Information Collection

Questionnaire for Children Claiming SSI Benefits - Paper Version

IC 9392 under ICR 202408-0960-001 · OMB 0960-0499.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3881 BK Questionnaire for Children Claiming SSI Benefits Questionnaire for Children Claiming SSI Benefits - Paper Version	Form
SSA 3881-BK - Revised PA Statement.pdf	Other-Revised Privacy Act Statement
SSA-3881 BK Questionnaire for Children Claiming SSI Benefits SSA-3881-BK - Revised Version.pdf	Form
SSA-3881-BK - Current Version.pdf Current SSA-3881-BK	IC Document

IC Title:

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			www.ssa.gov	Yes	No	Fillable Printable
Other-Revised Privacy Act Statement					Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 98,307

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	98,307	17,057	81,250
Annual IC Time Burden (Hours)	162,207	80,957	81,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-3881-BK		12/16/2024

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

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