SSA-5666

Request For Administrative Information

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SOCIAL SECURITY ADMINISTRATION
Form Approved OMB No. 0960-0646
REQUESTING OFFICE NAME AND ADDRESS
ATTACH LABEL OR TYPE IN CLAIMANT NAME

REQUEST FOR ADMINISTRATIVE INFORMATION

Please ask the person(s) most familiar with the child's records to complete this form.

Continue any answers as needed on next page.

Name of School

1. Has there been any recent evaluation or testing of this child? If yes, kind(s) of test / evaluation:

Date(s):

Please send us copies of all comprehensive evaluations, triennial assessments, psychological or speech/language testing, current Individualized Education Programs, teacher/therapist progress reports, and all other records that can help us evaluate the child's functioning

And much more...