Effective Dates: 12/05/2023 - Present Previous | Next

TN 5 (12-23)

SI 02306.020 SSA-L8003-U2 and SSA-L8004-U2, Supplemental Security Income Request for Information - Posteligibility

A. Description of forms

The Supplemental Security Income Request for Information (PE) is a general-purpose form for requesting information and setting up appointments with SSI recipients in posteligibility (PE) situations.

EXCEPTION: The Supplemental Security Income Posteligibility Notice of Appointment (SSA-L3074-U2 and SSA-L3075-U2) is the correct notice to schedule initial personal contact interview appointments for redeterminations and limited issues per SI 02305.019.

The two versions of the Supplemental Security Income Request for Information are:

  • •

    SSA-L8003-U2 for recipients other than 1619(b) eligibles

  • •

    SSA-L8004 for 1619(b) eligibles only

These notices are available in the Document Processing System (DPS), under the national tab.

Printed versions of these notices are available in both English and Spanish.

B. Procedure

1. Completing Fill-in Spaces in DPS

Follow instructions in DPS to complete notice fill-ins. Retain a dated copy of the notice in the Online Notice Retrieval System (ONRS) to document the 30-day closeout period.

2. Completing Fill-in Spaces on the Printed Version

  1. a. 

    Follow these steps to complete page 1:

STEP ACTION

1

Review a Supplemental Security Record (SSR)

  • •

    If a face-to-face or telephone interview is appropriate.

    EXAMPLE: ZH09 coding in the CG field of the SSR tells you that the individual has a hearing impairment and uses sign language; a telephone interview is not appropriate.

  • •

    If an individual has earned income. A telephone interview is the preferred method for a personal contact.

  • •

    If the individual needs to bring evidence to a face-to-face interview or submit evidence subsequent to a telephone interview.

    NOTE: The presence of a diary may be an indicator of required evidence.

 

 

3

Complete the address section:

  • •

    Individual's name and mailing address

  • •

    Office address.

  • •

    Office hours.

  • •

    Individual's social security number; and

  • •

    Date you complete the appointment notice.

4

“What You Need to Do” section - Check off the appropriate blocks and, if scheduling an appointment, fill in:

  • •

    Date and time of the appointment.

  • •

    The number the individual should call and the name of the person the individual should ask for if scheduling a call-in interview;

    or

    The number you will be calling if you will make the phone call to conduct a phone interview. or

    The address of the field office and the person the individual should ask for if scheduling a face-to-face interview.

5 “If We Do Not Hear From You” section - on page 1 fill in the month/day /year the individual needs to contact you to avoid suspension; i.e., 30 days from the date at the top of the form.
  1. b. 

    Follow these steps to complete page 2:

    • •

      Fill-in the date(s) for which evidence is needed.

    • •

      Check off the items the individual should bring to the interview or submit to the FO. For each item checked, enter the name of the person to whom the item belongs.

    • •

      For the “Pay stubs” item, include dates for the earliest through the latest month/year of earned income data which you need to verify earnings. When completing the form to further pursue development of redetermination or limited issue data, follow the rules of administrative finality when determining the earliest month/year.

    • •

      Fill-in the FO phone number and the name of the person the individual should ask for if they have any questions.

    • •

      Sign the letter with the FO manager's name.

    • •

      Include any appropriate enclosures with the form.

    • •

      Retain a dated copy of the form in ONRS to document the 30-day closeout period.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502306020
SI 02306.020 - SSA-L8003-U2 and SSA-L8004-U2, Supplemental Security Income Request for Information - Posteligibility - 12/05/2023
Batch run: 12/05/2023
Rev:12/05/2023