Effective Dates: 09/22/2025 - Present Previous | Next

SI 00604.000 Completion of Form SSA-8000-BK, Application for Supplemental Security Income

Subchapter Table of Contents
Section   Latest
Transmittal
SI 00604.001 Application For Supplemental Security Income, Form SSA-8000-BK TN 50 12-23
SI 00604.002 Form SSA-8000-BK (Application for Supplemental Security Income (SSI): Exhibit TN 5 03-12
SI 00604.003 Preliminary Discussion Before Completing the SSA-8000-BK TN 4 04-07
SI 00604.005 Telephone (TEL) Block on Form SSA-8000-BK (Application for Supplementary Security Income (SSI)) TN 6 05-12
SI 00604.006 Food Stamp-Social Security Administration/Application and Food Stamp (FS-SSA/APP and FS)-Referred Blocks TN 5 03-12
SI 00604.007 Unmarked Portion of Upper Right Corner of Page 1 TN 4 04-07
SI 00604.008 Filing Date Block TN 4 04-07
SI 00604.009 Preferred Language Block TN 4 04-07
SI 00604.010 Procedure for Type of Claim Section TN 55 12-23
SI 00604.015 Completing Part I (Basic Eligibility) of the SSA-8000-BK: General TN 5 03-12
SI 00604.016 Name, Sex, Birthdate, and SSN - Question 1(a) TN 12 04-20
SI 00604.017 Other Names and SSNs and Identifying Information - Question 1(b) - (d) TN 4 04-07
SI 00604.018 Marital Status: Question 5 TN 58 12-23
SI 00604.019 Prior Marriage(s) TN 10 08-19
SI 00604.020 Illnesses, Injuries, or Conditions (Blind or Disabled): Question 7 TN 70 08-25
SI 00604.022 Birthplace and U.S. Citizenship: Questions 8 Through 10 TN 5 03-12
SI 00604.023 Aliens Status: Question 11 TN 68 01-24
SI 00604.024 Alien Lawfully Admitted For Permanent Residence: Question 12 TN 49 12-23
SI 00604.025 Qualified Alien Status Based on Battery or Extreme Cruelty While in the U.S.: Question 13 TN 48 12-23
SI 00604.028 Qualified Alien Status Based on Active Military Duty: Question 14 TN 62 12-23
SI 00604.030 U.S. Residency: Question 15 TN 67 01-24
SI 00604.031 Presence in the U.S.: Question 16 TN 15 04-20
SI 00604.035 Alien Allocation: Question 17 TN 5 03-12
SI 00604.038 Fugitive Felons: Question 18 TN 5 03-12
SI 00604.045 Completing Part II (Living Arrangements) of the SSA-8000-BK: General TN 5 03-12
SI 00604.046 Where You Live: Question 20 TN 5 03-12
SI 00604.047 Institution: Question 21 TN 5 03-12
SI 00604.048 Institution Residence Information: Question 22 TN 5 03-12
SI 00604.049 Noninstitutional Care: Questions 22 and 23 TN 45 05-20
SI 00604.050 Household Arrangements: Question 24 TN 47 05-20
SI 00604.051 Living Alone or Only With Spouse: Question 25 TN 44 05-20
SI 00604.052 Household Composition: Question 26(a) TN 32 05-20
SI 00604.053 Children in Household Receiving Income: Question 26(b) and (c) TN 30 05-20
SI 00604.054 Rent-Free Shelter: Question 27 TN 54 12-23
SI 00604.055 Home Ownership: Question 28 TN 43 05-20
SI 00604.056 Rental Liability: Question 29 TN 25 05-20
SI 00604.057 Landlord/Tenant Relationship: Question 30 TN 27 05-20
SI 00604.058 Inside In-Kind Support and Maintenance (ISM) and Cash from Within Household: Question 31 TN 29 05-20
SI 00604.059 Separate Consumption and Separate Purchase of Food: Question 32 TN 52 12-23
