Addendum to Supporting Statement

Addendum to Supporting Statement for Form

SSA-8203-BK

Statement for Determining Continuing Eligibility for Supplemental Security Income Payments

Revision to the Collection Instrument

Form SSA-8203-BK is being revised to update the obsolete fugitive felon question with the current DOJ approved version of the question and to update outdated language on three questions.

The outdated language changes are as follows:

1. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 replaced Title IV-A of the Social Security Act (SSACT) (which provided for AFDC) with cash block grants to States for Temporary Assistance for Needy Families (TANF). This legislation was effective October 1, 1996. Therefore, remove references to Aid to Families with Dependent Children (AFDC) and replace with updated reference to Temporary Assistance to Needy Families (TANF). Questions 8 and 15 reference both AFDC and TANF. The AFDC reference will be deleted.

2. Question 11 will be updated to delete reference to clothing as in kind and support. The question will be reworded as, “Since the date on page 1, did anyone give you gifts which are not cash?” Due to a change in the regulations, “clothing” was eliminated from the definition of ISM beginning 03/09/2005.

3. Questions 27 and 28 of the SSA-8203-BK will be revised to ask the following fugitive felon questions:

The new question 27 is:

Do you have any unsatisfied felony warrants for your arrest (Y/N)

In which state or country was the warrant issued?

Was the warrant satisfied (Y/N)

Date warrant satisfied

The new question 28 is:

Do you have any unsatisfied Federal or State warrants for violating the conditions of probation or parole? (Y/N)

In which state or country was the warrant issued?

Was the warrant satisfied? (Y/N)

Date warrant satisfied

The fugitive felon questions on the SSA-8202-BK (OMB No. 0960-0145) are also obsolete and SSA will be seeking changes to this form to include the updated, approved language.

Attached is a mock up of the proposed changes.

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