Addendum to Supporting Statement

Addendum to the Supporting Statement for Form SSA-8001-BK

Application for Supplemental Security Income (SSI)

(Deferred or Abbreviated)

20 CFR 416.305 - 20 CFR 416.335, Subpart C

OMB No. 0960-0444

Revisions to the Collection Instrument

Below is a summary of changes for SSA-8001-BK. These revisions are to update minor changes in policy. There are no required changes for the Modernized Supplemental Security Income Claims System (MSSICS).

• Change 1: Page 5; Question #22(a), 22(b), and 22(c). We are removing the Probation and Parole Violation (PPV) questions.

Justification 1: The Clark v. Astrue Court Order prohibits the Social Security Administration from using probation or parole violation warrants to suspend or deny payments. Therefore, we should remove these questions to remain in compliance with the Clark Court Order.

• Change 2: We are adding in a new follow-up process, “iClaim/MSSICS,” for those SSI deferred applications that originate in iClaim but require SSA to collect additional information from the SSA-8001-BK in MSSICS.

Justification 2: We are adding a new functionality to iClaim (OMB No. 0960-0618) which will allow qualified individuals the ability to submit an online application for both Social Security and Supplemental Security Income (SSI) disability benefits. When an individual answers the disability benefit questions in iClaim, they will receive a question regarding their intent to file for SSI. For a qualified individual whose response is “yes,” iClaim will become an application for both Social Security and SSI disability benefits. The online SSI application will consist of questions that we currently ask in iClaim and are common to both the SSA-16 (Application for Disability Insurance Benefits) and SSA-8001-BK (Application for Supplemental Security Income) and an SSI household question, “Is everyone in your household receiving or applying for Supplemental Security Income” from the SSA‑8001‑BK. An iClaim disability application that also includes an SSI application will provide messages that contain information on filing an application for benefits under the Supplemental Nutrition Assistance Program (SNAP). The online SSI application responses will populate to the corresponding screens in the Modernized SSI Claims System (MSSICS) under OMB No. 0960-0444, creating an unsigned SSI deferred claim. Since there are some additional questions from the SSA-8001-BK which iClaim will not ask, we created the new “iClaim/MSSICS” process to collect the information iClaim missed during the initial claims request.

We will implement these revisions upon OMB’s approval for this information collection request.