SI 00604.060 Contributions to Household Expenses: Question 33 TN 42 05-20
SI 00604.061 Loan to Repay Share of Household Expenses: Question 34 TN 26 05-20
SI 00604.062 Earmarked Sharing: Question 35 TN 53 12-23
SI 00604.063 Household Operating Expenses: Question 36 TN 39 05-20
SI 00604.064 In-Kind Support and Maintenance (ISM) and Cash From Outside Of The Household: Question 37 TN 40 05-20
SI 00604.065 Changes In Living Arrangements: Question 38 TN 41 05-20
SI 00604.070 Completing Part III of the SSA-8000-BK (Resources) - General TN 72 09-25
SI 00604.071 Vehicles: Question 40 TN 51 12-23
SI 00604.072 Life Insurance: Question 44 TN 23 05-20
SI 00604.073 Life Estates, Unprobated Estates, and Other Items: Question 42 TN 5 03-12
SI 00604.074 Liquid Resources: Questions 42 and 43 TN 56 12-23
SI 00604.075 Other Property: Question 41 TN 61 12-23
SI 00604.077 Changes in Resources Since the Filing Date: Question 45 TN 34 05-20
SI 00604.078 Transfer of Resources: Question 49 TN 24 05-20
SI 00604.079 Burial Funds: Question 47 TN 36 05-20
SI 00604.080 Burial Space: Question 48 TN 35 05-20
SI 00604.085 Completing Part IV (Income) of the SSA-8000-BK: General TN 38 05-20
SI 00604.086 Income: Question 50 TN 57 12-23
SI 00604.087 Overpayment Collection From Other Benefits: Question 51 TN 5 03-12
SI 00604.088 In-Kind Support and Maintenance (ISM) to One Person or Other In-Kind Income: Question 52 TN 5 03-12
SI 00604.089 Wages: Question 53 TN 5 03-12
SI 00604.090 Self-Employment: Question 54 TN 5 03-12
SI 00604.091 Blind Work Expenses (BWE) and Impairment-Related Work Expenses (IRWE): Question 55 TN 19 05-20
SI 00604.092 Court Ordered Support: Question 56 TN 5 03-12
SI 00604.093 School Attendance: Question 57 TN 20 05-20
SI 00604.095 Completing Part V of the SSA-8000-BK (Potential Eligibility for Food Stamps/Medical Assistance/ Other Benefits) - General TN 4 04-07
SI 00604.096 Supplemental Nutrition Assistance Program (SNAP) (Formerly Known as Food Stamps): Question 58 TN 8 04-19
SI 00604.097 Medical Assistance: Question 59 TN 69 01-24
SI 00604.098 Leads For Other Benefits: Question 60 TN 18 05-20
SI 00604.100 Completing Part VI (Miscellaneous) of the SSA-8000-BK: Question 61 TN 5 03-12
SI 00604.105 Completing Part VII of the SSA-8000-BK (Remarks) TN 11 02-20
SI 00604.108 Important Information: Item 62 TN 64 01-24
SI 00604.109 Signatures: General TN 60 12-23
SI 00604.111 Signature: Item 63 and 65 TN 73 09-25
SI 00604.113 Mailing Address: Question 2 TN 5 03-12
SI 00604.114 Claimant's Residence Address: Question 3 TN 71 09-25
SI 00604.116 Direct Deposit Information: Question 4 TN 5 03-12
SI 00604.118 Blind or Visually Impaired Notice Options: Question 64 TN 5 03-12
SI 00604.119 Witnesses - Question 65 TN 4 04-07
SI 00604.120 Completing the "Receipt For Claim" and "Changes To Report" Tear-Off Page TN 59 12-23
SI 00604.130 Filing For Medicaid Based on SSI TN 4 04-07
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500604000
SI 00604.000 - Completion of Form SSA-8000-BK, Application for Supplemental Security Income - Table of Contents - 09/22/2025
Batch run: 09/22/2025
Rev:09/22/2025