e8508

e8508 Drop-Down Lists For All ComboBox Controls On All Forms
NOTES:  All dropdown boxes are addressed;
 Yes/NO dropdown boxes are summarized as "All Others:" and not addressed individually;
 Dropdown boxes not addressed here, fall under "All Others:".
Element 1 (Proof of Identity/ SSN)
Pages 3-9
All Others:

Element 2 (POA/US-Born Citizenship)
Pages 10-11
All Others:

YES
NO
Page 3

YES
NO
DOB Evidence

Evidence (names)

Birth Certificate
U.S. Immigration Document
U.S. Naturalization Record

US Drivers' License
State-issued Non-driver ID Card
US Passport
Employee ID Card
School ID Card
US Military ID Card

Element 3 (Nat. Citizen/ Alien Status)
Pages 12, 13
Type of Evidence

Other - See Remarks

N-550 Certificate of Naturalization
N-570 Cert. of Naturalization (replacement of N-550)
N-560 Certificate of Citizenship (derived US citizenship through parent)
N-561 Certificate of Citizenship (replacement of N-560)
I-179 or I-197 U.S. Citizen ID card
I-873 Northern Mariana ID Card
US Passport
Other - See Remarks

POB Evidence
Alien Status

Birth Certificate

Type of Evidence

Other: Any picture ID

U.S. Immigration Document

Identified via Telephone ID Method

U.S. Naturalization Record

AR-3, AR-3a Alien Registration Card

Identified per QR 07020.200.A.3.d

Other - See Remarks

I-94 Arrival/Departure Record

Sample Individual and Eligible Spouse

Other - See Remarks

N-551 Permanent Resident Card

SSN Determination

US Passport

No SSN Discrepancy
Multiple SSNs found, payment not affected
SI Receiving SSI under incorrect/multiple SSN

DOB Determination
Age verified

Evidence (SSNs)

U.S. citizen, born outside U.S. (includes naturalized citizens)

Age is not material

Alien - except the Immigration Reform and Control Act of 1986 (IRCA) legalized aliens
Refugee

SSN Card
Medicare Card

SI Determination & ES Determination

Does not meet age requirement

US-Born Citizenship Determination

Systems Query

US-Born
Foreign-Born

Does not meet citizenship/alien requirements.
An alien who has been granted lawful temporary resident status as a result of the IRCA
An alien who has had his/her status adjusted to that of lawful permanent resident by the IRCA.
Other
Unknown

Element 4 (Residency)
Pages 14, 15

Element 5 (Marriage)
Page 16

All Others:
YES
NO
Last date the SI Was Outside the U.S.?
Never Outside U.S.

All Others:
YES
NO
Since mm/dd/yyyy was the SI married or living with an unrelated
adult of the opposite sex?

Type of Evidence

CHILD

Passport

YES, MARRIED

Ticket

YES, HOLDING OUT

Third-party statement

YES, NOT HOLDING OUT
NO

Method of Travel (for Alleged and Verified)
Airplane

The following are the same for the BM, IM and SM

Automobile
Bus

Event

Train

Marriage

Boat

Divorce
Annulment

Method of Payment (for Alleged and Verified)
Cash
Credit Card

Death
Separation
Holding Out

Check
N/A

Maiden Name
N/A

Source of Funds (for Alleged and Verified)
Self
Relative
Non-Relative
Organization

Evidence Type
Agrees with SSR
Marriage Certificate
Divorce Decree
Annulment Papers

SI Determination and ES Determination
No (was not out of the U.S.)
Yes, but not out long enough to affect eligibility
Yes, back long enough to be eligible in SM

Death Certificate
SSA-795
SSA-4178

Yes, not back long enough to be eligible in SM
Yes, still out of U.S. (as of first day of SM)

The following is the same for the BM, IM and SM

Unknown

Determination
Child
Not Married (Adult)/ Not Holding Out
Married Living with Spouse
Holding Out
Separated
Divorced
Widowed

Element 6 (Living Arrangements/ISM)
Pages 17-135
All Others:

Element 6 (Living Arrangements/ISM)
Pages 59-64
Evidence

YES
NO

SSA-795
SSA-5002

Pages 17-22
Alternate Telephone Number?
None

SI eats all meals out? (Verified)
SSA-795
SSA-5002

Other (see remarks)
Residence Type
1- House/Apartment/Mobile Home/Houseboat
2- Room

Element 6 (Living Arrangements/ISM)
Pages 96-101
OSS code based on field review allegation
YES
NO
Pages 102-119
Type of ISM (for Alleged and Verified)
Food
Shelter
Food and Shelter

If NO, buy food separate from household? (Verified)
Evidence (for all Dropdowns)

SSA-795

3- Non Institutional Care

SSA-5002

SSA-795

4- Institution

Other (see remarks)

SSA-5002

Other (see remarks)

5- Transient

SI/Deemor contribute toward household expenses? (Evide
If Residence Type = 1 or 2, with whom does the SI live?

SSA-795

Alone

SSA-5002

Other (see remarks)

Spouse, Parents and/or Children
Others

Type of contribution
Food
Shelter
Food and Shelter

SI's contribution Earmarked for Shelter (Evidence)
Pages 23-34

Pages 127-135
BM iteration (IM Iteration and SM Iteration are the same)

SSA-795

Type of Facility

SSA-5002

Other (see remarks)

Public
Private-profit
Private-nonprofit

1
2

SI's contribution Earmarked for Food (Evidence)

Penal

SSA-795

3
4

Medical care

SSA-5002

5

Non-medical care

Other (see remarks)

6
NONE

Publicly operated community res.
Public emergency shelter
Tax-exempt organization
Public educational/vocational/technical
Private educational/vocational/technical
Private Non-profit residential care
Proprietary for profit residential care
Educational or vocational training facility
Public correctional/holding facility
Other (see remarks)

Pages 65-82
Type of Assistance (for Alleged and Verified)
Food
Shelter
Food and Shelter

Basis for Federal LA
Child lives in household with parent, and is not subject to VTR
Earmarked sharing (food)
Earmarked sharing (shelter)
Educational or vocational training facility

If no, Reason
HEA/SMA
ABON
No Value

Free Shelter
Home ownership
Intervening A
Medical care

Type of Contact

Non-medical care

Evidence

Personal visit

PA household

Letter

SSA-795

Penal

Telephone

SSA-5002

Private nonprofit residential care

Other (see remarks)

Private-nonprofit

Pages 35-40
Type of Facility
Adult foster care
Child foster care
Assisted living facility
Other (see remarks)

Type of Contact

Private-profit

Pages 83-88
The first row in the LA Basis column
1
2
3
4
5

Proprietary for profit residential care
Public correctional/holding facility, other (see remarks)
Public emergency shelter, tax-exempt organization
Public or Private educational/vocational/technical
Publicly operated community residence
Rental liability (other than room rental)
Room rental (flat fee)

Personal visit
Letter
Telephone

Pages 41-46
Disposal Date (for Alleged and Verified)
Continuing

Room rental (not flat fee)

All other rows in the LA Basis column
1
2
3

Separate consumption
Separate purchase
Sharing
Transient
VTR applies

PA Income Type
FLA

SSI

Home Ownership Type?
Title
Fee Simple

VA-BON
TANF
BIA GA

A
B
C

Equitable ownership
Life estate

Refugee Act- BON
Disaster Relief

D
N02

Unprobated estate

No PA Income

N03

Trust

N22
N23

PA Income Proof
Evidence

Award Letter
Mortgage statement

Notice

Deed

Query

OSS
A

Tax assessment notice
Tax bill

B

Name

C
The list of names inside these dropdowns

Title search report
Other Documents (See Remarks)

Indicate who are the Material Individuals
Pages 47-58
Residence End Date (for Alleged and Verified)
Continuing

A list of names will be displayed here from
the names added above.

F
G
H
I

Page 89
Evidence of Rental Payment

D
E

All IC's
A list of Ineligible Children names will be
displayed here, from the names added on
Pages 83-89 (Household Composition).

Rent Receipt
Rental Agreement
Lease
SSA-795
SSA-5002

J
Y
Z

SM FLA Determination
No Error
LA Deficiency

Pages 90-95
Is anyone in the household related to the landlord or the
landlord's spouse as parent or child? (Verified)
No One in the HH is related to the Landlord
The SI is a Parent of the Landlord
The SI is the child of the Landlord
The Spouse or other HH member is a parent of the Landlord
The Spouse or other HH member is a child of the Landlord

Evidence
Bill
Receipt
SSA-795
SSA-5002
Estimate
Does the SI have a loan agreement regarding HH

Type

SSA-795
Rent
Room Rental
Flat Fee

SSA-2854
SSA-5062
SSA-L5063

SM FLA ISM Determination
No Error
ISM Deficiency
SM OSS Determination
No Error
OSS Deficiency

Element 7 (Self Employment)
Pages 136-144
All Others:

Element 9 (Unearned Income)
Pages 173-197
All Others:

YES
NO

Element 10 (Financial Accounts)
Pages 198-213
All Others:

YES
NO
Page 136

Determination

YES
NO
Pages 173-175

Determination

Pages 198
Determination

No SEI Payment Error

No UM Error

Total countable funds in account(s) did not cause a payment error

SEI Payment Error
Deemed SEI Payment Error

UM Error
Deemed UM Error

Total countable funds in account(s) caused a payment error

Pages 199-213
Pages 137-144
Evidence

Pages 176-197
Unearned Income Type (SI Only)

Account Type
Checking

DEQY

None

Savings

Federal Tax Return

VA Pension

Money Market

Business Records

VA Compensation

Certificate of Deposit

Individual's Signed Allegation

Railroad Retirement

Holiday Club Account

Govt. Pension
Black Lung
State Disability Payments

Element 8 (Wages)
Pages 144-164
All Others:
YES
NO

Transacts Business

Evidence

Foster Care

SSA-e4641

Energy Assistance

SSA-4641

Unemployment Compensation

Evidence In Individual's Possession

Workers' Compensation
Sick Pay
Educational Assistance

Determination

Element 11 (Other Liquid Resources)
Pages 214-266

Dividends/Royalties

No Wage Payment Error

Rental Income

Wage Payment Error

Interest

Deemed Wage Payment Error

Gifts

All Others:
YES
NO

Loan Proceeds
Support from an absent parent

Frequency

Pages 215, 232, 249

Other CASH support
Weekly

Gambling income

Bi-Weekly
Monthly

Miscellaneous
Accelerated Life Ins. Payments

Evidence
Facility Records
SSA-5002

Semi-Monthly

Unearned Income Type (All Others)

Bi-Monthly

Pages 214-253
Series

Quarterly

None

Semi-Annually

TXVI

E

Annually

TII

EE

VA Pension

I

VA Compensation

H

Evidence
Paystubs

Railroad Retirement

SSA-L4201

Govt. Pension

Wage Verification Company

Black Lung

HH

Other Documents (See Remarks)

State Disability Payments

Paper Bond

Foster Care

Electronic Bond

Type (Paper/ Electronic)

Energy Assistance

Pages 216-257

Unemployment Compensation

Student Information
Pages 165-172

Workers' Compensation
Sick Pay

Dates of Attendance
Continuing

Evidence

Ownership
Sole Ownership

Educational Assistance

Co-Ownership

Dividends/Royalties

Beneficiary Registration

Rental Income

No Ownership

Interest

Pages 223-258

School Record
Home School Documentation

Gifts
Loan Proceeds

SSA-5002
SSA-795

Support from an absent parent
Other CASH support

Municipal
Corporate

Gambling income

Government

Student exclusion applies?
YES
NO

Type

Miscellaneous
Accelerated Life Ins. Payments

Page 227-243-261
Date Terminated

Date Ended

Continuing
Continuing

Pages 204-253
Evidence

Frequency
Weekly

SSA-795

Bi-Weekly

SSA-5002

Monthly

Other Documents (See Remarks)

Semi-Monthly
Bi-Monthly
Quarterly
Semi-Annually
Annually

Evidence
Verified by SSR
Verified by award letter
SSA-795
SSA-5002

Deductions / Exclusions
No UM Exclusion
Federal Laws
Public Agency refund of taxes
State/local assistance based on need
Educ. Grant for Tuition/Fees/Other Expenses
Payment for providing foster care
One-third of support payments from absent parent
Amount to fulfill a PASS
Disaster Assistance
Home Energy or Support/Maintenance Assistance
Dividends, Interest, Royalties
Dividends, Interest Excluded per P.L. 108-203
Gifts
Payments Based On Age & Residence
Court-ordered Payments
PASS

Element 12 (Non-Home Property)
Pages 267-272
All Others:

Element 13 (Negative Property Search)
Pages 273-275
Contact Method

YES
NO

YES
NO

Personal visit
Letter
Telephone
Internet

Pages 267-271
Type of Property
Farm Land rented)

Element 14 (Vehicles)
Pages 276-288
All Others:

Pages 277-288
Make

ST

ACURA

Farm Land (used by SI/MI)
Commercial (Non-Farm) rented

AL
AK

AUDI
BMW

Residential Property
Unimproved Land, idle

AS
AZ

BUICK
CADILLAC

Foreign Property

AR

CHEVROLET

Livestock

CA

CHEVROLET TRUCK

Machinery

CO

CHRYSLER

Mineral Rights

CT

DODGE

Water Rights

DE

DODGE TRUCK

Timber Rights

DC

FIAT

FM
FL

FORD
FORD TRUCK

Individual is the sole owner (non-life estate)

GA

GMC

Jointly owned with spouse

GU

HONDA

Jointly owned with a non-relative

HI

HUMMER

Unprobated estate

ID

HYUNDAI

Jointly owned with a relative (non-spouse)
Life estate

IL
IN

INFINITY
ISUZU

IA

JAGUAR

Type of Ownership

Evidence of Ownership

KS

JEEP

Mortgage statement
Deed

KY

KIA

LA

LAND ROVER

Tax assessment notice

ME

LEXUS

Tax bill

MH

LINCOLN

Title search report

MD

MAZDA

Other Documents (See Remarks)

MA

MERCEDES-BENZ

MI
MN

MERCURY
MINI

SSA-795

MS

MITSUBISHI

SSA-5002

MO

NISSAN

Other Documents (See Remarks)

MT

OLDSMOBILE

NE

PONTIAC

NV

PORSCHE

SSA-795

NH

SAAB

SSA-5002

NJ

SATURN

Other Documents (See Remarks)

NM

SUBARU

NY

TOYOTA

NC

VOLKSWAGEN

Evidence of CMV

Evidence

Reason for exclusion
Jointly owned property that cannot be sold without undue hardship

ND

Reasonable efforts to sell are unsuccessful

MP

Restricted Indian land

OH

VOLVO

Legal bar to selling property

OK

Transportation

OR
PW

Business
Junk

Use

PA
PR

Condition

RI

Excellent

SC

Good

SD
TN

Fair
Poor

TX
UT

Evidence of Ownership

VT

Allegation

VI
VA
WA

Title
Registration
Bill of Sale

WV
WI
WY
Determination

Evidence of CMV
SSA-795
SSA-5002
Other Documents (See Remarks)

No ownership alleged
Ownership alleged (see element 12)
Special review procedures (see element 12)

Reason for Exclusion
Exclusion of 1 vehicle, regardless of value
Property essential to self-support
Plan to achieve self-support
Conditional benefits apply
Type of Vehicle
Car
Truck
Boat
Airplane
Other (See Remarks)

Element 15 (Life Insurance)
Pages 289-298
All Others:

Element 17 (Burial Assets)
Pages 306-312
All Others:

YES
NO

YES
NO
Pages 290-298

Method of Discovery

Pages 307-312
Type of Burial Asset

Contact with insurance company

Burial Contracts

Identified prior to contact with LICO.

Burial Trusts
Cemetery Lot

Disposal Date
Continuing
Type of Policy

Urn

Deemed Earned Income Payment Error

Term Life
Universal Life
Variable Life

Element 18 (Transfer of Resources)
Pages 313-318
Policy Viewed

All Others:
YES
NO

Collateral Contact
Combined

Pages 314-318
Type of Resource
Element 16 (Other Non-Liquid Resources)
Pages 299-305
All Others:
YES
NO

Checking
Savings
Vehicles
Life Insurance Policy
Burial Asssets
Real Property

Pages 300-305

Patient Account

Type of Resource

Savings Bonds

NONE
Antiques

Promissory Note
Stocks

Art work

Bonds

Collectibles

Mutual Funds

Fine China

Trusts

Furs

Retirement (401k)

Gold Items

Cash

Heirlooms
Jewelry

Type of Transfer

Oriental rugs

Sale of property;

Silver Items

Trade or exchange
Spend-down of cash;

Evidence of Ownership

Giving away cash;

SSA-795

Transferring any financial instrument

SSA-5002

Giving away property

Other Documents (See Remarks)

Evidence
Evidence of CMV

Bills of Sale

SSA-795

SSA-795

SSA-5002

SSA-5002

Other Documents (See Remarks)

Page 323
Earned Income Determination
No Earned Income Payment Error
Earned Income Payment Error

Marker

Evidence

Resources DID NOT Cause Ineligibility- No Resources are Deemed
Resources DID NOT Cause Ineligibility- Resources are Deemed
SI's Resources Alone Caused Ineligibility
Deemed Resources Alone Caused Ineligibility
Combined Resources Caused Ineligibility

Crypt
Casket
Headstone

Whole Life

Element 19 (Summaries)
Page 321
Determination

Other Documents (See Remarks)

Determination
Valid Transfer-No Countable Resources
Invalid Transfer- Countable Resources
Uncompensated Value

Element 20 (Representative Payee)
Page 326-327
If yes, indicate the need

Element 22 (Potential Entitlement)
Pages 329-358
All Others:

SI’s mental/physical condition renders him incapable of handling benefits
SI medically determined to be a drug addict or alcoholic
SI is a child under 18 (not used if married or head of household)
SI has indicated a preference for a payee change
Payee has indicated a preference for a change or unwillingness to continue as payee
Payee has been misusing or misappropriating the SI’s payment
Payee’s mental/physical condition renders him incapable of handling benefits
Death of payee
Unable to locate payee
Payee refuses to cooperate

Is there an alleged or observed need for payee development?
YES
NO

Element 21 (Death of Material Individual)
Page 328
All Others:
YES
NO
Name

YES
NO
Pages 330-331
Person with Military service
List of names from Household Composition screen (Pgs 71-76)
Branch Of Service
ARMY
AIR FORCE
NAVY
MARINES
Pages 332-333
Union Member
List of names from Household Composition screen (Pgs 71-76)
Pages 334-335
Federal Employee
List of names from Household Composition screen (Pgs 71-76)
Pages 336-337
State/Local Employee
List of names from Household Composition screen (Pgs 71-76)

List of names from Household Composition screen (Pgs 71-76)
Relationship
Eligible Spouse

Pages 338-339
Railroad Employee
List of names from Household Composition screen (Pgs 71-76)

Ineligible Spouse
Father
Mother
Alien Sponsor/Spouse

Pages 340-341
Foreign Employee
List of names from Household Composition screen (Pgs 71-76)

Ineligible Child
Essential Person
Eligible Child

Pages 342-343
Employee
List of names from Household Composition screen (Pgs 71-76)

Evidence
Pages 330-343

Form SSA 704 (Certification of consent of document on record)
Form SSA 721 (Statement of Death from a Funeral Director)

Relationship to SI

Data on Numident (Based on an Electronic Death Registration report)

Eligible Spouse

Certified Death Certificate (Primary Evidence)

Ineligible Spouse
Father
Mother
Alien Sponsor/Spouse
Ineligible Child
Essential Person
Eligible Child

Pages 344-358
Has the SI ever applied for…
Receiving
Pending
Never Applied
Denied

Parent/Grandparent…
Parent
Grandparent
None

Element 23 (Fraud)
Page 359

Element 24 (Exclusions)
Page 360

Is fraud suspected?
YES
NO

Is this case excluded?
YES
NO

Reason

Reason for exclusion
False statements / misrepresentations made in applying for benefits
Failure to disclose facts affecting eligibility

Code 01 - Death of the SI During or After SM
Code 02 - All payments in Sample Period Totally Offset by Title II

Criminal misuse of benefits by the representative payee
Charging of unauthorized fees to applicants, prospective applicants or recipients

Code 03 - Fraud Investigation Intiated Before SI Interview
Code 04 - SI Contacted for Another SSA Program Review Within 12 Months

Excessive fee charging by a nonqualified individual or organization
Deception, threats, or misleading information provided by anyone connected with the application/receipt of SSI benefits

Code 05 - Appeal Pending
Code 06 - SI Contacted for FR Within 12 Months

Employee collusion or conspiracy with a recipient to receive payments

Code 08 - All Payments Issued In the Sample Period Were Title VIII

Manipulation of systems to illegally obtain benefits

Code 09 - Death of SI Prior to SM and Sample Period Checks Retd Timely

Theft or forgery of checks

Code 10 - All payments in Sample Period are Returned

Attempts to bribe an SSA employee

Code 11 - SI Ineligible for SSI; SI Eligible for Medicaid Under Special Deeming

Impersonation of Federal employee

Code 12 - SI Ineligible for SSI: SI Eligible for Medicaid Under 1619(b)

Unauthorized disclosure of confidential information

Code 47 - Katrina/Rita Exclusion
Code 48 - Case Not to Be Reviewed on CO Request
Code 49 - Other Reasons for Not Reviewing CaseI
Code 51 - UTL SI or Payee; Special Procedures Unproductive
Code 52 - UTL Collateral Source; Special Procedures Unproductive
Code 53 - SI Refusal to Cooperate; PS C01 or Force > $0
Code 54 - SI Refusal to Cooperate; Not PS C01 or Force = $0
Code 55 - Collateral Source Refuses to Cooperate
Code 56 - SI Unable to Respond to Interview
Code 57 - Fraud Suspected During FR (OQP Referral to OIG)
Code 60 - Potentially Unsafe or Threatening Situation
Code 63 - SI Outside the U.S. - Special Procedures Unproductive
Code 70 - Unable to Establish Identity
Code 80 - Information Cannot be Obtained From a Participating FII
Code 98 - Interim Exclusion at CO Request
Code 99 - Other FR Exclusions (After SI Interview)