Form SSA-3830. Certification of Low Birth Weight for SSI Eligibility

Form SSA-3830, the Certification of Low Birth Weight for SSI Eligibility, is used to certify the low birth weight of a child for eligibility for Supplemental Security Income (SSI) benefits. The primary purpose of this form is to document and verify the low birth weight of a child, which is one of the criteria for SSI eligibility.

For example, if a child is born with low birth weight and their parents or guardians are applying for SSI benefits on the child's behalf, this form is used to provide evidence of the child's low birth weight. The purpose is to establish eligibility for SSI benefits based on the child's medical condition.

The parties involved are parents or guardians of children applying for SSI benefits due to low birth weight and the SSA. The form consists of sections for documenting the child's birth weight and medical information. Accurate reporting is essential to establish eligibility for SSI benefits.