To apply for SSI for your child, you will need to complete a child disability report form, called Form SSA-3820-BK. Social Security will want you to have this form completed by the time the agency interviews you about your child's disability.
The childhood disability report is divided into ten sections and is twelve pages long. The form is available from Social Security online (Form SSA-3820-BK online) or in paper form (Form SSA-3820-BK). Before filling out the form, gather all of the records you have about your child's disability and have them available to help you answer some of the questions.
Sections 1 and 2 on the form ask for general information about your child, like who lives in the child’s household and who is filling out the form for the child. It asks for contact information, including the primary language of the child and the people in the child's household. If you do not speak English, Social Security will provide a free interpreter for you.
In sections 3 through 7, Social Security asks questions about your child's medical history and disability. Section 3 asks you to describe your child’s disability and estimate the date that the child became disabled. Remember that your child must have a disability that results in severe functional limitations in order to meet the disability criteria for SSI, so be specific when you are describing your child's condition. Don't just name the disability without describing how the disability restricts your child's daily life.
In section 4, Social Security asks you to list information that will help the agency get your child’s medical records, including contact information for all of your child’s medical providers. Fill the form in completely. Don't expect Social Security to even look up a zip code. Although the disability claims examiner who is assigned to review your child's case will make an effort to get all of your child's records, missing information on this form will delay the processing of the claim. If you have any medical records, send a copy with the report. If you do not already have them, Social Security will use the information you provide in this section to get them.
Section 5 asks you to list your child’s medications. In addition to completing this section, you should make a copy of your child’s medicine containers or prescriptions and send those with the form. Section 6 gives a long list of different kinds of medical tests and asks you to identify any that your child has had, along with the name of the referring doctor.
Section 7 asks for the contact information for other agencies that may have information about your child’s disability. If your child attends HeadStart or Vocational Rehabilitation, for example, this is the place to list those contacts.
In Section 8, Social Security asks questions about your child’s education. School records are often important in child SSI cases because they show how severe the child's functional limitations are. If your child has an IEP (Individualized Education Plan), you should try to make a copy of it and submit it with the report form.
Section 9 asks about work history. If your child has worked, complete this section. Social Security will look at any employment to see whether it shows that the child is not severely limited enough to meet the SSI criteria.
In Section 10, Social Security gives you additional room to answer any of the other questions on the form more completely.
If your interview with Social Security is in person, take the form and all of your attachments with you. If you have a phone interview, have the form with you during the interview, and send the attachments to Social Security separately.