screen records the types of resources the claimant, eligible spouse or deemor(s) owns.

b. More than one resource on a line

Circle each type of resource listed on a line that the claimant owns. If the claimant owns more than one resource, show the total equity value of all circled resources, except vehicles. For information on resources that are vehicles, see SI 01130.200.

c. Providing additional information

If you want to provide additional information about a resource, use the “Remarks” section to specify the question number and subpart, and to whom the information applies, the item, and provide an explanation.

Example of documenting a resource:

If the claimant has a stamp collection, which he estimates he could sell for $300, in item h (“Other items that can be turned into cash”), check “Yes”, enter “stamp collection” and $300 in the “Dollar Value You Own” column.

2. Question 26(a) Vehicles

If the answer is “Yes,” enter the number of vehicles owned. We collect vehicle information on the RVEH screen for applications taken in MSSICS. For information on the RVEH screen, see MSOM MSSICS 013.003.

Complete the “Dollar Value” column. Consider the vehicle exclusion rules in SI 01130.200.

a. One vehicle

When there is only one vehicle and we totally exclude its value based on its usage, draw a line through the “Dollar Value” column. For information on excluded vehicles based on its usage, see SI 01130.200C.

b. More than one vehicle

When there is more than one vehicle, and we can exclude one vehicle totally based on its usage, record the equity value of additional vehicles.

When there is more than one vehicle and can partially exclude one vehicle because its converting to monthly amounts (CMV) exceeds $4500, enter the CMV over $4500 and the equity value of additional vehicles. For more information on CMV on automobiles, see SI 01130.200D.

3. Question 26(b) Insurance policies

a. No cash surrender value

If the policies the claimant owns has no cash surrender value, enter “0.” For information on the value of life insurance policies, see SI 01130.300.

b. Face value $1,500 or less

If the total face value of all policies owned by a claimant on the same insured person is $1,500 or less, enter “Face value under $1,500” in the appropriate “Dollar Value” column.

c. Face value exceeds $1,500

If the total face value of all policies the claimant owns exceeds $1,500 for any insured person, enter the estimated cash surrender value in the appropriate “Dollar Value” column.

We collect information about life insurance policies on the RLIF screen for applications taken in MSSICS. For instruction on the RLIF screen, see MSOM MSSICS 013.004.

4. Question 27- Burial expenses

Complete as directed on the form. For information on resources that we may exclude under the burial set-aside exclusion, see SI 01130.400 through SI 01130.425. In MSSICS, the RFND screen collects burial information. For instruction on the RFND screen, see MSOM MSSICS 013.012.

5. Question 28 Transfer of resources

Always complete 28(a) and (b). Complete (c) if the claimant answers “yes” to (a) or (b). The RGIV screen collects transfer of resources information for applications taken in MSSICS. For instruction on the RGIV screen, see MSOM MSSICS 013.014. For information on transfer of resources, see SI 01150.001.

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SI 00605.020 - Completing Part 3 Resources of the Application for Supplemental Security Income SSA-8001-BK - 07/26/2013
Batch run: 07/26/2013