Child-Care Dropout Questionnaire

The basic Social Security disability benefits application form (cleared under OMB No. 0960-0618) contains a lead question asking if the applicant cared for their own or their spouse’s children under age 3, and had no earnings during that period. If the answer is yes, the applicant completes Form SSA-4162 (either on paper or through a Social Security Administration (SSA) claims representative (CR) during a personal interview). SSA uses the information to determine if the applicant qualifies for the child-care exclusion. For the modernized claims system (MCS) application version, the beneficiary provides the information verbally to the SSA CR during a personal interview, and the CR inputs the information directly into the MCS application. The CR prints the MCS application for the beneficiary to verify and sign. Respondents are applicants for Title II disability benefits.

The latest form for Child-Care Dropout Questionnaire expires 2022-09-30 and is listed under ICR 201903-0960-006.