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Questionnaire for Children Claiming SSI Benefits

OMB 0960-0499 · SSA.

OMB 0960-0499

Parents or legal guardians seeking to obtain or retain SSI eligibility for their children use Form SSA-3881-BK to provide SSA with the addresses of non medical sources such as schools, counselors, agencies, organizations, or therapists who have information about a child’s function. The adjudicative team (a disability examiner and a medical or psychological consultant) of the State disability determination services (DDS) office collects the information to help determine a child’s claim or continuing eligibility for SSI. The respondents are the parents, guardians, and other caretakers of applicants who appeal SSI childhood disability decisions, or of recipients undergoing a continuing disability review.

The latest form for Questionnaire for Children Claiming SSI Benefits expires 2026-04-30 and can be found here.

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Questionnaire for Children Claiming SSI Benefits - Paper Version

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-3881 BKQuestionnaire for Children Claiming SSI BenefitsFillable PrintableForm

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