Identification Number:
SI 00604 TN 9
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Completion of Form SSA-8000-BK, Application for Supplemental Security Income
Type:POMS Transmittals
Program:Title XVI (SSI)
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 006 – The SSI Application Process
Subchapter 04 – Completion of Form SSA-8000-BK, Application for Supplemental Security Income
Transmittal No. 9, 08/15/2019

Audience

OCO-OEIO: CR, FCR, FDE, RECONE;
OCO-ODO: CR, CST, CTE, CTE TE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

SI 00604.111 Signature: Item 63 and 65

Subsection C

  • We rewrote the sentence in subsection C.2 regarding witnessed signature and MSSICS exclusions and replaced the incorrect reference of SI 02001.015A with a reference to GN 00201.015A.

SI 00604.111 Signature: Item 63 and 65

A. When to complete items 63 and 65

A signature and date are required for all claimants. For alternative signature methods, see GN 00201.015.

B. Claimant with ineligible spouse

The ineligible spouse should not sign the application because a spouse's signature constitutes an application for payments. If the ineligible spouse signs the application, follow the protective writing closeout procedures in GN 00204.012.

C. In-person interview

1. Pen-and-ink signature

  • Claimant files: Ask the claimant to sign in the “Sign Here” block and enter the date.

  • If a couple is filing, ask the claimant identified in 1(a) to sign in the "Sign Here" block.

  • Ask the spouse to sign the "Spouse's Signature" block if he or she is applying for payment and is present at the interview.

  • Enter the date the claimant signs the application if the claimant is completing the application for a couple.

  • If the spouse applying for payment is not present at the interview, see SI 00604.010E.1 (in this section).

2. Witnessed signature

When we receive a signed application if there is no Modernized Supplemental Security Income Claims System (MSSICS) exclusion, follow the procedures in GN 00201.015H. Annotate the DW01. If a couple files, remember to annotate both DW01s.

If a MSSICS exclusion exists, refer to the NOTE in GN 00201.015A.

D. Teleclaim

1. Pen-and-ink signature

If we take an SSA-8000-BK (Application for Supplemental Security Income) during a telephone interview, mail the form to the claimant for signature.

2. Witnessed signature

When we receive the signed application and there is no MSSICS exclusion, follow procedures in GN 00201.015H. If a couple files, remember to annotate both DW01s.

E. Applicant filing on behalf of a claimant

Apply the Proper Applicant rules in SI 00601.012 and have the appropriate person sign the application.

NOTE: Enter a telephone number where we may reach the applicant during the day. If the claimant, spouse or applicant have different telephone numbers, enter the respective numbers in "Remarks".

F. References


SI 00604 TN 9 - Completion of Form SSA-8000-BK, Application for Supplemental Security Income - 8/15/2019