SSA-3820

Disability Report - Child

Download and Print the SSA-3820

READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM THIS IS NOT AN APPLICATION

IF YOU NEED HELP If you need help with this form, complete as much of it as you can, and your interviewer will help you finish it.

HOW TO COMPLETE THIS FORM The information that you give us on this form will be used by the office that makes the disability decision on your disability claim. You can help them by completing as much of the form as you can.

Fill out as much of this form as you can before your interview appointment. Print or write clearly.
DO NOT LEAVE ANSWERS BLANK. If you do not know the answers, or the answer is "none" or "does not apply," write: "don't know," or " none," or "does not apply."

IN SECTION 4, PUT INFORMATION ON ONLY ONE DOCTOR/HMO/THERAPIST/ OTHER/HOSPITAL/CLINIC IN EACH SPACE.

Each address should include a ZIP code.

Each telephone number should include an area code.

DO NOT ASK A DOCTOR OR HOSPITAL TO COMPLETE THE FORM.
However, you can get help from other people, like a friend or family member.

If your appointment is for an interview by telephone, have the form ready to discuss with us when we call you.

If your appointment is for an interview in our office, bring the completed form with you or mail ahead of time, if you were told to do so.

Be sure to explain an answer if the question asks for an explanation, or if you want to give additional information.

If you need more space to answer any questions or want to tell us more about an answer, please use Section 10, "DATE AND REMARKS," on Pages 11 and 12, and show the number of the question being answered.

ABOUT THE CHILD'S MEDICAL AND OTHER RECORDS
If you have any of the following records for the child at home, send them to our office with your completed forms or bring them with you to the interview. If you need the records back, tell us and we will photocopy them and return them to you.

The child's medical records Copies of the child's prescriptions or medicine containers

The child's Individualized Education Program The child's Individualized Family Service Plan

YOU DO NOT NEED TO ASK DOCTORS OR HOSPITALS FOR ANY MEDICAL RECORDS THAT YOU DO NOT ALREADY HAVE. With your permission, we will do that for

And much more...