Block 001 – Social Security Number
Block 002 – Name
Block 003 – Date of Birth
Note: Blocks 004 – 010 are addressed in article IMS: State Data Exchange (SDX) Payment Status Codes.
Block 011 Source File
Block 012 – Recipient type
- AI
- – Aged Individual
- AS
- – Aged Spouse
- BI
- – Blind Individual
- BS
- – Blind Spouse
- BC
- – Blind Child
- DI
- – Disabled Individual
- DS
- – Disabled Spouse
- DC
- – Disabled Child
- EP
- – Essential Person
Block 013 – SSI Application Date
Block 014 – Living arrangements
- A
- – Own Household
- B
- – Another’s Household
- C
- – Parent’s Household (Child Cases Only)
- D
- – Title XIX Institution
- Blank
- – Individual is in a non-title institution, living arrangement change in progress or outside U.S.
Block 015 – Over/Underpayment indicator
- O
- – Overpayment
- U
- – Underpayment
- B
- – Both overpayment and underpayment exist
Block 016 Earned Income
Block 017 Deemed Income
Block 018 – Direct deposit indicator
- C
- – Checking
- S
- – Savings
Block 019 Payee Name and Mailing Address
Block 020 Competency Code
- A
- Recipient is competent and payee legal guardian
- B
- Recipient is competent and there is no legal guardian
- C
- Recipient is competent and legal guardian
Block 021 Type of Payee
- SEL or Blank
- Recipient if own payee
- SPO
- Spouse
- FTH
- Natural or adoptive father
- MTH
- Natural or adoptive mother
- STF
- Stepfather
- STM
- Stepmother
- GPR
- Grandparent
- CHD
- Natural, adoptive or stepchild
- REL
- Other relative
- FDO
- Federal nonmental institution
- FDM
- Federal mental institution
- SLO
- State/local nonmental institution
- SLM
- State/local mental institution
- PRO
- Proprietary nonmental institution
- PRM
- Proprietary mental institution
- NPO
- Nonprofit nonmental institution
- NPM
- Nonprofit mental institution
- FIN
- Financial organization
- AGY
- Social agency
- OFF
- Public official
- OTH
- Other
- PYE
- Recipient previously had payee, but is now receiving direct payment
- ESP
- Essential person is payee
Block 022 – Rep Payee Date
Block 023 – Marital status
- 1
- – Married and living with (ceremonial marriage, common law marriage or De Facto marriage)
- 3
- – Single, Widowed or Divorced
- 4
- – Married and Separated
Block 024 – Zebley Ind
- Z
- Zebley Class Member
- F
- Disability claim allowed
- D
- Disability claim denied
Note: Blocks 025 – 029 are addressed in article IMS: State Data Exchange (SDX) Resource Codes
Block 030 – Record Processing Date
Block 031 – Record ID Code
- I
- Individual
- C
- Couple (Eligible individual with eligible spouse)
- M
- Child claim with mother
- F
- Child claim with father
- P
- Child claim with parents
Block 032 – Denial Code
Block 033 – Denial Date
Block 034 – Appeal code Level of Appeal and Latest Action
- A
- – Request filed (reconsideration)
- B
- – Request, dismissed or withdrawn (reconsideration)
- C
- – Affirmation of prior decision (reconsideration)
- D
- – Reversal or modification of prior decision (reconsideration)
- P
- – Request filed (hearing)
- Q
- – Request dismissed or withdrawn (hearing)
- R
- – Affirmation of prior decision (hearing)
- S
- – Reversal or modification of prior decision (hearing)
- W
- – Request filed (appeals council)
- X
- – Appeal request dismissed or withdrawn (appeals council)
- Y
- – Affirmation of prior decision (appeals council)
- Z
- – Reversal or modification of prior decision (appeals council)
Block 035 – Appeal Date
Block 036 – Alien Indicator
- A
- Proven U.S. born, U.S. citizen
- B
- Alleged U.S. born, U.S. citizen
- C
- U.S. citizen born outside the U.S. (includes naturalized citizen)
- D
- Alleged U.S. citizen, Pre-Jan. 1, 1972
- E
- No citizenship or alien status development undertaken; case denied for reason(s) other than citizenship/alien status
- F
- Refugee status – Sections 207 or 203 (A)(7) of INA
- G
- Parole status – Section 212(D) of INA
- H
- Silva vs Levi Alien
- I
- Indochinese refugee
- J
- Deferred action status alien
- K
- Alien lawfully admitted to U.S. for permanent residence
- L
- Asylum status, Section 208 of INA
- M
- Resident of Northern Mariana Islands
- N
- Identity and citizenship verified
- P
- Pre-Jan. 1, 1972 Alien (Presumed lawfully admitted for permanent residence)
- Q
- Alleged U.S. born, U.S. citizen
- R
- Legal temporary resident – status granted as a result of the Immigration Reform and Control Act of 1986
- S
- Legal permanent resident – status granted as a result if the Immigration Reform and Control Act of 1986
- T
- Alien granted voluntary departure
- U
- Unknown
- W
- Alien granted stay of deportation
- X
- Cuban/Haitian entrant
- Y
- Legalized agriculture worker
- Z
- Alien on whose behalf an immediate relative petition has been approved
Block 037 – Alien Date of Residence
Block 038 – Reaccretion Ind
- T
- Record being terminated; will not be reaccreted
- X
- Record being terminated; will be reaccreted
Block 039 – Date of Death
Block 040 – Medicaid Test Indicator
Block 041 – Disability Onset Date
Block 042 – Alien Sponsor Status Code
Block 043 – Alien Exception Code
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