Parents or legal guardians seeking to obtain or retain SSI eligibility for their children use Form SSA-3881-BK to provide SSA with the addresses of non medical sources such as schools, counselors, agencies, organizations, or therapists who have information about a childâs function. The adjudicative team (a disability examiner and a medical or psychological consultant) of the State disability determination services (DDS) office collects the information to help determine a childâs claim or continuing eligibility for SSI. The respondents are the parents, guardians, and other caretakers of applicants who appeal SSI childhood disability decisions, or of recipients undergoing a continuing disability review.
US Code:
42 USC 1383
Name of Law: Social Security Act
When we last cleared this information collection in 2021, the burden was 62,500 hours. However, we are currently reporting a burden of 75,622 hours. This change stems an increase in the number of responses from 125,000 to 151,243. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.
SSA is unable to breakdown the method in which the form was completed, whether it was completed electronically (internet) via in-office or telephone appointment or if it was a paper version submitted to the FO upon completion, which was then scanned into the electronic file. Therefore, unlike the information collection in 2021, this information collection is unable to precisely predict how many respondents physically traveled to the FO. At the prior information collection for this form (2021), we determined that approximately 65% of respondents visited the FO to submit a paper version of the SSA-3881-BK. We are continuing to use that data; however, we are still working on a better way to obtain more accurate data to make this estimate.
* Note: The total burden reflected in ROCIS is 246,905, while the burden cited in #12 of the Supporting Statement is 75,622. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form SSA-3881 BK Questionnaire for Children Claiming SSI Benefits - Paper Version
Supporting Statement - 0499 (Final).docx
Questionnaire for Children Claiming SSI Benefits - Paper Version