Application for Supplemental Security Income

SSA uses Form SSA-8001-BK to determine an applicant’s eligibility for SSI and SSI payment amounts. SSA employees also collect this information during interviews with members of the public who wish to file for SSI. SSA uses the information for two purposes: (1) to formally deny SSI for nonmedical reasons when information the applicant provides results in ineligibility; or (2) to establish a disability claim, but defer the complete development of non-medical issues until SSA approves the disability. The respondents are applicants for SSI payments. This is a non-substantive Change Request to make Form SSA-8001-BK in a fillable form.

The latest form for Application for Supplemental Security Income expires 2022-06-30 and can be found here.

Application for Supplemental Security Income - SSI Claims System/PCS Screens

Federal Enterprise Architecture: Income Security - General Retirement and Disability