Reporting Events - SSI

ACID - CLIENT IDENTIFICATION
MSSICS
CLIENT IDENTIFICATION
ACID
[1-O]
SSS-SS-SSSS
TRANSFER TO: XXXX
[2-M]
NAME: PPPPPPPPPPPPPPP PPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPP PPPP
[3-M]
[4-M]
SEX (M/F): P BIRTHDATE (MMDDCCYY): PPPPPPPP
[5-M]
[6-C]
BIRTHDATE PROOF: P
PROOF TYPE: P
A=ALLEGED OR N/A
P=PRE-AGE FIVE STATE/LOCAL PUBLIC
B=PRIMARY EVIDENCE
BIRTH CERTIFICATE
C=CONVINCING EVIDENCE
H=HOSPITAL BIRTH RECORD
F=DOB PREVIOUSLY ESTABLISHED N=NOTIFICATION OF BIRTH REGISTRATION
Q=DOB ESTABLISHED (OTHER)
O=OTHER EVIDENCE OF AGE
[7-M]
[8-C]
[9-C]
BIRTHPLACE CITY: PPPPPPPPPPPPPPP
STATE: PP OR COUNTRY: PP
[10-M]
OTHER NAMES USED OR SSNS PREVIOUSLY ISSUED/USED (Y/N): P
[11-M]
FILING, CLAIM PENDING, OR EVER ELIGIBLE FOR SSI SINCE 99/99/9999 (Y/N): P
[12-O]
MOTHER'S MAIDEN NAME: PPPPPPPPPPPPPPP PPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPP PPPP
[13-O]
FATHER'S NAME: PPPPPPPPPPPPPPP PPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPP
PPPP
[14-O]
[15-O]
DATE OF DEATH (MMDDCCYY): PPPPPPPP
REMOVE DEATH (Y): X
[16-O]
REMOVE DEATH SUSPENSE (Y): X
[17-O]
PROOF (Y/N): X
[18-O]
SOURCE OF NOTIFICATION: P 1=FO 2=EDR 3=MBR 4=TREASUR
[19-O]
REMARKS (Y): X

DISB - DISABILITY INFORMATION
TRANSFER TO: ______: XXXX
DISABILITY INFORMATION
DISB
NH SSSSSSSSS SSSSS SSSSSSSSSS
CL SSSSSSSSS SSSSS SSSSSSSSSS
[1-M]
DISABLING
CONDITION::XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
[2-M]
[3-C]
STILL DISABLED (Y/N):: X IF NO, DATE DISABILITY ENDED (MMYY): 9999
[4-M]
[5-M]
BLIND (Y/N):: X
FREEZE (Y/N):: X
[6-M]
AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION (Y/N)::: X
[7-M]
FILED OR INTEND TO FILE FOR:: 9 9 9 1. VA 2. WC/Public disability Benefits
3. NOT FILING
[8-M]
[9-C]
DISABILITY WORK RELATED (Y/N)::X REASON NOT FILING: XXXXXXXXXXXXXXXXXXXXXXXXXX
[10-M]
[11-C]
MONEY FROM EMPLOYER AFTER ONSET DATE (Y/N):: X
AMOUNT:: 99999999
[12-C]
TYPE: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
[13-M]
[14-C]
ADDITIONAL MONEY EXPECTED FROM EMPLOYER (Y/N):: X AMOUNT:: 99999999
[15-C]
TYPE: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
[16-M]
[17-C]
NUMBER OF CHILD CARE YRS:: 9 ACTUAL CHILD CARE YRS:: 99 99 99 99 99 99
IF PARENT RECEIVED 1/2 SUPPORT AT TIME OF ONSET OF DISABILITY COMPLETE:
[18-C]
NAME: XXXXXXXXXX X XXXXXXXXXXXXXXXXXXX
[19-C]
ADDRESS:
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
[20-C]
NAME: XXXXXXXXXX X XXXXXXXXXXXXXXXXXXX
[21-C]
ADDRESS:
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
FILED OR INTEND TO FILE FOR OTHER DISABILITY (Y/N):: S SPECIFY::SSSSSSSSSSSSSS

FFSCF

FUGITIVE FELON WARRANT MAIN MENU

FFMN

[1-M]
*FUGITIVE FELON SSN: 999999999
[2-M]
*WARRANT DATE (MMDDCCYY): 99999999
[3-M]
*ORIGINATING AGENCY INDICATOR: XXXXXXXXX
[4-M]
*SELECT THE DESIRED OPTION: 9 1=ESTABLISH 2=UPDATE 3=QUERY.
[5-M]
*SELECT THE DESIRED FUNCTION: 9
1=WARRANT INFORMATION
2=WARRANT PERSONAL INFORMATION
3=WARRANT DISPOSITION
4=WARRANT DUE PROCESS/GOOD CAUSE.

