Application for Supplemental Security Income (SSI)

The SSI program provides aged, blind, and disabled individuals who have little or no income with funds for food, clothing, and shelter. There are two ways respondents can apply for SSI. Individuals may obtain and complete the SSA-8000-BK application paper form, or via personal interview, during which the SSA employee will enter the applicant’s data directly into the SSI Claims System. SSA uses the information gathered to: (1) determine whether claimants meet all statutory and regulatory requirements for SSI eligibility; and (2) calculate SSI payment amounts. The respondents are SSI applicants or their authorized representative. This is a non-substantive Change Request to replace the current SSI Claims System screens with the new Person Information screens.

The latest form for Application for Supplemental Security Income (SSI) expires 2021-12-31 and can be found here.

Application for Supplemental Security Income--SSI Claims System/Signature Proxy and Preliminary Claims System (PCS)

Federal Enterprise Architecture: Income Security - General Retirement and Disability