Questionnaire for Children Claiming SSI Benefits - Paper Version

Questionnaire for Children Claiming SSI Benefits

Documents and Forms

Document Name Document Type
Form SSA-3881 BK Questionnaire for Children Claiming SSI Benefits - Paper Version Form
SSA 3881-BK - Revised PA Statement.pdf Other-Revised Privacy Act Statement
SSA-3881 BK Questionnaire for Children Claiming SSI Benefits SSA-3881-BK - Revised Version.pdf www.ssa.gov Form
SSA-3881-BK - Current Version.pdf Current SSA-3881-BK IC Document

Information Collection (IC) Details

IC Title:	Questionnaire for Children Claiming SSI Benefits - Paper Version	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-BK - Revised Version.pdf	www.ssa.gov	Yes	No	Fillable Printable
Other-Revised Privacy Act Statement			SSA 3881-BK - Revised PA Statement.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 98,307	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	98,307	17,057	81,250
Annual IC Time Burden (Hours)	162,207	80,957	81,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-3881-BK	SSA-3881-BK - Current Version.pdf	12/16/2024

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