Form SSA-3380-BK. Function Report - Adult - Third Party Form
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.
Form SSA-3441-BK. Disability Report - Appeal
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.
Form SSA-3820-BK. Disability Report - Child
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.
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.
Form SSA-3881-BK. Questionnaire for Children Claiming SSI Benefits
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.
Form SSA-3885. Government Pension Questionnaire
Form SSA-3885, the Government Pension Questionnaire, is used to collect information about government pensions received by individuals who are claiming Social Security benefits.
Form SSA-4111. Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits
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.
Form SSA-4162. Child Care Dropout Questionnaire
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.
Form SSA-4178. Marital Relationship Questionaire
Form SSA-4178, the Marital Relationship Questionnaire, is used to collect information about an individual's marital history and relationships that may affect their eligibility for Social Security benefits.
Form SSA-437-BK. Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration
Form SSA-437-BK, the Complaint Form for Allegations of Discrimination in Programs or Activities Conducted by the Social Security Administration, is used to report allegations of discrimination in programs or activities conducted by the Social Security Administration (SSA).