Information Collection

Questionnaire for Children Claiming SSI Benefits

IC 9392 under ICR 201102-0960-001 · OMB 0960-0499.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0499 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3881 BK Questionnaire for Children Claiming SSI Benefits	Form
SSA-3881 BK Questionnaire for Children Claiming SSI Benefits SSA-3881 Current Version.pdf	Form
SSA-3881 Current Version.pdf Questionnaire For children Claiming SSI Benefits (Current Version)	IC Document

IC Title:

Questionnaire for Children Claiming SSI Benefits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.912(a)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3881 BK	Questionnaire for Children Claiming SSI Benefits	SSA-3881 Current Version.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 152,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	152,000	-101,000	253,000
Annual IC Time Burden (Hours)	76,000	-50,500	126,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Questionnaire For children Claiming SSI Benefits (Current Version)	SSA-3881 Current Version.pdf	03/03/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.