TN 1 (10-89)

SI 01310.600 Statement of Income and Resources (SSA-8010-BK) - General

A. Introduction

Form SSA-8010-BK, Statement of Income and Resources, collects information about deemors which is not collected on other forms. It is not designed for self-help completion.

B. When to Use

1. When to Use SSA-8010-BK

Use form SSA-8010-BK, or selected portions of it, to collect information about the income and resources of these deemors:

  • parent(s) or the parent and spouse of the parent

  • essential person

  • sponsor of an alien (and the sponsor's spouse living in the same household with the sponsor).

Interviewers may use the SSA-8010-BK to record an ineligible child's income, where material. Modify the form into a Statement of Income. See SI 01310.610 C.

Interviewers may also use the modified form to record a report of changes in income, especially when there are several types of income to record.

2. When Not to Use the SSA-80100BK

Interviewers should not use the SSA-8010-BK for eligible or ineligible spouse since the SSI application and other forms capture all the spouse's income and resources information.

3. Decide Which Form to Use

Use this chart to decide which form to use in each deeming situation.

  1. Initial Claims

    An individual living with a spouseSSA-8000-BKSI 00604.001
    A child under age 18 living with a parent AND parent is not filing for SSI at the same timeSSA-8010-BKSI 01320.500
    SI 01330.200
    A child under age 18 living with a parent who is filing for SSI at the same timeSSA 8000-BK
    Place a photocopy of the parent's SSA-8000-BK in the child's claim folder.
    SI 01320.620
    SI 01320.630
    A previously eligible qualified individual who still has essential person
    (EP) in the household
    Exception : If the EP is an ineligible spouse, use form SSA-8000-BK. No SSA-8010-BK is required.
    SI 00501.100
    SI 01320.800
    An alien who has a sponsorSSA-8010-BK
    Exception : If the sponsor is an ineligible spouse, use form SSA-8000-BK. No SSA-8010-BK is required.
    SI 01320.910
    SI 01320.920
    An alien who has multiple sponsorsSSA-8010-BK for each sponsor (unless the sponsors are married to each other).SI 01320.950

    NOTE: This chart should not be used to determine whether deferral of nondisability development applies.

    • See SI 00603.010 to determine whether simultaneous development or deferred development applies.

    • See SI 00602.001 ff. if the claimant clearly does not meet a requirement for eligibility.

    • See SI 00603.035 and use this chart when processing a deferred claim after a medical allowance.

  2. Posteligibility Situations

    An eligible individual living with a spouseSSA-8203-BK; or SSA-8202 and document changes in the income or resources of the ineligible on a signed statement.SI 02305.032
    A child