TN 5 (04-12)

A. General procedure for completing the SSA-8000-BK as an ABAP

Partially complete the SSA-8000-BK (Application for Supplemental Security Income (SSI)) only for the following situations:

1. You discover ineligibility after partially completing an SSA-8000-BK; or

2. You decide the SSA-8000-BK can better document the denial (e.g., deeming is involved); or

3. An SSA-8001-BK is unavailable at the time of the interview (e.g., contact station interview).

For information on ABAP and paper application forms, see SI 00602.001C.4.

B. Mandatory items to complete when using the SSA-8000-BK as an ABAP

Complete these items on the SSA-8000-BK as an ABAP:

• Write “ABAP” in the upper right-hand corner;

• Telephone (TEL) block, if appropriate;

• Date block;

• Preferred Language, if appropriate;

• Type of Claim;

• Questions 1, 2, 3, and 5 through 8 (including sub-items of these questions). Currently, the Modernized Supplemental Security Income Claims System (MSSICS) also requires answers to 18, 19, 20, 58, and 64;

• Items 40 through 50 and 56, if appropriate; and

• Tear-off page ("Receipt for Claim") portion per the instructions on completing the receipt for claim and changes to report tear off page in SI 00604.120. Discuss any pre-checked or unmarked item(s) that relate(s) to the reason for denial on the "Changes to Report" portion.

C. Additional items to complete when using the SSA-8000-BK as an ABAP

1. Paper Application

Complete any item(s) that pertain(s) to the allegation (or evidence presented) that causes ineligibility. If the reason for denial is:

a. Part II, Living Arrangements

Complete the questions in Part II that pertain to the living arrangement and in-kind support and maintenance issue(s) that cause ineligibility. Also, complete question 39. Document the file per the instructions on living arrangements and in-kind support and maintenance in SI 00835.000.

b. Resident of a Public Institution

Complete questions 21 and 22. Document the form per the instructions on institutionalization in SI 00520.000. An ABAP is not appropriate if the claimant meets the requirements for a prerelease case as explained in SI 00520.900.

c. Part III, Resources

Complete the questions in Part III that pertain to the allegation or evidence which causes ineligibility and question 48

d. Part IV, Income

Complete the items in Part IV pertaining to earned and unearned income as follows. For:

• unearned income only, complete questions 50 and 52.

• earned income only, complete questions 53, 54, and 55. Also, complete question 57 if filing as a child.

• unearned and earned income, complete all questions in Part IV.

2. MSSICS instruction for the ABAP

Select function #16, (New Claim/Abbreviated) from the SSI menu. Complete basic identification screens like:

• client identification (ACID),

• additional client data (ACLD),

• disability data (ADIB),

• mailing address (ADDR),

• residence address (LRES), and

• social security lead (BSSA).

The type of abbreviated denial selected on the SSI Claims Application (ACLM) determines which other screens are included in the path. Complete screens necessary to support the denial. Currently, for income denials, answer all questions on the income menu screen (IMEN). For resource denials, answer all questions on the resource menu screen (RMEN).

D. References

• SI 00604.002, Form SSA-8000-BK (Application for Supplemental Security Income (SSI): Exhibit

• MSOM MSSICS 008.003, SSI Claims Application (ACLM)