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.
Form SSA-2855. Statement of Funds you Received
Form SSA-2855 is the Statement of Funds You Received. The main purpose of this form is to document and report any funds received by an individual or household, which may impact their eligibility for certain Social Security benefits.
Form SSA-5666. Request for Administrative Information
Form SSA-5666, the Request for Administrative Information, is used to request specific information from organizations, institutions, or government agencies regarding a claimant's disability case.
Form SSA-3377-BK. Function Report - Child Age 3 to 6th Birthday
Form SSA-3377-BK, the Function Report for Children from Age 3 to 6th 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 3 and their 6th b
Form SSA-604. Certificate of Incapacity
Form SSA-604, the Certificate of Incapacity, serves as a medical certificate for individuals who are unable to manage their own Social Security benefits due to a mental or physical incapacity.
Form SSA-3375-BK. Function Report - Child Birth to 1st Birthday
Form SSA-3375-BK is the Function Report for Children from Birth to 1st Birthday. The primary purpose of this form is to collect information about a child's development and functioning during their first year of life.
Form SSA-5062. Claimant's Statement about Loan of Food or Shelter
Form SSA-5062, Claimant's Statement about the Loan of Food or Shelter, is used to collect information from Supplemental Security Income (SSI) applicants or beneficiaries regarding the receipt of food or shelter.
Form SSA-546. Worker's Compensation/Public Disability Questionnaire
Form SSA-546, the Worker's Compensation/Public Disability Questionnaire, serves as a tool to gather information regarding a claimant's receipt of workers' compensation or public disability benefits.
Form SSA-3376-BK. Function Report - Child Age 1 to 3rd Birthday
Form SSA-3376-BK is the Function Report for Children from Age 1 to 3rd Birthday. The main purpose of this form is to collect information about a child's development and functioning between their first and third birthdays.
Form SSA-4-INST. Reporting Responsibilities for Child's Insurance Benefits
Form SSA-4-INST, Reporting Responsibilities for Child's Insurance Benefits, serves as instructions for individuals who are receiving or applying for Child's Insurance Benefits under the Social Security program.