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

Statement of Income and Resources

SSA-8010-MSSICS Screens

Statement of Income and Resources

OMB: 0960-0124

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2.C-GNIDAFIP-


SCREEN FASCIMILE 1: AFIP


MSSICS FINANCIAL PERMISSIONS PAGE 1 OF AFIP

SSS-SS-SSSS SSSSS SSSSSSSSSSS


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:

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

DISPOSTION OF GOOD CAUSE: 9

1 = ESTABLISHED 2 = NOT ESTABLISHED 3 = PENDING


EVALUATION OF GOOD CAUSE REQUEST

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX


MORE(Y): X






File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCandace Hill
File Modified0000-00-00
File Created2021-01-23

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