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No. , P.O. Box, Rural Route) |  |  |  |  |  |  |  |\n|  | City and State (U. S. )/State/Province/Region (Foreign) |  |  |  | ZIP Code/Postal Code |  |  | County/Country |\n| 3. | Claimant's Residence Address (If different from applicant's mailing address) |  |  |  |  |  |  |  |\n|  | City and State (U. S. )/State/Province/Region (Foreign) |  |  |  | ZIP Code/Postal Code |  |  | County/Country |\n| 4. | DIRECT DEPOSIT PAYMENT INFORMATION (FINANCIAL INSTITUTION) |  |  |  |  |  |  |  |\n|  | Routing Transit Number | Account Number |  | Checking\u003Cbr>Savings |  |  |  Enroll in Direct Express |  |\n|  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  Direct Deposit Refused |  |\n|  |  |  | |  |  |  |  |  |\n\n\n| 5. | (a) Are you married? |  | YES Go to (b)  NO Go to \\#6 |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  | (b) Date of marriage: (MM/DD/YYYY) |  |  |  |  |  |  |  |\n|  | (c) Spouse's Name (First, middle initial, last) |  |  |  | Birthdate\u003Cbr>(MM/DD/YYYY) |  |  | Social Security Number |\n|  | (d) Did your spouse ever use any other names (including maiden name) or Social Security Numbers? |  |  | YES Go to (e)  NO Go to (f) |  |  |  |  |\n|  |  |  | |  |  |  |  |  |\n|  | (e) Other Name(s) |  | Other Social Security Number(s) Used |  |  |  |  |  |\n|  | (f) Are you and your spouse living together? |  | | YES Go to \\#6  NO Go to (g) |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |\n|  | (g) Date you began living apart : (MM/DD/YYYY) |  |  |  |  |  |  |  |\n|  | (h) Address of spouse or name of someone who knows where spouse is. (Complete only if spouse is age 65, blind or disabled.) |  |  |  |  |  |  |  |\n| 6. | (a) Have you had any other marriages?\u003Cbr>If never married, check this box  |  | You |  |  |  | Your Spouse, if filing  YES  NO Go to (b) Go to 6(c) |  |\n|  |  |  |  YES Go to (b) |  |  NO Go to 6(c) |  |","cbCaiu0d3grW36rr","https://ap.wps.com/l/cbCaiu0d3grW36rr","pdf",1097720,24,"English","# Part 1 - Basic Eligibility\n## Applicant identity and name history\n## Addresses and contact information\n## Direct deposit payment information\n## Marital status and spouse details\n## Additional eligibility questions","[{\"question\":\"What is this form used for?\",\"answer\":\"It is used to apply for Supplemental Security Income (SSI) under Title XVI, and for related federally administered state supplementation. It may also be used where applicable for medical assistance under Title XIX.\"},{\"question\":\"What information does the form request for basic eligibility?\",\"answer\":\"It requests identity details (including name history and Social Security numbers), mailing and residence addresses, and direct deposit payment information, along with answers to eligibility questions.\"},{\"question\":\"How does the form handle marital status questions?\",\"answer\":\"It asks whether you are married, the marriage date, spouse details, and whether you and your spouse live together. It also asks about prior marriages and, in some cases, about living arrangements and other individuals presenting as a married couple.\"}]","Form SSA-8000-BK - 6-2019 - Application for Supplemental Security Income (SSI) | PDF",1789837657,8]