LCHG - LIVING ARRANGEMENT CHANGE
MSSICS
LIVING ARRANGEMENT CHANGE
LCHG
[1-D]
[2-O]
SSS-SS-SSSS SSSSS SSSSSSSSSS PERIOD BEGAN: SS/SS/SSSS TRANSFER
TO: XXXX
[3-M]
CHANGE IN LIVING ARRANGEMENT AND/OR RESIDENCE SITUATION SINCE
SS/SS/SS (Y/N): X
[4-C]
IF YES, DATE OF CHANGE (MMDDYY): 999999
[5-C]
IF NO, EXPECT CHANGE IN LIVING ARRANGEMENT AND/OR RESIDENCE (Y/N): X
[6-O]
SHOW LIVING ARRANGEMENT SUMMARY (Y/N): X

CRCS - RESOURCE CASE SUMMARY
MSSICS
RESOURCE CASE SUMMARY
PAGE X OF CRCS
SSS-SS-SSSS SSSSSSSSSSSSSSSS [5-D]
[1-O] [2-D] [3-D] [4-D]
ELIG/INEL [6-D]
[7-D]
[8-D]
DETAIL: FROM TO CLAIMAINT SPOUSE DEEMED TOTAL
EXCESS
(Y) MM/YY MM/YY RESOURCES RESOURCES RESOURCES RESOURCES
RESOURCES
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
SS/SS SS/SS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS SSSSSSSSS
[9-D]
MORE (Y): S

APAD - APPLICANT MAIL ADDRESS
MSSICS
APPLICANT MAIL ADDRESS
APAD
[1-O]
SSS-SS-SSSS SSSSS SSSSSSSSSS
TRANSFER TO: XXXX
[2-M]
ADDR: PPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPP
[3-M]
[4-C]
[5-C]
CITY: PPPPPPPPPPPPPPPPPPPPPP STATE: PP
ZIP: PPPPP
[6-C]
[7-C]
FOREIGN COUNTRY: PPPPPPPPPPPPPPPPPPPPPP POSTAL ZONE:
PPPPPPPPPPPPPPP
[8-C]
[9-C]
CONSULAR CODE: PPP
STATE/COUNTY CODE: PPPPPP
[10-O]
[11-O]
DOMESTIC PHONE NO: PPP PPP PPPP FOREIGN PHONE NO:
PPPPPPPPPPPPPPP
[12-O]
REMARKS (Y): X

IMEN - INCOME MENU (INDIVIDUALS)
MSSICS
INCOME MENU
PAGE 1 OF IMEN
[1-O]
SSS-SS-SSSS SSSSS SSSSSSSSSS
TRANSFER TO: XXXX
[2-M]
[3-D]
SINCE THE FIRST MOMENT OF SS/SS/SSSS, HAVE YOU RECEIVED OR EXPECT TO RECEIVE
INCOME IN THE NEXT 14 MONTHS FROM ANY OF THESE SOURCES:
Y/N
X
SSI
X
STATE OR LOCAL ASSISTANCE BASED ON NEED
X
REFUGEE CASH ASSISTANCE
X
AFDC
X
GENERAL ASST FROM BUREAU OF INDIAN AFFAIRS
X
DISASTER RELIEF
X
VA BASED ON NEED (PAID DIRECTLY OR INDIRECTLY AS A DEPENDENT)
X
* HAVE YOU RECEIVED ANY OTHER INCOME
X
SOCIAL SECURITY
X
* HAVE YOU RECEIVED AND EXPECT TO CONTINUE RECEIVING WITHOUT
INTERRUPTION THE PAYMENTS LISTED ABOVE
X
* DO YOU MAKE ANY SUPPORT PAYMENTS UNDER A COURT ORDER OR UNDER
TITLE IV-D
MSSICS

