If the person making the statement answers question 4(a) “Yes,” obtain the following information in (b):

• •

  type of business (e.g., shoe repair)

• •

  last tax year's gross income (for the tax year before application)

• •

  last tax year's net income (profit) or loss

• •

  this tax year's expected net income or loss

• •

  the dates of self-employment.

Explain any significant decrease in net income from the last tax year to the current tax year in “Remarks.”

1. a. 

   Explain to a self-employed individual that he/she should submit evidence of his/her net earnings (or loss) from self-employment after the current taxable year ends.

2. b. 

   List the assets of the business in questions 6-12 if the SSA-8010-BK is being completed for anyone other than an ineligible child.

3. c. 

   If the person alleges no self-employment activity, go to question 5.