OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Questionnaire for Children Claiming SSI Benefits

OMB 0960-0499 · SSA.

OMB 0960-0499

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 child’s 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 child’s 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.

The latest form for Questionnaire for Children Claiming SSI Benefits expires 2026-07-31 and is listed under ICR 202005-0960-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-3881 BK Questionnaire for Children Claiming SSI Benefits - Paper VersionForm
Supporting Statement - 0499 (Final).docxSupporting Statement A
Addendum - 0499 (Final).docx Supplementary Document
Questionnaire for Children Claiming SSI Benefits - Paper Version Form
Questionnaire for Children Claiming SSI Benefits - Intranet Version Other-Internal Intranet-Based EDCS Screens

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202408-0960-001 Revision of a currently approved collection 2024-12-16
202005-0960-005 Revision of a currently approved collection 2020-09-08
201701-0960-013 Revision of a currently approved collection 2017-05-17 Approved without change
201402-0960-008 Revision of a currently approved collection 2014-06-02 Approved without change
201304-0960-005 No material or nonsubstantive change to a currently approved collection 2013-08-06 Preapproved
201102-0960-001 Revision of a currently approved collection 2011-05-05 Approved without change
200807-0960-003 Extension without change of a currently approved collection 2008-07-18 Approved without change
200612-0960-011 Extension without change of a currently approved collection 2007-05-11 Approved without change
200404-0960-001 Extension without change of a currently approved collection 2004-04-12 Approved without change
200102-0960-010 Extension without change of a currently approved collection 2001-02-28 Approved without change
199908-0960-013 No material or nonsubstantive change to a currently approved collection 1999-08-06 Approved without change
199801-0960-005 Extension without change of a currently approved collection 1998-01-22 Approved without change
199707-0960-006 Reinstatement without change of a previously approved collection 1997-07-23 Approved without change
199511-0960-010 Extension without change of a currently approved collection 1995-11-21 Approved without change
199404-0960-006 Revision of a currently approved collection 1994-04-25 Approved without change
199302-0960-003 Reinstatement with change of a previously approved collection 1993-02-08 Approved without change
199108-0960-008 New collection (Request for a new OMB Control Number) 1991-08-15 Approved without change

OMB Details

Questionnaire for Children Claiming SSI Benefits - Paper Version

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-3881 BKQuestionnaire for Children Claiming SSI BenefitsFillable PrintableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.