TN 49 (09-00)

GN 00204.002 Prescribed Application


A prescribed application may be:

  • A specific benefit application form (e.g., SSA-1-BK, SSA-8000-BK) or an exact copy of that application (see SI 00601.010B.1. for SSI related applications);

  • The Modernized Claims Systems (MCS) or the Modernized Supplemental Security Income Claims System (MSSICS), or application output generated from SSA's Internet website;

  • An application for an annuity from the Railroad Retirement Board (RRB) (RS 01601.230); or

  • An application for Department of Veterans Affairs (DVA) survivor benefits (RS 01702.410).

Application policy is extended to include applications produced by personal computer. (This policy does not apply to electronic applications produced via SSA's Internet website as discussed in GN 00204.055.) Regarding requests for approval of a facsimile, any facsimile must be an exact reproduction of a SSA application. The SSA component which oversees forms management is the Office of Publications and Logistics Management (OPLM). OPLM may authorize requesters to computer-generate SSA forms using two methods of reproduction: (1) optical scanning and (2) hand-keying (retyping). However, computer-generated forms must correspond to the SSA paper form in layout and design. The form design information and layout shall not be altered or redesigned in any way.

All requests for computer-generated forms must be submitted for approval in writing to:

Social Security Administration

Forms Management

Office of Publications and Logistics Management

1325 Annex Building

6401 Security Boulevard

Baltimore, Maryland 21235

The request must state:

  1. 1. 

    The title and SSA number of the form;

  2. 2. 

    The reason/need for the electronic reproduction;

  3. 3. 

    The requester's full name and address;

  4. 4. 

    The requester's area code and telephone number;

  5. 5. 

    The intended user;

  6. 6. 

    The estimated printing quantity;

  7. 7. 

    The estimated annual usage;

  8. 8. 

    The type of hardware that will be used to generate the electronic reproduction; and

  9. 9. 

    The request must include a facsimile of the computer-generated form.

The requester also must certify in the request that a fee will not be charged for the SSA form itself nor will the cost of the actual form be incorporated into a charge for service. OPLM will decide on the acceptability of the computer facsimile and the requester will be notified of the decision. A form cannot be considered acceptable until OPLM informs the requester that the facsimile meets the requirements for an acceptable SSA application and OPLM provides the date the form was accepted.

SSA approved Third Party Computer Generated Forms can be accessed on the following OPLM website:

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GN 00204.002 - Prescribed Application - 03/06/2014
Batch run: 03/12/2014