TN 1 (10-89)
SI 01310.610 Completion Instructions for the SSA-8010-BK - General
The interviewer must complete the SSA-8010-BK. Make sure any individual signing the form understands
the purpose of the interview
the uses of the information
the penalties for giving false information.
Following are the general requirements for completing the SSA-8010-BK.
B. Procedure — General
1. Related Information
Record information obtained from the individual(s) signing the form.
Use other forms to record reports from other persons and sources, deeming computations, or verifying information from other sources. Do not add such information to a completed SSA-8010-BK.
2. Using the Form for a Couple
Enter responses by the individual making the statement under the column labeled You and information about the spouse under Your Spouse .
Do not use one SSA-8010-BK to combine income and resources information for people who do not have a marital relationship as defined in SI 00501.150C.
3. Changing Answers
Ask the individual to initial or sign any change in an answer. (See GN 00205.015 for the procedure if the individual cannot write.)
NOTE: Do not change answers once the individual has signed the SSA-8010-BK. Take a statement on another signed form (e.g., an SSA-795) explaining the change.
4. Dollar Amounts
Enter actual stated amounts in dollars and cents; do not round them.
5. Answer Unknown
Enter “unknown” and begin appropriate development when the individual does not know the answer to a question.
C. Procedure — Use as a Statement of Income
When you use the form as a Statement of Income (SI 01310.600 B.3.c.), modify the SSA-8010-BK as follows: