Addendum to the Supporting Statement for Form SSA-8508 BK
Minor Revisions to the Collection Instrument
SSA is making the following revisions:
We are revising the PRA statement to reflect our current boilerplate language. The current language, which dates back to the last reprint of the form, is now outdated.
SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.
Revisions to the Collection Instrument
Page #3 (Element 2-Verification Column)
Change: We are removing the “Allegation accepted. Age is not material.” from the Verification column.
Justification: We will prove age in each case.
Change: We are removing “Allegation of Citizenship by U.S. birth accepted.” from the verification column.
Justification: We will prove citizenship in each case.
Page #3 (Element 2-Conclusion Column)
Change: We are removing “Allegation of Age Accepted” from the conclusion column.
Justification: We will prove age in each case.
Page #13 (Element 6-Verification)
Change: We are removing the “VA” box from the verification column.
Justification: We will verify VA in each case.
Upon approval of these changes, SSA’s Forms Management Team will format the revised SSA-8508-BK to make sure it follows the agency’s formatting.
In this ICR, we are requesting clearance of a new electronic version of form SSA-8508-BK. The electronic version will be in Excel format. Interviewers will complete the electronic version (e8508) on Tablet PC’s which will:
Provide multiple iterations of a screen for a comprehensive view of the data provided by the recipient (e.g., Element 6/Living Arrangements allows the reviewer to document six living arrangement changes).
Provide drop down fields and copy functions (e.g., click on labels to copy data in the alleged column fields to the verified column fields if data is a match) to limit the need for typing.
Perform calculations, reducing mathematical errors.
Generate appropriate screens and propagate data (e.g., names and addresses) to subsequent screens based on answers provided by the respondents, thereby, eliminating unnecessary questions, or duplicating data.
Safeguard the respondent’s personally identifiable information.
Explanation of e8508 process
e8508 Start-Up Form screen [see e8508.pdf, page 1]
Systems Data column
These fields show propagated SSR data.
Case Review Information
Interviewer Name and Interview Date – Text input fields.
Type of Interview
Type of interview – Checkbox. Select Face-to-Face, Telephone, or NONE.
Death of SI Date or Death of ES Date – Text input fields. Input date(s) if applicable, otherwise, these fields remain blank.
SI Payee Involvement, Eligible Couple Case, or ES Payee Involvement - Select all checkboxes that apply.
First Day in Review Period – Text input field.
Retro Payment involved – Checkbox. Select, if applicable.
Navigation buttons
EXIT to exit the form
START navigates to the main menu
e8508 Main Menu screen [see e8508.pdf, page 2]
Click on the label to access the screen (sequential order not mandated).
UTC – Checkbox. Select if unable to complete the element.
Navigation button
START-UP FORM
Element 1, Proof of Identity/SSN (Face-to-Face interviews screen) [see e8508.pdf, page 3]
This screen is always in the path.
Systems Data shows propagated SSR Data.
My SSR/MSSICS Notes – Text input field.
MATCH column – YES/NO, drop down options. If YES, Systems Data propagates to the Interview column. If NO, input the new data to the interview column.
Evidence - Input free text or see attached for drop down options.
Proven – YES/NO, drop down options.
SSN Determination - See attached for drop down options.
Navigation buttons
MAIN MENU
SI Telephone ID Screen
SI Payee ID Screen
ES Payee ID Screen
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 1, Proof of Identity/SSN (Telephone interviews screen) [see e8508.pdf, pages 4-5]
This screen is visible for telephone interviews, or if proof of identity document is not available.
My SSR/MSSICS Notes – Text input field
Systems Data shows propagated SSR Data.
MATCH column – YES/NO, drop down options. If YES, Systems Data propagates to the Interview column. If NO, input the new information to the interview column.
Mother’s Maiden Name – Text input field.
OTH INFO – Text input field.
Navigation buttons
MAIN MENU
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
Element 1, Proof of Identity/SSN (Non-Organizational Payee for SI screen) [see e8508.pdf, page 6]
Access this screen from the Proof of Identity/SSN main screen by selecting SI Payee ID Screen navigation button. This screen is only required when the SI has a non-organizational payee.
Systems Data shows propagated SSR Data.
Type of Payee: - Checkbox. Select Non-Organizational Payee.
MATCH column – YES/NO, drop down options. If YES, Systems Data propagates to the Interview column. If NO, input the new information to the interview column.
OTHER INFORMATION – Text input field.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
ES Payee ID Screen
Element 1, Proof of Identity/SSN (Organizational Payee for SI screen) [see e8508.pdf, page 7]
Access this screen from the Proof of Identity/SSN main screen by selecting SI Payee ID Screen navigation button. This screen is only required when the SI has an organizational payee.
Systems Data shows propagated SSR Data.
Type of Payee: - Checkbox. Select Organizational Payee.
MATCH column – YES/NO, drop down options. If YES, Systems Data propagates to the Interview column. If NO, input the new information to the interview column.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
ES Payee ID Screen
Element 1, Proof of Identity/SSN (Non-Organizational Payee for ES screen) [see e8508.pdf, page 8]
Access this screen from the Proof of Identity/SSN main screen by selecting ES Payee ID Screen navigation button. This screen is only required if Eligible Couple Case is selected for Type of Interview in the start-up form screen, and the ES has a non-organizational payee.
Systems Data shows propagated SSR Data.
Type of Payee: - Checkbox. Select Non-Organizational Payee.
MATCH column – YES/NO, drop down options. If YES, Systems Data propagates to the Interview column. If NO, input the new information to the interview column.
OTHER INFORMATION – Text input field.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
ES Payee ID Screen
Element 1, Proof of Identity/SSN (Organizational Payee for ES screen) [see e8508.pdf, page 9]
Access this screen from the Proof of Identity/SSN main screen by selecting ES Payee ID Screen navigation button. This screen is only required if Eligible Couple Case is selected for Type of Interview in the start-up form screen and the ES has an organizational payee.
Systems Data shows propagated SSR Data.
Type of Payee: - Checkbox. Select Non-Organizational Payee.
MATCH column – YES/NO, drop down options. If YES, Systems Data propagates to the Interview column. If NO, input the new information to the interview column.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
ES Payee ID Screen
Element 2, Proof of AGE – US-BORN CITIZENSHIP screen [see e8508.pdf, pages 10-11]
This screen is always in the path.
Systems Data shows propagated SSR data.
Alleged column text input fields show information obtained during the interview.
Verified column text input fields and drop down options show verified information. See attached for drop down options or input free text.
DOB Determination for SI and ES - See attached for drop down options.
US-Born Citizenship Determination for SI and ES - See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE –select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 3, NATURALIZED CITIZEN/ALIEN STATUS screen (if applicable) [see e8508.pdf, pages 12-13]
This screen is visible if the interviewer selects the Foreign Born option from the Determination drop down in the Proof of Age – US-Born Citizenship screen.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Naturalized Citizen – Text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Alien Status - Text input fields and drop down options show information obtained during the interview. See attached for drop down options.
The tab for ES is visible only if the interviewer selects the Eligible Couple Case for Type of Interview in the start-up form screen.
SI and ES Determinations - See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE –select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 4, Continuous Residency in US screen [see e8508.pdf, pages 14-15]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Last date the SI was outside the U.S.? – Input date or see attached for drop down options.
Last date the ES was outside the U.S.? – Input date or see attached for drop down options. Note: ES will only display if the interviewer selects the Eligible Couple Case for Type of Interview in the start-up form screen.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
SI and ES Determinations - See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE –select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 5, Marriage screen [see e8508.pdf, page 16]
This screen is always in the path.
Systems Data shows propagated SSR data for the SM, IM, and BM fields. Spouse Name and SSN are text input fields. Holding Out field – See attached for drop down options.
My SSR/MSSICS Notes – Text input field.
Since MM/DD/YYYY was the SI married or living with an unrelated adult of the opposite sex? – YES/NO, drop down options.
Does the SI’s allegation match the SSR? – YES/NO, drop down options.
If not married or holding out, and allegation matches the SSR, complete only the Determination field.
If marriage or holding out exist, complete applicable drop down and text input fields for the event month. See attached for drop down options.
If Marriage or holding out exist, complete the Evidence, Issuing Entity, Place Issued, Document Number, Date Issued, Date Recorded and Event Date fields as applicable. See attached for drop down options.
Determination – See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (main screen) [see e8508.pdf, pages 17-22]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
SM Residence Address (propagated data) - If Match is YES, SM Residence Address data propagates to Current Residence Address field. If Match is NO, input new information to the Current Residence Address field.
SM Mailing Address (propagated data) – If Match is YES, SM Mailing Address data propagates to the Current Mailing Address field. If Match is NO, input new information to the SM Mailing Address field.
SM Telephone Number (propagated data) – If Match is YES, SM Telephone Number data propagates to the Current Telephone Number field. If Match is NO, input new information to the Current Telephone Number field.
Alternate Telephone Number – Text input field or see attached for drop down options.
Residence Address – Text input field.
Same as SM? – If YES, SM Residence Address data propagates to Residence Address field. If NO, input new information to the Residence Address field.
Residence Start Date – Text input field.
Are the SI and ES living in the same residence? –YES/NO, drop down options.
Residence Type – See attached for drop down options.
If Residence Type = 1 or 2, with whom does SI live? - See attached for drop down options.
Does the SI live in a state that offers Federally Administered Optional Supplementary Payments? –YES/NO, drop down options. If YES, Optional State Supplement screen will be visible in the path.
Six living arrangement iterations are available to document details for the SI/MI(s).
Navigation buttons
Tabs 1-6, on the left of the screen, provide space for multiple living arrangement changes. Each Tab represents a living arrangement path. Tabs will not be visible unless the Review Period LA Change screen shows a change occurred.
LA Navigator is visible only after completing a living arrangement path.
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Institution screen) [see e8508.pdf, pages 23-34]
This screen is visible if the interviewer selects the Residence Type (4) in the LA main screen.
Alleged column text input fields and drop down options show information obtained during the interview. Note: Alleged Residence data will propagate from the main screen.
Verified column text input fields and drop down options show verified information.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Non-Institutional Care screen) [see e8508.pdf, pages 35-40]
This screen is visible if the interviewer selects the Residence Type (3) in the LA main screen.
Alleged column text input fields and drop down options show information obtained during the interview. Note: Alleged Residence data will propagate from the main screen.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Home Ownership screen) [see e8508.pdf, pages 41-46]
This screen is visible if the interviewer selects Residence Type (1) in the LA main screen and LA Basis field (1) for the SI or (4) selects in the Household Composition screen.
Systems Data shows propagated SSR data.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Rental Liability screen) [see e8508.pdf, pages 47-58]
This screen is visible if the interviewer selects Residence Type (1) or (2) in the LA main screen and LA Basis (2) for the SI or (5) in the Household Composition screen.
Systems Data shows propagated SSR data.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Other Household LA Situations screen) [see e8508.pdf, pages 59-64]
This screen is visible if the interviewer selection Residence Type (1) in the LA main screen and LA Basis (1-5) is for someone other than the SI or deemor in the Household Composition screen.
Systems Data shows propagated SSR data.
Alleged column text input fields and drop down options show information obtained during the interview.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
HH Expenses Summary fields propagate with verified data from the Household Expenses screen.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
Go to HH Expenses – Ability to jump directly to Household Expenses or use NEXT to continue on the path
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Transient screen) [see e8508.pdf, pages 65-82]
This screen is visible if the interviewer selects Residence Type (5) in the LA main screen.
Systems Data shows propagated SSR data.
Has anyone provided the SI with Food or Shelter since mm/dd/yyyy? - If YES, complete the screen. If NO, select the NEXT navigation button to continue to the Review Period LA Change screen.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Household Composition screen) [see e8508.pdf, pages 83-88]
This screen is visible if the interviewer selects Residence Type (1) or (2) in the LA main screen.
Only the first line is visible with SI’s name propagated. To add additional household members, select the checkbox in the +/- column.
All PA Household – Checkbox. Select, if applicable. If selected, the Inside ISM section will hide in the In-Kind Support and Maintenance screen.
Text fields and drop down options show information obtained during the interview. See attached for drop down options.
Indicate who the Material Individuals are by selecting a name from the drop down. The drop downs consist of names identified as household members in the top section.
Total number of Ineligible Children is a numeric field.
Establish the IC button navigates to the Ineligible Children Names screen.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
Establish the IC
NEXT navigates to the next screen within an element or the first screen of the next element
Ineligible Children Names screen [see e8508.pdf, page 89]
This screen is visible if the Total number of Ineligible Children field shows a number greater than one in the Living Arrangement, Household Composition screen.
The drop downs consist of names identified as household members in the top section.
Select up to a maximum of five ineligible children.
Navigation button
CLOSE –closes screen and displays Household Composition screen
Element 6, Living Arrangement (LA) - (Household Expenses screen) [see e8508.pdf, pages 90-95]
This screen is visible if the interviewer selects Residence Type (1), (2), or (3) in the LA main screen.
Residence Address propagates from the LA main screen.
Averaging Period: - Text input field.
Alleged column text input fields and drop down options show verified information. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Evidence - Input free text or see attached for drop down options.
Navigation buttons
MAIN LA SCREEN
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Optional State Supplement screen) [see e8508.pdf, pages 96-101]
This screen is visible if the question, “Does the SI Live in a state that offers Federally Administered Optional Supplementary Payments?” is YES in the LA main screen.
Systems Data shows propagated SSR data.
Residence Address propagates from the LA main screen.
OSS development remarks – Text input field.
OSS code based on field review allegation – YES/NO, drop down options.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (In-Kind Support and Maintenance screen) [see e8508.pdf, pages 102-119]
This screen is visible if the interviewer selects Residence Type (1), (2), or (3) in the LA main screen.
Systems Data shows propagated SSR data.
Residence Address propagates from the LA main screen.
Infrequent or Irregular – Checkbox. Select, if applicable.
OUTSIDE ISM section
Does the SI/MI receive contributions from outside the household? – If YES, answer the next question.
Does contribution benefit the SI only? – If YES and the Household Composition screen indicate additional household members, ISM TO ONE PERSON section becomes visible. If NO, OUTSIDE ISM section becomes visible.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
INSIDE ISM section
The INSIDE ISM section is visible when the Household Composition screen indicates more than one household member, and there is no checkbox selection for the ALL PA Household.
Does contribution benefit the SI only? – If YES, ISM TO ONE PERSON section becomes visible. If NO, complete INSIDE ISM section only.
Household Members propagate from Household Composition screen
Amount Alleged and Amount Verified – Text input fields.
Evidence - Input free text or see attached for drop down options.
Total Contributions, Household Expenses, Excess Income, # of HH members, Pro-Rata Share, SI’s Contribution, Countable ISM Amount – Text input fields.
ISM TO ONE PERSON section
This section is completed only if the question,” Does contribution benefit the SI only?” is YES for either OUTSIDE ISM or INSIDE ISM sections.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Review Period LA Change screen) [see e8508.pdf, pages 121-126]
Residence Address propagates from the LA main screen.
Residence Type propagates from the LA main screen.
“Has the SI’s residence, household composition, or expenses, or ISM or PA status changed since mm/dd/yyyy?” - YES/NO, drop down options. If No, select the NEXT to navigate to the LA ISM Determination screen.
If Yes, date of change? – Text input field. Input date, and select NEXT to navigate to the LA Main screen.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
ADDR HISTORY navigates to Address History screen
NEXT navigates to the next screen within an element or the first screen of the next element
Element 6, Living Arrangement (LA) - (Address History screen) [see e8508.pdf, page 120]
Access this screen from the Review Period LA Change screen by selecting ADDR HISTORY navigation button or from the LA Main screen by selecting Address History from the LA Navigator.
This read only screen shows a summary of all living arrangement changes.
Navigation buttons
MAIN LA SCREEN
BACK navigates to the Review Period LA Change Screen
Element 6, Living Arrangement (LA) - (LA/ISM Determination screen) [see e8508.pdf, pages 127-135]
This is the last screen in the LA path.
Systems Data shows propagated SSR data.
Select a living arrangement iteration of NONE, 1, 2, 3, 4, 5, or 6 for each of the tabs (BM, IM, and SM). If the interviewer selects NONE, the Residence Date and Residence Address will remain blank for manual input. If the interviewer selects any of 1-6, the data for the iteration selected propagates to the Residence Date and Residence Address fields.
The interviewer completes the text input fields and drop downs based on field review findings.
SM FLA Determination - See attached for drop down options.
SM FLA ISM Determination - See attached for drop down options.
SM OSS Determination - See attached for drop down options.
Navigation buttons
MAIN LA SCREEN
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 7, Self-Employment (main screen) [see e8508.pdf, page 136]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Any Earned Income Exclusions Shown in SSR/MSSICS? – See attached for drop down options.
For the previous or current tax year, have the SI/MI/IC been self-employed? –YES/NO, drop down options.
Does the SI/MI/IC expect to be self-employed in the sample month’s taxable year? – YES/NO, drop down options.
If the answer to both questions is NO, complete the Determination only. See attached for drop down options.
Indicate who earned or expects to earn income from Self-Employment – Complete if the answer to any of the previous questions is YES. Select checkboxes based on interview responses.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s)/IC(s) identified in the case. Select the individual with discrepant information.
Determination - See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
List of ICs by Name navigates to the Ineligible Children Names screen
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 7, Self-Employment (detail screen) [see e8508.pdf, pages 137-144]
This screen is visible if any of the questions, “For the previous or current tax year, have the SI/MI/IC been self-employed?” or “Does the SI/MI/IC expect to be self-employed in the sample month’s taxable year?” is YES in the Self-Employment main screen, or if the Override checkbox is selected.
One screen is available for each individual identified in the case to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Was the SI a Student during the Review Period? – YES/NO, drop down options.
Total SEI - Column on the right propagates verified SM, IM, and BM SEI amounts for SI, MI-1 and MI-2
Navigation buttons
Tabs on the left (SI, MI-1, MI-2, IC-1 through IC-5) are visible only if individuals are identified in the Self- Employment main screen
BACK navigates to the first screen of the current element
STUDENT STATUS navigates to the Student Status screen
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the SI/MI Income Summary screen
NEXT navigates to the next screen within an element or the first screen of the next element
Element 8, Wages (main screen) [see e8508.pdf, pages 145]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Any Earned Income Exclusions Shown in SSR/MSSICS? – See attached for drop down options.
Have the SI/MI/IC earned wages since mm/dd/yyyy? – YES/NO, drop down options. If NO, only the Determination field is completed. If YES, the remaining fields are completed, and the Wages detail screen will be visible.
Indicate who earned or expects to earn wages – Complete if the answer to the previous questions is YES. Select checkboxes based on interview responses.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s)/IC(s) identified in the case. Select the individual with discrepant information.
Was the Telephone Wage Reporting in the SM? –YES/NO, drop down options for individuals who earned wages.
Was there Monthly Wage Reporting in the SM? –YES/NO, drop down options for individuals who earned wages.
Determination – See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
List of ICs by Name navigates to the Ineligible Children Names screen
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 8, Wages (detail screen) [see e8508.pdf, pages 146-164]
This screen is visible the interviewer selects the checkbox for the question, “Have the SI/MI/IC earned wages mm/dd/yyyy?” is YES in the Wages main screen, or the Override.
Two iterations are available for each of the SI and MI(s) to document details. One screen is available for each IC to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Infrequent or Irregular – Checkbox. Select, if applicable.
Was the SI a Student during the Review Period? – YES/NO, drop down options.
The Additional button is visible when Total Number of Employers alleged or verified exceeds two.
Verified Wage Details for Additional Employers – Input total Gross wage amounts and applicable Deductions/Exclusions amounts.
Total Gross Wages - Column on the right propagates verified SM, IM, and BM wage amounts for SI, MI-1 and MI-2.
Navigation buttons
Tabs on the left (SI, MI-1, MI-2, IC-1 through IC-5) are visible only if individuals are identified in the Wage main screen
BACK navigates to the first screen of the current element
STUDENT STATUS navigates to the Student Status screen
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the SI/MI Income Summary screen
NEXT navigates to the next screen within an element or the first screen of the next element
Student Information screen [see e8508.pdf, pages 165-172]
This screen is visible when the question, “Was the (SI, MI1-2, IC1-5) a Student during the Review Period?” is YES in either the Self-Employment or Wages screens.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Navigation button
List of ICs by Name navigates to the Ineligible Children Names screen
Element 9, Unearned Income (main screen) [see e8508.pdf, pages 173-175]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Any Earned Income Exclusions Shown in SSR/MSSICS? – See attached for drop down options.
Address each type of unearned income for the SI/MI/IC identified in the case as of mm/dd/yyyy - YES/NO, drop down options.
No to ALL checkbox propagates NO to all YES/NO, field for each unearned income item. If YES is selected for any unearned income drop downs, or the Override checkbox is selected, the Other Liquid Resources detail screen will be visible. If the interviewer selects the No to ALL checkbox, they complete only the Determination field.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s)/IC(s) identified in the case. Select the individual with discrepant information.
Determination - See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
List of ICs by Name navigates to the Ineligible Children Names screen
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 9, Unearned Income (detail screen) [see e8508.pdf, pages 176-197]
This screen is visible if YES is selected for any unearned income sources listed in the Unearned Income main screen, or the Override checkbox is selected.
Four iterations are available for each of the SI, MI(s), and IC(s) to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of UM Sources alleged or verified exceeds four.
Verified Additional Unearned Income Details – Input total additional unearned income amounts and applicable total additional Deductions/Exclusions amounts.
Total Gross UM - Column on the right propagates verified SM, IM, and BM unearned income amounts for SI, MI-1 and MI-2.
Navigation buttons
Tabs (SI, MI-1, MI-2, and IC-1 through IC-5) are visible if individuals are identified in the Unearned Income main screen
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
NEXT navigates to the next screen within an element or the first screen of the next element
Element 10, Financial Institution Accounts (main screen) [see e8508.pdf, page 198]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Address each of the categories listed below for the SI/MI/IC since mm/dd/yyyy – YES/NO, drop down options.
No to ALL checkbox propagates NO to all YES/NO, fields for each financial institution account. If the interviewer selects YES for any of the financial account drop down options, or the Override checkbox, the Financial Institution Accounts detail screen will be visible. If the interviewer selects No to ALL selection, complete only the question, since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away funds from any financial institution accounts?” and the Determination field.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s)/IC(s) identified in the case. Select the individual with discrepant information.
Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away funds from any financial institution accounts? – YES/NO, drop down options. YES will generate an alert in Element 18, Transfer of Resources.
Determination – See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 10, Financial Institution Accounts (detail screen) [see e8508.pdf, pages 199-213]
This screen is visible if YES is selected for any financial institution accounts listed in the Financial Institution Accounts main screen, or the Override checkbox is selected.
Four iterations are available for each of the SI and MI(s) to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Financial Accounts alleged or verified exceeds four.
Document alleged and verified information in text input boxes for all additional financial institution accounts. See attached for drop down options.
Total Financial Accounts - Column on the right propagates verified SM, IM, and BM financial account amounts for SI, MI-1 and MI-2.
Navigation buttons
Tabs (SI, MI-1, MI-2, and IC-1 through IC-5) are visible if individuals are identified in the Financial Institution Accounts detail screen
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
NEXT navigates to the next screen within an element or the first screen of the next element
Element 11, Other Liquid Resources (main screen) [see e8508.pdf, page 214]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Address each of the liquid resources listed below for the SI/MI/IC since mm/dd/yyyy – YES/NO, drop down options.
No to ALL checkbox propagates NO to all YES/NO, fields for each liquid resource. If the interviewer selects YES for any of the liquid resource drop downs, or the Override checkbox, the Other Liquid Resources detail screen will be visible. If the interviewer selects No to All, only complete the question, “Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away funds from any other liquid resources?”
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s)/IC(s) identified in the case. Select the individual with discrepant information.
Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away funds from any other liquid resources? – YES/NO, drop down options. YES will generate an alert in Element 18, Transfer of Resources.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 11, Other Liquid Resources (detail screens) [see e8508.pdf, pages 215-265]
The following screens are visible if YES is selected for a liquid resource listed in the Other Liquid Resources main screen, or the Override checkbox is selected.
Tabs on the left are visible based on YES responses in the Other Liquid Resources main screen.
Total Oth. Liquid Resources - Column on the right propagates verified SM, IM, and BM liquid resource amounts for SI, MI-1 and MI-2.
Patient Accts screen
One screen is available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Patient Accounts alleged or verified exceeds one.
Additional Patient Accounts – Input total countable values of all additional patient accounts for the SM, IM, and BM.
US Svg Bonds screen
Five iterations are available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of U.S. savings bonds alleged or verified exceeds five.
Additional U.S. Savings Bonds – Input total countable value amounts for all additional U.S. savings bonds for the SM, IM, and BM.
Promissory Notes screen
One screen is available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of promissory notes alleged or verified exceeds one.
Additional Promissory Notes – Input total countable value amounts for all additional promissory notes for the SM, IM, and BM.
Stocks screen
Two iterations are available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Stocks alleged or verified exceeds two.
Additional Stocks – Input total countable value amounts of all additional stocks for the SM, IM, and BM.
Bonds screen
Two iterations are available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Bonds alleged or verified exceeds two.
Additional Bonds – Input total countable value amounts of all additional bonds for the SM, IM, and BM.
Mutual Funds screen
One screen is available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Mutual Funds alleged or verified exceeds one.
Additional Mutual Funds – Input total countable value amounts of all additional mutual funds for the SM, IM, and BM.
Trusts screen
Two iterations are available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Trusts alleged or verified exceeds two.
Additional Trusts – Input total countable value amounts of all additional Trusts for the SM, IM, and BM.
Ret. Funds screen
One screen is available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Retirement Funds alleged or verified exceeds one.
Additional Trusts – Input total countable value amounts of all additional retirement funds for the SM, IM, and BM.
LIP Div. Accum. screen
Four iterations are available to document details for the SI and MI(s).
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Policies with Div. Accumulations alleged or verified exceeds four.
Additional Policies with Dividend Accumulations - Input total countable value amounts of all additional policies with dividend accumulations for the SM, IM, and BM.
Cash on Hand screen
Alleged column drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
View Summary navigates to the Income Summary screen
NEXT navigates to the next screen within an element or the first screen of the next element
Element 12, Non-Home Property (main screen) [see e8508.pdf, page 266]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – text input field.
Since mm/dd/yyyy have the SI/MI(s) owned or are they buying any non-home property? – YES/NO, drop down options. If the interviewer selects the YES or the Override checkbox, the Non-Home Property detail screen will be visible. If NO, complete only the question, “Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any non-home property?”
Record who owns or is buying non-home property. – Checkbox.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. A new row of the SI/MI(s) identified in the case is visible when the interviewer selects the Override checkbox. Select the individual with discrepant information.
Total number of properties – YES/NO, drop down options.
Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any non-home property? – YES/NO, drop down options. YES will generate an alert in Element 18, Transfer of Resources.
Check to display a list of possible non-home properties – Checkbox (optional reminder).
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 12, Non-Home Property (detail screen) [see e8508.pdf, pages 267-272]
This screen is visible if YES is selected for the question, “Since mm/dd/yyyy have the SI/MI(s) owned or are they buying any non-home property?” or the Override checkbox is selected.
Property Location - Text input field.
ID’d via Negative Property Search? – YES/NO, drop down options.
One screen is available for each of the SI and MI(s) to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Non-Home Properties alleged or verified exceeds one.
Additional Non-Home Properties - Input total verified countable amounts of all additional properties for the SM, IM, and BM.
Total Countable Amount - Column on the right propagates verified SM, IM, and BM countable non-home property amounts for SI, MI-1 and MI-2.
Navigation buttons
Tabs (SI, MI-1, MI-2) are visible only if individual is identified in the Non-Home Property main screen
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 13, Negative Property Search screen [see e8508.pdf, pages 273-275]
This screen is always in the path.
Jurisdiction(s) searched County/Parish/City – Text input field.
Jurisdiction(s) search ST – See attached for drop down options.
Name(s) searched – Text input field.
Copy To MI1 - Checkbox copies all fields from the SI screen to the MI1 screen except Name(s) searched.
Copy To MI2 – Checkbox copies all fields from the SI screen to the MI2 screen except Name(s) searched.
ALPHA LISTING – Text input field.
Contact Method – See attached for drop down options.
Name of Contact – Text input field.
Title of Contact – Text input field.
Date of Contact – Text input field.
Contact Information or Website – Text input field.
Determination – See attached for drop down options.
Record the number of properties found – Text input field.
Navigation buttons
Tabs (SI, MI-1, MI-2, and IC-1 through IC-5) are always visible
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 14, Vehicles (main screen) [see e8508.pdf, page 276]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Since mm/dd/yyyy have the SI/MI(s) owned or are they buying any vehicles? – YES/NO, drop down options. If the interviewer selects the YES or the Override checkbox, the Vehicles detail screen will be visible. If NO, complete only the question, “Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any vehicles?”
Record who owns or is buying vehicles – Checkbox.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s) identified in the case. Select the individual with discrepant information.
Total number of vehicles – See attached for drop down options.
Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any vehicles? – YES/NO, drop down options. YES will generate an alert in Element 18, Transfer of Resources.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 14, Vehicles (detail screen) [see e8508.pdf, pages 277-288]
This screen is visible if YES is selected for the question, “Since mm/dd/yyyy have the SI/MI(s) owned or are they buying any vehicles?” or the Override checkbox is selected.
Three iterations are available for each of the SI and MI(s) to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of vehicles alleged or verified exceeds three.
Additional Vehicles - Input total verified countable CMV amounts of all additional vehicles for the SM, IM, and BM.
Total Countable CMV - Column on the right propagates verified SM, IM, and BM countable vehicle values for SI, MI-1 and MI-2.
Navigation buttons
Tabs (SI, MI-1, MI-2, and IC-1 through IC-5) are always visible
BACK navigates to the first screen of the current element
Transfer of Resources
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 15, Life Insurance (main screen) [see e8508.pdf, page 289]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Since mm/dd/yyyy have the SI/MI(s) owned or are they buying any life insurance policies? – YES/NO, drop down options. If the interviewer selects the YES or the Override checkbox, the Life Insurance detail screen will be visible. If NO, complete only the question, “Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any life insurance policies?”
Record who owns or is buying life insurance policies – Checkbox.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s) identified in the case. Select the individual with discrepant information.
Total number of life insurance policies – See attached for drop down options.
Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any life insurance policies? – YES/NO, drop down options. YES will generate an alert in Element 18, Transfer of Resources.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 15, Life Insurance (detail screen) [see e8508.pdf, pages 290-298]
This screen is visible if YES is selected for the question, “Since mm/dd/yyyy have the SI/MI(s) owned or are they buying any life insurance policies?” or the Override checkbox is selected.
Four iterations are available for each of the SI and MI(s) to document details.
Complete Insurance Company and Contact Information fields based on leads or information obtained during the interview. Remaining text box fields and drop downs show verified information. See attached for drop down options.
The Additional button is visible when Total Number of LI Policies alleged or verified exceeds four.
All Additional LIPs are TERM – Checkbox.
Additional Life Insurance Policies - Input total amounts, for applicable fields, of all additional policies for the SM, IM, and BM.
Total CSV and Total FV - Column on the right propagates verified SM, IM, and BM CSV and FV values for SI, MI-1 and MI-2.
Navigation buttons
Tabs (SI, MI-1, MI-2) are always visible
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 16, Other Nonliquid Resources (main screen) [see e8508.pdf, page 299]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Have the SI/MI(s) acquired or held personal property because of value or as an investment since mm/dd/yyyy? – YES/NO, drop down options. If the interviewer selects the YES or the Override checkbox, the Other Nonliquid Resources screen will be visible. If NO, complete only the question, “Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any nonliquid resources?”
Record who owns or is buying nonliquid resources – Checkbox.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s) identified in the case. Select the individual with discrepant information.
Total number of nonliquid resources – See attached for drop down options.
Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any life insurance policies? – YES/NO, drop down options. YES will generate an alert in Element 18, Transfer of Resources.
Check to display a list of possible non-liquid resources - Checkbox (optional reminder).
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 16, Other Nonliquid Resources (detail screen) [see e8508.pdf, pages 300-305]
This screen is visible if YES is selected for the question, “Have the SI/MI(s) acquired or held personal property because of value or as an investment since mm/dd/yyyy?” or the Override checkbox is selected.
One screen is available for each of the SI and MI(s) to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Nonliquid Resources alleged or verified exceeds one.
Additional Nonliquid Resources - Input total verified countable amounts of all additional nonliquid resources for the SM, IM, and BM.
Total Nonliquid Resources - Column on the right propagates verified SM, IM, and BM countable nonliquid resource values for SI, MI-1 and MI-2.
Navigation buttons
Tabs (SI, MI-1, MI-2) are always visible
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 17, Burial Assets (main screen) [see e8508.pdf, page 306]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Since mm/dd/yyyy have the SI/MI(s) designated any assets for burial? – YES/NO, drop down options. If the interviewer selects the YES or the Override checkbox, the Other Burial Assets detail screen will be visible. If NO, complete only the question, “Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any assets previously set aside for burial?”
Record who owns or is buying burial assets – Checkbox.
Override preserves the original allegation and identifies when findings are discrepant with information alleged during the interview. Select the Override checkbox to activate a new row of the SI/MI(s) identified in the case. Select the individual with discrepant information.
Total number of properties – YES/NO, drop down options.
Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any non-home property? – YES/NO, drop down options. YES will generate an alert in Element 18, Transfer of Resources.
Check to display a list of possible burial assets – Checkbox (optional reminder).
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 17, Burial Assets (detail screen) [see e8508.pdf, pages 307-312]
This screen is visible if YES is selected for the question, “Since mm/dd/yyyy have the SI/MI(s) designated any assets for burial?” or the Override checkbox is selected.
Two iterations are available for each of the SI and MI(s) to document details.
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
The Additional button is visible when Total Number of Burial Assets alleged or verified exceeds two.
Additional Burial Assets - Input total verified countable amounts of all additional burial assets for the SM, IM, and BM.
Total Burial Assets - Column on the right propagates verified SM, IM, and BM countable burial asset values for SI, MI-1 and MI-2.
Navigation buttons
Tabs (SI, MI-1, MI-2) are always visible
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 18, Transfer of Resources screen [see e8508.pdf, pages 313-318]
This screen is visible when YES is selected for the question, “Since mm/dd/yyyy have the SI/MI(s) transferred, disposed of or given away any (Financial Accounts, Other Liquid Resources, Vehicles, Life Insurance policies, Burial Assets, or Other Nonliquid Resources)?” in previous Elements.
Transfers Indicated – Checkboxes will propagate to indicate which Elements show a transfer occurred.
One screen is available for each of the SI and MIs to document details
Alleged column text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Verified column text input fields and drop down options show verified information. See attached for drop down options.
Explanation of Transfer – Text input field.
Determination – See attached drop down options.
Did the uncompensated value cause ineligibility – YES/NO, drop down options.
Uncompensated Value – Text input field (if applicable).
Period of Ineligibility: - Input dates (if applicable).
The Additional button is visible when Total Number of Transfers alleged or verified exceeds one.
Additional Transfers - Document verified information in text input boxes for all additional transfers. See attached for drop down options.
Element 19, Summaries screen [see e8508.pdf, pages 319-325]
This screen is always in the path.
Tabs for Resources, SI/MI Income, and IC Income
Resource Tab
Resource Tab shows propagated verified SM, IM and BM Resource amounts for the SI and MI(s).
Determination – See attached for drop down options.
SI/MI Income Tab
SI/MI Income Tab shows propagated verified SM, IM, BM total gross income, and deductions/exclusion amounts for the SI, MI(s).
Caption from UM Exclusions/Deductions – Field propagates verified Deduction/Exclusions selected in the unearned income detail screen.
Earned Income Determination – See attached drop down options.
IC Income Tab
IC Income Tab shows propagated verified SM, IM, BM total gross income, and deductions/exclusion amounts for the IC(s).
Navigation buttons
MAIN MENU
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 20, Representative Payee (SI screen) [see e8508.pdf, page 326]
This screen is always in the path.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Is there an alleged or observed need for payee development? – YES/NO, drop down options.
If YES, indicate the need – Input text or select from the drop down options. See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 20, Representative Payee (ES screen) [see e8508.pdf, page 327]
This screen is visible if the interviewer selects the Eligible Couple Case for Type of Interview in the start-up form screen.
Systems Data shows propagated SSR data.
My SSR/MSSICS Notes – Text input field.
Is there an alleged or observed need for payee development? – YES/NO, drop down options.
If YES, indicate the need – Input text or select from the drop down options. See attached for drop down options.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 21, Death of Material Individual screen [see e8508.pdf, page 328]
This screen is always in the path.
My SSR/MSSICS Notes – Text input field.
Were there any MI(s) during the review period? – YES/NO, drop down options.
Did any MI (spouse, essential person, parent, spouse of parent, sponsor of alien, ineligible child, eligible child) die during the review period? – YES/NO, drop down options. If YES, complete text input fields or drop down options. If NO, continue to next element.
Determination – See attached for drop down options.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 22, Potential Entitlement (main screen) [see e8508.pdf, page 329]
This screen is always in the path.
My SSR/MSSICS Notes – Text input field.
Has the SI/Spouse/Former Spouse or Parent (if SI is filing as a Child) ever: - YES/NO, drop down options for each item. If YES to any, the corresponding detail screen will be visible. If NO to all, proceed to Title II Potential Entitlement.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 22, Potential Entitlement – Other Benefits (detail screens) [see e8508.pdf, pages 330-343]
These screens are visible if YES is selected for any question in the Potential Entitlement main screen.
Tabs for corresponding YES responses are visible (Military Service Screen, Labor Union, Federal Government, State/Local Government, Railroad, Social Security or foreign pension, or private employer).
Two iterations are available, within each tab, for each benefit to document details.
Text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
Go to T II
NEXT navigates to the next screen within an element or the first screen of the next element
Element 22, Potential Entitlement – Title II (detail screens) [see e8508.pdf, pages 344-358]
This screen is always in the path. Access this screen by selecting Title II Potential Entitlement from the Potential Entitlement main screen or selecting the Go to T II navigation button from the detail screens.
Systems Data shows propagated SSR data.
SI tabs are always visible. The ES tabs are visible if the interviewer selects the Eligible Couple Case for Type of Interview in the start-up screen.
Text input fields and drop down options show information obtained during the interview. See attached for drop down options.
Navigation buttons
BACK navigates to the first screen of the current element
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
NEXT navigates to the next screen within an element or the first screen of the next element
Element 23, Fraud [see e8508.pdf, page 359]
This screen is always in the path.
Is fraud suspected? – YES/NO, drop down options.
Reason – Text input field or select from the drop down options. See attached for drop down options.
Date Referred to OIG – Input date, if applicable.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
Element 24, Exclusions [see e8508.pdf, page 360]
This screen is always in the path.
Is this case excluded? – YES/NO, drop down options.
Reason – Text input field or select from the drop down options. See attached for drop down options.
Link to QR section – Links to section based on exclusion code selected in the Reason field.
Navigation buttons
MAIN MENU
PREVIOUS navigates to the first screen of the previous element in sequential order
ADD REMARKS opens text box. ADD REMARKS caption converts to SEE REMARKS after input
COMPLETE – Select checkbox when element is complete
NEXT navigates to the next screen within an element or the first screen of the next element
| File Type | application/msword |
| Author | 889123 |
| Last Modified By | 889123 |
| File Modified | 2011-06-07 |
| File Created | 2011-03-31 |