Form SSA-4162, the Child Care Dropout Questionnaire, is used to collect information about periods when a parent or guardian had to reduce or stop work due to the need for childcare. The primary purpose of this form is to allow individuals to report interruptions in their work history caused by childcare responsibilities.
Form SSA-4111, the Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits, serves as a certification form for individuals who are eligible for widow(er)'s or surviving divorced spouse's benefits but choose to receive a reduced benefit amount. The main purpose of this form is to document an individual's choice to receive reduced benefits before reaching full retirement age.
Form SSA-3885, the Government Pension Questionnaire, is used to collect information about government pensions received by individuals who are claiming Social Security benefits. The main purpose of this form is to determine if a person's Social Security benefits may be affected by a government pension.
Form SSA-3881-BK, the Questionnaire for Children Claiming SSI Benefits, is a questionnaire for parents or guardians of children claiming Supplemental Security Income (SSI) benefits. The primary purpose of this form is to collect information about a child's medical condition and daily activities to assess eligibility for SSI benefits.
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.
Form SSA-3820-BK, the Disability Report for Children, serves as a report for parents or guardians to provide detailed information about a child's disability or medical condition. The primary purpose of this form is to assist the Social Security Administration (SSA) in evaluating disability claims for children under the age of 18.
Form SSA-3441-BK, the Disability Report - Appeal, is a form used by individuals who wish to appeal the SSA's decision regarding their disability benefits. The primary purpose of this form is to collect updated information about the individual's medical condition, treatments, and any changes in their ability to work or perform daily activities.
Form SSA-3380-BK, the Function Report for Adults - Third Party Form, is used by individuals or organizations who have knowledge of an adult's daily activities and limitations. This form serves as a way for a third party, such as a friend, family member, or social worker, to provide information about an adult's abilities and impairments. The primary purpose of this form is to assist the SSA in evaluating disability claims for adults who may have difficulty completing the report themselves.
Form SSA-3379-BK, the Function Report for Children Age 12 to 18th Birthday, is a questionnaire for parents or guardians to provide detailed information about a child's abilities, developmental milestones, and any impairments or delays in development between the ages of 12 and their 18th birthday. The main purpose of this form is to assist the SSA in evaluating disability claims on behalf of children.
Form SSA-3378-BK, the Function Report for Children Age 6 to 12th Birthday, serves as a questionnaire for parents or guardians to provide detailed information about a child's abilities, developmental milestones, and any impairments or delays in development between the ages of 6 and their 12th birthday. The primary purpose of this form is to assist the Social Security Administration (SSA) in evaluating disability claims on behalf of children.
