SSA-8202 Revision Addendum

ADDENDUM TO SUPPORTING STATEMENT FOR FORM

SSA-8203-BK

STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS

20 CFR 416.204

OMB #0960-0416

Revision to the Collection Instrument

Form SSA-8203-BK is being revised to update several items:

• Update obsolete fugitive felon question with the current DOJ approved version of the question

• Update outdated language on three questions.

• Add Access to Financial Information question

The outdated language changes are as follows:

1. Remove references to Aid to Families with Dependent Children (AFDC) and replace with updated reference to Temporary Assistance to Needy Families (TANF). Questions 8 and 15 reference both AFDC and TANF. The AFDC reference will be deleted.

2. Questions 28 and 29 of the SSA-8203-BK will be revised to ask the following fugitive felon questions:

The new question 28 is:

Do you have any unsatisfied felony warrants for your arrest (Y/N)

In which state or country was the warrant issued?

Was the warrant satisfied (Y/N)

Date warrant satisfied

The new question 29 is:

Do you have any unsatisfied Federal or State warrants for violating the conditions of probation or parole? (Y/N)

In which state or country was the warrant issued?

Was the warrant satisfied? (Y/N)

Date warrant satisfied

3. In 2005, OMB approved language to incorporate section 213 of the Foster Care Independence Act of 1999.

Do you give us permission to obtain any of your financial records from any financial institution? You – Y/N Your Spouse – Y/N

Additionally, Section 213 of the Foster Care Independence Act of 1999 (P.L. 106-169) requires that SSA explain how we will use the permission and how long the permission lasts. Recognizing this, we are adding the below statement underneath the Privacy Act Statement of the SSA-8203-BK. This statement will be located after the Computer Matching Statement:

Access to Financial Information-We have asked you for permission to obtain, from any financial institution, any financial record about you that is held by the institution. We will ask financial institutions for this information whenever we think it is needed to decide if you are eligible or if you continue to be eligible for SSI benefits. Once authorized, our permission to contact financial institutions remains in effect until one of the following occurs: (1) you notify us in writing that you are canceling your permission, (2) your application for SSI is denied in a final decision, or (3) your eligibility for SSI terminates. If you do not give or cancel your permission you will not be eligible for SSI and we will deny your claim or stop your payments.

Attached is a mock up of the proposed changes.

2 2151801