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USSSARev. 03-2023

Official form guide

Form SSA-8000-BK: Application for Supplemental Security Income (SSI)

Applies for Supplemental Security Income (SSI), a needs-based federal assistance program for people who are aged (65+), blind, or disabled, with limited income and resources.

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Form Overview

SSA Form SSA-8000-BK - Application for Supplemental Security Income (SSI)

Applies for Supplemental Security Income (SSI), a needs-based federal assistance program for people who are aged (65+), blind, or disabled, with limited income and resources.

An application for a monthly federal benefit to help cover basic living expenses like food, clothing, and shelter.

Risk Radar

Scan points
  • 1Not reporting all income and resources — SSA verifies through databases; unreported assets can result in overpayments.
  • 2Misunderstanding the resource limit ($2,000 for individuals, $3,000 for couples) — certain resources like your home and one car are excluded.
  • 3Not reporting changes in income or living situation promptly — failure to report changes can result in overpayments that must be repaid.

Plain English

SSI is a monthly payment for people with limited income and assets who are 65 or older, blind, or have a disability. This form starts your application.

Submission Date

  • Filing date: Apply as soon as you believe you may qualify. Benefits cannot be paid for months before your application month.
  • Preparation window: collect IDs, supporting records, and signatures in advance.
  • Final review: verify names, dates, and required fields before submission.

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Glossary Terms

paymentfederallivingincome

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Field map

Compact field-by-field guide

10 fields

Personal Info

4 items

Full Name

Your full legal name.

Requiredtext
Social Security Number

Your SSN.

Requiredssn
Date of Birth

Your date of birth.

Requireddate
Citizenship Status

U.S. citizen or qualifying non-citizen.

Requiredselect

Disability

1 items

Disabling Condition

Medical conditions preventing work (for disability applicants).

text

Financial

2 items

Monthly Income

All sources of monthly income (wages, Social Security, pensions, etc.).

Requiredamount
Resources

Cash, bank accounts, stocks, bonds, and other countable assets.

Requiredamount

Living

1 items

Living Arrangement

Where you live and who owns or rents the residence.

Requiredtext

Signature

2 items

Signature

Sign to certify accuracy of the application.

Requiredsignature
Date

Date signed.

Requireddate

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Quick Facts

People aged 65 or older, or those who are blind or disabled, with limited income and resources who are U.S. citizens or qualifying non-citizens.
An application for a monthly federal benefit to help cover basic living expenses like food, clothing, and shelter.
Apply as soon as you believe you may qualify. Benefits cannot be paid for months before your application month.
Apply online at ssa.gov, by phone (1-800-772-1213), or in person at your local SSA office.
SSI helps cover basic living costs for those who did not work enough to qualify for standard Social Security or whose benefits are very low.
Complete the application with your personal, financial, and medical information. SSA will verify all income, resources, and residency.

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Source transparency

Copyright & Licensing - US Government Forms

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Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Verify current license terms with the source agency before reuse outside this platform.

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