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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.
Download the SSA-8000-BK Application for Supplemental Security Income (SSI) form in PDF or Word format. Fill it out online and save as a ready-to-print PDF. Army
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
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).
A Form SSA 8000 is known as an Application for Supplemental Security Income. This form will be received and recorded by the Social Security Administration in the United States. The form is used to apply for SSI benefits, which can be given to someone who has a disability and thus has reduced income. This is a long form that has over 60 questions.
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-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.
