SI 00604: Completion of Form SSA-8000-BK, Application for Supplemental Security Income
TN 5 (03-12)
A. When to complete type of claim section
Complete the type of claim section for each application. At the beginning of the interview, decide whether the type of claim will be "Individual," "Individual with Ineligible Spouse," "Couple," "Child," or "Child with Parent(s)." Mark the appropriate block.
B. Individual block
If the claimant is one of the following, check "Individual"
Single; or
Married but separated from his or her spouse and "Couple" or “Individual with Ineligible Spouse" is not applicable.
C. Married claimants policy
The status of the claimant and the claimant's spouse as of the first moment of the filing date month helps determine the type of claim in most situations. To determine if a marital relationship exists, see SI 00501.150.
D. Individual with ineligible spouse block
If the spouse is not filing for Supplemental Security Income (SSI), do not complete the spouse's answer ("Your Spouse, if filing") for questions 6, 7-13, 15-16, 18, 19, 58 and 59.
Whether or not the spouse is filing, complete all other questions about the spouse.
Do not have the spouse sign the application.
E. Couple block
1. Claimant's spouse also filing
If the claimant's spouse is also filing for SSI, check the "Couple" block. Both should answer all questions as directed on the form. We have labeled the spouse's answer blocks either "Your Spouse" or "Your Spouse, if filing." If only one member of the couple is present at the interview, follow the guidelines below:
Step |
Action |
|---|---|
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1 |
Complete the application for the couple. |
|
2 |
Before the claimant, present at the interview, signs the completed application, photocopy it. |
|
3 |
Obtain the signature of the claimant present at the interview on the original application. |
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4 |
Write or date stamp the receipt date in the upper right-hand corner of the original application. |
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5 |
Explain to the claimant that the absent spouse needs to review, correct if necessary, and sign the photocopy of the application. Provide the appropriate SSI cover notice with the photocopy of the application, per SI 00601.040C.4 |
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6 |
Explain that the claimant or spouse should return the signed photocopied application to the field office. |
2. Claimant separates from a spouse who is also filing for SSI
For eligible couple determinations, see SI 00501.154 and SI 00501.155. Use the procedures in Steps 2-5 in SI 00604.010E.1 (in this section). Develop the living arrangements of the separated spouse in the "Remarks" section of the application or on a SSA-795 (Statement of Claimant or Other Person) and SSA-8006-F4 (Statement of Living Arrangements, In-Kind Support and Maintenance), if necessary.
3. Husband and wife have filing dates in the same month
Couples rules apply as of the first day of the month following the date they file the application if the couple meets specific criteria. (For couple computation rules, see SI 00501.154 Determining When Couple Computation Rules Apply and SI 00501.155 Couple Computation Rules for Applications Filed On or After August 22, 1996.)
4. Spouse is receiving SSI benefits or is in suspense status
Treat the new claimant, if eligible, as an eligible spouse:
Check the "Couple" block;
Retain a copy of the current SSI query in the file;
Explain in the "Remarks" section that the spouse already receives SSI payments (or is in suspense status); and
On the SSA-8000-BK Application for Supplemental Security Income, answer all questions as for a couple.
Only the new claimant should sign the application (not the spouse who already receives SSI). Obtain a redetermination from the spouse who is currently receiving benefits (For more information on an unscheduled redetermination, see SI 02305.022).
For establishing a start date, record whenever an ineligible spouse files an application, see MSOM MSSICS 007.003 Start Date Data and SM 01801.034 Selection of the Appropriate Start Date Month and Timing of T30/T33/SD Transmissions.
For MSSICS print options, see MSOM MSSICS 022.004.
NOTE: Complete the spouse's answer for questions 3 and 57 to obtain leads for SSI for the spouse and for other benefits for the claimant.
5. Child or child with parents
If the claimant meets the definition of child in SI 00501.010, check either "Child" or "Child with Parent(s).” Checking "Child with Parent(s)" means that:
Parent-to-child deeming may apply,
An SSA-8010-BK (Statement of Income and Resources) may be needed, and
We may need information about parents.
F. References
SI 00501.150 Determining Whether a Marital Relationship Exists, through SI 00501.155 Marital Relationship and Couple Computation Rules
SM 01005.010 Type of Claim