Explanation Change Sheet

Explanation Change Worksheet

SSA-8000 BK Application for Supplemental Security Income

OMB# 0960-0229

In the clearance package of Application for Supplemental Security Income (SSA-8000 BK), approved on March 5, 2004, we inadvertently inserted “if filing” in the Spouse column of several questions. This means that information about the spouse would only be answered if the spouse were also filing for SSI, which is incorrect. SSA always collects the spouse's information for those questions whether or not the spouse is filing.

• Delete “If filing” from the Spouse column in questions 37, 38, 41, 42, 45, 46, 48, 50 (e) and (h) and 51 and 52.

Because of the “go to instructions” on the paper application, question number 41 (c) may be erroneously skipped. Please change numbering for question 41 (a) through 41 (c) to the following:

• Change numbering of question 41 (a) that reads “Do you own, or does your name appear on (either alone or with any other person’s name) any of the following items?” to 41 (b)

• Change numbering of 41 (b) that reads “If all the items in #41 (a) are answered “NO”, Go to #42. For any “YES” answer, give the following information.” to 41 (c).

• If all the items in #41 (b) are answered “NO”, Go to #42.

• Move number of 41 (c) that reads “Do you give permission to obtain any of your financial records from any financial institution?” to 41 (a).

The Modernized SSI Claims System (MSSICS) correctly collects the information; the error is only on the paper application (approximately 97% of SSI claims are taken via MSSICS). The former version (5/90) of the paper application also correctly collected the spouse's information.

No other application questions were involved.