5063 Addendum to Supporting Statement

ADDENDUM TO SUPPORTING STATEMENT

SSA-L5063

STATEMENT ABOUT FOOD OR SHELTER PROVIDED TO ANOTHER

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Add the question, “When did you and the above individual establish the agreement that he/she will repay you for this food and/or shelter?” In most cases food and shelter provided as in-kind support and maintenance (ISM) is countable income for individuals applying for or receiving SSI benefits. If the ISM is provided as a bona fide loan, it is not countable income. To identify when the loan period begins, interviewers ask the date and write a statement on the form to document the date that the loan began. Adding the question does not increase the amount of information that we gather to determine SSI eligibility. The additional question will increase payment accuracy by reducing the instances in which the information is not obtained and will decrease current labor expenditures spent hand writing the statement on the form.

The form is a locally produced form. The Agency does not maintain this form in stock. The form will be issued in our Program Operations Manual System (POMS) with instructions to destroy prior editions that the field office may have.