SSI Facilitation - Children's Applications

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SSI Facilitation - Children's Applications

Revised October 28, 2007

This section includes information about:

Disability Criteria

Application Packet

Disability Criteria

A person under age 18 is considered disabled when:

There is a medically determinable physical or mental impairment or combination of impairments that cause marked and severe functional limitations, and

The impairment is expected to cause death or has lasted or is expected to last for twelve months.

A medically determinable physical or mental impairment is an impairment that:

Results from anatomical, physiological or psychological abnormalities,

Can be shown by medically acceptable clinical and laboratory diagnostic techniques, and

Can be established by medical evidence consisting of signs, symptoms, and laboratory findings.

The impairment substantially reduces the child’s ability to:

Grow, develop or mature physically, mentally or emotionally.

Attain developmental milestones at an age-appropriate rate.

Engage in age-appropriate activities of daily living such as:

Self-care,

Play,

Recreation and sports,

School and academics, and

Peer and family relationships.

Acquire the skills needed to assume roles reasonably expected of adults.

Application Packet

The SSA application packet contains:

SSA cover letter printed from ICMS.

SSA-8001-F5, Application for Supplemental Security Income.

SSA-3820-F6, Medical History and Disability Report-Disabled Child.

Age-specific function reports similar to adult Activities of Daily Living forms.

All available medical records.

All available school records. Include the following information:

Name of teacher, school, and district,

School address,

Individual Education Plan, and

Any special accommodation.

SSA-827, Authorization for Source to Release Information to Social Security Administration. When the child is 12 years old or older, please have him/her sign the SSA-827 and the parent or guardian sign as a witness. If the child is less than 12 years old, the parent or guardian signs the SSA-827.

Personal Observation statement. This is a one page objective statement of how the child appeared to you. It may include information from non-medical sources such as day care providers, parents, neighbors, or others.

Stamped self-addressed envelope for return of an application receipt from the SSADO.

SSI Facilitation - Children's Applications
Revised October 28, 2007

This section includes information about: Disability Criteria Application Packet
Disability Criteria A person under age 18 is considered disabled when: There is a medically determinable physical or mental impairment or combination of impairments that cause marked and severe functional limitations, and The impairment is expected to cause death or has lasted or is expected to last for twelve months. A medically determinable physical or mental impairment is an impairment that: Results from anatomical, physiological or psychological abnormalities, Can be shown by medically acceptable clinical and laboratory diagnostic techniques, and Can be established by medical evidence consisting of signs, symptoms, and laboratory findings. The impairment substantially reduces the child’s ability to: Grow, develop or mature physically, mentally or emotionally. Attain developmental milestones at an age-appropriate rate. Engage in age-appropriate activities of daily living such as: Self-care, Play, Recreation and sports, School and academics, and Peer and family relationships. Acquire the skills needed to assume roles reasonably expected of adults.
Application Packet The SSA application packet contains: SSA cover letter printed from ICMS. SSA-8001-F5, Application for Supplemental Security Income. SSA-3820-F6, Medical History and Disability Report-Disabled Child. Age-specific function reports similar to adult Activities of Daily Living forms. All available medical records. All available school records. Include the following information: Name of teacher, school, and district, School address, Individual Education Plan, and Any special accommodation. SSA-827, Authorization for Source to Release Information to Social Security Administration. When the child is 12 years old or older, please have him/her sign the SSA-827 and the parent or guardian sign as a witness. If the child is less than 12 years old, the parent or guardian signs the SSA-827. Personal Observation statement. This is a one page objective statement of how the child appeared to you. It may include information from non-medical sources such as day care providers, parents, neighbors, or others. Stamped self-addressed envelope for return of an application receipt from the SSADO.

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