TN 1 (06-94)

SI 02306.020 SSA-L8003-U2 and SSA-L8004-U2, Supplemental Security Income Request for Information - Posteligibility

A. Description of forms

The Supplemental Security Income Request for Information (PE) is a general-purpose form for requesting information and setting up appointments with SSI recipients in PE situations.

EXCEPTION: The Supplemental Security Income Posteligibility Notice of Appointment (SSA-L3074-U2 and SSA-L3075-U2) is the correct notice to schedule initial personal contact interview appointments for redeterminations and limited issues per SI 02305.019.

The two versions of the Supplemental Security Income Request for Information are:

  • The SSA-L8003-U2 for recipients other than 1619(b) eligibles;

  • The SSA-L8004 for 1619(b) eligibles only.

These notices are on the “Field Office Notice Software” (FONS) personal computer (PC) package in English.

Printed versions of these notices are available in both English and Spanish.

B. Procedure

1. Completing Fill-in Spaces On The FONS

Follow instructions on the FONS to complete fill-ins on the PC. Retain a dated copy of the notice to document the 30-day closeout period.

2. Completing Fill-in Spaces on the Printed Version

  1. Follow these steps to complete page 1:

STEPACTION

1

Review an SSID and the Post Entitlement Operational Data Store (PE ODS):

  • If a face-to-face or telephone interview is appropriate.

    EXAMPLE: ZH09 coding in the CG field of the SSID tells you that the recipient is deaf and uses sign language; a telephone interview is not appropriate.

  • If a recipient has earned income. A telephone interview is the preferred method for a personal contact.

  • If the recipient needs to bring evidence with him to a face-to-face interview or submit evidence subsequent to a telephone interview.

    NOTE: The presence of a diary may be an indicator of required evidence.

2

Tear off the perforated tab at the top of the form to separate pages 1 and 2.

3

Complete the address section:

  • Recipient's name and mailing address or use a preprinted label.

  • Office address.

  • Office hours.

  • Recipient's social security number; and

  • Date you complete the appointment notice.

4

“What You Need to Do” section - Check off the appropriate blocks and, if scheduling an appointment, fill in:

  • Date and time of the appointment.

  • The number the recipient should call and the name of the person the recipient should ask for if scheduling a call-in interview;
    or

    The number you will be calling if you will make the phone call to conduct a phone interview. or

    The address of the field office and the person the recipient should ask for if scheduling a face-to-face interview.

5“If We Do Not Hear From You” section - on page 1fill in the month/day /year the recipient needs to contact you to avoid suspension; i.e., 30 days from the date at the top of the form.
  1. Follow these steps to complete page 2:

    • Fill-in the date(s) for which evidence is needed.

    • Check off the items the recipient should bring to the interview or submit to the FO. For each item checked, enter the name of the person to whom the item belongs.

    • For the “Pay stubs” item, include dates for the earliest through the latest month/year of earned income data which you need to verify earnings. When completing the form to further pursue development of redetermination or limited issue data, follow the rules of administrative finality when determining the earliest month/year.

    • Fill-in the FO p