Questionnaire for Children Claiming SSI Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0499 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3881 BK Questionnaire for Children Claiming SSI Benefits Form
SSA-3881 BK Questionnaire for Children Claiming SSI Benefits ssa-3881(revised).pdf Form
ssa-3881(current).pdf Questionnaire For children Claiming SSI Benefits (Current Version) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Questionnaire for Children Claiming SSI Benefits	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3881 BK	Questionnaire for Children Claiming SSI Benefits	ssa-3881(revised).pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 110,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	110,000	-42,000	152,000
Annual IC Time Burden (Hours)	55,000	-21,000	76,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Questionnaire For children Claiming SSI Benefits (Current Version)	ssa-3881(current).pdf	03/24/2014

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