Complete if the claimant has a spouse as defined by the marital relationship rules in SI 00501.150 through SI 00501.153. If married, enter the claimant's date of marriage.

Record information about children living in the household in “Remarks” when deeming applies and this information is relevant to eligibility (e.g., date of birth, student status and income). For information on spouse-to-spouse deeming, see SI 01320.400.

When filling out the form for a child living with one or both parents, enter the father's name on one line and the mother's name on the other line in question 5. Show the corresponding information in questions 6 through 8.

When other children living in the household is relevant to eligibility, record the date of birth, student status and income in “Remarks”. For parent-to-child deeming instructions, see SI 01320.500.

If you have not already entered the identifying information for a spouse or parent(s), enter sponsor or sponsor's spouse's name in question 5 when sponsor-to-alien deeming applies. Complete question 8 for the sponsor or sponsor's spouse. Cross out “Spouse/Parent(s)” and enter “Sponsor/Sponsor's Spouse,” as applicable.

Note in “Remarks” the sponsor's marital status and dependents, if any. For dependents, enter all information relevant to eligibility. Include name, relationship, and whether receiving or filing for supplemental security income (SSI).

If you already entered identifying information for a spouse or parent(s), enter the required sponsor information in “Remarks”.

For sponsor-to-alien deeming instructions, see SI 01320.900. For sponsor-to-alien deeming instructions, see SI 00502.200.

NOTE: The sponsor or sponsor's spouse does not have to complete questions 6 and 7.

Complete questions 5, 6, and 8 with information about essential person(s). Cross out “Spouse/Parent(s)” and enter “Essential Person.” For definition of essential person(s), see SI 00501.100. For instructions on essential person deeming, see SI 01320.800.

Naming another person on the application:

• •

  who is at least age 65,

• •

  will attain age 65 within the evaluation period; or

• •

  who is blind or disabled,

creates a protective writing for them.

However, unless the named person is a spouse or former spouse, they must be living with the claimant to establish a protective writing. For information on title XVI protective writing, see SI 00601.020. For closeout instructions on protective writing see, SI 00601.037. If the claimant is potentially entitled to title II benefits, see GN 00204.010 for instructions.

Complete this question for every claimant.

This question is self-explanatory. Follow the “Go To” instructions within the question. The disability data screen (ADIB) collects this information for applications taken in MSSICS. For instruction on the ADIB screen, see MSOM MSSICS 008.010.

Do not complete question 13 through 16. Go directly to question 17.

Complete this question for the claimant and claimant's spouse (if filing). Follow the “Go To” instructions depending on the allegation. The citizenship (ACIT) screen collects citizenship status for applications taken in MSSICS. For instruction on the ACIT screen, see MSOM MSSICS 008.012.

Complete question 13(a) and follow the “Go To” instructions within the question.

Check the appropriate box, complete (c) and follow the “Go To” instructions within the question. If the alien alleges being an American Indian born in Canada, verify the status per SI 00502.105B.1. If the alien alleges being a member of a federally recognized Indian tribe, verify status per SI 00502.105B.2.

In general, to get SSI, an alien must be in a qualified alien category and meet an exception condition that permits eligibility for qualified aliens. For alien eligibility, see SI 00502.100. Consider time-limited eligibility based on prior alien status if the claimant has been in lawful permanent resident (LPR) status less than 7 years and does not meet the other alien eligibility requirements in SI 00502.100A.3.a. For Department of Homeland Security (DHS) documents that are evidence of qualified alien status, refer to SI 00502.130. For information on verifying DHS documents, see SI 00502.115.

The alien data (AALN) screen collects alien status for applications taken in MSSICS. For instruction on the AALN screen, see MSOM MSSICS 008.016.