If you need more space in Part 7 - Remarks, use a signed form SSA-795.
Part 1: answer the questions beginning with the first moment of the filing date month.
Signature: sign in ink; the spouse signs only if applying for payments.
Witness: the application does not ordinarily have to be witnessed; if you have signed by mark (X), two witnesses who know you must sign.
Changes: failure to report any change within 10 days after the end of the month in which the change occurs could result in a penalty deduction.
| Question | Answer |
|---|---|
| Form Name | Form SSA-8000-BK |
| Form Length | 24 pages |
| Fillable? | Yes |
| Fillable fields | 1114 |
| Avg. time to fill out | 60+ min |
| Edition | Rev 09-2024 |
| Issuing agency | Social Security Administration |
| Other names | SSA-8000-BK, SSA 8000 BK, SSA-8000, Application for Supplemental Security Income, SSI application PDF |
| Official source | Form SSA-8000-BK (Rev 09-2024), Social Security Administration |
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