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.
Witnesses: if you have signed by mark (X), two witnesses to the signing who know you must sign below giving their full addresses.
Sponsor: may be liable for overpayments made to an alien that result from the sponsor's failure to provide correct information regarding deemable income and resources.
Signature: write in ink.
| Question | Answer |
|---|---|
| Form Name | Form SSA-8010-BK |
| Form Length | 11 pages |
| Fillable? | Yes |
| Fillable fields | 653 |
| Avg. time to fill out | 60+ min |
| Edition | 11-2025 |
| Issuing agency | Social Security Administration |
| Other names | SSA-8010-BK, SSA-8010, SSA 8010, SSA 8010 BK, Form 8010, Form SSA-8010-BK, Statement of Income and Resources |
| Official source | Form SSA-8010-BK (Rev 11-2025), Social Security Administration |
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