INCOME MENU
PAGE 2 OF IMEN
[1-O]
SSS-SS-SSSS SSSSS SSSSSSSSSS
TRANSFER TO: XXXX
[2-M]
[3-D]
SINCE THE FIRST MOMENT OF SS/01/SSSS, HAVE YOU RECEIVED OR EXPECT TO RECEIVE
INCOME IN THE NEXT 14 MONTHS FROM ANY OF THESE SOURCES:
Y/N
X
OTHER INCOME BASED ON NEED
X
BLACK LUNG
X
RAILROAD BOARD BENEFITS
X
VA PAYMENTS NOT BASED ON NEED (PAID DIRECTLY OR INDIRECTLY
AS A DEPENDENT)
X
OFFICE OF PERSONNEL MANAGEMENT
X
PENSION
X
UNEMPLOYMENT COMPENSATION
X
WORKERS' COMPENSATION
X
INTEREST
X
DIVIDENDS
X
ROYALTIES/HONORARIA (UNEARNED)
X
RENTAL/LEASE INCOME NOT FROM A TRADE OR BUSINESS
X
ALIMONY
MSSICS

INCOME MENU
[1-O]
SSS-SS-SSSS SSSSS SSSSSSSSSS

PAGE 3 OF IMEN
TRANSFER TO: XXXX

[2-M]
[3-D]
SINCE THE FIRST MOMENT OF SS/01/SSSS, HAVE YOU RECEIVED OR EXPECT TO RECEIVE

INCOME IN THE NEXT 14 MONTHS FROM ANY OF THESE SOURCES:
Y/N
X
CHILD SUPPORT
X
OTHER BUREAU OF INDIAN AFFAIRS INCOME
X
SICK PAY (EARNED)
X
SICK PAY (UNEARNED)
X
WAGES
X
SELF-EMPLOYMENT INCOME prior / current taxable year
X
OTHER INCOME OR SUPPORT NOT PREVIOUSLY MENTIONED
MSSICS

INCOME MENU

PAGE 4 OF IMEN

[1-O]
SSS-SS-SSSS SSSSS SSSSSSSSSS
TRANSFER TO: XXXX
(Y/N) ADDITIONAL DEVELOPMENT:
[4-O]
X PASS INPUT NEEDED
[5-O]
X SCHOOL INPUT NEEDED
[6-O]
X BLIND COUNTABLE INCOME INPUT NEEDED
[7-O]
X DISPLAY INCOME SUMMARY SCREEN
INCOME MENU (MULTIPLES)
MSSICS

INCOME MENU
PAGE _ OF IMEN
[1-0]
TRANSFER TO: XXXX

[8-M]
[3-D]
SINCE THE FIRST MOMENT OF SS/01/SSSS, HAVE ANY OF THE FOLLOWING PEOPLE
RECEIVED OR EXPECT TO RECEIVE INCOME IN THE NEXT 14 MONTHS FROM ANY OF THESE SOURCES:
[9-D]
01=(NAME RELATION SSSS) 04=(NAME RELATION SSSS) 07=(NAME RELATION SSSS)
02=(NAME RELATION SSSS) 05=(NAME RELATION SSSS) 08=(NAME RELATION SSSS)
03=(NAME RELATION SSSS) 06=(NAME RELATION SSSS) 09=(NAME RELATION SSSS)
(Y/N)
X
SSI
02: 03: 04: 05: 06: 07: 08: 09:
X
STATE OR LOCAL ASSISTANCE BASED NEED
01:
02: 03: 04: 05: 06: 07: 08: 09:
X
REFUGEE CASH ASSISTANCE
01:
02: 03: 04: 05 06: 07: 08: 09:
X
AFDC
01:
02: 03: 04: 05: 06: 07: 08: 09:
X
GENERAL ASST FROM BUREAU OF INDIAN AFFAIRS
01:
02: 03: 04: 05: 06: 07: 08: 09:
X
DISASTER RELIEF
01:
02: 03: 04: 05: 06: 07: 08: 09:
X
VA BASED ON NEED (PAID DIRECTLY OR INDIRECTLY AS A DEPENDENT)
01:
02: 03: 04: 05: 06: 07: 08: 09: