Form SSA-8010 Statement of Income and Resources (Screens)

2.C-GNIDAFIPSCREEN FASCIMILE 1:
MSSICS
SSS-SS-SSSS

SSSSS

AFIP
FINANCIAL PERMISSIONS
SSSSSSSSSSS

PAGE 1 OF AFIP

PERMISSION TO CONTACT FINANCIAL INSTITUTIONS (Y/N): X
EFFECTIVE DATE (MMDDYY): 999999
EFFECTIVE END DATE (MMDDYY): 999999
IF NO, GOOD CAUSE ALLEGED (Y/N): X
IF YES, CLAIMANT’S STATEMENT EXPLAINING GOOD CAUSE:
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DISPOSTION OF GOOD CAUSE: 9
1 = ESTABLISHED
2 = NOT ESTABLISHED

3 = PENDING

EVALUATION OF GOOD CAUSE REQUEST
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MORE(Y): X