Justification for Non-Substantive Change to Form SSA-3820-BK and i3820
Disability Report - Child
OMB No. 0960-0577
SSA-3820-BK
Change 1: We are adding examples in Section 4 (Information About the Child’s Medical Records), part E., page 6, and changing the order of the examples for a more logical sequence.
Old Language:
Does anyone else have medical records or information about the child’s illnesses, injuries or conditions (Workers’ Compensation, insurance companies, counselors, detention centers, attorneys, and/or tutors), or is the child scheduled to see anyone else?
New Language:
Does anyone else have medical records or information about the child’s illnesses, injuries or conditions (foster parents, social workers, counselors, tutors, school nurses, detention centers, attorneys, insurance companies, and/or Worker’s Compensation), or is the child scheduled to see anyone else?
Justification 1: These are important sources of information about a child’s condition; we want to ensure applicants/claimants remember to report, when applicable.
Change 2: We are revising Section 7 (Additional Information), part A, page 8, by combining the current 3rd and 4th lines and creating a new 4th line for Early Intervention Services Section. All lines keep the yes and no checkboxes.
Old Language:
Has the child been tested or examined by any of the following?
Headstart (Title V)
Public or Community Health Department
Child Welfare or Social Service Agency
Women, Infant and Children (WIC) Program
Program for Children with Special Health Care Needs
Mental Health/Mental Retardation Center
New Language:
Has the child been tested or examined by any of the following?
Headstart (Title V)
Public or Community Health Department
Child Welfare or Social Service Agency or WIC
Early Intervention Services
Program for Children with Special Health Care Needs
Mental Health/Mental Retardation Center
Justification 2: The Women, Infant and Children Program is much more commonly known as “WIC” and as a child welfare program. Therefore, it is clearer to use only the acronym and couple it with child welfare. Early Intervention Services replaces the full name of the WIC program and adds an important source of information to the form.
Change 3: We are changing the language in Section 8 (EDUCATION), part A, page 9.
Old Language:
What is the child’s current grade in school or the highest grade completed?
New Language: Is the child currently enrolled in any school?
check box, Yes, Grade______
checkbox, No, too young
Justification 3: We are clarifying both the question and the possible responses to eliminate confusion.
Change 4: We are changing the language in Section 8 (EDUCATION), part B, page 9.
Old Language:
Is the child currently attending school (other than summer school)?” YES NO
If “NO”, explain why the child is not attending school”
New Language:
Other Reason the child is not enrolled in school.
Justification 4: This further clarifies and streamlines the education questions consistent with part A. under this section.
Change 5: We are revising Section 8 (EDUCATION) part C, page 9, by adding “/language” to “Is the child in speech therapy?” and NAME OF SPEECH THERAPIST.
Old Language:
Is the child in speech therapy? YES NO
If “YES”, and different from above, give:
NAME OF SPEECH THERAPIST
New Language:
Is the child in speech/language therapy?
If “Yes”, and different from above, give:
NAME OF SPEECH/ LANGUAGE THERAPIST
Justification 5: Speech and language disorders are commonly addressed together because each is addressed by a speech and language therapist.
Internet 3820
Change 6: We are revising Education and Work Section by adding language to the section.
Old Language:
Has Frank Doe ever attended school (including daycare, preschool, Headstart, home school, public, private or other educational programs)?
New Language:
Has Frank Doe ever attended any school (including daycare, preschool, Headstart, home school, public, private or other educational programs)?
Justification 6: We are clarifying both the question and possible responses to eliminate confusion.
Change 7: We are revising Education and Work Section by adding language to the section.
Old Language:
Is Frank Doe currently enrolled in school? List the names of the schools that Frank Doe has attended over the last 12 months. Include preschool, after school programs and special education classes. Example: George Washington Elementary.
New Language:
Is Frank Doe currently enrolled in any school? List the names of the schools that Frank Doe has attended over the last 12 months. Include daycare, preschool, Headstart, kindergarten, home school, summer school, after school programs and special education classes. Example: George Washington Elementary.
Justification 7: We are clarifying both the question and possible responses to eliminate confusion.
Change 8
We are revising the Education and Work: More About Education History Section by removing the question What is the highest grade that Frank Doe completed?
Justification 8: Information not required – comparable to SSA-3820.
Change 9
We are changing the language in the Medical History: Additional Sources of Testing or Examination Section by adding Early Intervention Services to options to add “Early Intervention Services”.
Old Language:
Has Frank Doe been tested or examined by any of the following
Headstart(Title V)
Public or Community Health Department
Child Welfare or Social Service Agency
Women, Infants and Children (WIC) Program
Program for Children with Special Health Care Needs
Mental Health/Mental Retardation Center
New Language:
Has Frank Doe been tested or examined by any of the following
Headstart(Title V)
Public or Community Health Department
Child Welfare or Social Service Agency
Women, Infants and Children (WIC) Program
Program for Children with Special Health Care Needs
Mental Health/Mental Retardation Center
Early Intervention Services
Justification 9: Early Intervention Services adds an important source of information to the form.
Change 10:
We are changing the language in the Medical History: Other Medical Records Section by deleting the “and/or” option from the sentence.
Old Language:
Does anyone else have medical records or information about Frank Doe’s illnesses, injuries or conditions (foster parents, social workers, counselors, tutors, school nurses, detention centers, attorney, insurance companies, and/or Worker’s Compensation), or is Frank Doe scheduled to see anyone else? Yes or No
New Language:
Does anyone else have medical records or information about Frank Doe’s illnesses, injuries or conditions (foster parents, social workers, counselors, tutors, school nurses, detention centers, attorney, insurance companies, Worker’s Compensation), or is Frank Doe scheduled to see anyone else? Yes or No
Justification 10: Clarifies changes comparable to the paper Form SSA-3820-BK.
| File Type | application/msword |
| Author | 889123 |
| Last Modified By | 889123 |
| File Modified | 2010-05-24 |
| File Created | 2010-05-24 |