Supplemental Security Income (SSI) Disability Forms

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Be prepared! Access and review the forms needed to file a Supplemental Security Income (SSI) disability claim for a disabled adult or disabled child.

The base application form for Supplemental Security Income (SSI) disability benefits, whether the applicant is an adult or a child, is the SSA-8000-BK. Because the application asks for a lot of detailed information, it can be very helpful to prepare a rough draft of this form to refer to when you file the application.

In addition to the base application, for adults complete the same medical and occupational forms as for a Social Security disability claim. These forms can be found in the Disability Application Forms section of this website. But, if you applying for a disabled child, complete the SSA-3881-BK instead. For a child’s claim, it can be helpful to offer additional information on the function report below that corresponds to the child’s age and to have the child’s teacher complete the SSA-632-BK. And, of course, an SSA-827 is needed to allow Social Security to gather information.

Please click on the link below to open your desired form in a separate browser window. You can then download the form from directly to your computer.

SSA-8000-BK Supplemental Security Income (SSI) Application

SSA-545-BK Plan for Achieving Self-Support (PASS)

SSA-2855 Statement of Funds You Received
To prove a bona fide loan

SSA-4815 Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection

SSA-632-BK Teacher Questionnaire
To be completed by teacher regarding function of disabled child

SSA-3375-BK Function Report – Child Birth to 1st Birthday
(to be completed by applying adult)

SSA-3376-BK Function Report – Child Age 1 to 3rd Birthday
(to be completed by applying adult)

SSA-3377-BK Function Report – Child Age 3 to 6th Birthday
(to be completed by applying adult)

SSA-3378-BK Function Report – Child Age 6 to 12th Birthday
(to be completed by applying adult)

SSA-3379-BK Function Report – Child Age 12 to 18th Birthday
(to be completed by applying adult)

SSA-3881-BK Questionnaire for Children Claiming SSI Benefits
(for adult responsible for the child to submit additional information about child’s limitations)

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