
SOCIAL SECURITY ADMINISTRATION. APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (SSI) Form Approved OMB No. TEL Note: Social Security Administration staff or others who help people apply for SSI will fill out this form for you.

Title XVI of the Social Security Act , for benefits under the other programs administered by the Social Security Administration, and where applicable, for medical assistance under Title XIX of the Social Security Act. Was your entry into the United States sponsored by any person or promoted by an institution or group? A voluntary petition is filed without the debtors social security number being provided or.
Papers in electronic format shall be converted to PDF from the word processing. What is Social Security income statement? What qualifies as Social Security disability?
Apply Now for Social Security Disability. Fast, 1 Free Evaluation. Take Advantage of our $Trial and Credit Monitoring. Your Place of Birth (City and State or Foreign Country) 11.
Procedure for deferred development explanation Provide the claimant with the following explanations for deferred development claims only. Get Your New Card From Home Without Hassle. Not all forms are listed.
This form will be received and recorded by the Social Security Administration in the United States. The form is used to apply for SSI benefits, which can be given to someone who has a disability and thus has reduced income. This application is only for SSI ― not SSDI. Questions pertain to your citizenship, living situation, assets and income.
Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Supplemental Security Income (SSI) is a program administered by the Social Security Administration (SSA). We will use the information you provide on behalf of the minor child to determine his or her benefit eligibility.
Furnishing us the information is voluntary. It asks questions that are not included on the online application, including specific living arrangements, amount a claimant owns in assets and resources such as property, vehicles, lan and bank accounts, as well as household income. For an SSDI application, that form is SSA -16-BK.
SSA uses this form to obtain medical records. If disabled child is age or over, child must sign the 827). Consent for Release of Information. These are scanned images. THIS SAMPLE PACKET IS FOR A FICTIONAL APPLICANT NAMED ANNETTE FARNSWORTH, AND IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY.
No Installation Needed. Convert PDF to Editable Online. SSA may require the applicant to produce a copy of their birth certificate to verify their age. This is not required at the time of application, but may be needed prior to payment.
If SSA has seen and recorded the birth certificate on a prior occasion it may not need to be presented again. Check with the local SSA office. Refer to SSI Forms for a description of documents used. Send the completed SSI application packet to the local SSA District Office (SSADO) within calendar days of ABD cash approval.

The SSI program provides payments to blind or disabled children who live in households with low income and limited resources if they meet our strict definition of disability.
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