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Form SSA-8000-BK (05-2021) UF Discontinue Prior Editions Social Security Administration Page 1 of 24 OMB No. 0960-0229. APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (SSI) Note: Social Security Administration staff or others who help people apply for SSI will fill out this form for you. I am/We are applying for Supplemental Security Income
PART 1 - BASIC ELIGIBILITY - Answer the questions below beginning with the first moment of the filing date month. PART 2 - LIVING ARRANGEMENTS - The questions in this section refer to the signature date.
Form SSA-8000-BK, Application For Supplemental Security Income (SSI), is a legal document completed to apply for disability benefits through the SSI program. Fill out this document to provide the Social Security Administration (SSA) with information about your income and assets so that the SSA determines whether you qualify for SSI.
19 maj 2023 · Form SSA-8000-BK includes several questions about your citizenship status—whether you're a citizen of the United States or if you meet the criteria for non-citizens to receive SSI. The form also asks if you've ever left the country for 30 days or more and when that happened (if it did).
I am/We are applying for Supplemental Security Income and any federally administered state supplementation under Title XVI of the Social Security Act, for benefits under the other programs administered by the Social Security Administration, and where applicable, for medical assistance under Title XIX of the Social Security Act.
The SSA-8000: Application for Supplemental Security Income (SSI) is completed by an SSA claims representative either at a field office or on the phone. In some SOAR communities, case workers are trained to complete the SSA-8000 and submit the paper version to SSA.
The SSA-8000-BK is the primary paper application form to apply for SSI payments. The instructions in this section through SI 00604.130 use "claimant" and "applicant" as defined in GN 00201.005.
