Form SSA-5665-BK. Teacher Questionnaire

Form SSA-5665-BK, the Teacher Questionnaire, is used to collect information from educators about a student's ability to function independently due to a physical or mental condition. The main purpose is to assess a child's eligibility for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) based on their disability.

For instance, when a child with a disability applies for SSI or SSDI benefits, their teachers can fill out this questionnaire to provide insight into the child's limitations and how their disability affects their daily activities. The benefits include gathering valuable information that helps the SSA make accurate disability determinations for children.

The parties involved are teachers, educators, and school officials who are familiar with the child's condition and the SSA. The form typically includes sections for providing information about the child's abilities, limitations, and the impact of the disability on their daily life. Accurate and detailed information from teachers is essential for a thorough evaluation of the child's eligibility.